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Flexner's Thesis Was Prescient Flexner’s Thesis Was Prescient: Ethical Practices for Social Workers “In the Trenches” Requires Forensic Knowledge Dana E. Prescott, JD, Ph.D. Boston College [email protected] Journal of Social Work Values and Ethics, Volume 16, Number 2 (2019) Copyright 2019, ASWB This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of ASWB. Abstract observational strategies, hypothesis-testing, and In a speech in 1915, Abraham Flexner, M.D. effective transmission of data to host environments described his taxonomy for defining a profession to minimize unguided guesswork or reflexive and concluded that social work may be an “amateur decision making. occupation.” Social work scholars have challenged his criteria for decades. Flexner, however, Keywords: Forensics, social work ethics, expertise, foreshadowed a tension inherent in social work’s Abraham Flexner, pedagogy approach to delivering social justice in the various “trenches” where vulnerable populations work and Introduction live. The capacity to critically analyze and apply In the United States, social work has various forms of knowledge and science to social historically been defined by the identity and and individual problems requires more than good role of case managers, advocates, and clinicians intentions and vigorous advocacy. In modern terms, acting for clients who often live in the shadows this means that social work should teach and train of host environments: prisons, schools, courts, its profession to critically formulate and evaluate and hospitals (Hardcastle, Powers, & Wenocur, multiple hypotheses, to employ multiple sources 2004; Karger & Stoesz, 2013; Prescott, 2013). This of data beyond just what a client expresses, and to article derives from my experience of 35 years in critically apply and transform evidence-informed these environments and particularly the courts. research from other disciplines to environments As a trial lawyer, I have witnessed the stress an in which social welfare policy shapes outcomes adversarial system places on professionals to for clients. The eventual implementation of a code maintain ethical decision making and practices. of ethics for social work filled a significant gap in For licensed social workers, in particular, the power terms of providing a formal mechanism for decision and privilege to label and diagnose carries with it making at the organizational, political, and clinical the authority to influence the rights of vulnerable levels. I argue, however, that Flexner was correct persons by offering expert opinion to courts or in his assertion that social work may lose its way if other host environments such as prisons, hospitals, it becomes so enamored with the righteousness of and schools. These expert opinions may concern its causes that it loses the rigor required to sustain parental termination and child custody, competency social justice. In response, I propose that social work and criminal responsibility, clinical and medical pedagogy should adapt specialized forensic models treatment services, elder safety and protection, and as a method for teaching conceptual frameworks, a range of other powerful gatekeeping roles played by social workers. Journal of Social Work Values & Ethics, Fall 2019, Vol. 16, No. 2 - page 40 Flexner’s Thesis Was Prescient: Ethical Practices for Social Workers “In the Trenches” Requires Forensic Knowledge As a trial lawyer for many years and a realm to a core competency in practice that suggests social worker with advanced degrees, I have spent the need to develop critical consciousness and skill- significant time as a graduate student and an based competencies for social work as a profession instructor in MSW and PhD programs. In those (Abrams & Moio, 2009; Sakamoto & Pitner, 2005). roles, I have witnessed the struggle to teach social The foundation for this argument may be workers the means to critically assess ethical risks traced to the often cited and criticized speech by and liability. I have also witnessed the impact of Abraham Flexner, a physician and the Assistant legitimately accepting the client’s truth for purposes Secretary to the General Education Board of New of clinical treatment but then translating that truth, York City at the turn of the 20th century, who without looking for or examining other alternative understood that social work had the potential to data, to adversarial systems and institutional be unique among all other professions. In 1915, authorities. Training in MSW programs offers many however, Flexner questioned social work’s identity positive pedological and rigorous opportunities. The as a profession as he defined other professions, knowledge gap, however, is in the transfer of those such as medicine and law. Much literature has been skills to actions within host environments that may expended responding to this speech of more than critically test rather than accept the well-intended a century ago. More recent interpretations have opinions of a social worker. made the argument that its strange influence on the In such policy and practice environments, development of social work was disproportionate social workers may be held to a standard of competent to its argument or a misreading of his thesis and ethical practice that requires much more than (Morris, 2008). clinical instincts or a personal feeling about right and As discussed in this article, Flexner wrong (Reamer, 2013). These environments require foreshadowed the struggle by social workers to pass social workers who can engage in the independent on their core set of methodologies and conceptual review of multiple sources of data and hypotheses, frameworks. The active, real-time delivery of social as well as explanations for how one knows what they justice within communities and host environments claim to know. From such a framework, the social where people daily survive was well known to worker may acquire a particular way of knowing Flexner. In fact, as I argue here, because social that is supported by intellectual and technical rigor, workers were in the trenches from the inception, emotional insight, and, ultimately, expert opinions the profession’s role and identity were shaped by drawn from a transparent analysis of observational much more than a clinical duty to understand one and assessment data (Goldblatt, 2004; Grimwood, person’s story or struggles. Instead, social workers 2015). These skills may be found in the specialty of sought to apply the best science of that day to forensic pedagogy, methodology, and ethics. better understand and alter the biological, political, In this article, I argue that becoming a social and social forces that shaped individual outcomes worker ought to mean “being forensic.” By this (Fook, Ryan, & Hawkins, 1997). As Reamer (1998) term, as I will further describe, I mean the praxis summarized on the hundred-year anniversary of that flows from the mindset and academic influence social work’s founding, during late 20th century that connects pedagaogy and theory to being “many social workers were more concerned about forensic. Being forensic is the act of rigorously cultivating perspectives and methods that would applying methods of data gathering, hypothesis be indigenous to social work, partly in an effort to testing, research analysis, and clinical observation distinguish social work’s approach to helping from to individuals living in organic and adaptive those of allied professions, such as psychology and organizational or institutional systems (Barker psychiatry” (p. 489). & Branson, 2014; Bartol & Bartol, 2017). It is this The historical duty of social workers is to transfer of skills and knowledge from the academic advocate for clients by embracing the concomitant Journal of Social Work Values & Ethics, Fall 2019, Vol. 16, No. 2 - page 41 Flexner’s Thesis Was Prescient: Ethical Practices for Social Workers “In the Trenches” Requires Forensic Knowledge ethical duty to function with integrity and with is not a rejection of values in the role and identity of evidence-informed competence within the client’s social work, rather, it is a recognition that individual host environment. As the social work profession thoughts about how something “should be” is not the shifted to a more formal pedagogy and academic same as what is feasible or possible or supported by structure offered within the university, the balance a careful balancing of evidence and research (Webb, between academic rigor through classroom learning 2001). If that is so, the operative question then and the role of field placement has been the source becomes whether graduate programs and training of ongoing study and refinement (Lay & McGuire, in social work should adopt models that impose the 2010; Wayne, Bogo, & Raskin, 2010). The underlying ethical duty and rigor of becoming a forensic expert struggle is how to transfer academic and practice on all social workers as a core function of their duty skills to the active capacity to make reflective and to client and community. rational ethical judgments (i.e., competently and with integrity) within the client’s environment. The Value of Becoming Forensic If intellectual and emotional skill sets are limited Generally, values can be defined as what to what they perceive as “right” or “wrong” social religious, moral, cultural, ideological, or social workers might reflexively align with a client or beliefs are “worthy or valuable” to an individual or
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