[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
CARING FOR THE VULNERABLE: THE STATE OF SOCIAL WORK IN AMERICA
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTHY
FAMILIES AND COMMUNITIES
COMMITTEE ON
EDUCATION AND LABOR
U.S. House of Representatives
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
HEARING HELD IN WASHINGTON, DC, JULY 29, 2008
__________
Serial No. 110-105
__________
Printed for the use of the Committee on Education and Labor
Available on the Internet:
http://www.gpoaccess.gov/congress/house/education/index.html
----------
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COMMITTEE ON EDUCATION AND LABOR
GEORGE MILLER, California, Chairman
Dale E. Kildee, Michigan, Vice Howard P. ``Buck'' McKeon,
Chairman California,
Donald M. Payne, New Jersey Senior Republican Member
Robert E. Andrews, New Jersey Thomas E. Petri, Wisconsin
Robert C. ``Bobby'' Scott, Virginia Peter Hoekstra, Michigan
Lynn C. Woolsey, California Michael N. Castle, Delaware
Ruben Hinojosa, Texas Mark E. Souder, Indiana
Carolyn McCarthy, New York Vernon J. Ehlers, Michigan
John F. Tierney, Massachusetts Judy Biggert, Illinois
Dennis J. Kucinich, Ohio Todd Russell Platts, Pennsylvania
David Wu, Oregon Ric Keller, Florida
Rush D. Holt, New Jersey Joe Wilson, South Carolina
Susan A. Davis, California John Kline, Minnesota
Danny K. Davis, Illinois Cathy McMorris Rodgers, Washington
Raul M. Grijalva, Arizona Kenny Marchant, Texas
Timothy H. Bishop, New York Tom Price, Georgia
Linda T. Sanchez, California Luis G. Fortuno, Puerto Rico
John P. Sarbanes, Maryland Charles W. Boustany, Jr.,
Joe Sestak, Pennsylvania Louisiana
David Loebsack, Iowa Virginia Foxx, North Carolina
Mazie Hirono, Hawaii John R. ``Randy'' Kuhl, Jr., New
Jason Altmire, Pennsylvania York
John A. Yarmuth, Kentucky Rob Bishop, Utah
Phil Hare, Illinois David Davis, Tennessee
Yvette D. Clarke, New York Timothy Walberg, Michigan
Joe Courtney, Connecticut [Vacancy]
Carol Shea-Porter, New Hampshire
Mark Zuckerman, Staff Director
Vic Klatt, Minority Staff Director
------
SUBCOMMITTEE ON HEALTHY FAMILIES AND COMMUNITIES
CAROLYN McCARTHY, New York, Chairwoman
Yvette D. Clarke, New York Todd Russell Platts, Pennsylvania,
Carol Shea-Porter, New Hampshire Ranking Minority Member
Dennis J. Kucinich, Ohio Howard P. ``Buck'' McKeon,
Raul M. Grijalva, Arizona California
John P. Sarbanes, Maryland Kenny Marchant, Texas
Jason Altmire, Pennsylvania Luis G. Fortuno, Puerto Rico
John A. Yarmuth, Kentucky David Davis, Tennessee
[Vacancy]
C O N T E N T S
----------
Page
Hearing held on July 29, 2008.................................... 1
Statement of Members:
Altmire, Hon. Jason, a Representative in Congress from the
State of Pennsylvania, prepared statement of............... 42
Davis, Hon. David, a Representative in Congress from the
State of Tennessee......................................... 3
Prepared statement of.................................... 3
McCarthy, Hon. Carolyn, Chairwoman, Subcommittee on Healthy
Families and Communities, Committee on Education and Labor. 1
Prepared statement of.................................... 2
Additional submissions for the record:
Letter from the National Association of Social
Workers, dated August 14, 2008..................... 42
``Cost Outcomes and Social Work Practice,'' Sage
Publications, 2006................................. 44
``Relationships Between Social Work Involvement and
Hospice Outcomes: Results of the National Hospice
Social Work Survey,'' Social Work, July 2004....... 49
``Cost-Effectiveness of Case Management in Substance
Abuse Treatment,'' Sage Publications, 2006......... 57
``The Impact of a Caregiver Health Education Program
on Health Care Costs,'' Sage Publications, 2006.... 68
Shea-Porter, Hon. Carole, a Representative in Congress from
the State of New Hampshire, submissions for the record:
Letter from the Clinical Social Work Association, dated
July 28, 2008.......................................... 79
``The NASW Code of Ethics and State Licensing Laws''..... 81
NASW slides: ``Social Workers are the Largest Group of
Clinically Trained Mental Health Providers''........... 85
Statement of Witnesses:
Bailey, Gary, MSW, ACSW, associate professor, School of
Social Work, clinical associate professor, School of Health
Science, Simmons College................................... 6
Prepared statement of.................................... 7
Bergeron, L. Rene, Ph.D., associate professor of social work,
University of New Hampshire................................ 17
Prepared statement of.................................... 19
Bird, Michael, MSW, MPH, public health consultant............ 14
Prepared statement of.................................... 15
Fuller, Adina, MSW, licensed graduate social worker,
Washington, DC, Department of Youth Rehabilitation Services 24
Prepared statement of.................................... 25
Mama, Robin S., Ph.D., professor and dean, School of Social
Work, Monmouth University.................................. 10
Prepared statement of.................................... 11
Wells, Rev. Sarah C., BSW, CSWM, Good Samaritan Ministries... 21
Prepared statement of.................................... 22
CARING FOR THE VULNERABLE:
THE STATE OF SOCIAL WORK IN AMERICA
----------
Tuesday, July 29, 2008
U.S. House of Representatives
Subcommittee on Healthy Families and Communities
Committee on Education and Labor
Washington, DC
----------
The subcommittee met, pursuant to call, at 3:00 p.m., in
room 2175, Rayburn House Office Building, Hon. Carolyn McCarthy
[chairwoman of the subcommittee] presiding.
Present: Representatives McCarthy, Shea-Porter, Yarmuth,
and Davis of Tennessee.
Staff Present: Tylease Alli, Hearing Clerk; Denise Forte,
Director of Education Policy; David Hartzler, Systems
Administrator; Jessica Kahanek, Press/Outreach Assistant;
Deborah Koolbeck, Policy Advisor, Subcommittee on Healthy
Families and Communities; Susan Ross, Director of Education and
Human Services Policy; Margaret Young, Staff Assistant,
Education; Stephanie Arras, Minority Legislative Assistant;
James Bergeron, Minority Deputy Director of Education and Human
Services Policy; Cameron Coursen, Minority Assistant
Communications Director; Kirsten Duncan, Minority Professional
Staff Member; and Linda Stevens, Minority Chief Clerk/Assistant
to the General Counsel.
Chairwoman McCarthy. A quorum is present, the hearing of
the subcommittee will come to order. Pursuant to committee rule
12(a) any member may submit an opening statement in writing
which will be made part of the permanent record.
Before we begin I would like everyone to take a moment to
ensure that your cell phones and BlackBerrys are on silent. We
like it when everybody looks in their pocketbooks and purses to
make sure it doesn't go off.
I now recognize myself, followed by the Congressman Davis
from Tennessee, for an opening statement. I want to thank each
and every one of you for being here today for this
informational hearing on the state of social work in America.
Social work is a profession involving the education,
treatment, care, support, and often nurturing of vulnerable
individuals and families, with the objective of assisting or
guiding them on how to improve their lives.
The average person's image of a social worker is someone
who is very passionate about what they do in the face of
challenging, difficult, mean, horrific situations, and whose
work results in life-changing experiences, all while being
underpaid and under appreciated.
I am not sure if this is exactly the case for each social
worker in America, and that is why we are having this hearing
today, to educate the subcommittee on the work of social work.
The year 2008 to 2009 edition of the Bureau of Labor
Statistics Occupational Outlook states that social work
employment is expected to grow faster than average and that a
Master's Degree in social work or related field has become
standard for many positions. Further, it is expected that
opportunities for employment in the social work profession
should be good in rural areas, competitive in urban areas.
In the year 2006, there were 595,000 social workers, and
that number is projected to reach 727,000 by the year 2016.
Each year social work is expected to experience a growth of
projected employment, with some areas expecting a larger
increase than others. For example, it is expected that as the
Baby Boom generation ages that there will be a greater demand
for health and related services. Clearly if you are a young
person looking for job opportunities in the future, social work
is a field to consider.
However, that being said, most people don't know what
social work is and what social workers do on a given day.
Social workers engage in many fields and in many locations,
including working with children, families, the elderly, those
who are incarcerated or at risk of incarceration, those facing
serious or life-threatening illness, those with mental health
or substance abuse challenges, and with public health
organizations and agencies.
Social workers also engage in public policy and government.
We have six social workers in Congress, including my colleague,
Congressman Shea-Porter, who is on the subcommittee here today.
Welcome.
I employ a licensed social worker on my staff in my
district. It was actually one of the first things I did because
I had a feeling that with the work that I was getting into it
was going to need a lot of hand holding and somebody that knew
the way to get around, giving the services to my constituents.
I think that somehow nearly all of us are connected to or have
interacted with a social worker in some capacity.
Today we will learn about the various fields of social
work, an overview of the profession, and perspectives on the
state of the profession through the lens of educated, research
diversity, and on-the-ground experience.
Again, I want to thank each of you for attending the
hearing, and I look forward to your testimony.
Now I would like to introduce my colleague, Mr. Davis from
Tennessee, for his opening statement.
[The statement of Mrs. McCarthy follows:]
Prepared Statement of Hon. Carolyn McCarthy, Chairwoman, Subcommittee
on Healthy Families and Communities
I want to thank each of you for being here today for this
informational hearing on the state of social work on America.
Social work is a profession involving the education, treatment,
care, support, and often nurturing of vulnerable individuals and
families with the objective of assisting or guiding them on how to
improve their lives.
The average person's image of a social worker is someone who is
very passionate about what they do in the face of challenging,
difficult, and even horrific situations and whose work results in life-
changing experiences, all while being underpaid and underappreciated. I
am not sure if this is exactly the case for each social worker in
America, and that is why we are having this hearing today--to educate
the Subcommittee on the state of social work.
The 2008-2009 edition of the Bureau of Labor Statistics
Occupational Outlook states that social work employment is expected to
grow faster than average and that a master's degree in social work or a
related field has become standard for many positions.
Furthermore, it is expected that opportunities for employment in
the social work profession should be good in rural areas and
competitive in urban areas. In 2006 there were five hundred ninety-five
thousand social workers and that number is projected to reach seven
hundred twenty seven thousand by the year 2016.
Each area of social work is expected to experience a growth in
projected employment, with some areas expecting a larger increase than
others. For example, it is expected that as the Baby Boom generation
ages that there will be a greater demand for health and related social
services. Clearly, if you are a young person looking at job
opportunities in the future, social work is a field to consider.
However, that being said, most people don't know what social work is
and what social workers do in a given day.
Social workers engage in many fields and in many locations,
including working with children, families, the elderly, those who are
incarcerated or at risk of incarceration, those facing serious or life-
threatening illness, those with mental health or substance abuse
challenges, and with public health organizations and agencies. Social
workers also engage in public policy and government.
We have six social workers in Congress, including my colleague
Congresswoman Shea-Porter who is on this Subcommittee and here today. I
employ a licensed social worker on my staff in my district. I think
that somehow nearly all of us are connected to or have interacted with
a social worker in some capacity.
Today we will learn about the various fields of social work, an
overview of the profession, and perspectives on the state of the
profession through the lenses of education, research, diversity, and
on-the-ground experience.
Again, I want to thank each of you for attending the hearing and I
look forward to your testimony.
______
Mr. Davis. Good afternoon. Thank you, Chairman McCarthy,
for holding this important hearing. I would like to thank each
of our witnesses who have taken the time to provide this
subcommittee with their testimony. I would like to extend a
special welcome to my fellow Tennesseean, Sarah Wells, who I
will introduce later.
The importance of social workers cannot be overstated.
These professionals serve every age range, race, ethnic group
and social background, and they do so selflessly. Social
workers advocate for people who cannot do it themselves and
help them navigate the sometimes confusing array of public
services available to them. Whether it is ensuring that an
abused child is placed in a safe foster home or helping a
family cope with a terminal illness, social workers improve the
lives of individuals and families and their communities on a
daily basis.
Chairwoman McCarthy, I look forward to working with you on
this important issue. Again, I thank each of you for being here
today and I am eager to hear your testimony. With that, I yield
back.
[The statement of Mr. Davis of Tennessee follows:]
Prepared Statement of Hon. David Davis, a Representative in Congress
From the State of Tennessee
Good afternoon. Thank you, Chairwoman McCarthy, for holding this
important hearing. I'd like to thank each of our witnesses who have
taken the time to provide this Subcommittee with their testimony. I'd
like to extend a special welcome to fellow Tennessean, Sarah Wells, who
I will introduce later.
The importance of social workers cannot be overstated. These
professionals serve every age range, race, ethnic group and social
background, and they do so selflessly. Social workers advocate for
people who cannot do so for themselves and help them navigate the
sometimes confusing array of public services available to them. Whether
it is ensuring that an abused child is placed in a safe foster home or
helping a family to cope with a terminal illness, social workers
improve the lives of individuals and families in their communities on a
daily basis.
Chairwoman McCarthy, I look forward to working with you on this
important issue. Again, I thank each of you for being here today and am
eager to hear your testimony. I yield back.
______
Chairwoman McCarthy. Thank you, Mr. Davis. Without
objection, all members will have 14 days to submit additional
materials or questions for the hearing record.
Let me explain our lighting system. In front of you, you
will see three boxes there, green, yellow and red. Red
basically means we would like to you stop your testimony. If
you are in the middle of a sentence, believe me, we will let
you go on. But just try and keep your testimony into that, and
that goes for the members also.
So with that, if we have additional time, we will be asking
additional questions.
Today we will hear from a panel of witnesses. Your
testimonies will proceed in the order that I introduce you. I
would like to introduce our first witness, Mr. Gary Bailey. He
is an Associate Professor of the Simmons College for Social
Work in Massachusetts and Assistant Professor at the Boston
University School of Public Health. He is immediately past
President of the National Association of Social Workers and
serves as Chair of the International Federation of Social
Workers Commission on Policy, Advocacy and Representation. In
1998, he received the honor of Social Worker of the Year and
has received numerous awards since.
Today, Mr. Bailey will give us an overview of the social
work profession, and we will look forward to learning what
social work is and the success and challenges of the profession
from him.
Our next witness, Dr. Mama, comes to us from New Jersey. I
know Congressman Rush Holt wanted to be here, but unfortunately
he got tied up back in his district. He wanted to introduce
you. Dr. Mama is the Dean of School of Social Work at Monmouth
University. She also serves as the representative of the
International Federation of Social Workers at the United
Nations in New York City.
Dr. Mama will speak to us about undergraduate and graduate
education as well licensure requirements for the social work
profession.
Mr. Michael Bird comes to us from New Mexico. Welcome. Mr.
Bird has over 25 years of public health experience in the areas
of medical social work, substance abuse prevention, health
promotion, and disease prevention, HIV/AIDS prevention,
behavior health and health care administration. Of his many
accomplishments from 2000 to 2001, Mr. Bird was the first
American Indian and the first social worker to serve as
President of the American Public Health Association. He has
also been involved in numerous health disparity projects and
programs on a local, tribal, national, and international level.
Most recently, he was named to serve on the Robert Wood
Johnson Foundation, Urban Indian Health Commission. Today Mr.
Bird will discuss the impact and necessity of diversity in the
social work profession, in which he is a living example.
Welcome again.
Our next witness, Dr. Bergeron----
Ms. Bergeron. Bergeron.
Chairwoman McCarthy [continuing]. Bergeron, will be
introduced by our subcommittee social worker, Congresswoman
Shea-Porter.
Ms. Shea-Porter. Thank you. It is my privilege today to
introduce a constituent of mine. Dr. Rene Bergeron's impressive
resume includes over 30 years of experience and numerous
publications that focus on various topics from elder abuse and
neglect, to family poverty, to domestic violence, just to name
a few. She is a monthly contributor to the New Hampshire Senior
Times and on the Board of the Advising Editors for the Journal
of Elder Abuse and Neglect.
Dr. Bergeron serves as an Associate Professor in the Social
Work Department at my alma mater, University of New Hampshire.
We are both so proud of it. And as if all that is not enough to
keep anyone busy, she currently serves as the President of the
New Hampshire chapter of National Association of Social Work.
As a social worker and administrator myself, I would like
to thank you, Dr. Bergeron, for your work in our field and for
taking the time out today. You have a very busy schedule, as we
know, and you are testifying and we appreciate it very much,
and I look forward to your testimony.
Thank you, Madam Chairwoman.
Chairwoman McCarthy. You are quite welcome.
Next I turn to my colleague from Tennessee, Mr. David
Davis, to introduce the Reverend Sarah Wells.
Mr. Davis. Thank you, Chairwoman McCarthy. I appreciate the
opportunity to introduce our next witness. Reverend Sarah Wells
has been an Executive Director of the Good Samaritan Ministries
in Johnson City, Tennessee since 1998. Sarah graduated from
East Tennessee State University from the Department of Social
Work as a certified social work manager. Sarah served east
Tennessee's first homeless education liaison for the upper east
Tennessee region and worked to expand this program to what it
is today throughout the State of Tennessee. Today Sarah strives
to work towards learning new ways to reach out to her
community.
Sarah is married to Dr. Vernon Wells and is the mother of
four children and grandmother to 14.
Sarah, welcome to Washington.
Chairwoman McCarthy. Our next witness is Ms. Fuller. Ms.
Fuller is a licensed social worker at the Department of Youth
Rehabilitation Services in Washington, D.C.'s juvenile justice
system. Her daily work involves a caseload of 27 young people
who have been committed to the DYRS for acts of delinquency.
Today she will share with us a view of her day-to-day work to
help us gain an understanding of what social work is on a daily
basis in the JJ system here in Washington. I want to thank you
for being here today and joining you us.
I have already explained to you the lighting system. I am
fairly lenient on that, but if you go way over you will
probably hear me tap a little bit first, and then hopefully you
will finish up your testimony. We are now going to hear from
our first witness, Mr. Bailey.
STATEMENT OF GARY BAILEY, MSW, ACSW, ASSOCIATE PROFESSOR,
SCHOOL OF SOCIAL WORK, CLINICAL ASSOCIATE PROFESSOR, SCHOOL OF
HEALTH SCIENCE, SIMMONS COLLEGE
Mr. Bailey. Thank you, Madam Chair and Mr. Davis. It is an
honor to have been invited here today to address you and to
talk about the state of social work in the United States.
My name is Gary Bailey, and I am proudly an Associate
Professor of Social Work at Simmons College School of Social
Work in Boston, Massachusetts. Simmons was established in 1904
and was the Nation's first institute of higher learning to
offer training for clinical social workers, and was begun in
response to the need to professionalize charity.
I feel very fortunate to have been a professional social
worker for the past 30 years, having worked in direct services
and administrative capacities in the field of child welfare,
gerontology, social work education, and having volunteered in
the area of HIV/AIDS early on in the epidemic at the AIDS
Action Committee in Boston, one of the Nation's foremost AIDS
service organizations.
As I speak before you today, the Nation faces many complex
and converging challenges, from our military engagement abroad
to rising food and commodity prices and untenable mortgages at
home. While each of the challenges individually demand the
comprehensive engagement of the Nation's social workers, these
trends taken together suggest a significantly increased need
for professional social work services within vulnerable
communities, both locally, nationally and internationally.
While it is clear that the Nation's social work community
will be strained to meet this increased demand, a broader work
community and an assessment of the true scope of these demands,
along with the comprehensive plan to provide for adequate
service to all in need is of vital importance.
I have had the honor of serving as President of the
National Association of Social Workers from 2003 to 2005, and
currently I am the Chairman of the National Social Work Public
Education Campaign. I join you today to discuss the important
role that the profession of social work plays in our society.
Social work is the helping profession. Across the Nation
the profession of social work and social workers improve and
enrich the lives of individuals and families and help build
strong communities. Social workers provide critical services in
rural, urban and suburban areas, and have long been society's
safety net for a broad range of issues, including child
welfare, mental and behavioral health, aging, corrections,
health, and military and veterans affairs.
Much of society only encounters a social worker when
dealing with a problem, such as moving a family member from a
hospital to a nursing home, and there is limited public
understanding of the role of social workers. However, we work
to help individuals, families, and communities across the
country, and the need for social work services will only grow
with time.
As Chair of the Social Work Public Education Campaign, I
have traveled this country and met numbers of people who have a
universal awareness of social work as a helping profession.
Many people lack, however, an accurate knowledge related to the
education and credentials needed to be a professional social
worker. They did not appreciate the diversity of the work, they
were confused by the use of the more general term of
caseworker, which at times is used interchangeably with that of
social worker.
As the Baby Boomers continue to age, they will increasingly
need social work services, ranging from mental health and
family counseling to health, education, group programs and case
management. Social workers, who provide the majority of the
mental health services in the United States, will work with the
26 percent of the American population aged 18 and older that
experience a diagnosable mental disorder. Professional social
workers will counsel students to prevent high school dropout
rates, work with formerly incarcerated individuals to ensure
positive community reentry, and help patients diagnosed with
serious illnesses such as cancer to make informed decisions
about their care.
While the need for social work services will only increase
with time, we are not equipped to keep pace with this demand,
and Dr. Mama will go into that in more detail.
The social work profession has existed for over a century
and has enriched many lives. Thirty years ago I made a decision
to become a professional social worker, and I have never
regretted that decision. While it is clear that the Nation's
social work community will be strained to meet these increased
demands, a broader assessment of the true scope of these
demands, along with a comprehensive plan to provide adequate
service for all in need, is a vital necessity.
So today I say to you again, my name is Gary Bailey and I
am proud to be a professional social worker.
[The statement of Mr. Bailey follows:]
Prepared Statement of Gary Bailey, MSW, ACSW, Associate Professor,
School of Social Work, Clinical Associate Professor, School of Health
Science, Simmons College
Chairwoman McCarthy, Ranking member Platts, and honorable members
of the Subcommittee on Healthy Families and Communities, I would like
to thank you for inviting me here today to discuss the state of the
profession of social work. My name is Gary Bailey and I am currently an
associate professor at Simmons College of Social Work in Boston,
Massachusetts. Established in 1904, Simmons was the nation's first
institute of higher learning to offer training for clinical social
workers. Simmons also was at the forefront of educating students for
medical social work and managed care.
I feel fortunate to have been a professional social worker for the
past 30 years having worked in many capacities including the fields of
child welfare, gerontology and social work education. I served as
President of the National Association of Social Workers from 2003 to
2005 and am the current Chairman of the National Social Work Public
Education Campaign.
Background
I join you today to discuss the important role that the profession
of social work plays in our society. Social work is the helping
profession. Across the nation the profession of social work and social
workers improve and enrich lives every single day. Social workers
provide critical services in rural, urban and suburban areas and have
long been society's safety net for a broad range of issues including
child welfare, mental and behavioral health, aging, corrections, health
and military and veterans' affairs.
As the baby boomers continue to age, they will increasingly need
social work services ranging from mental health and family counseling
to health education, group programs and case management. Social
workers, who provide the majority of mental health services in the
United States, will work with the 26 percent of the American population
aged 18 and older that experience a diagnosable mental disorder.
Professional social workers will counsel students to prevent high
dropout rates, work with formerly incarcerated individuals to ensure
positive community reentry, and help patients diagnosed with serious
illness to make informed decisions about their care.
Social work began in the late 19th century when concerns about
increasing poverty led people to question how to prevent and protect
people from ``falling through the cracks'' in society. Many credit Jane
Addams for the emergence of the profession as she created the first
settlement house in America, Chicago's Hull House in 1889. Settlement
workers were often women who settled in urban areas to address the
various challenges facing immigrant communities. The settlements
provided a vital service, Addams believed, both for the volunteer
residents, who needed a purpose in life, and for the society at large,
by building needed bridges between the classes in an increasingly
stratified and fragmented society (Addams, 1893). Settlement house
workers, charity organization societies, and child savers worked
together throughout the end of the century to preserve healthy
communities and ensure that biopsychosocial needs were being met.
During the Great Depression, economic, mental, and social needs
rose dramatically and the social work profession was recognized as
necessary to solve the seemingly intractable challenges of the times.
Social workers created programs for the Department of Labor and the
Department of Health, Education, and Welfare to combat widespread
hunger and unemployment. The profession was dedicated to restoring hope
for the American people and continued to see significant growth during
the Civil Rights Movement and the War on Poverty as many of the
architects of these important social initiatives were social workers.
Recent decades have produced competition for financial resources and
less understanding of the role of the social worker in society; however
these professionals continue to help individuals, families, and
communities across the country. The need for social work services will
only grow with time.
Current Issues
The profession of social work has grown with and reflected the
changing needs of our society. As previously mentioned, social workers
are the largest group of mental health providers in the country. There
are 192,000 clinical social workers across the United States treating
adults, adolescents, children, veterans, the incarcerated, the elderly,
and those diagnosed with diseases such as HIV/AIDS for a variety of
mental health concerns ranging from emotional disturbances to serious
debilitating illnesses. Social workers' most frequent specialty
practice area is mental health whether it be in private practice, a
mental health clinic , hospital, prison, or long term care facility.
Social workers not only practice in a variety of settings including
child welfare and foster care agencies, community action centers,
hospitals, government offices, mental health centers, homeless
shelters, and schools but also cater to a diverse clientele. Social
workers help people and communities overcome some of life's most
difficult challenges including poverty, discrimination, abuse,
addiction, physical illness, divorce, loss, unemployment, educational
problems, disability, and mental illness.
Professional social workers have advanced educational preparation
and practice experience. A professional social worker must have a
bachelor's (BSW), master's (MSW) or doctorate (PhD or DSW) degree in
social work. A master's degree in social work is the predominant degree
for licensed social workers (79% for active practitioners) and we pride
ourselves in being the profession trained to work with people in their
environment, looking at all dimensions of the individual's life. Social
workers recognize that most clients face complex situations and often
have co-occurring needs and work to address all of these needs. For
instance, a social worker specializing in aging would not only support
their client's physiological, psychological, and social needs through
mental health therapy, caregiver and family counseling, and health
education but will also need to understand chronic illness as many
elderly clients will be faced with these issues.
Social workers undergo advanced training in accredited education
programs and grow their expertise through standards, credentials, and
state licensing requirements. Social workers have the right education,
experience, and dedication to help people help themselves whenever and
wherever they need it. They understand complex support systems and work
to connect people to the resources they need. Social workers focus on a
person's strengths and help clients reach their full potential. It is
this unique blend of training, education, and experience that equips
professional social workers with the tools necessary to tackle
society's most pressing problems.
Challenges
Despite a century of service, the public is still not clear about
what social workers do. The media often report on the profession only
when a problem arises in the child welfare system and far too often
these individuals are not professionally trained social workers as less
than 35% of child welfare workers actually have any social work
training. They may be performing in a social work capacity or hold a
social work title without proper supervision or education. Despite some
public perception, the vital services that social workers do provide in
the child welfare system, as well as in numerous other areas,
contribute to a healthy society.
There is confusion among the public as there is not one typical
social worker. Social workers may work in traditional child welfare
agencies or may hold public office as a member of Congress. They may
own their own private mental health practice or work in a long term
care facility. Few are aware that the largest employer of social
workers in the nation is the Department of Veterans Affairs with over
5,000 professional social work employees. Uniformed social services
play a critical role in our military efforts at home and abroad. It
also often goes unnoticed that professional social workers are first
responders to disasters such as Hurricane Katrina and the Virginia Tech
shootings. They provide vital supports to victims and their families
during times of crisis and for years beyond.
Professional social workers hold positions in government,
nonprofit, business and educational settings. Informing the public
about the breadth and depth of the profession is important as it
affects the public's access to care, the ability of social workers to
perform essential duties, and to impact important policy decisions.
Many of the benefits U.S. citizens take for granted were implemented
because social workers--working with families and institutions--spoke
out against abuse and neglect.
During my tenure as Chair of the Social Work Public Education
Campaign I have traveled the United States and met numbers of people
who have a universal awareness of social work as a ``helping''
profession but who lack accurate knowledge related to the education and
credentials needed to be a professional social worker; they did not
appreciate the diversity of the work; they were confused by the use of
the more general term of ``case worker'' used interchangeably with that
of social worker. Generally the public has had a strong respect for the
difficulty of the job and believes that social workers are overworked
and are under valued. They also believed that we worked with the
underserved, handle a variety of problems and generally believe that
they will never need a social worker.
The need for social work services will only increase with time,
however we are not equipped to keep pace with this demand. For example,
there are currently 30,000 licensed social workers working in the field
of aging; however the National Institute on Aging projects that 60,000
to 70,000 social workers will be needed by 2010. If schools of social
work do not recruit young professionals and if we do not retain
experienced social workers, the public will suffer from a lack of
critical services. This is particularly true in the areas of aging and
child welfare.
A key component of recruitment and retention of professional social
workers is their ability to earn comparable salaries. Increases in
social work salaries have not kept pace with other professions such as
teaching and nursing. A survey conducted by the John A. Hartford
Foundation, Inc. found that between 1992 and 1999 the annual rate of
wage growth for degree-holding social workers was less than one
percent. In addition, high educational debt is a concern of every
graduating social work student. According to one study, 68 percent of
individuals surveyed with a Master's Degree in Social Work (MSW)
graduated with an average debt of $26,777. Many social workers will
earn less than that upon graduation. Low salaries and high educational
debt are making this profession an impossible choice for many.
These challenges must be overcome in order to ensure that the
profession grows and thrives in the future and so that clients can
continue to be served for years to come.
Conclusion
The social work profession has existed for over a century and has
enriched many lives. Social work skills are broad and applicable in a
variety of settings and make this profession unique and important.
Social workers are educated, experienced, and ethical and provide a
diverse range of services across the life span.
Thirty years ago I made a decision to become a professional social
worker. I was introduced to the field of social work by a woman who was
teaching a winter intercession course at my alma mater of Tufts
University. Until that time I was preparing to pursue a career in
medicine. In her class I was introduced to a field that resonated with
my desire to be a catalyst in people's lives for change; and to create
opportunities where previously there had been none.
I have never regretted that decision and I am delighted to say that
my name is Gary Bailey and I am a proud professional social worker.
______
Chairwoman McCarthy. Thank you very much, right on the mark
too.
Dr. Mama.
STATEMENT OF ROBIN S. MAMA, PH.D., PROFESSOR AND DEAN, SCHOOL
OF SOCIAL WORK, MONMOUTH UNIVERSITY
Dr. Mama. Thank you, Chairwoman McCarthy and members of the
committee, for allowing me to speak to you today about social
work education. My name is Robin Mama, and I am the Dean of the
School of Social Work at Monmouth University in West Long
Branch, New Jersey.
My oral comments will be targeted to undergraduate social
work education; however, my written testimony provides you with
some additional information on Master's level education as well
as social work licensure for practicing social workers.
There are over 400 Bachelor of Social Work programs in the
United States. Some BSW programs stand alone, in departments
that are combined with sociology, anthropology and/or criminal
justice. Some BSW programs, like ours at Monmouth, are in the
School of Social Work or a department that also offers a Master
of Social Work program. And then there are a few who are
combined with Master of Social Work, Bachelor of Social Work
and Ph.D. In social work programs.
All undergraduate social work programs are generalist in
their focus. Students in BSW programs do not concentrate in any
area of practice or theoretical focus, as is the case with
Master's programs. BSW students are taught to work in many
areas of practice, whether it is casework or case management,
group work, community practice, research or policy, and they
should be able to work in any field of practice, be it
gerontology, mental health, aging, child welfare.
Critical to the BSW curriculum is the field internship
where students are placed in social service agencies to learn
the day-to-day aspects of social service delivery. At Monmouth
our BSW students complete a 30-hour volunteer experience in the
sophomore year, a 100-hour junior internship, and 450-hour
senior internship. These internships are always supervised by a
licensed social worker at the Master's level and the agency
supervisors often take a course in supervision that many social
work programs offer.
So for example, Monmouth runs a course called SIFI,
Supervision in Field Instruction, for all our new internship
supervisors. The field internship is the place where academia
meets practice. It is the applied aspect of social work and as
such the vehicle that allows students to grow professionally
and personally. A baccalaureate student usually knows they made
the right choice of profession when they begin their field
internship.
I was asked to address both the challenges of undergraduate
social work education and their strengths, and I see these to
be the following:
In terms of strengths BSW graduates have generalist skills
and knowledge which allow them to work in many facets of social
work. Their skills are portable, they are not tied to a
specific job or function, but can be taken wherever the
graduate goes and are applicable to a number of fields of
social work practice.
BSW graduates are idealistic and enthusiastic. They want to
change the world. This idealism often helps social services
agencies because these interns allow agencies and their staffs
to remember their own idealism, and many times they help the
agencies to see the situations in a new light and help to renew
their enthusiasm for social work. They also help to rejuvenate
their faculty.
BSW students are at an advantage in the workplace because
they are taught systems theory and learn to see the whole
picture. They work well with professionals from other
disciplines because they see everyone's role, they understand
how roles fit together, and with their interpersonal skills
they help to mediate difficult situations.
In terms of challenges, recruitment is the biggest
challenge facing undergraduate social work programs. Many
people, especially parents, are under the impression that
social workers only help the poor and take children away from
families. They also have the impression that social workers do
not make livable salaries. All academic social work programs
work hard to negate these impressions, but until the society at
large begins to change their opinion this will be difficult.
Public education on what social work is and what we do as
professionals is essential.
Ensuring cultural awareness and sensitivity can also be a
challenge, depending upon where the BSW program is located and
who the students are. We need more bi- and trilingual social
workers, and we need students to develop cultural awareness for
all the clients and agencies that they come into contact with.
Finally, ensuring that social work as a program stays
vibrant and respected at the college or university level is
also a challenge. This is an applied working discipline that
does not often garner large research grants nor garners large
donations, and there are times when its usefulness to the
larger university can be questioned.
Thank you again for this opportunity to speak to you.
[The statement of Ms. Mama follows:]
Prepared Statement of Robin S. Mama, Ph.D., Professor and Dean, School
of Social Work, Monmouth University
Thank you for this opportunity to provide testimony for this
important hearing. My remarks are focused on undergraduate social work
education. I will generalize some of my comments to baccalaureate
social work education, giving some specific examples from my experience
at Monmouth University. I began teaching at Monmouth in social work in
1992, became the BSW Program Director in 1998 (when we added a master
of social work program to our curriculum), became the Chair of the
Department and MSW Program Director in 2004, and I am now the Dean of
the School of Social Work which was just created on July 1, 2008.
Monmouth University has had a Bachelor of Social Work program since
1977 and we added a Master of Social Work program to our curriculum in
1998. We are very typical of a small to medium size baccalaureate
social work program. Currently, we average 100 to110 BSW students in
our program.
There are over 400 Bachelor of Social Work programs in the United
States. Some BSW programs stand alone in a department that is often
combined with sociology, anthropology and/or criminal justice. Some BSW
programs (like ours at Monmouth) are in a School of Social Work or a
Department of Social Work which also offers a Master of Social Work
program. Fewer are in Schools of Social Work that offer the BSW, the
MSW and the Ph.D. in Social Work.
All undergraduate social work programs draw heavily from content in
the liberal arts. Students are usually required to complete courses in
Sociology, Anthropology, Psychology, Economics, Political Science,
Biology, and Mathematics, along with History, English and Literature.
All undergraduate social work programs are generalist in their
focus. Students in BSW programs do not concentrate in any area of
practice or theoretical focus, as is common in MSW programs. BSW
students are taught to be able to work in many areas of practice,
whether it is casework or case management, group work, community
practice or even research and policy. And they should be able to work
in any field of practice, be it gerontology, mental health, child
welfare, criminal justice, etc.
The undergraduate social work curriculum introduces students to
human behavior (the life to death sequences of events and milestones
that all individuals go through), they are taught to assess clients,
how to interview them, and then how to form an intervention plan with
the client for their treatment. Students then look to evaluate how well
their interventions worked, engaging in both practice and program
evaluations. Students learn to make these assessments at the individual
level (micro), with families (mezzo) and with communities (macro). They
use a variety of skills in making assessments and in planning for
treatment or for an intervention. A key component to these assessments
is learning systems theory which helps the students see all of the
factors involved in a client's situation. Another component is to take
a strengths perspective to all assessments, looking specifically for
strengths of the individual first, and deficiencies second.
Critical to the BSW curriculum is the field internship, where
students are placed in social service agencies to learn the day to day
aspects of social service delivery. At Monmouth, our BSW students
complete a 30 hour volunteer experience in the sophomore year, a 100
hour internship in the junior year, and a 450 hour internship in the
senior year. These internships are always supervised by a licensed
social worker at the master's level, and these agency supervisors often
take a course in supervision and field that many social work programs
offer. For example, we run a SIFI course--Supervision in Field
Instruction--for all our new internship supervisors.
The field internship is the place where academia meets practice. It
is the applied aspect of social work, and as such is the vehicle that
allows students to grow personally and professionally. A baccalaureate
student usually knows they made the right choice of profession when
they begin their field internships. It is sometimes the case that
students get hired by their field agencies upon graduation from their
BSW program. For a social service agency that can hire their student
intern, their investment into that student over the course of the
academic year is very beneficial, as they know their new employee
before they start work, and that person is already oriented to the
agency and its culture.
Not all BSW students go right to work however. Our experience at
Monmouth is that about 80% of our students go right on to graduate
education, usually the Master of Social Work. The other 20% go into
employment.
The advantage of going straight into an MSW program comes from the
ability of a BSW graduate of an accredited program to apply for
Advanced Standing in a number of MSW programs in the US. Advanced
Standing programs allow accredited BSW graduates who meet admissions
requirements to move into the 2nd year of graduate work. This means
that the MSW degree is completed in one year, rather than the 2 years
it normally takes for someone who enters an MSW program without a BSW
degree (if the coursework is done on a full-time basis of 15 credits/
semester).
This is an important feature of BSW--MSW education, as it indicates
that the senior year of the BSW program theoretically is equivalent to
the first year of graduate education and that prepared BSW graduates
have the knowledge base and the skills to skip one year of graduate
school. From my experience, properly prepared BSW graduates can move
into graduate level education without a problem, and can then spend
their year in graduate school refining their skills and deepening their
knowledge.
The first year of most MSW programs contain ``foundation'' courses,
like Social Welfare Policy, Research, Human Behavior and the Social
Environment and usually several practice courses like Individuals and
Families, Group work, etc. Students also complete first year
internships. At Monmouth, our students in the MSW program take their
classes concurrently with their field internship, and complete 500
hours of field work in the first year of the program. Two days of the
week are spent in class and three days are spent in the field.
In the second year of the MSW curriculum students choose a
concentration, where they focus their academic work and their
internship in a more specific area of social work practice. Almost all
MSW programs offer at least two concentrations; some offer more
depending on the size of the School or University. At Monmouth, we have
two concentrations: Clinical Practice with Families and Children and
the other is International and Community Development. The latter
concentration is the only one of its kind in the US in a social work
program. The ICD concentration allows students to go overseas in the
spring semester of their final year to complete an 8--10 week
internship in an NGO or government agency. We have internships
currently in Ghana, Bangladesh, Southern India, Mexico, Chile, and Hong
Kong. Both concentrations require another 500 hours of field
internship.
The Master of Social Work is the terminal degree in the social work
profession, meaning that you do not need a Ph.D. to practice as a
social worker and to receive third-party reimbursement for your
clinical work. However, you do need a license. Licensure for social
workers is required in all 50 states, and all 50 have varying
requirements to obtain a license to practice social work. Each state
differs on the naming of their licenses and not all states offer
reciprocity to social workers who want to move their license from say
New Jersey to Florida or to Wisconsin. Some states require a re-test,
others require verification of clinical course work.
In New Jersey, there are two social work licenses and one
certification (the CSW, the LSW, and the LCSW). If you graduate with a
BSW and go right to work, you apply for your CSW--or Certification in
Social Work. There is no test for this certification, you need only to
submit proof of your graduation from an accredited undergraduate social
work program and pay the fee to the State.
When a student completes the MSW, they can then take a test for
their LSW--the License in Social Work. Any student at the MSW level
should apply for their LSW. If you want to specialize in clinical
social work and receive 3rd party reimbursement for your services (from
Medicare, Medicaid, HMO's etc), then you have to take an additional
test and work (with your LSW) under the supervision of another social
worker who has the License in Clinical Social Work (LCSW) for
approximately 2,000 hours to qualify for the LCSW license.
Those social workers who desire the Ph.D. or DSW (Doctorate in
Social Work) usually pursue doctoral work in order to enter the
academic world. It is increasingly a requirement at Colleges and
Universities for tenure-line faculty to hold a Ph.D. in their
discipline in order to teach and to be conferred with tenure.
Strengths of a BSW degree:
1. BSW graduates have generalist skills and knowledge, which allow
them to work in many facets of social work.
2. These skills are portable--they are not tied to a specific job
or function, but can be taken wherever the graduate goes and are
applicable to a number of fields of practice.
3. BSW graduates are idealistic and enthusiastic--they definitely
want to ``change the world.'' This idealism often helps social service
agencies because social work interns allow agencies and their staff to
remember their own idealism and many times can help agencies see their
situations in a new light and can bring about needed change and renewed
enthusiasm.
4. BSW graduates are at an advantage in a workplace, because they
are taught systems theory, and learn to see ``the whole picture.'' They
work well with professionals from other disciplines because they can
see everyone's role, see how all roles fit together, and with their
interpersonal skills can help to mediate difficult situations.
Challenges for undergraduate social work education:
1. Recruitment is the biggest challenge facing undergraduate social
work programs. Many people (especially parents) are under the
impression that social workers only help the poor and take children
away from families. They also have the impression that social workers
do not make livable salaries. All academic social work programs work
hard to negate these impressions, but until society at large begins to
change their opinion, this will be difficult. Public education on what
social work is, and what we do as professionals is essential.
2. Ensuring cultural awareness and sensitivity can also be a
challenge, depending on where the BSW program is located and who the
students are. We need more bi- and tri-lingual social workers. And we
need students to develop cultural awareness for all the clients and
agencies that they might come into contact with.
3. Ensuring that social work as a program stays vibrant and is
respected at the College or University level can also be a challenge to
programs. This is an applied, working discipline that does not often
garner large research grants, or large donations, and there are times
when its usefulness to the larger University can be questioned.
______
Chairwoman McCarthy. Thank you.
Mr. Bird.
STATEMENT OF MICHAEL BIRD, MSW, MPH, PUBLIC HEALTH CONSULTANT
Mr. Bird. Chairman McCarthy and members of the
subcommittee, I am pleased to be here with you today. As was
mentioned, my name is Michael Bird. I have over 25 years in
social work in a variety of areas. Most notably, I was the
first American Indian and the first social worker to serve as
President of the American Public Health Association.
I have been fortunate in many respects. Most notably, I
also have a Master's in public health, and I have found that
the combination of the MSW and the MPH has served me well,
served both my associations, and provides a unique perspective
that I think has been relevant to the issues we are addressing
today.
Most importantly, we have mentioned some of the things and
I have mentioned some of the things I have accomplished, but I
think more importantly to me is the fact I am from Santo
Domingo and San Juan Pueblo. I am a Pueblo Indian. My people
have a documented history of being in the Southwest from
anywhere from 30 to 40,000 years, with a unique culture and
unique tradition and unique language. That has shaped and
forced and focused my whole personality and my experience.
But I am here today to talk about the importance and the
role of diversity in social work. There really is a need to
begin to really look at increasing the workforce and increasing
a workforce that better serves the diverse population, the
diversity of this country, but also increasing that workforce
so that it better serves all of us.
The social worker strives to ensure access to needed
information, services, and resources, equality of opportunity
and meaningful participation and decision making for all
people. The profession is unique in that social workers are
expected to understand different cultures and the function that
culture plays in everyday life. They believe that strengths can
be found in every culture and that building upon those
strengths is the best way to help clients reach their full
potential.
The profession of social work values an understanding of
different political, religious, and ideological beliefs, and
social workers are expected to respect the dignity and worth of
each individual that they work with.
Social workers are not only expected to understand the role
that social diversity plays on the society, but actively to
work to end all forms of discrimination. The clients that
social workers work with often are vulnerable and face
prejudice and discrimination.
Professional social workers support and advocate for
recruitment, admissions, hiring, and retention efforts in
social work programs and agencies to ensure diversity within
the profession. They also seek to provide an advocate for the
profession and information referrals and services in the
language appropriate to the client.
My career as a social worker and my background in public
health have led me to a deep understanding of diversity issues
in this country. Having worked to address health disparities
with American Indian, Alaska Native, and Native Hawaiian
communities, as well as all ethnic minority communities for
over 25 years has been a major area of my personal and
professional body of work. This is a moral and spiritual issue
and cries out to be addressed. It is also wasting our most
important natural resource, our human capital and the Nation's
potential.
As early as the U.S. census report in 1970, it chronicled
there are major differences in social, economic, political and
health conditions in the U.S. population. A Federal court also
identifies the Latino and African American populations as
having the lowest per capita income in the United States. And
an argument can be made that Native Americans on reservations
have lower per capita incomes but not included in the Federal
studies.
These statistics are unacceptable and social workers are
the professionals equipped with the tools and understanding to
make a real difference in the lives of their clients.
Although the profession of social work has a rich history
of respecting and appreciating social diversity, it also has a
historical tendency to attract Caucasian women to the field.
While women have done an exceptional job building a strong
foundation of social service and strengthening individual
families and communities, we must look to the future, and that
involves reevaluating our recruitment and retention techniques
with a commitment to diversity.
Another concern is that of the aging. Not only does social
work serve the aging Baby Boomers, but there will be a
significant need to recruit new social workers once the
professionals begin to retire.
When I reflect upon my career in social work and public
health, I believe that what attracted me to this area was a
simple desire to help others who might be confronted by
something larger than themselves. As a child I felt I had no
control over my situation at home in growing up with an
alcoholic father. This experience instilled in me a desire to
help people gain some control in their lives. I also wanted to
give them hope and a sense of direction.
I also thought that only Indians had these kinds of
problems. As I grew wiser I came to understand that we all have
problems, just different kinds of problems, and that we all
need help now and again. Social workers made a critical
difference in my life, as they do in the lives of people every
day.
Thank you very much for this opportunity today.
[The statement of Mr. Bird follows:]
Prepared Statement of Michael Bird, MSW, MPH, Public Health Consultant
Chairwoman McCarthy, Ranking member Platts, and honorable members
of the Subcommittee on Healthy Families and Communities, I am honored
to be here today to discuss the state of the profession of social work.
My name is Michael Bird and I feel fortunate to have worked in this
profession for over 25 years in many capacities including medical
social work, substance abuse prevention, health promotion, disease
prevention, and health care administration. In addition to my
professional training as a social worker, I also have a master's degree
in public health and have found this combination of careers and
professional experience to be extremely valuable in my practice. I was
the first American Indian and the first social worker to serve as
President of the American Public Health Association and have been an
active member of APHA for over 18 years. I've also served as president
of the New Mexico Public Health Association and was a fellow in the
U.S. Public Health Service Primary Care Fellowship Program.
Background
I'm here today to not only discuss the important role that social
work plays in our society but also the unique value placed on diversity
in the social work profession. Social workers provide critical services
to clients across the nation everyday. They work with a broad spectrum
of clients including the homeless, the elderly, students at risk of
dropping out of school, and the incarcerated from all racial, ethnic,
and linguistic backgrounds. Social workers have an ethical
responsibility to pursue social change, particularly with and on behalf
of vulnerable and oppressed individuals and group of people. They also
seek to promote sensitivity to and knowledge about oppression and
cultural and ethnic diversity. Social workers strive to ensure access
to needed information, services, and resources; equality of
opportunity; and meaningful participation in decision making for all
people.
The profession is unique in that social workers are expected to
understand different cultures and the functions that those varying
cultures play in everyday life situations. They believe that strengths
can be found in every culture, and that building on those strengths is
the best way to help clients reach their full potential. Specialized
knowledge and understanding about the history, traditions, values,
family systems, and artistic expressions of major client groups is a
key component to the practice of social work as well as the use of
appropriate methodological approaches, skills, and techniques that
reflect the workers' understanding of the role of culture in the
helping process. Through education, experience, and training, social
workers strive to understand the nature of social diversity and
oppression. The profession of social work values an understanding of
differing political, religious, and ideological beliefs and social
workers are expected to respect the dignity and worth of each
individual they work with.
Social workers are not only expected to understand the role that
social diversity plays on society but to also actively work to end any
form of discrimination. Again, the clients that social workers work
with are often vulnerable and oppressed and face prejudice and
discrimination. In order to promote the welfare of each client, social
workers recognize the importance that the environment plays in each
situation. The profession utilizes a ``person in environment''
approaches that acknowledges the role that all social influences play
on a person's biopsychosocial needs.
Professional social workers support and advocate for recruitment,
admissions and hiring, and retention efforts in social work programs
and agencies to ensure diversity within the profession. They also seek
to provide or advocate for the provision of information, referrals, and
services in the language appropriate to the client.
My career as a social worker and my background in public health has
led me to have a deep understanding of the diversity issues in this
country. Having worked to address health disparities with American
Indian, Alaska Native and Native Hawaiian Communities as well as all
ethnic minority communities for over twenty five years has been a major
area of my personal and professional body of work. This is a moral and
spiritual issue and cries out to be addressed. It is also a wasting our
most important natural resource, our human capital and nation's
potential.
As early as the first U.S. Census in 1790, federal reports
chronicled major differences in socioeconomic, political, and health
conditions in the population. (U.S. Bureau of the Census, 1975). Today
we feel the effects of these disparities. For instance, in 2001 Native
Americans were the group most likely to be uninsured (35% lacked health
insurance) (Census Bureau/National Center for Health Statistics, 2001).
This has far reaching effects, particularly for the children of Native
Americans. In fact, the Indian Health Service spends $1,914.00 per
person for medical care which is lower than Medicare at $5,915.00 and
less than the United States spends on federal prisoners at $3,803.00
(U.S. Commission on Civil Rights Report titled ``A Quiet Crisis''
Federal Funding and Unmet Needs in Indian Country. July 2003).
Federal reports also identify Latino and African American
populations as having the lowest per capita income in the United States
(U.S. Census Bureau, 2007). However, Taylor and Kalt (2005) argue that
Native Americans on reservations have lower per capita incomes but are
not included in many federal income studies.
These statistics are realistic, yet unacceptable and social workers
are the professionals equipped with the tools and understanding to make
a real difference in the lives of their clients.
Challenges
Although the profession of social work has a rich history of
respecting and appreciating social diversity, it also has a historical
tendency to attract Caucasian women to the field. According to one
study by the National Association of Social Workers Center for
Workforce Studies, ``social work, like most health care professions, is
less ethnically diverse than the U.S. population.'' Licensed social
workers who responded to the survey were overwhelmingly White, non-
Hispanic (86%) and are disproportionately likely to be women (81%).
While white women have long led the profession of social work, the
clients social workers serve often belong to a non-White minority group
(51% or more). According to this study of licensed social workers, ten
percent of social workers have caseloads that are predominantly Black/
African American, and five percent handle caseloads that are
predominantly Hispanic/Latino. Additionally, only 14 percent of social
workers work in settings in which their caseloads are 75 percent or
more female. Efforts have begun to recruit more men into the profession
to ensure that the needs of all our clients are successfully being met.
Another concern is the aging of the profession. Not only do social
workers serve the aging baby boomers, but there will be a significant
need to recruit new social workers once experienced professionals begin
to retire. Licensed social workers are significantly more likely to be
in older age groups than the U.S. civilian labor force. A higher
percentage of social workers are ages 45 to 54 (33% compared with 23%),
ages 55 to 64 (24% compared with 11%) and 65 and older (5% compared
with 3%).
While women have done an exceptional job of forming the important
tenets of the profession, building a strong foundation of social
service, and strengthening individuals, families, and communities, we
must look to the future and that involves reevaluating our recruitment
and retention techniques. While a deep understanding of culture is
intrinsic to every social worker, there is great value in reflecting
the populations we serve. When every voice is present at the table,
more informed decisions can be made and the community can be more fully
served. Not only does everyone deserve the right to service, but they
also deserve the right to be served by a social worker that makes them
comfortable and can best understand and work to address their various
social needs. More social workers of color must be recruited into the
profession to ensure that clients can continue to have exceptional,
culturally competent service.
Conclusion
When I reflect upon my career in social work and public health I
believe that what attracted me to this area was the simple desire to
help others who might be confronted by something bigger than
themselves. As a child, I felt that I had no control over my situation
at home in growing up with an alcoholic father. This experience
instilled in me a desire to help people gain some control in their
lives. I also wanted to give them hope and a sense of direction. I also
thought that only Indians had these types of problems. As I grew wiser,
I came to understand that we all have problems, just different kinds of
problems, and that we all need help now and again. Social workers made
a critical difference in my life as they do in the lives of people
every day.
Social work and public health have always been guided by values of
equity, diversity and social justice and these values should be guiding
values for us all.
______
Chairwoman McCarthy. Thank you.
Ms. Bergeron.
STATEMENT OF L. RENE BERGERON, PH.D., ASSOCIATE PROFESSOR OF
SOCIAL WORK, UNIVERSITY OF NEW HAMPSHIRE
Ms. Bergeron. I would like to thank Chairwoman McCarthy and
the members of this subcommittee for allowing me to testify
today. I have a Bachelor's from the University of New
Hampshire, a Master's from the University of Connecticut, and a
doctorate from Boston College all in social work. Social work
is truly the profession I love, and I am so pleased to be able
to talk to you about it today.
My testimony is based on my 30 years plus of practice as a
medical social worker and as an outreach worker to elderly
people in the community. Included in those years is also 24
years of teaching at a university level and 10 years of
conducting research. I would also like to add that social work
has been personally very important in my life, as I have a
child with Fragile X disease and so social work entered into
our family's life at the date of his birth, and continued to be
a part of our life as my father died of a brain tumor at home
and as my mother developed severe Parkinson's and had to be
placed in assisted living, and now with myself as I struggle
with my battle with cancer. So social work is extremely
important and just in my own family very varied in what it
does.
My testimony is going to focus primarily on research. To
simplify, I am going to organize this into three categories:
Who is responsible for research; what are the fields of
practice that research needs to be conducted in; and where
social work needs to go in the future with research.
Social work education, as you heard, is primarily divided
into three levels, baccalaureate level, Master's level and the
doctorate level. The expectation is that the commitment of the
baccalaureate worker is minimal. However, the work that they do
opens our research base in order to see what is effective and
useful in practice.
The master level, while preparing primarily for practice,
supervisory and management position, does have the expectation
to do research. However, high caseloads often inhibit them from
doing so.
At the doctorate level the expectation is that in addition
to administration and teaching they certainly will conduct
research. Thus, this level of education is what drives research
and places an obligation on doctors of social work to link with
the baccalaureate workers, the Master's workers, agencies and
clients themselves to produce a practice-based research that
will enrich the field and identify effective interventions, as
well as discourage interventions that are not very effective.
The field of practice of social work, as you have heard, is
very global, and this in fact can make research difficult. An
overview is: Family interventions; that includes family
violence. Child services, medical services; that include mental
health issues, as well as catastrophic issues. Aging and
gerontology; that includes elder abuse, neglect and financial
exploitation. Anti-poverty programs; that include homelessness,
job training, income assistance. Transitional programs,
immigrant, refugee services, as well as veterans services.
Clinical issues and discrimination issues.
These practice fields suggest that creative approaches in
research may include coordination of efforts among educational
institutions, the various levels of practitioner education,
practice agencies and organizations and of course the clients
themselves.
Research is basically divided into two types, qualitative
research, which is exploratory and develops hypotheses for
future studies. It also incorporates ethnographic types of
studies. And then we have quantitative, which is just survey
data based types of work, and it can include meta-analysis of
large data banks like the U.S. Census.
The future agenda of social work is multi-faceted and
really is going to involve four main areas: Health care,
general family issues, underserved communities, which is going
to include substance and violence issues, and community needs
such as disaster preparation.
Research has an obligation to analyze creative approaches
and meeting both national and international needs of clients.
That involves faith-based services, volunteerism, and
education. The need to know what changes in behavior and social
factors could contribute to the effective functioning of
clients and the efficiency of programs is important, both from
a human factor and a cost factor.
We cannot afford in this country not to support social work
because those areas that go unsupported will have a great
impact on all of the citizens who live here.
Thank you very much.
[The statement of Ms. Bergeron follows:]
Prepared Statement of L. Rene Bergeron, Ph.D., Associate Professor of
Social Work, University of New Hampshire
Organizing the needed research and developing standards of research
matching other bodies of knowledge, such as medicine, sociology, and
psychology began in the schools of social work and later translated
into the complex fields of practice. What quickly became apparent is
that the diversity of practice would dictate that no one theory could
guide social work practice, but there would need to be several
theories. Social work practitioners would need to be taught how to
assess and choose the necessary theory for the particular client
situation, evaluating its effectiveness and changing the intervention
as dictated by its effectiveness. It also became clear that more than
one theory may drive a case (a ``case'' being defined as a single
client, family, or group). In 1949 the Social Work Research Group was
established to help bring special focus to these challenges. Such
challenges continue today.
Social work education is primarily divided into three levels, the
Baccalaureate (BSW) level, the Master (MSW) level, and the Doctorate
(DSW or PhD) level. The expectation is that the commitment of the BSW
practitioner is minimal in adding to the research base. What is
expected is that BSWs have knowledge of theory and research, how to
read and interpret it, and how to use it in practice. Their practice
outcomes add to the field of research.
The MSW level, while preparing primarily for practice, supervisory,
and management positions, does have an expectation that these
practitioners will contribute to the field of research by examining
cases and conducting studies that show the effectiveness of their
practice. However, the reality is that these practitioners, with high
caseloads, do not have the time to conduct research.
At the DSW/PhD level, the expectation is that, in addition to
administration and teaching, research will be of paramount importance.
Thus, this level of education is what drives research and places an
obligation on Doctors of Social Work to link with the BSW, and in
particular, the MSW practitioners to produce practice-based research
that will enrich the field and identify effective interventions or
discourage approaches that do not achieve the desired results.
Research Needs
Because social work focuses on the intra- and the interpersonal
aspects of clients' lives research must consider these aspects as well
as the various settings of the client. The broad range of practice
settings and roles makes it difficult to succinctly explain the various
areas of that social work research that are needed because practice
modalities and client needs continue to change.
Fields of Practice Affecting the Research Agenda
The following is an overview of the various fields of practice;
while not a final list it is meant to identify the complexity of and
need for social work research today. In social work interventions it is
understood that assessment is necessary in determining what the issues
are facing the client or client system and the need for case management
(the organization and assistance in implementing a case plan) is
necessary. Additionally, The National Institutes of Health clearly
states that critical behavioral and social factors affect the health
and wellbeing of people and are important areas for research regarding
treatment and, very importantly, prevention. (See Department of Health
and Human Services, National Institutes of Health, NIH Plan for Social
Work Research).
The need to know what changes in behavior and social factors could
contribute to the effective functioning of clients and the efficiency
of programs is important both from a human factor and a cost factor
perspective:
Family Interventions
Employment issues
Family therapy
Crisis intervention
Housing
Adult education
Incarceration and integration back to communities and
families
Family violence
Family planning
Child Services
Safety/child welfare/foster care/prevention abuse and
neglect
School social work
National and international adoption
Medical Services
Mental and physical illness
Substance use and abuse
Catastrophic
Congenital and accidental disability
Developmental/learning disability
Hospice/end of life counseling
Aging and Gerontology
Community services
Residential care
Caregiver issues
Medicare
Housing
Elder abuse, neglect, emotional abuse, financial
exploitation
Anti-poverty Programs
Job training/placement
Income assistance
Food bank
Homelessness
Transitional Programs
Immigrant and refugee services
Veteran services
Administration
Program development and implementation
Clinical supervision and consultation
Ethical issues
Board and task force involvement
Clinical Issues
Counseling/psychotherapy/psychoanalysis/group therapy
Discrimination Issues
Racism, ageism, sexism
Lesbian, gay, bisexual, and gender supports
Research Agenda
Examination of the above practice fields and issues suggest that
creative approaches in the area research may include coordination of
efforts among educational institutions, the various levels of
practitioners' education, practice agencies and organizations, and of
course the clients themselves. Two types of research approaches
dominate the research field: qualitative research (exploratory research
and the development of hypotheses for future research; ethnographic
study; and single case designs); and quantitative research (survey data
gathering and analysis; may include meta-analysis of completed survey
date, e.g. U. S. Census, large study data banks). In addition, social
work is very concerned with outcome studies to determine if practice
approaches are as efficient and effective as they should or could be to
assist clients and maintain agency and organization implementation of
services.
Social work research must be practice based; practice must inform
research and research similarly informs practice. Educational
institutions are well positioned to interface with the practice
community in order to ensure the focus of research meshes with the real
world needs, and also critical is the need to coordinate on a
multidisciplinary level with allied professions and organizations.
The future agenda of social work research is multifaceted and
involves four main areas. One area, health care, includes discharge
planning and care management, prevention of illness, effectiveness of
health promotion, teen pregnancy prevention, mental health services
including returning veterans and survivors of domestic violence. A
second area needing continued attention is general family issues of
child care, aging, family supports, family-centered practice, and
family preservation. An added area are the underserved communities
including persons substance abuse issues, refugee and immigrant groups,
minority rights, welfare reform, housing and community development,
economic depreciation and the accessing of services. This also
encompasses community needs such as disaster preparation and response
services, homeless service needs, the delivery of human services,
public housing, schools in communities, and welfare to work programs.
And last, creative approaches in meeting both national and
international needs of clients that involve faith-based services,
volunteerism, educational externship and internship programs, forming
linkages among various disciplinary teams for more effective and
efficient delivery of services.
Conclusion
Social work is a dynamic field of practice driven by sound
educational programs and research methodologies that build on that of
other disciplines, as well as research that stands on social work
practice exclusively. Social work research also has assisted, and will
continue to do so, in the development of programs that affect the daily
lives of the citizens of the United States from all social classes with
an array of social issues that if left unattended will affect the
quality of life for all or our citizens.
______
Chairwoman McCarthy. Reverend Wells.
STATEMENT OF REV. SARAH WELLS, EXECUTIVE DIRECTOR, GOOD
SAMARITAN MINISTRIES
Rev. Wells. Thank you very much. I appreciate you so much
allowing me to come today and to share with you. I share with
you the generalist view of social work. And social workers
throughout America today are facing tragic situations, and we
hear this every single day as someone will come and sit before
us and break and begin to cry. But I would like to tell you a
story of a young lady that I know of very well.
This young lady had gotten married when she was only 14
years old, which was very normal in the life of Tennesseeans,
and she quit school and at 28 years old she found herself being
divorced and left alone. So she didn't know any way at all to
take care of herself. As she went off she took what money she
had and she traveled all the way to Florida, where she had
never been before. And there she set up a tent and began her
family.
She would tell her children that they were on vacation and
everything was fine, that it was an enjoyable time. But at
night when they would go to sleep she would hold them very
tight and she would cry herself to sleep. She admits that this
is the most frightening part of her whole life and she didn't
know what to do and didn't know who to turn to. But her faith
kept her strong, even though depression and thoughts of suicide
plagued her every single day.
In case you have not heard or that you have not guessed at
this time, I am that woman and those are my children.
I am very pleased to be able to tell you about a gentleman
that came into my life. He was a social worker. It was the
first time I had ever heard the words. They seemed very strange
and frightening at first, but very important to me. He was a
generalist, which meant that he looked at the whole picture. He
was able to dissect my problems, break them down, and help me
to be able to face them and confront them head on. We were able
to make decisions together. He gave me all the facts that I
would need.
While I was going through this time being homeless nine
times in 10 years I was also electrocuted, and I was told by
one doctor I was very, very blessed to be able to be alive. And
for that I admit today I am. At the time I did not feel that
way. The pain was much greater than the pleasure of being
alive.
But through that time I did learn all about social work
from all the way through the Master's and the LCSW and those
who would walk by my side to help me become whole and healthy
again. So I look at this and I know that the plan for me--I am
a generalist social worker. That is very much important to me.
I like being able to see the whole picture, to be able to find
the resources, to give those people the life skills that they
have need of. So walking together is very important.
Today I am much happier, much healthier, and much stronger
all because there was a social worker along the way in my life,
and I am so very thankful for that.
Today I see the greater needs at the time of homelessness
for those that I am serving than even when I had. During that
time I had people who at least could help me find part-time
jobs, and now finding a part-time job is very hard. Waiting
lists for housing is so hard. Recently I had a woman and 5
children, I couldn't even put her in a shelter because her two
older children were boys and they were ages 12 and 14.
So we are facing so many different barriers that are
stopping us from getting the care that they do need. Struggles
are not new for social workers; however, for some of their very
own, working for a ministry is very difficult. I have a lower
income than most would ever expect. I work many more hours, I
am paid very little, but also I have insurance. I do not have a
retirement to look forward to, but what I have every day is the
joy of being able to be with others that are hurting and to be
able to lead them through that journey.
I believe with all my heart social workers are helping
angels. They are there to walk by the sides of those in pain
each day. They work to bring positive change in this world, as
you have already heard. Solutions are not simple; however, by
working together well we will receive answers.
Thank you very much.
[The statement of Rev. Wells follows:]
Prepared Statement of Rev. Sarah C. Wells, BSW, CSWM, Good Samaritan
Ministries
``While the social service needs are dramatically rising, the
ability to meet those needs is getting tighter.''
Good Afternoon, my name is Sarah Wells, I hold a BSW from East
Tennessee State University, I am Certified Social Work Manager, a
minister with the United Methodist Church, and I work for Good
Samaritan Ministries in Johnson City Tennessee.
Last Monday I arrived to work to find that we had three consecutive
families coming in with medical emergencies. All three had a parent
with cancer, were facing death, and had to accept they were becoming
homeless. The most urgent was a father, mother, and three children that
were behind in rent and their utilities were in danger of being cut-
off. The father had been diagnosed with stage four cancer, the wife had
lost her job while missing work caring for her husband, and they had
received an eviction notice. The children were very quiet and seemed to
cling to their parents during the interview. Soon I had heard that they
were three months behind in rent totaling $1,200.00. The power bill was
another $289.00, there was very little food for the family, and medical
bills were piling up. It was hard to believe that this family's income
last year was $60,000.00 and now they had lost everything. Due to a
recent acquired homeless prevention grant, I was able to pay the rent,
utilities, and give them food. Then I began my task of helping the
family find the community and government resources needed in the future
days to come.
Social Workers throughout America face these tragic stories each
and every day. They are trained to look at the ``whole picture'' and to
assist individuals and families to form positive action plans. While
the social service needs are dramatically rising, the ability to meet
those needs is getting tighter. Many times finding the needed resources
becomes difficult at its best, to an almost impossible task. By working
for a ministry I normally would not have had the financial resources to
help this family to the tune of $1,489.00, but due to the new grant
opportunity that better allows our ministry to aid our community's
homeless prevention assistance, they were assisted in-house. However,
this just began the wide array of services that still had to be located
to under-gird the needs. It is absolutely necessary to have excellent
knowledge of, and communication with all community and government
agencies. It is the role of the social worker to pull all of these
resources together to be able to offer the means to solutions. In the
aforementioned case, this particular family was rescued from
homelessness and having to move at such a delicate time, but many
others are forced to leave the security of their sanctuary and all that
is familiar to them. America's schools are now overwhelmed with the
special needs of homeless and at-risk children. The elderly are now
facing homelessness at a greater rate than ever before.
I would now like to tell you about another family: a mother that
quit school at fourteen to marry and had to face divorce at age 28.
She, like so many, had no idea how to support herself, or her two
children. She got into her car with her children and drove from
Tennessee until she ran out of money for gas in Florida. She had a tent
for the family to stay in until she could find work and housing. She
reminded her children that they were on ``vacation'' and that camping
was fun. Each night after the children went to sleep she cried and held
them tight. The mother admits to having more fear during that time than
ever in her life. She was blessed with two part time jobs and a small
apartment in which to live. Unfortunately, there was never enough money
to pay the bills and each month the family faced eviction and
termination of the utilities. They found themselves homeless nine times
in ten years, and during one period they lived with no power for six
weeks, without water for four, and knew no one to help. The mother had
never asked for help in her life and was raised to be strong.
Depression and thoughts of suicide were with her everyday, but because
of her children, she had to go on. One day she walked into a social
service ministry and met a wonderful gentleman. This was the first time
she had ever heard the title ``social worker.'' He listened as she
cried and watched as she dumped all of her bills and receipts on his
desk. After reviewing the items, he pulled out a checkbook. She cried
out that she had not come to beg, but to be taught to budget. He said,
``No money, no budget.'' He paid all her current bills and then set a
budget. As the visits continued over the next few weeks, he helped her
to see areas that she could receive help. Finally, he helped her enroll
in school and she began her road to a new future.
If you have not guessed by now, I am that mother and those are my
children. I am your homeless * * * the hopeless, but now one that knows
success and hope for a lifetime. I was privileged to have a social
worker that was educated, that cared, and listened to me. He did not
feed me for a day, but taught me to fish. I completed my education with
lots of help and I too, became a social worker and now even a minister.
I now give back by helping others as they overcome their journeys of
pain. My past has made me more sensitive to the struggles of others, to
have deeper wisdom, and to firmly believe in accountability. I have
helped start 8 agencies that assist the poor, and I serve as the pastor
of a United Methodist Church. Being able to work each day to lighten
one person's load makes my past struggles worth it all.
Today, I see much greater needs than those in my time of
homelessness. It is harder to find and to keep jobs these days not to
mention the lack of safe, affordable housing. Utility and rent deposits
are astronomical. Most of the low-income people cannot meet the needed
payments to obtain housing. Waiting lists for affordable housing are as
long as two years. If a person with no income gets into public housing,
they are required to still pay a minimum of $25.00. There is not enough
transitional housing or shelters, with lengthy housing waiting lists.
Many of the shelters do not allow mothers with boys over the age of
twelve, nor single fathers with children to stay at all. Disability
requests now take from 2-4 years for a decision and there is very
little help for those waiting. The list goes on for obstacles to
service and we face services being cut each day.
Struggles are not new to social workers; however many have some of
their own. Working for a ministry is financially difficult. Most are
paid very little, are provided no benefits, insurance, nor retirement.
Fulfillment and dedication keep them serving and doing work for others.
The role of the social worker is evolving to become even more
intricate, however it remains the stronghold and bridge for those in
need. Lives are guided by the ``helping angels'' serving in ministries,
agencies, and government settings each day as they work to bring
positive changes to our world. Solutions are not simple; however by
working well together we will receive answers.
______
Chairwoman McCarthy. Thank you.
Ms. Fuller.
STATEMENT OF ADINA FULLER, MSW, LICENSED GRADUATE SOCIAL
WORKER, DEPARTMENT OF YOUTH REHABILITATION SERVICES
Ms. Fuller. Good afternoon, Madam Chair, committee members.
Chairwoman McCarthy. Could you bring the mike a little
closer?
Ms. Fuller. My name is Adina Fuller. I am a licensed social
worker with the Department of Youth Rehabilitation Services in
Washington, D.C.'s juvenile justice system. As a social worker
with DYRS, I am responsible for the management and care of 27
youth on my caseload who have been committed to our agency by
D.C. Family Court for acts of delinquency.
D.C. case management protocols require that I meet with
youth twice a month, speak with them over the phone weekly,
also make collateral contacts with parents, teachers, anyone
else who is involved with the child.
Most of the young people committed to DYRS come from the
most vulnerable communities in D.C. I often have to provide
supporting guidance not only to the child but also the
families. And my job takes me into their schools, their
neighborhoods and their homes.
The goal of our agency is to ensure that young people are
provided with an enriching and educational experience that will
enable them to become productive citizens in their communities.
Over the past 4 years, DYRS has taken on the task of
reforming the juvenile system with the idea of improving
community safety, as well as achieving better outcomes for
young people. We have adopted the principle of positive youth
development, which draws upon the strengths and the needs of
the families, as well as helping them to find the resources and
the support that they need to meet their own needs, but also we
don't like to focus on the deficits, because we know that
people struggle. So we definitely look for the strengths in the
youth in the family.
We have added a host of services to young people to include
in-home family counseling, service-learning projects, new
educational experiences, employment training and job placement
assistance.
A day in the life of a social worker is often varied by the
crisis that a family is in. It also requires counseling
support, information, and referrals. I spend countless hours
researching information over the Internet, reading newspapers,
and also speaking with fellow social workers who obviously are
doing the same thing I am doing in terms of finding those
community-based programs that are available to youth and
families.
Part of my job entails that I help them to develop viable
transitional plans so that they can successfully return home.
Throughout the process of engagement an assessment is important
for youth and families to identify their strengths and their
needs. It is my job to identify the resources, the services and
support that would enable them to achieve their goals with the
help of them becoming self-sufficient and accepting personal
responsibility. Those meaningful experiences is what enables
youth and families to improve the quality of their own lives.
Today I have a young person who is placed in a therapeutic
group home, and right now his relationship with his mother has
significantly improved, because he is in our care, but also
because the youth and the family understand that they must now
work together so that there is less conflict and more cohesion
within the family system. This young man attends an after-
school program with Sasha Bruce Youthworks, and it is our
collective responsibility to help the family improve their
functioning.
We have monthly team meetings to discuss our next steps,
plans and goals. And when given an opportunity most families
learn that they can effectively communicate with each other.
And this particular young man will be returning home within the
next 30 days. He will continue to receive special education
services, intensive third-party monitoring, family therapy, and
participate in those after-school programs so that he doesn't
have a lot of idle time in the community.
I have another youth who invited me to attend his high
school graduation, and this was a young man who came into the
system for committing an obvious offense, but with individual
therapy he learned how to manage conflict, as well as to
peacefully resolve his differences. We met biweekly to discuss
what he had learned in anger management and to explore after-
school employment opportunities. So as a social worker I
assisted him with completing on-line job applications, but
after some careful thought he decided that he wanted to play in
the high school band and serve meals to the homeless.
Although he made a poor decision, he did not allow that to
ruin his opportunity to become a productive young person. He
participated in a group interview at Trinity College where he
was selected as a candidate to receive one the scholarships
available through Bill and Melinda Gates Foundation, and he
will be attending Johnson and Wales university in Providence,
Rhode Island this coming fall. So for him this was a meaningful
experience and it is something that he desired to do.
So I am glad that I have those experiences and those
successes, and that is what makes me enjoy social work as well.
[The statement of Ms. Fuller follows:]
Prepared Statement of Adina Fuller, MSW, Licensed Graduate Social
Worker, Department of Youth Rehabilitation Services
Good morning Mr. Chairman, committee members, and other
distinguished participants. My name is Adina Fuller and I am a licensed
social worker at the Department of Youth Rehabilitation Services--
Washington DC's juvenile justice system.
Prior to coming to DYRS, I was a social worker in DC's child
welfare system.
As a social worker at DYRS, I am responsible for managing the care
and supervision for 27 youth on my case load. These are all youth who
have been committed to the department by the DC Family Court for acts
of delinquency.
DYRS case management protocols mandate that I see all the youth on
my case load twice a month, talk to them once per week, regularly
update their case files in our data management system, and connect my
youth with appropriate services, programs, supports, and opportunities.
Most of the youth committed to DYRS come from the most vulnerable
communities in Washington. I often have to provide support and guidance
not only to my client, but also to their families. My job takes me into
the schools, neighborhoods, and homes of all the youth I serve.
The goal of our agency to ensure that youth are provided with
opportunities that will provide an enriching and educational experience
that will enable them to become productive citizens in their
communities.
Over the past four years, DYRS has been engaged in a huge reform
effort. In order to improve public safety and achieve better outcomes
for youth DYRS has been making a number of changes in the system.
DYRS has adopted the principle of Positive Youth Development as its
overarching reform agenda--to build on young people's strengths and
assets instead of solely dwelling on their deficits.
DYRS has added a host of new services and supports for the youth
and the family we serve, including: in home family counseling, service
leaning, employment training and job placement, new educational
experiences, and other Evidence Based Practices.
To give a snap shot of a day in the life of a DYRS social worker, I
will briefly review the case of one of my youth:
Case Review
A day in the life of Social Worker is often varied by the
circumstance of the youth and family whether is it a crisis, counseling
support, and/or information and referrals that will enable a youth and
family to address their needs and concerns. I spend countless hours
beyond my tour of duty counseling youth and families on developing a
viable transition plans out of the juvenile justice system. Throughout
the process of engagement and assessment, it is important for youth and
families to identify their strengths and needs. It is my job to
identify the resources, services, and supports that would enable to
them achieve their goals that would enable them to become self
sufficient and to accept personal responsibility for their lives. Those
experiences must be meaningful, which improves the likelihood that the
youth and family will be vested in improving the quality of their
lives.
Some parents seem to rely upon me as a co-parent, particularly, if
they are unable to effectively reason with their adolescent. I have a
young person who will completing his stay in one of our therapeutic
group homes whose relationship with his mother has significantly
improved during this out of home place. While in placement, the youth
and family were connected to the Department of Mental Health Services
to receive individual therapy (youth), family therapy, and medication
management. The family meets with the Psychologist on a biweekly basis
in their home while the young person participates in individual and
group therapy with a Psychologist in the therapeutic group home. He
also attends an after school program at Sasha Bruce Youthworks. It is
our collective responsibility to ensure that the young and family have
improved their capacity to function as a unit. We have regular team
meetings on a monthly basis to discuss our next steps and goals that
will ensure the young person will successfully transition home. I have
to maintain regular contact with parents who have provided insight of
how they intend to supervise, reward and encourage her child to
continue making responsible choices. When given an opportunity whereby
parents and children can learn to effectively communicate with each
other, it is amazing how they come to appreciate each other's
differences when placed in an setting that is non threatening and non
judgmental. I also work closely with teachers who often contact me to
set schedule parent/teacher conferences and to schedule individual
education plans (IEP) meetings to ensure that the young person is
receiving educational supports and services. I have to maintain contact
with the group home staff and therapists to discuss the young person's
adjustments in a structured settings and encouraging youth to sustain
their compliant attitudes and behavior during weekend visits at home.
This young person will be returning home within the next 30 days with
an identified transition plan. He will continue to receive special
education services with District of Columbia Public Schools, third
party intensive monitoring, continued in-home family therapy with
Universal Healthcare, a core service agency with the Department of
Mental Health, and continue to participate in the afterschool program
with Sasha Bruce, which will continue to provide him with the
opportunity to participate in constructive activities
I have a youth who invited me to attend his graduation from a DC
Public School. While under my supervision, the youth and family were
referred to individual where he learned how to manage conflict and
peacefully resolve differences by asking for the support of other
adults in the school setting. We met on a biweekly basis to discuss
what he learned in anger management and to explore after school
employment opportunities. He was assisted with completing online job
applications with CVS Pharmacy, Harris and Teeter, and Home Depot.
After some careful thought and consideration, he decided that he would
pay in his high school band and volunteered at So Others May Eat,
serving meals for the homeless, because it was important for him to
demonstrate that he had varied interests, talents, and his way of
giving back to those who were less fortunate. Although he erred in his
judgment, he demonstrated that it was a regrettable offense, but he did
not allow it ruin his chances of becoming a productive young adult. He
recommended by his teachers to participate in group interviews that
were held at Trinity College asked to vie for an opportunity to receive
a scholarship from the Bill and Melinda Gates Foundation. He seemed so
posed when he answered questions whose themes centered about race/
ethnicity, team building, and diversity. I am happy to report that he
will be attending Johnson and Wales University in Providence, Rhode
Island in August 2008. He plans to major in Business Administration and
Culinary Arts because he intends to own his own restaurant in the
Washington, DC. He was awarded a scholarship after completing the
rigors of their program. He plans to major in Business Administration
and Culinary Arts because he intends to own his own restaurant in the
Washington, DC.
______
Chairwoman McCarthy. Thank you. With that, I will start the
questioning.
Listening to your testimony and having read the testimony
the other night, one of the things that I want to ask is
obviously we have talked about diversity, and I represent a
fairly large underserved area and to me sometimes its
overwhelming with some of the constituents that come to us when
they don't know where to go. I had mentioned earlier that I
have a social worker on my staff, but even with that, trying to
pull together the services for some of these constituents that
have multiple issues that need to be worked out, and each
agency is a separate entity to start with, I find it mind
boggling, I truly do. So I have gone through, unfortunately,
serious injuries in my family. So I know what the social worker
did for me. I spent my life as a nurse, by the way, up to that
point and so I thought I knew everything until I couldn't
handle anything and that is what it came down to.
With that being said, we are talking about diversity and,
Dr. Mama and Mr. Bird, I think that you bring that subject up.
How do we get the diversities to be able to see their way on
becoming social workers to become part of the community, to
heal their community, to help their community? What is being
done to try to recruit?
Obviously, you know when we look at our Nation today, it is
a very large diversity. And those communities and all
communities at one time or another are probably going to need
the help of a social worker. Is there anything that you see or
any of you see on how we could bring that diversity into
encouraging young people, anybody, second jobs actually, not
even a second job, second careers that we can fill those needs?
And I will open that up.
Dr. Mama. That is a very good question, and I think in
terms of schools and social work programs we try to be as
available in the community as possible. One of the things that
helps when we try to recruit students--in fact, we take this
from a student perspective--is that we try to reach students in
high schools, in community colleges. We try our own students in
their social work activities, try also to go into various
communities surrounding the college, all of which are diverse
at Monmouth, and to do service projects, learning projects,
research projects, help with the community. So they are almost
like ambassadors into those communities in helping them to see
some of the value of social work.
But the university itself tries to make available
themselves to students from diverse communities to try and pull
them into the university. And some of that has to come through
recruitment and marketing and those usual pieces. But some of
it also needs to come in the form of financial assistance for
students in diverse communities to be able to come to college
and making loans available to families and opportunities
available in terms of financial assistance.
I think it also requires that programs themselves be open
to opportunities. Right now Monmouth has an increasing number
of men and women, but mostly women from an orthodox Jewish
community south of the university coming into our program, into
the Master's program, for the reasons that you mentioned. They
want to now go back into their own community to help their
community. And the only reason I think that we are seeing
increasing numbers come to Monmouth is because we have been
very open in terms of how we structure our classes, allowing
them to miss classes for religious observance and not
penalizing them in their education and being respectful of
their needs as a religious community.
Chairwoman McCarthy. Mr. Bird.
Mr. Bird. Yes. As I understood your question, you were
talking about--my response would be that in terms of I think we
have to begin to view diversity as a strength, not as a
weakness or a threat. In many cases, at least in my experience
both in social work school, graduate school and as well as in
the public health arena, there were times because I was
different, because I was different than dominant society, I
think there were times that people felt like embarrassed to
engage me in discussions about what the reality for Indian
people in this country is today. And because of that we
wouldn't go there and we wouldn't have a fruitful discussion or
a dialogue that really would benefit everyone. This goes beyond
the Indian community obviously. I think all of us have so much
to learn from each other, and I am reminded of a quote by Will
Rogers, Cherokee humorist, and that quote is, we are all
ignorant, just about different things. And I think until we
come to the table recognizing that we are all ignorant and that
we all have something to learn from each other and find some
common ground in terms of--like the lady who spoke of her
homelessness, that condition in that situation, that is, you
know--I mean, I respect that, appreciate that, but that sort of
experience transcends her community or her State. There are
native people throughout this country, they are in rural and
urban areas, who experience very similar sort of circumstances.
So rather than sort of look at what makes us different, I
think we need to move towards the common experience, what can
we learn from that experience and how can we really build a
community that is inclusive, that recognizes that we all are
part of a larger community. And until I think we have that sort
of honest bringing people to the table, I think we will
continue to face many of the challenges that we face.
Chairwoman McCarthy. I hope you are right, because I have
been waiting a long time to see that happen in this country.
With that, Mr. Davis.
Mr. Davis. Thank you. It looks like we are all the health
care providers today. You are a nurse, I am a respiratory
therapist and a lot of social workers. We could just about
start a clinic today.
Ms. Wells, thank you again for sharing your very personal
testimony. I know sometimes that is not easy to do and I do
appreciate you doing that for us. Could you talk a little bit
about how your background and your education came together, and
how you used those together to provide services in our
community and a little bit about your personal philosophy of
how you actually help families.
Rev. Wells. At age 14 years old when I quit school, and
that was the norm for growing up in my family. Most the women
were married by the age of 15 years old. But I still had this
desire to go back to school, even though my mother told me I
didn't need it, I was just going to be a wife anyway. So at 18
years old after I had been married for 4 years, I went and I
took my GED. I had to slip off in order to do that and to hide.
And when I went in they told me that I would not be able to
take it that day because I had not gone back to school in order
to take the GED. But I talked the young lady into letting me
going in and taking it. And I walked out with my paper stated
that I had indeed graduated that day.
I was very proud of that, and that helped me in seeing the
needs of those that I work with on a daily basis. I work with
so many that quit school as they are very, very young, and
there is no hope for them to go back to school. Of course
working with our Families First in the State of Tennessee, we
at Good Samaritan Ministries are a site for those coming in.
And when they can't get a job, they come in to us for job
training and placement.
So the exciting part is to be able to share my story with
them on each and every day basis and letting them know that I
know where they have worked, what journey they are going down
and that I too can be there as a help for them. But it is an
encouragement to know you can escape poverty, which is
definitely a killer of dreams.
The young man that worked with me taught me something very
special. He sat down and he said, barring the fact that you
have no money and you don't know anybody, you don't know where
you are going in life, if you were to dream today, what is it
that you would tell me that you would like to do? So that is
where we began because I also wanted the help field more than
anything. And after meeting him I wanted to be a social worker.
I wanted to be able to share with others and hold them and to
help them, but also bring that wisdom that it is also in our
minds and in our hearts whether we want to go forward.
As I told you, it was very difficult for me because every
day I wanted to escape and I wanted to be able to take my own
life even at those points. And it is for me that he gave me
that hope to allow me to dream. So now when you come to my
office the very first thing is we have a dreaming session. We
go back to the very first thing that you ever knew that you
wanted to be. And then we look to see what would it take today
for you to be there and what is it you would like to do today.
So I believe in having those dreams and to getting up and
going on and being strong. That helps me so much in working
with those that are actually the street homeless also. This
past year we had six that came and had been with us for several
years. We lost all six of those to death. And on one of those,
one of our homeless ladies did something I didn't know to do.
She went to the library and typed in and she found his family.
She came in and told me their phone numbers. So we had a
gathering that night and had a funeral. And we had cell phones
all over the room and the family was able to have closure by
being there and hearing how their loved one lived and how they
grew and were healthy in the end. So there was closure for
their family.
That is in my heart, it helps me to know that without a
doubt that that is very important. I have closure in my life,
too. It doesn't bother me at all to talk about my past, not
anymore, there is no pain and there is no sorrow, because I
have been allowed to know success, and I just want to share
that success with others.
Mr. Davis. Thank you. One of my favorite quotes comes from
Henry Ford. He said if you think you can or if you think you
can't, you are right. That is the type of people we deal with
as Members of Congress; that is the type of people you deal
with in your profession. And I thank each and every one of you
for doing that. And if you let people know if they have a
dream, they can do anything they want to in America.
Just real quickly, Ms. Wells, you talk about you provide an
all encompassing type of social work. How do you pool the
resources together to be able to provide these other services,
homeless, food, education? Just real quickly.
Rev. Wells. At Good Samaritan Ministries we have an on-site
food pantry, we have off-site feeding called the Melting Pot in
Johnson City, Tennessee. So we are able to come up with a list
that we can give them about food, and we can help them with
food. That is never a problem. Our community does very well at
feeding its poor.
When we get into the complicated cases such as those like
mine, it is pulling together our resources. For me it was
vocational rehabilitation, it was going back to school. Even
though I was told by the college and so was my social worker
that with my disabilities, because I was legally blind for 3
years and was disabled, and they felt that my disabilities were
much too great in order for me to go. So even above those
disabilities it was looking at the programs that were community
and government-based that would be able to work hand in hand.
Our office on a daily basis are gleaning out all of the
resources, checking to see what the situation is, what do you
have to do in order to be able to apply for their services. We
keep all of their applications there in our office, so they are
helped to fill out their applications. We also make their
appointments, and if they need an advocate that is what we are,
we go with them, especially getting into housing.
Like I told you, the woman who really frustrated me the
other afternoon, this is one of the first times I have felt
this frustration for us in our community. She was from Nigeria,
she spoke very little English. She had five children ages from
4 to 17. Two of the boys were ages 4 and 17, so they couldn't
go into the shelter with the mother. I called every shelter in
the tricities area and they all told me the very same thing.
Then I began what would be the normal thing for the night, I
can't let her sleep on the streets. So I called a motel and
they refused to allow me to bring her in to the motel due to
the fact that for her--you are not allowed more than three
people in a motel.
So we are still facing a lot of barriers and resources that
are needed. Family shelters is the one that I realized for our
community that we are needing. So now we just work together in
finding those resources on a daily basis.
Mr. Yarmuth. Thank you, Madam Chairman.
I want to thank all the witnesses also for their testimony.
One of the things that has been very striking to me, as I
have traveled around my district in Louisville, Kentucky, and
visited many varying social service agencies and different
programs, is that you can analyze the value of social work in a
variety of ways. Certainly we have talked a lot about the
compassionate side. Social workers do provide comfort and aid
to a lot of people in distress, as we have heard.
But I also want to focus for a minute--I am going to sound
like a Republican here--I want focus a little bit on the
economic side.
Ms. Fuller, you talked about one young man that you helped
take from a very at-risk, vulnerable position and turned him
into a person with a promising future. We have done a lot of
work here on the Runaway and Homeless Youth Act, and we hope
that the Senate will get its act together and pass it on their
side, as we did.
One of the things that I found in my hometown, we had a
young man named Rusty Booker, who testified before this full
committee some time ago, who was someone who had been in five
different foster homes, had been homeless and was destined
statistically for a dependency status. He was going to be a
drain on society, there is no question about it.
A similar thing happened to him through the programs that
the Runaway and Homeless Youth Act funds. Case managers, social
workers got him the services, the guidance he needed. He is
going to go off to college this fall as well.
So my question to you is over the course of a year, how
many young people do you think that you help move from a
position in which they are going to be a drain on society and
which they are likely to be a positive contributor to society?
Ms. Fuller. I think every youth I serve, they don't
intend--I mean, they didn't grow up wanting to become
criminals. I mean, sometimes just the circumstances, the
impoverished states of the family just puts you in a position
where it is about survival. But most do want to do something
different.
So it is my responsibility to, in any way I can, to find
that service that meets their needs, because it is a host of
programs that we can refer them to. But if it is not a good
match, if they don't feel comfortable, if they don't feel like
someone is connected to them, then they won't complete.
So it is about relationships, and it is about engagements.
Those youth do go on to complete the programs, and most end up
in just entry-level jobs, but that is a good thing, because we
are helping them to establish their character, their work
ethic, their integrity.
Mr. Yarmuth. I am just trying to get a sense of a cost-
benefit analysis. If you pay a social worker--I don't know what
the average social worker makes, I know it is not very much.
Certainly it is probably lower than the average income in the
country, I would say, not much more--you are smiling. But I am
talking about how many people during the course of the year, in
the same situation as that young man you talked about, would
you help turn their lives around?
Ms. Fuller. Every one of them if given the opportunity.
Mr. Yarmuth. Because I think what----
Ms. Fuller. This is about vocational training, because some
students are somewhat behind, so by the time they get to 16 and
17, there is a lot of catching up to do. So my focus becomes
skill-based; what is it that you are good at, what can you do,
what do you want to do, and then taking that skill base and
helping them to sort of foresee whatever it is that they want
to do.
So for me it is about connecting them to employment
assistance training programs, job-training programs. In part of
that you do get that educational piece in terms of their GED,
but 16, 17 is about being able to have a skill so that you can
become employable.
Mr. Yarmuth. Thank you.
I want to ask Dr. Bergeron, because you do research, has
there been any research done on the cost-benefit analysis of
money spent on social work?
Ms. Bergeron. Yes, and I certainly could send you some.
There has not been enough. What we do know is that the earlier
we begin intervention, the less costly it is, and the more
successful we are. It is so broad-based. I mean, I am just
thinking of your story, and, you know, right away I was
thinking, research, research.
You know, whoever decided that in adult education, for
somebody to get their GED, that they had to return back to
school, is that a good policy? That is a great research
question. We decided not to let boys ages 14 and up into
shelters. Originally that was decided because of violence
issues. But is that a good policy? We need research to begin to
decide, you know, if we are going to attract women to shelters.
They are not going to give up their boys any more than they are
going to give up their little girls.
So there is a cost benefit. The question really is if you
don't intervene, what is the cost? The cost is huge. Had my son
not received services, and had I not had the professional
background I had, I can tell you right now he probably would
not have his driver's license. He would not be employed. He
would not be able to communicate very well to people. The cost
benefits to society would be huge.
So let me see what I can get to you, because it is an
excellent question.
Mr. Bailey. May I also respond briefly, if that is within
the protocol?
There are some studies, Michael Barth out of a Hartford
study in 2001, that really looks at the cost-benefit analysis
of the role of intervention--of prevention versus intervention,
which I think is part of the question; that clearly it costs
more on the back end to provide the service than it does to try
to remediate the service on the front end and prevent the care,
long-term care.
We also know, through the National Association of Social
Workers, Center for Workforce Studies, as we begin to evaluate
the value added of social work to the United States, that,
indeed, having social workers present reduces more costly
episodes in children's lives. And we can also think about this
in terms of the elder parent who is at home who, if they can
get the geriatric wrap-around services, won't require a nursing
home immediately, won't break a hip. So that we know that
prevention is always, always the way to go rather than waiting
for intervention. Intervention is always more costly.
Yes, social workers are not compensated at that time rate--
the average social worker salary is about $26,000 across the
United States. That does well in some places and not well in
most.
Chairwoman McCarthy. We actually are going to have a second
round, I just asked some of my colleagues, because I think a
lot of us have a lot more questions.
Is anybody on the panel in a time restraint? Great.
Mr. Davis.
Mr. Davis. Thank you. I am just going to have some very
generic questions for anybody on the panel that would like to
answer.
The first, how do you protect privacy of your clients,
anyone?
Mr. Bailey. Part of our code of ethics of the profession is
protecting the confidentiality of your client, with the
exception of suicidality and homicidal threats or tendencies,
so that confidentiality is of paramount importance in the field
of social work that we are--it is part of what is trained into
you from the very beginning, that you respect the
confidentiality of your clients, with those exceptions, if that
is the question.
Mr. Davis. Yes.
Mr. Bailey. We also are looking at the moves around
electronic records and particularly around medical records, and
are going to be looking at and coming up with recommendations
from the national association around standards dealing with
electronic--with electronic records. That is of concern.
Mr. Davis. Anyone else like to answer that?
Rev. Wells. I know as far as for our office, when they come
in, we do it by the HIPAA rules, and we are very, very
cautious. If someone calls to talk with someone on the
telephone, I do not even allow anyone in my office to identify
that they are present there.
We will take the name of the person and go and seek, and
let them know if they are present, they will give them a call
back. So we will not even make mention that they are in our
office for any reason. So we go the extra mile to protect their
privacy.
Mr. Davis. Thank you.
Next general question for anybody on the panel. Can you
talk to me about faith-based initiatives and faith-based
programs; are they working, not working? Would you like to see
them continue? Anyone.
Rev. Wells. I think the White House just came out with a
new research, according to the faith-based funds that have been
released and how effective they were, and we were very excited
to see that the faith-based programs are much more effective
due to the fact that we are used to already operating on a
shoestring. So we make those dollars go even tighter and longer
than most of the other agencies can do. It is also because we
pay less, and our operations are much lower.
The faith-based programs themselves are working. The major
thing for me was this young man, when I came into the program,
he was working for a ministry, and the fact was he asked me
what my preferences were, if I had any leaning, you know,
towards the fact that--and, seeing that I was suicidal in
particular, wanting to make sure, is there a way for faith-
based programs to intervene.
So he offered; he did not demand. That is one of the
greatest things for us, coming into my office. It is not a
practice that anyone has to participate in to receive services,
nor to even hear about, but the major thing is they are there
for the offering.
But in particular programs such as Celebrate Recovery, in
those it gives them that faith and be able to go through the
recovery at the same time. I feel it is one of the greatest
programs that ever was, that we have been able to have.
Having to have--you know, being able to give the privilege
of faith-based programs is greater than just giving them one
side, and that is very important in our office.
Mr. Davis. Anyone else?
Mr. Bailey. Social work comes out of the faith-based
community, and it is at its genesis. What we know is that
especially within the Catholic, Protestant, Jewish faith, there
has been a tradition around social justice, social action, and
that there are many years of history of faith-based
organizations.
Many of these agencies utilize social workers and are very
active in their communities. I would like to share with you one
group, which is Coalition against Religious Discrimination,
which is comprised of many long-standing faith-based groups who
really are looking at ways of working together and including a
variety of ways of thinking.
When we talk about diversity, faith is one area, one of the
key areas, of diversity and the ways in which people can be
engaged in doing social work, professional social work, but
also be connected to faith-based organizations, Lutheran
Services, Catholic Charities, et cetera, wonderful examples of
organizations that have done amazing work over the years.
Mr. Bird. I would just like to just say, since the
beginning of time, American Indian people have offered prayers
for this land and for all things and the blessings we have. So
this mind, body, spirit sort of recognition by everyone is
welcome, and it is an important, critical aspect to all of us
that we acknowledge the role of spirituality and people's
religious sort of traditions, because, in fact, there is health
and well-being in that.
Mr. Davis. Thank you.
One last question: High energy costs, what it is doing to
your clients? Anybody? High energy costs, high cost of
gasoline, high cost of heating in the winter, if somebody could
just talk to that, and that will be my last question.
Ms. Bergeron. I am sorry, I missed the first part of your
question. I didn't get it all.
Mr. Davis. I think I am out of time. I will come back
around if the Chairman will give me that opportunity. I will
hold my question for now.
Chairwoman McCarthy. Ms. Shea-Porter.
Ms. Shea-Porter. Thank you. I have had to hold myself back,
want to jump on that side of the table and talk about this
myself. Thank you so much for being here.
First of all, I wanted to say that so often we get a phone
call, and it will be, well, somebody has to do something about
this, and social workers are the somebodies that do something
about it. So I am very proud to identify myself with all of
you, and thank you.
You know, social workers find that little spark of faith
and that little spark of hope in somebody when other people
write them off, and it is our job. I will say that, miserably
paid, I can remember getting a job that required a master's
degree, which I have, and yet in a different department within
this organization, high-school graduates were earning more. So
obviously something else motivates people to work like that. It
is a love of other people.
Often, very often, it is also inspired by faith. I have
been privileged to work in organizations that didn't have--they
were government organizations, and also I started up a private
nonprofit that was faith-based, and it was interfaith. And we
only set one set of rules there, which was that you did not try
to convert anybody, and you did not discuss that at all; that
everybody who came came out of need, and we didn't try to, you
know, position ourselves so that one had an advantage or tried
to proselytize.
So I think it works very well because we are driven by
something, all of us, and whatever the reason is, when we come
to the table to help each other, that can be a great motivator.
Then, again, for some it is not. So I think you have to be very
careful and respectful about that.
What I wanted to ask all of you was if you had one item on
your wish list that you wish people knew, or you wished that
they would give, or they would know, what would it be, because
each one of us has that one thing that we wish people would
know. I would tell you what mine is; that if Americans really
understood and policymakers really understood that if you
provided housing, even if it were just a simple room somewhere,
you could stabilize people so that they could get on with the
rest of their business, but that need for housing is so
essential in order to provide the stability to work on
everything else. So I give you mine, showed my hand. Would you
all like to take a stab at it?
Mr. Bailey. Mine would be one part with a semicolon,
divided into two pieces, if I may.
Ms. Shea-Porter. That is a politician for you.
Mr. Bailey. I have been called that.
The first part would be that people have a sense of
belonging to community, a place of belonging, that that place
of connectedness, either to one other person or multiple other
people, however they define that sense of connectedness, helps
us to have a wholeness and a functionability.
In that I would also like to have recognized and understand
at the level of government, both Federal, State and local, the
role that professional social work plays in helping to maintain
healthy communities, that, indeed, people need support and help
to be able to achieve health and wholeness, and that the social
work profession is that.
Ms. Shea-Porter. Thank you.
Dr. Mama. I think my one wish would be education, but
education and social work from a very early age. The schools
that we place students in for social work internships, those
that have a school-based youth program that includes school
social workers as well as the usual case study team, have a
better program in their schools for students, and you find that
students make better progress when you have got social workers
right in the school system, from elementary all the way up
through high school. And so that will be mine.
Ms. Shea-Porter. Thank you.
Mr. Bird. Mine comes from the Southwest in that when you
live in a region that is dependent, I mean, high desert, and
you grow your own crops, and oftentimes one very important crop
historically has been corn, or any other sort of vegetable or
something that you rely on, well, one of the elements you have
to have, metaphorically speaking in today's discussion, is
rain. Without rain, you can't grow anything. So we need to be
aware of the fact that in order to provide the kind of
resources we are discussing today, you have got to have a
little rain. Without a little rain, nothing grows.
Ms. Shea-Porter. I think I got that, thanks.
Ms. Bergeron. I think mine would be very creative
approaches to health care. Right now in New Hampshire, we
cannot get dental care for children on Medicaid because of the
payment system and the fact that dentists can't afford to give
dental care to Medicaid patients.
So I think, while we have probably the best medical
services in the world, we do not have universal access on any
level. I mean, right now we have Helen's van in Portsmouth.
That is a wonderful thing. It is very creative. It drives
around to both the towns and the cities and the rural areas to
try to encourage people to do preventive as well as treatment
health care.
Ms. Shea-Porter. Thank you. I think that is a good point.
Madam Chairman, do you want me to finish the last two?
Chairwoman McCarthy. Sure.
Ms. Shea-Porter. Reverend Wells.
Rev. Wells. I think I would like for all of us to have
unconditional respect for one another and to see the value of
human life, and that helping them is much greater than just
helping.
Ms. Shea-Porter. Thank you.
Ms. Fuller.
Ms. Fuller. I would like to see everyone with a liveable
wage, where you didn't feel the struggle every day. So that is
what I would like to see.
Ms. Shea-Porter. Thank you. Thank you for the extra time. I
told you they are great people. Thanks.
Chairwoman McCarthy. Thank you.
Mr. Bailey, and certainly Ms. Fuller, and to my colleague
Mr. Yarmuth, maybe because I am a nurse, we always try to look
at things holistically. When you were talking about cost
analysis on how many young people you have helped, and how to
put a cost analysis on your--basically saying we don't have
enough research, I will tell that you when my son was seriously
hurt and about 4 months into his rehabilitation, which is only
really the beginning of that, because, of course, it lasted for
years, the insurance companies basically turned around and said
he wasn't going to get any better, and that they did not feel
that it was worth spending the extra money so that he could
learn how to feed himself.
Now, I have taken care of a lot of stroke patients in my
life, and I know that it was a lot of patience and perseverance
on the patient and certainly the nurse on just trying to get
that patient to feed himself if that was the only thing they
could do. It changed their life tremendously.
So I don't know how you could put a cost analysis on
something, and I mean this with all my heart and soul, because
I have tried to go to CBO and say, give me a cost analysis if
we do prevention. They say, we can't give you a cost analysis
because we don't know. But people know, because you see the
results.
I know that we have to do that, because we are the Federal
Government, and we need to certainly watch the taxpayers'
money, and I believe in that. But I also know that when you are
dealing with human life, and you are dealing with the family,
which all of you are doing, you say, I am sorry, you just don't
quite fit into the criteria, and we can't give you any more
help.
When do you cut that off? I haven't found that spot yet and
believe I am very conservative and very thrifty, but there are
certain things that I think are worth putting a dollar towards
to prevent.
And going back earlier on early education, from the day I
first got here, if we spent the money that we need to spend on
early education, preeducation, we wouldn't have half the
problems we see in society. What I never understood is even
though those young children that we help, for some reason, we
stop giving those services in junior high. Now, I am old enough
to realize what junior high was like even back then. Let me
tell you, a lot of people got into a lot of trouble. Of course,
I didn't, I was very good.
But with that being said, I mean, how much information do
we need?
But I guess the one thing I will say to you for many years
as a nurse, our pay was really, really bad. And the only
difference is most of us worked in a nursing home or hospital,
so they would set salaries. I know that all social workers that
I deal with in my different communities, they are getting paid
nothing, and I live on Long Island. They live on Long Island,
and I don't know how to raise your pay, and I think especially
with those that are nonprofit, they don't have the money. They
are always scrambling for money. They will always scramble for
money. There is not enough money that we could give them to
take care of the problems they have.
The only thing I am thinking, and I wish I had this hearing
a long time ago, from my nurses and teachers, we actually are
giving student loan forgiveness, mainly to help them this way:
If they stay in the profession for 5 years, their loans would
be forgiven. So, hopefully, that is something that we can look
into help for those that are going into social work.
Maybe it is not even too late, although I hear higher
education is coming on Thursday. I don't know, I will work on
it. With that, I just need to say that, because people don't
understand what is going on until you have been affected by it.
Unfortunately, the one thing I did want to say, because we
are dealing with this in Financial Services, Reverend Wells, my
committee came up to me and they said, well, we have a problem
with the housing problem. We have this much money, even though
it has been bumped up a little bit. We have two different
groups that take care of people, terrific groups. One takes
care of the most desperate, homeless people out there that
don't have a house or anything over their roof. Then we have
our families that might be living in a car, or they might be
living with a second family, just so they get through it. They
can't go to a shelter for exactly the same reason you said,
because they have two teenage boys. The mother is not going to
allow the two teen age boys go into the shelter without her
being here.
Here is the dilemma. Each group is trying to open up the
wording. Those that are taking care of the homeless don't want
the wording to be changed because that will take away their pot
of funds. Obviously those with families, they want to open up
the wording, because they want to take care of those families
that they are taking care of.
I feel like I am splitting the baby here. That,
unfortunately, is what we deal with constantly here. I am
hoping that through these hearings, people actually understand
we are just trying to take care of each other.
Mr. Davis.
Mr. Davis. One last question, and I started down this road
before.
One of the biggest issues facing the American family right
now is the high cost of fuel, gasoline. This winter we are
going to go into a problem with not having enough supply, and
energy costs are going to be high. Home-heating costs are going
to be high. Tell me some stories if it is affecting the people
that you care for and work with on a day-to-day basis. I open
it up to anyone on the panel or everyone on the panel.
Rev. Wells. Briefly I had a case that came to me, and it
was two elderly ladies living together. They had been without
power for 5 weeks. By that time it was $689 for me to get their
power restored. Because our--there is--another vision of this
is the deposits in order to have utilities. Our utility deposit
is now $200. If their power is disconnected, then you have
another deposit. And each time that it is disconnected, there
is another deposit that is added on to that.
So one of the things that I have to come up with is--to be
able to pay for the utilities is including paying for their new
deposits in order to get it turned back on; of course, then
bringing in services that would help them--especially with
these being elderly people, we were able to get several
agencies that would come in and help undergird their situation
so that they could stay in their home.
But we are seeing utility bills, in particular right now,
where most of the people can't even come in for gas in order to
get food. We are actually having to go and deliver the food to
the elderly. Our elderly are calling our offices on a daily
basis and crying because they--just because they get Social
Security, they get $10 worth of food stamps. You and I both
know you can't buy much for $10. But they are wanting milk and
eggs and bread, margarine, the simple things of life we look at
and take for granted. This is what they call asking us. Then we
have to take it to them, because there is no way for them to be
able to have their gas to come in.
We are also seeing the fact that our young men and women
who are on Families First program and the struggle they are
having with gas, with fuel, to be able to get to work. They are
already working at minimum wage. So when we added these high
costs now, they are not even able to afford to go to work. If
they miss work, then they lose their jobs, so we are back to
square one.
You are going to be seeing much greater of this, and you
are going to be hearing more stories like this, I truly believe
this, over the next few months to come.
Mr. Bailey. You are also going to see the impact and
continue to see in food banks and other programs the increased
cost of food that is given out to people who do not have enough
food, that that cost is also being spread. In Boston, where I
live, where we have a very, very successful food pantry, food
bank program, they already are talking about the increased cost
of having food. Also we are seeing a reduction in people giving
food because they are needing to hold onto it for themselves.
So we are going to face both challenges in terms of the
cost, donations, as well as the rise in energy costs, enormous
concerns now coming from Boston, which is heavily dependent in
terms of old housing stock on oil heat. So the cost of oil for
many older people, many families, will be for them the
difference between eating, getting their oil. I just talked to
someone the other day who says that she is trying to manage to
keep a quarter of a tank if she can hold onto that and not go
below that, but that is all she can afford to do. She is afraid
because she knows the cost is going to go up even to just keep
that quarter of a tank and how is she going to get through the
winter.
Mr. Bird. Also I think the case--I think it is very much
the case for rural and reservation communities where people
have to travel large distances to buy gas, to buy groceries and
to just conduct their business. They are not--they can't rely
on public--any sort of public transportation systems that urban
areas have, so I think it is sort of a unique issue.
Ms. Bergeron. Yes. I would agree with everything that has
been said. And, in addition, you know, States like New
Hampshire, we have such poor structure, public transportation,
that you are not only talking about the cost of gas, they are
talking about the cost of a vehicle, if you really wish to
employ people and have them working in areas that may earn them
money.
Mr. Bailey. I would also add one other comment that very
often people think about when they are thinking about older
people, and they are saying, well, we are going to raise the
bus fare, but you seniors get a discount. If you have ever
worked with older adults who talk about what that difference of
a dime or when something goes up a quarter when they are on
fixed income, and the anxiety that that creates when it speaks
to reducing their activities of daily living, that what for
some of us seems minimal for other people is catastrophic.
We really have to look at the context in the which these
activities and changes occur. For some people something that
appears very negligible, for someone else is a life-and-death
catastrophic issue and has a catastrophic impact.
Chairwoman McCarthy. Mr. Yarmuth.
Mr. Yarmuth. Thank you, Madam Chairman.
I want to follow up on something that you began, and this
is the question of education and early childhood development.
David Brooks had a fascinating column this morning in the New
York Times, I hope everybody reads it, that talked about the
real challenge to American revival as an economic power.
He talked about--he made the statement in the column that
boosting educational attainment at the bottom is more promising
than trying to reorganize the global economy. His point was
that what we have seen over the last 30-something years in this
country is actually a decline in educational attainment,
largely attributable to the fact that we have so many at-risk
families where children, in their very early years, before they
are 5 years old, are not developing the social skills, the
confidence levels, the nurturing that many others do. Actually,
because of this, this contributes to drop-out rates and so
forth. We know we have a horrible problem with drop-out rates
throughout the country.
My question, after that long introduction, is what role do
social workers have to play in trying to correct or--and I
know, Reverend Wells, this sounds like something that was your
personal situation--in trying to balance, if you will, the
early childhood development of at-risk families? As a corollary
question, is there anyone else who can do that?
Rev. Wells. I think in particular for my situation and in
growing up is that I was never encouraged to go to school
because it was already cut out that--you know, that I was going
to be a wife and a mother and nothing else. That was to be my
role. That was something to be very proud of. That was--not to
put that down, that was an important role for us to play.
But I think the schoolteachers--and they are another one
who steps in--the schoolteachers I had encouraged me and kept
me going. At that time there was no such thing as social work
in the field of education, but my schoolteachers kept me going
and dreaming and desiring and believing in myself that there
was something else that I could do.
Now, being able to have social workers that specialize in
the testing and development and being able to work with the
children at risk are very important. Also the agencies that
work with children, as we have at home, Coalition for Kids and
Boys to Men, these are mentoring programs to keep the children
going forward instead of stopping and giving up.
We have such a hopelessness among our at-risk families
because it is multigenerational, as we all know. You are
fighting--I have them coming into my office, well, we filed for
Social Security today. This is a thrill, this is an excitement,
you know, we finally got to the point where we can file for
Social Security on our own and be able to be supported by the
government. They are not looking to see what can I do for my
government in order to help support others.
So it is the mentality all the way around, and that is why
the social worker is so important, I believe, this day and
time, is to be able to help them to keep dreaming and go
forward.
Ms. Bergeron. I think social work also will come up with
some innovative programs. At the University of New Hampshire,
social work, along with the other disciplines in the College of
Health and Human Services, has started an early intervention
assessment program that includes physical therapy, occupational
therapy, psychosocial assessment, speech therapy, and
developmental profiling. This is made free to anyone who, you
know, can get there.
We are still trying to fine-tune it, we are trying to
broaden the scope of it. We partnered with Dartmouth College.
It has been a wonderful program that has helped the schools. We
provide consultation to schools in order to help them learn how
to deal with the multitude of diagnoses that they are getting.
Let me just insert here, we tend to talk about the needs of
developmental disabled children, but we also need to think
about--and I think social work is just beginning to get into
this area--the gifted child that gets lost in the educational
system, and we can't afford to lose those children.
Mr. Bird. I would just like to mention that, you know, we
have programs that have clearly demonstrated their
effectiveness through research, and Head Start is clearly one
of them. So we have models already in place.
I think that we also, in the research, have a knowledge and
understanding of what goes into creating or recognizing the
resilience of children coming out of dire circumstances. We
know what it takes to intervene.
One of the critical pieces that has been mentioned today is
the ability to create a positive relationship with someone or
people over time, whether it be a grandparent, a teacher or
other sort of people that are there for that child when they
are in crisis or to provide support.
The other thing I wanted to mention was that, getting back
to your question, I think there has been some research about
incarceration, and that there has been some research, and I am
sure we can find that data or the study, that, as I recall,
given what we are paying to incarcerate people per capita, that
we could almost send them all to Ivy League schools.
One of the realities and--personally speaking, one of the
realities when I was growing up was the low expectation that
people--some teachers, not everyone--and some people placed
upon Indian students and expecting that they would not achieve,
could not achieve, and were not capable of higher education,
were not capable of having a dream, and that reality is still
out there for many in this country, that there is a low
expectation. They don't expect many of us to achieve. They
don't expect us to be productive. They don't expect us to be
president of the American Public Health Association. They don't
expect those sorts of things. Consequently, that is what they
get. They don't--and those children are marked, and their
dreams end and are dashed, and we all lose out on a very
valuable resource to this Nation.
Chairwoman McCarthy. I want to thank everybody for the
testimony that you have put forth, and certainly with your
answers.
Mr. Bird, it wasn't that many years ago that they said the
same thing about Irish, the Polish, the German. So a lot of
people kind of forget their ancestry.
I know when I first came on this committee and started
visiting schools on Mondays, and people will say our children
can't learn. Our children can learn if we give them the
opportunity, and that is proven. We already have the statistics
on that.
But with that being said, again, I thank you all for your
information, anything that you feel that this committee should
have, and the only thing I would ask you to think about, you
know, is what can we in Congress do. Obviously, because you are
so diversified, the pay scale is going to be totally different.
Those for nonprofits are going to be there because that is
where they want to be, and the pay, unfortunately, is going to
be low. Those who are in Civil Service and other areas will
have better pay. Those that are teaching, you know, you will be
where salaries are going to be different. So you are all over
the place, and I don't even know how to address that, to be
very honest with you.
I will try to do what I can do on student loan forgiveness.
That is someplace where you can go. This way we can hopefully
educate our young people to go into a field that they can
actually help an awful lot of people.
With that, I am not going to read my closing statement. I
think we are all on the same page on what we want to do.
As previously ordered, Members will have 14 days to submit
additional materials to the hearing. Any Member who wishes to
submit follow-up questions in writing to the witnesses should
coordinate with the Majority staff within the requested time.
[The statement of Mr. Altmire follows:]
Prepared Statement of Hon. Jason Altmire, a Representative in Congress
From the State of Pennsylvania
Thank you, Chairwoman McCarthy, for holding this important hearing
on the state of social work in America.
I look forward to learning more about the social work profession
today from our esteemed panel of witnesses. Social work is one career
that the Bureau of Labor Statistics estimates will grow faster than
average. Some fields of social work are anticipated to grow by as much
as 30 percent by 2016. Social workers perform a great service in our
communities, providing our children, families and seniors with guidance
and education.
Social workers often face difficult and challenging work, and I
appreciate all that they do to help members of our communities. I look
forward to today's testimony and I would like to thank the witnesses
for lending us their time today.
Thank you again, Chairwoman McCarthy, for holding this hearing. I
yield back the balance of my time.
______
[Additional submissions for the record by Mrs. McCarthy
follow:]
National Association of Social Workers,
Washington, DC, August 14, 2008.
Hon. Carolyn McCarthy, Chairwoman,
Subcommittee on Healthy Families and Communities, U.S. House of
Representatives, Washington, DC.
Dear Chairwoman McCarthy: On behalf of the National Association of
Social Workers (NASW), I would like to thank you for the important role
you played in the Subcommittee hearing on July 29, ``Caring for the
Vulnerable: The State of Social Work in America.'' Congressman Yarmuth
had several questions regarding the cost effectiveness of social work
interventions, and I would like to clarify a few points and provide
some additional materials.
Research has proven that social work is necessary to solve the
seemingly intractable societal problems we are facing. For instance,
professional social workers are more likely to find permanent homes for
children who were in foster care for two or more years. Yet, fewer than
40 percent of child welfare workers are professional social workers.
Professional social workers not only have a positive impact on the over
500,000 children in the U.S. foster care system but provide significant
cost saving services. Child welfare agencies that hire social work
staff also have lower turnover than those that do not. Likewise, the
Child Welfare League of America determined that targeted case
management ``enhances the child's condition and/or reduces the
likelihood that more intensive, more expensive Medicaid covered
services will be needed in the future.'' Social workers play an
important role in social services and psychosocial care that leads to
increased successful outcomes in a variety of fields.
Studies of the cost effectiveness of social work are still a
burgeoning area of research, yet Rizzo and Rowe note that, ``it
provides convincing empirical evidence that social work services can
have a positive and significant impact on quality of life and health
care costs and use for aging individuals.'' Research has been done on
the cost effectiveness and efficacy of social work practice with
various populations, including caregivers of the elderly, elders
receiving geriatric evaluation and management, those in poverty with
individual development accounts, substance abusers, stroke patients,
and aging individuals receiving social work services. Research on
Social Work Practice published a full issue in 2006 dedicated to these
issues, which we will deliver to you as soon as possible.
Again, thank you for the important role you played in the July 29
hearing and we look forward to working together to strengthen our
families and communities.
Sincerely,
Elizabeth J. Clark, Ph.D., ACSW, MPH,
Executive Director.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
[Additional submissions for the record by Ms. Shea-Porter
follow:]
Clinical Social Work Association,
Seattle, WA, July 28, 2008.
Hon. Carolyn McCarthy, Chairwoman,
Subcommittee on Healthy Families and Communities, U.S. House of
Representatives, Washington, DC.
Dear Chairwoman McCarthy: Thank you so much for the opportunity to
provide information to the Subcommittee on Healthy Families and
Communities on the current state of social work in America. The
Clinical Social Work Association is pleased to offer the clinical
social work perspective on this important topic. Clinical social work,
an important subspecialty of social work, is one of the major providers
of mental health treatment for families, especially in assisting
families with the care of children and the elderly. Licensed clinical
social workers (LCSWs), called licensed independent clinical social
workers (LICSWs) in some states, are the largest group of mental health
professionals, providing services for mental health and chemical
dependency disorders to all strata of society.
There are approximately 175,000-200,000 licensed clinical social
workers across the country (ASWB, 2007), by far the single largest
group of mental health clinicians (SAMHSA, 2001). Licensed clinical
social workers have at least a Master's degree plus 2-3 years of
supervised post-graduate training or roughly the same clinical training
and experience as psychologists. The concept of biopsychosocial
assessment, so crucial to understanding and treating mental health and
chemical dependency disorders, was also an outgrowth of basic clinical
social work concepts (Simpson, G., Segall, A., and Williams, J.,
``Social Work Education and Clinical Learning,'' Clinical Social Work
Journal, March, 2007.) The clinical social worker's scope of practice
includes diagnosis of mental health and chemical dependency disorders
and provision of clinical treatment for these disorders, popularly
known as ``psychotherapy'', ``talk therapy'', or ``counseling''. In
addition, clinical social workers assist with problems in social
functioning within a ``person in environment''. (Karls, J. and Wandrei,
K.,1994, Person-in-Environment System: The PIE Classification System
for Social Functioning Problems, NASW Publishing.)
According to a Consumer Reports survey of over 3000 participants
who received help with emotional and chemical dependency disorders,
``Talk therapy rivaled drug therapy in effectiveness. Respondents who
said their therapy was `mostly talk' and lasted at least 13 sessions
had better outcomes than those whose therapy was `mostly medication.'
Therapy delivered by psychologists and clinical social workers was
perceived as effective as that given by psychiatrists.'' (Consumer
Reports, ``Drugs vs. Talk Therapy,'' October, 2004.)
The CSWA membership can attest that LCSWs are providing talk
therapy that works in a variety of modalities, i.e., to individuals,
couples, families, in several different settings, i.e., offices,
schools, hospitals, and skilled nursing facilities, among others. The
capability and skills of clinical social workers to provide a wide
array of services in a variety of settings is partly due to the
training that all social workers receive in understanding internal and
external systems. In rural areas, clinical social workers are often the
only mental health providers available. Fortunately, most insurers,
including Medicare and TriCare, accept LCSWs as reimbursable providers
for mental health treatment.
The most difficult areas of social work practice are those where
abuse is reported, which often include the vulnerable populations of
children, the elderly, and/or the disabled. Domestic violence and
addictions also generally contain multi-faceted difficulties. These
situations, which include harm to self or others, are the most complex
and most challenging to resolve, both in terms of impaired social
functioning and mental health disorders. Licensed clinical social
workers could be a valuable resource in the biopsychosocial assessment
and treatment of these situations, but often this work is being
conducted by caseworkers who have little or no social work education
and experience, even though they are frequently called social workers.
Cases where abuse may be present should receive services from the
most experienced well-trained licensed clinical social workers, in
manageable caseloads, with a funding that is commensurate with the
difficulty of this work, in the opinion of CSWA. Improving the
standards of education and supervision for those who work with the
abused and their families in public and private agencies, and
specifically including clinical social workers in these jobs, would
save lives, reduce harm, and cut down on anti-social behavior which can
cause people to spiral into the corrections system.
In addition to cases which include abuse, there are three areas of
practice which require more biopsychosocial assessment and
psychotherapy. These areas are working with the elderly, children, and
active military personnel/veterans. The services clinical social
workers can provide in these areas are as follows:
Working with the elderly involves understanding family
dynamics and the impact of the aging process on individuals, their
families, and their communities. Clinical social workers are trained to
intervene effectively these areas.
CSWA has a strong concern about the kinds of services
being offered to children and adolescents with emotional disturbance.
There is an increasing emphasis on medication alone, not talk therapy,
to control behavioral problems in children. Children and adolescents
who learn to identify their feelings and put them into words, as well
as to engage others to help them function more effectively, are more
likely to become adults who are able to avoid behavior that is hurtful
or harmful to themselves or others. LCSWs are the trained professionals
who, in many cases, help children who have not been able to manage
their feelings find better ways to manage them.
The problems faced by veterans themselves, including
traumatic brain injuries, are the tip of the iceberg when it comes to
addressing the myriad problems caused by the impact of deployment on
the spouses, children, and other family members of those who have
served their country in the military. The levels of domestic violence,
emotional disturbance, and addiction disorders involving spouses,
children and extended family of current or discharged members of the
military are far above the national average (Center for the Study of
Traumatic Stress, Overview for Practitioners, 2008, http://
www.centerforthestudyoftraumaticstress.org/downloads/
CSTS%20Helping%20Service%20Members%20for%20Providers.pdf). Licensed
clinical social workers are qualified to provide the crucial services
to treat these serious problems. As H.R. 5447 states, the need for
clinical social workers to provide services in these critical areas is
increasing, and there is an anticipated shortage of clinical social
workers to serve these populations.
In addition to these crucial areas, there hundreds of thousands of
clinical social workers providing effective psychotherapy and improved
social functioning to our citizens at all economic levels and in a
variety of settings, a major part of our mental health and social
service delivery system.
CSWA is proud to help clarify the role of clinical social workers
as the mental health professionals who treat problems in emotional and
social functioning. We appreciate the efforts of the Subcommittee to
understand the many ways that social workers contribute to our
country's well-being and CSWA would be happy to assist your sub-
committee further.
Sincerely,
Kevin Host, President,
Clinical Social Work Association.
______
The NASW Code of Ethics and State Licensing Laws
By Sherri Morgan, JD, MSW, NASW (c) June 2007
Development of the NASW Code of Ethics and Legal Regulations
The first formal code of ethics adopted by social workers was
published in 1947 by the American Association of Social Workers
(Reamer, 2006). Almost fifteen years later, in 1960, the National
Association of Social Workers published its first Code of Ethics. It
has evolved and been revised several times since then, in 1979, 1996
and 1999.
During the 1960s only seven states had passed some form of
credentialing statutes for social workers (Biggerstaff, 1995). This
number doubled in the 1970s, increased in the 1980s, and by the early
1990s some form of licensing, registration or certification for social
workers was required in all states and the District of Columbia
(Biggerstaff, 1995).
As the profession of social work evolved and gained statutory
recognition among the states, the NASW Code of Ethics was used as a
primary source for national ethics standards. In states where there was
no regulation, the NASW Code of Ethics set the standard for ethical
social work practice. Thus, until the last decade of the 20th century,
state licensing did not cover all of the states, and the NASW Code of
Ethics filled a critical role, unmet by other forms of professional
governance.
As states developed rules of conduct for the discipline of social
work licensees, they often relied on the standards of the NASW Code of
Ethics as a guideline for acceptable professional behavior. NASW also
promoted the creation of state social work licensing and regulation,
publishing a model licensing law in 1970 (Models for licensing,
registration, 1970). The relationship between professional association
standards and the development of state-by-state regulation has
necessarily been, and continues to be, an interactive one.
As the federal government has increasingly played a role in
standardizing the privacy and security of client treatment records, the
Department of Health and Human Services (HHS) has acknowledged the
unique role of professional ethics standards. In its preamble to the
Health Insurance Portability and Accountability Act (HIPAA) privacy
standards, HHS stated, ``We expect and encourage covered entities to
exercise their judgment and professional ethics in using and disclosing
health information, and to continue any current practices that provide
privacy protections greater than those mandated in this regulation.''
(Standards for Privacy of Individually Identifiable Health Information,
2000). Although the current HIPAA privacy standards defer to more
stringent state laws regarding disclosure of confidential client
information, the need for uniform national standards is emerging as a
critical and controversial issue in the development of electronic
medical information systems. Traditional standards for the protection
of client information that are common to both the NASW Code of Ethics
and social work licensing boards' codes of misconduct may be vulnerable
to erosion from new data transfer standards.
Rationale for Incorporating the NASW Code of Ethics into State Law
Current legal research indicates that almost half the states are
relying on the NASW Code of Ethics for some portion of the state's
regulation of the social work profession. The use of the NASW Code in
state social work licensing laws or regulations serves a number of
purposes. Reference to a national standard for professional conduct in
state law or regulation provides a touchstone to enhance local and
regional recognition of social work as a profession. Since social
workers in a particular state may come from many locations and out-of-
state schools, incorporation of the NASW Code serves to reinforce the
common underpinnings of professional social work values, education, and
training, regardless of social workers' geographic backgrounds.
The NASW Code of Ethics is the longest-standing and most
consistently developed set of standards that have been part of the
social work professional culture for longer than any state law.
Inclusion of the NASW Code of Ethics creates a uniform standard for all
social workers subject to the state standard. Thus, NASW members and
social worker non-members are all on notice that they need to
understand and comply with national standards and to consider how to
integrate the high standards of the NASW Code with other state and
workplace requirements.
The NASW Code was developed by social workers for the social work
profession with the interests of the public in mind. For states with
composite or ``multi-disciplinary'' licensing boards, inclusion of the
NASW Code of Ethics assists licensing board members to clarify the
unique standards applied to social work licensees. Inclusion of the
NASW Code in specific practice areas also assists in the recognition of
social workers' unique role among other professionals, such as in the
school setting, hospice or specialty clinics.
Social Work Licensing Boards' Treatment of the NASW Code of Ethics
Twenty-two states explicitly incorporate the NASW Code of Ethics
into some portion of state law. In most of these states the NASW Code
is referenced, incorporated or adopted as part of the state social work
disciplinary standards. However, there are other applications as well.
Interestingly, South Dakota makes the greatest number of multiple uses
of the NASW Code of Ethics among all the states. South Dakota includes
the NASW Code in both statute and regulation and relies on two separate
versions of the Code, uses it in the definition of practice, as a rule
of conduct, and requires a statement of adherence to the Code's
principles for licensees and supervisors.
The NASW Code of Ethics in state social work law is used in several
ways, including:
As part of the definition of social work practice
As a rule of conduct
As a curriculum requirement for social work students
As part of the continuing education requirement.
Clinical Social Work Definition
Rhode Island includes adherence to ``the principles and values
contained in the NASW Code of Ethics,'' as part of its definition of
clinical social work practice, rather than as an explicit standard of
misconduct. Thus, in that state only ethical practice falls within the
scope of practice. Code R.I. R. Sec. 15 050 001. South Dakota has a
similar provision, S.D. Codified Laws Ann. Sec. 36-26-45; however, it
also includes the NASW Code of Ethics as a standard for evaluating
misconduct, Sec. 36-26-32. Minnesota includes the NASW Code of Ethics
standards in its definition of ``professional social work knowledge,
skills, and values.'' Minn.Stat.Ann. Sec. 148D.010.
School Social Work Only
California and Washington limit their application of the NASW Code
of Ethics to school social workers. In California, the knowledge
requirements for the specialization in School Social Work, include
knowledge of the NASW Code of Ethics, and of the NASW Standards for
Social Work Practice in the schools, and the joint policy statement of
NASW and the National Education Association. It also includes the skill
of applying the NASW Code of Ethics to school-site situations. Cal.
Admin. Code tit. 5 Sec. 80632.3.
The state of Washington requires school social work candidates to
complete courses and/or receive experience where they will gain
knowledge in relevant field of study including the NASW Code of Ethics
and school social work guidelines for practice. Thus, the NASW Code of
Ethics is used as a curriculum requirement, rather than as a standard
for determining misconduct. Wash. Admin. Code 180-78A-270.
Hospital and Hospice Social Work Only
The Connecticut Public Health Code, applicable to hospitals and
hospice, requires a written social work service plan with policies that
incorporate ``the current standards, guidelines, and code of ethics
determined by the National Association of Social Workers.'' This
provision helps to protect hospital and hospice social workers from
ethical conflicts, as it provides leverage for social workers in those
settings to advocate for ethical practice as a legal requirement.
Public Health Code 2000, 19-13-D4b.
Composite Licensing Boards
The Wyoming board includes several mental health professions and
adopted by reference the ethics and professional standards of several
different professional organizations. For three levels of social work
licensees the NASW Code of Ethics is incorporated into the rules as an
appendix as ``additional guidelines to ethical standards.'' Mental
Health Profession Board, Rules, Ch. 11 (Professional Responsibility).
Mississippi has incorporated the standards of both the NASW Code of
Ethics and the American Association for Marriage and Family Therapy,
and does not distinguish between the professions as to whether to
adhere to both sets of standards and only the one applicable to the
specific profession. C. Miss. R. Sec. 50 032 001.
The New Hampshire board licenses five mental health professions and
requires licensees to adhere only to that set of ethical principles
adopted by their professional association. The specific associations
are listed. N.H. Code Admin. R. Psy. 501.02 (1993).
Ohio subscribes to both the code of ethics promulgated by NASW as
well as the American Counseling Association, and does not distinguish
that these shall apply to the professions separately, although a common
sense interpretation would suggest that they should. Ohio Rev. Code
Sec. 4757-5-01 (1997).
Separate Code of Conduct Established and Inclusion of the NASW Code
Tennessee requires licensed social workers to conform to
``professional standards promulgated by the board under its current
statutes and rules and regulations,'' and adopts in its entirety the
NASW Code of Ethics as well. Tenn. Comp. R. & Regs. 365-1-.13
(Unethical Conduct). Ohio and Oklahoma are similar. Ohio specifies that
if there is a conflict between the board's rules and that of the
professional association, the board's rules shall prevail.
Judicial Application of the NASW Code of Ethics
At least 30 reported cases in state and federal courts across the
country refer to the NASW Code of Ethics. Some of these represent
groundbreaking precedents, such as the creation of a federal
psychotherapist-patient privilege by the U.S. Supreme Court in Jaffee
v. Redmond, while others illustrate the common usage of the NASW Code
in a variety of matters. These tend to fall within four broad
categories:
appeals of social work board licensure or disciplinary
decisions,
malpractice or personal injury complaints filed by former
clients against the social worker, supervisor, or agency,
employment cases involving social workers, and
cases involving social work clients where the social
worker is called as a witness or records custodian.
Practicing social workers and social work educators should be aware
of how the NASW Code has been interpreted and applied by the courts in
the state where they are practicing. The summary of cases provided as
an Appendix provides a resource for social workers seeking such
information.
Conclusions and Implications for the Future
The NASW Code of Ethics relies on principles and values as a basis
for relationships between social workers and their clients and other
professionals. It is broader, more universally accepted, and more well
understood that the various social worker conduct codes among the fifty
states. Almost half the states have relied on its provisions in some
form for regulating social worker conduct. These uses of the NASW Code
include definitions of social work practice, continuing education
requirements, curriculum requirements, disciplinary standards, and
affirmative statements of adherence to the Code as requirements for
licensure.
State and federal courts have relied on the standards of the NASW
Code of Ethics regardless of whether they are sitting in a jurisdiction
that has incorporated the NASW Code into state law. The extent to which
courts find the NASW Code of Ethics to be a controlling authority
varies. The collected opinions referencing the NASW Code of Ethics
indicate that courts are sensitive to the contours of professional
social work ethics, and generally display the ability to review the
NASW Code of Ethics in an effective manner and apply it to a wide
variety of cases.
The incorporation of the NASW Code of Ethics as a disciplinary
standard by state licensing boards raises important questions as to how
the Code should be interpreted and by whom. The NASW Professional
Review Process affords the opportunity for volunteer NASW leaders to
interpret and apply the NASW Code of Ethics. As the organization that
created the NASW Code, this is most appropriate. When used for
Professional Review purposes, the NASW Code functions as a self-
policing set of principles and standards for the profession, to avoid
harm to the public, and to provide social workers the opportunity to
improve their practice and professional relationships.
In states that have adopted the standards of the NASW Code of
Ethics into state disciplinary laws, a finding by NASW of a violation
of the NASW Code of Ethics, if reported to the state social work board,
should trigger a review of the social worker's conduct by the state
authority. More information as to the degree of concurrence by state
boards with NASW Professional Review findings would be useful for
future analysis.
In other situations, state social work boards are in the position
of interpreting and applying the NASW Code of Ethics without the
benefit of a prior finding by NASW. In some instances, social work
boards may have little guidance as to the accepted contours of the NASW
Code, especially for non-social worker members of a board. The broad
principles stated in the Code may seem too vague for a concise
application to the matter at hand or conflicts between provisions of
the Code may create a confusing array of alternatives. Some state
boards address this by requiring expert social worker testimony as to
the ethical standard of care.
As Congress and the Executive agencies continue to carve out health
privacy as the province of the federal government, rather than the
states, conflicts with the NASW Code of Ethics are likely to increase.
State boards can anticipate that state and federal legislatures and
agencies will be involved in efforts to streamline the flow of health
information and that these efforts may involve changes in traditional
arenas of state regulatory power, in areas such as confidentiality and
privilege for mental health records.
In many ways, future applications of the NASW Code of Ethics could
be guided by forces and authorities external to NASW. It is important
to identify ways in which the principles of the NASW Code of Ethics
will continue to influence those external processes in order to retain
the core values of the profession.
references
Biggerstaff, Marilyn A. (1995). Licensing, regulation, and
certification. In R.L. Edwards (Ed.-in-Chief), Encyclopedia of
social work (19th ed., Vol. 2, p.1618). Washington, DC: NASW
Press.
Models for licensing, registration (May 1970). NASW NEWS (Vol. 14, No.
4). National Association of Social Workers.
Reamer, Frederic G. (2006). Ethical standards in social work 2.
Washington, DC: NASW Press.
Standards for privacy of individually identifiable health information
(2000). 65 Fed.Reg. 82462, *82680, 2000 WL 1875566 (to be
codified at 45 CFR Sec. 160 and 164).
Appendix: Court Decisions Referencing the NASW Code of Ethics
Readers should note that decisions listed as ``Not Reported'' do
not have precedent-setting value in other cases. They are presented for
purposes of illustration only.
Malpractice or Personal Injury Complaints
Carroll v. Casey Family Services, 32 Conn. L. Rptr. 297 (2002)
(unpublished opinion) (Connecticut).
Cosgrove v. Lawrence, 214 N.J.Super. 670, 520 A.2d 844 (1986),
affirmed, 215 N.J.Super. 561 (1987) (New Jersey).
Doe v. Samaritan Counseling Center, 791 P.2d 344 (1990) (Alaska).
Eckhardt v. Charter Hosp. of Albuquerque, Inc., 124 N.M. 549, 953 P.2d
722 (1997) (New Mexico).
Homer v. Long, 599 A.2d (1992) (Maryland).
Horak v. Biris, 474 N.E.2d 13 (1985) (Illinois).
Kara B. v. Dane County, Mikela R. v. Dane County, 542 N.W.2d 777 (1995)
(Wisconsin).
Martino v. Family Service Agency of Adams County, 445 N.E.2d 6 (1983)
(Illinois).
Roe v. Catholic Charities of the Diocese of Springfield, Illinois, 588
N.E.2d 354 (1992) (Illinois).
Social Worker as a Witness or Custodian of Records
In re: Grand Jury Subpoena, 748 A.2d 821 (2000) (Rhode Island).
Jaffee v. Redmond, 518 U.S. 1 (1996) (Illinois).
Kinsella v. Kinsella, 150 N.J. 276, 696 A.2d 556 (1997) (New Jersey).
People v. R.R., 12 Misc.3d 161 (2005) (New York).
Social Work Licensure Board Cases
Andrews v. Board of Social Worker Licensure, Not Reported in A.2d, 2005
WL 3338880 (2005) (Maine).
Connolly v. State, Not Reported in A.2d, 2003 WL 21387189 (2003)
(Maine).
Heinmiller v. Dep't of Health, 903 P.2d 433 (1996) (Washington).
Prinz v. State Counselor and Social Worker Bd., 2000 WL 43707, Ohio
App. 1 Dist. (2000) (Ohio).
Penny v. Wyoming Mental Health Professions Licensing Board, 120 P.3d
152 (2005) (Wyoming).
Zegel v. Board of Social Worker Licensure, 843 A.2d 18 (2004) (Maine).
Employment Law Cases
Birthisel v. Tri-Cities Health Services Corp., 424 S.E.2d 606 (1992)
(West Virginia).
Enright v. Special Adoption Family Services, Inc., 52 Mass.App.Ct.
1102, 750 N.E.2d 34 (Table) Mass.App.Ct. (2001) (unpublished
opinion) (Massachusetts).
Greenberg v. Kmetko, 922 F.2d 382 (1991) (Illinois).
Harnett v. Ulett, 466 F.2d 113 (1972) (Missouri).
Kelly v. City of Meriden, 120 F.Supp2d 191 (2000) (Connecticut).
Lown v. Salvation Army, Inc., 393 F.Supp.2d 223 (2005) (New York).
NASW's Professional Review Process
Quinones v. NASW, Not Reported in F.Supp.2d, 2000 WL 744146 (2000) (New
York).
Probate of a Will
Heinrich v. Silvernail, 500 N.E.2d 835 (1987) (Massachusetts).
DISCLAIMER: The information contained in this document is provided
as a service to members and the social work community for educational
and information purposes only and does not constitute legal advice. We
provide timely information, but we make no claims, promises or
guarantees about the accuracy, completeness, or adequacy of the
information contained in this message or linked to the NASW Web site
and its associated sites. Transmission of the information is not
intended to create, and receipt does not constitute, a lawyer-client
relationship between NASW, LDF, or the author(s) and you. NASW members
and online readers should not act based solely on the information
provided by the LDF. Laws and court interpretations change frequently.
Legal advice must be tailored to the specific facts and circumstances
of a particular case. Nothing reported herein should be used as a
substitute for the advice of competent counsel.
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[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairwoman McCarthy. Without objection, this hearing is
adjourned.
With that, I would like to say thank you to Mr. Davis for
being here with us. We appreciate his inputs. I thank you
again, each and every one of you.
We are adjourned.
[Whereupon, at 4:40 p.m., the subcommittee was adjourned.]