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Practice with Children and Their Families: a Specialty of Clinical Social Work

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Practice with Children and Their Families: a Specialty of Clinical Social Work Practice with Children and Their Families: A Specialty of Clinical Social Work A position statement of The Center for Clinical Social Work © April, 2007, Center for Clinical Social Work Executive Summary Practice with Children & Their Families: A Specialty of Clinical Social Work © 2007 Center for Clinical Social Work, www.CenterCSW.org This is a précis of the position statement by the American Board of Examiners in Clinical Social Work (ABE), Practice with Children & Their Families: A Specialty of Clinical Social Work, to which the reader is referred for a much fuller discussion of this specialty and its impact on children and families. The position statement is the source for ABE’s national credential, the Board Certified Clinical Social Worker Specialist in Practice with Children & Their Families. Background and Rationale for the Practice Specialty Clinical Social Work is the largest provider of mental healthcare in the United States, with 200,000 active practitioners, of whom many thousands work expertly with children and their families. These specialists profoundly affect the quality of mental healthcare in America. Children, from infants through early adolescents, are the most vulnerable members of society and are not usually aware of their problems or able to seek out help. Therefore, the specialist must be able to identify their needs and assist them expertly, through his/her own interactions in children-related settings such as schools and through the cooperation and referral of other adults, such as parent-caregivers, nurses and physicians and other professionals, personnel at private or public agencies, and others in a position to serve as champions of children in need. The tragic fact is that millions of children have been and are being abused and neglected. It is in this area that specialty practice, with an emphasis on public safety and protection issues, is most important. Without early interventions, most of these damaged children will not receive professional help until they are old enough to seek it themselves, often after they have begun a pattern of destructiveness toward self and others. Even among children who do get help, many do not get it from a competent specialist able to provide what is truly needed. This is the crucial reason for national certification of specialty practitioners in this area: Since expert practitioners are best able to achieve good outcomes, society requires that competent experts be readily identifiable in order to help the largest number of children in need. Whatever the apparent nature or degree of a child’s problem, the quality of the rest of the child’s life—and sometimes life itself—may be at stake in any given interaction. Just one encounter with a specialist professional may be the only chance a child will have to begin on a track toward the love and nurturing that lead to proper development and a fulfilling life. With so much at stake, it is important to identify the characteristics of practice by which a clinical social worker may be recognized for specialty competence, and to explore the many issues that affect them and their clients. Attributes of the Specialist Specialist clinical social workers have high levels of knowledge, training, skill, and experience in a certain area of practice, and are proficient in utilizing relevant theory and proven techniques to address the bio-psychosocial problems and disorders unique to the population served. Among the specialist’s competencies are the ability to assess and ameliorate disorders and environmental influences that interfere with the healthy functioning—developmental, psychological, behavioral, social, cognitive—of children and their families. There is no single pathway toward proficiency: within the range of knowledge, skills, and behaviors that constitute competency, there is great diversity, of which no one practitioner will have complete mastery. The specialist is, however, expected to have broad, deep expertise in most of the major aspects of practice with children and their families: developmental stages, types of problems and disorders, settings and cultures, and intervention approaches and techniques. The specialist excels in the following: • forming and maintaining a therapeutic alliance with the child • integrating understanding of the physical, mental, and emotional difficulties that may arise in childhood • advocating for the child and family • collaborating with other professionals and collateral resources • helping children at various levels of their development • working with the three systems—family, school, community—that most affect child development • addressing issues pertaining to caregiver while respecting their values, culture, and relationship with the child • recognition as an expert by colleagues who make referrals, seek consultation • serving on professional boards and community organizations • continuously seeking and integrating new knowledge in field and bio-psychosocial theories into clinical practice. Competency in Specialty Practice with Children and Their Families Competent, proficient specialty practice requires that the clinical social worker have high levels of knowledge and skill. The specialist’s expertise in individual child dynamics and the familial and relational contexts is matched by a knowledge of systems—school, medical, welfare, legal—and by behaviors that make it possible to intervene effectively. In addition to direct practice with the clients, interventions include collaborating with other professionals and accessing community resources that support the child’s development and empower the caregiver(s). The specialist understands how to apply theory flexibly and effectively to practice, and has practice wisdom gained from years of experience. The specialist pursues professional development, knows when to seek consultation or supervision, and models and teaches what is needed for autonomous practice. He or she may also serve as mentor or consultant to colleagues. Competency: Knowledge Base The clinical social worker specialist in this area has a high level of knowledge about the range and types of problems and disorders that affect children, and of the best approaches for intervening with an individual based on his/her unique circumstances. Such knowledge comes from education and training, and includes insights based on clinical experience, reading, supervision-consultation, multidisciplinary collaboration, and various forms of continuing education. The specialist’s knowledge-base informs every aspect of his/her work and skills, and includes significant learning in the following areas: Biological: Physical growth and development Genetics and neurobiology Medical conditions Psychopharmacology Practice Methods: Individual therapy Family & Group therapy Larger systems work Parent-Infant Therapy Play-based approaches Psychological (primary list): Attachment theory Developmental theory Diagnostic psychometrics and assessment Trauma theory Regulatory, Legal, and Ethical: Professional codes of ethics State and federal regulations & legislation (including confidentiality) Social: Cultural factors Environmental factors (e.g. economic) Family system Peer Group influences Social systems (e.g. schools, courts, health facilities, religious organizations) Competency: Practice Skills. The specialist’s level of knowledge is matched by excellent practice-related skills, through which he/she creates a sustainable therapeutic alliance with clients and applies relevant theory. A specialist is capable of bringing about good clinical outcomes with a child and will generally have satisfied clients. Entry- level, intermediate, and advanced-generalist clinical social workers may practice in the same skills arena as the specialist, but not with the same level of mastery. Specific skills, reflective of the capabilities and functioning of the specialist in practice with children and their families, are described in the following competency areas: • Assessment • Diagnosis • Treatment Planning • Outcomes Evaluation • Intervention • Supervision, Consultation, Teaching and Writing Sample Practice Approaches The approaches described below are only a sampling (listed alphabetically) of those that are frequently applied in specialty practice with children and their families. It is expected that the specialist will have the creativity and mastery to use such approaches flexibly and selectively in interventions with clients and to recognize that modalities are not mutually exclusive. 1. Cognitive-Behavioral Therapy 2. Family Therapy 3. Group Therapy 4. Multi-systemic Treatment 5. Narrative Therapy 6. Parent-Infant Therapy 7. Play Therapy 8. Psychodynamic Psychotherapy 9. Solution-focused Therapy Diversity of Practice and Settings The clinical social worker specialist practices in any setting in which children and their families are helped with bio-psychosocial problems and disorders. These settings typically include those associated with schools and systems of mental healthcare, medical care, and child welfare, as well as juvenile facilities, courts, private offices, and the child’s home. Clinical social worker specialists can also be found in after-school and child-care settings, camp and recreation centers, and programs aimed at violence, substance abuse, and problems with parents or peers. Whatever the role or job title in the setting, the specialist still is doing clinical social work. Family Context The family, or primary living group—by whatever name, of whatever model or structure—is responsible
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