WEBVTT

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- Okay, I just want to
introduce Marsha Kline Pruett,

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who is a professor at the
school for social work.

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Many of you know her.

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Shhh.

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Thanks.

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And she can't speak very loudly tonight

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so I just wanted to try
and quiet things down

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before she introduced
our speaker, Jim Drisko,

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so here she is.

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- Thanks Josh.

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See here I have laryngitis
and I was trying

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to get you all to be quiet
and you couldn't hear me.

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So I'm glad Josh came to help.

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It's nice to see you all
so excited to be back

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and to see each other and we're glad

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you're that excited because we have

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an exciting program and hopefully

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you'll bring some of that excitement

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to your questions later, then you can

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socialize afterwards.

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Because we have a
wonderful program tonight

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and it's my distinct pleasure to introduce

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my colleague, James Drisko, who will

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be talking about what
is clinical social work

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in the 21st century?

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Jim Drisko holds an MSW from Smith College

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School for Social Work and a PhD

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from the Boston College Graduate School

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of Social Work.

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He's done clinical practice in community

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mental health centers and
in public school settings,

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as well as in private practice.

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His areas of professional
interest currently

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include clinical practice
with children and families,

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reactive attachment
disorders, and the treatment

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of such disorders,
psychotherapy evaluation.

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He's written on clinical practice theory,

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on psychotherapy process
and outcome research.

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Clearly he has wide-ranging
interests having

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to do with clinical social work

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and he has been the author
of The Evidence-Based

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Practice in Clinical Social
Work with Melissa Grady,

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and author of many journal
articles, book chapters,

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he's written extensively on
qualitative research methods,

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he is currently a member
of CSWE's Commission

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on Accreditation for US
Schools of Social Work,

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and he was elected to
the National Academies

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of Practice for Social Work in 2008.

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More recently he was
named an Inaugural Fellow

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of the Society for
Social Work and Research.

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He has given so much to our community

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and we're looking forward to hearing

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what he has to say about social work

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in the upcoming years.

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Jim.

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(applause)

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- Thank you Marsha for
that kind introduction.

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Can you all hear me?

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Not quite sure in the back, okay.

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I'm soft-spoken so do give me a wave

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or something if it's difficult to hear.

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I was asked to do this
lecture by Dean Carolyn Jacobs

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several months ago while
Carolyn was our Dean.

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As you know, she's moved on now
to a well-earned sabbatical.

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This is one of the things that we're asked

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to do as Smith faculty, to give back

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after we have sabbatical time,

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and the idea is to inform the community

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a bit about what we've done
while we were on sabbatical.

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And, for me, three events
during my sabbatical

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were really telling and very important.

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The first one was that I
was invited to participate

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in September of 2013 at the
first White House briefing

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on social work education
and it was an honor

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to go to this event.

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There were about 150 social work educators

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from around the United States invited.

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The members of the Obama Administration

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who did presentations at
this White House briefing

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focused a lot on social work's role

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within the Affordable Care Act.

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But it was interesting to
me that their focus was

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on the role of social
workers as patient navigators

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and as case managers, not as providers

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of more skilled assessment
and treatment services,

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and this I found profoundly disturbing.

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Once again, it seemed like
social work would have

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to fight for an equal role
with psychiatry and psychology.

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A dilemma that we've
been through in the past

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and have been very
successful in working on,

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but here it is arising
again as medical homes

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become the focus for contemporary delivery

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of public services.

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The next event was participating

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in a National Association
of Social Workers

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and Counsel on Social
Work Education think tank

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on the advance practice
doctorate, or DSW degree.

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This was held in October of 2013.

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About 150 social work educators
from the United States

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and also Canada participated
and they voiced a lot

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of support for the need
for advanced education

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in clinical social work.

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There was no question that training

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beyond the Master's Degree was needed

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to develop real expertise
for clinical social work.

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But in the discussion,
research issues quickly

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began to take priority
over practice needs,

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which appear to be due to a
truly limited understanding

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of what clinical social
work practice takes

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to do effectively and a
priority on research evidence,

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rather than the rest of what it takes

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to do practice effectively.

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And it became clear to
me that the compentencies

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for doing clinical social
work practice weren't widely

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understood and perhaps
were being a little less

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honored and respected than they had been

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in recent years.

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And it seemed to me that
a more comprehensive

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understanding of the competencies required

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to do clinical social
work well were needed.

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And, as if that wasn't
enough, a little bit later

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Dr. Joan Berzoff, in the
back, and I were asked

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to do a keynote for the doctoral group,

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the group for advancement
of doctoral education

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in social work.

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And we basically did a paper that promoted

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the need of the social
work profession to train

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advanced practitioners to meet the needs

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of BSW, MSW, and PhD
programs to train folks

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who could do practice and could

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also do practice research
that really mattered.

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And it was interesting that
I think, Joan, our response

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was mixed and there was
certainly some active

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disagreement with our position.

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Several folks said that the
role of the PhD in social work

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should be on research
and solely on research,

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and clinical practice was
actively off the radar

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of many of the people in the room

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who are directors of doctoral programs.

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Now since both Joan and I had served

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as co-directors of
Smith's doctoral program,

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we thought that a combined emphasis

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on research and on clinical practice was

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entirely possible and really justified

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and really useful.

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And it was also ironic to me that many

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of the programs represented
at the GADE meeting

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were the same programs that were actively

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going for an advance practice degree

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called the DSW, but they didn't understand

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the importance of clinical
education at a PhD level,

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as if somehow practice and
research and scholarship

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weren't going to be
connected among the people

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who'd become the future
teachers, conceptualizers,

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and researchers in social work.

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So this got me thinking about two things.

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What are the competencies
for social work practice?

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And it also got me thinking about the need

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for much greater advocacy on our part

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to support clinical social work practice

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and excellence in clinical
social work education.

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The mission statement of the Smith College

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School for Social Work is
to educate for excellence

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in clinical social work
practice, and it's something

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I believe strongly in,
I'm a graduate of Smith

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as well as a faculty
member, and this has been

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something that's really
been sustaining for me

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and something that I
think we need to come back

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to thinking about our
role not only as students

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and educators and practitioners, but also

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as advocates for the needs
of the profession at large.

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So this led me to think about
what is clinical social work

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in the 21st century?

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First thing that puzzled
me is I often hear

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that clinical social work
is somehow not a key part

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of the social work profession, but indeed,

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we may be one of the larger parts.

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Clinical social work draws
on social work's person

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and environment
perspective, always looking

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at the internal and the
external dilemmas of clients,

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and that's our key and
unique professional way

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of understanding people and situations.

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And it's certainly part
of clinical social work.

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Clinical social work also
draws on the six core values

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of social work that are defined
in the NASW Code of Ethics.

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First, clinical social work
seeks to serve those in need.

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Service is our first value
and especially we seek

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to serve vulnerable, oppressed,
and diverse populations.

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And I hear too often that
clinical social workers

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hide in private practice
and pay no attention

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to vulnerable, diverse,
and oppressed populations,

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and frankly from my talk even with people

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who are doing private practice,
because of the diversity

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in our population now and
because of the challenges

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of doing private practice,
it's basically impossible

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to avoid service to vulnerable, oppressed,

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and diverse populations.

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It's simply not true that
clinical social workers

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go out of their way to avoid these groups.

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And all of this brings
me to the next knock

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on clinical social work, which has to do

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with our role in promoting social justice.

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Well Jerome Wakefield, a
terrific social work scholar

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at NYU, and Carol Swenson
from Simmons College

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School for Social Work,
have written papers looking

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at theories of social justice
largely out of Rawls' theory

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of distributed justice,
and they claim that helping

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people individually fully
realizing their capacities

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is socially just because
it helps people realize

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all they can be, and in turn,
it helps society be better.

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To me, that works as one
definition of social justice.

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And as I go further into
this talk, we'll come back

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to whether or not clinical
social workers have

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an obligation to do
advocacy, and I'm going

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to argue that we do and I think many of us

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do roles that relate
to advocacy in addition

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to direct service.

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So to say that clinical
social work doesn't support

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the social justice value
of social work just seems

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to me entirely unfounded.

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The next value is to support the dignity

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and worth of individuals and to enhance

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the capacity of people to
address their own needs.

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And I would argue again
that clinical social work

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does this head-on, that
there's very little way

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to say that the work we
do to help people get out

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of the dilemmas that
limit them, isn't a way

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of building their worth
and to do so requires us

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to work in a way that
supports their dignity

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and that empowers them.

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The next value, which
to me has been the one

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that social workers in
writing about the values

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of social work are most
likely to leave out

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of the list is the
emphasis on the importance

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of relationship, and this one strikes me

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as the oddest omission of them all.

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In clinical social work we have no choice

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but to develop relationships with clients

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and collaterals and community supports,

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but it's also true in
community organization

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and advocacy and in policy.

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You can't do any work with human beings

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without developing relationships,

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but for clinical social
work this is really key

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to what we do.

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And then finally, the
last two values relate

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to our capacities and characteristics

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as clinical social workers.

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Clinical social workers have
to show personal integrity

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in their work and that
doesn't differ whether it's

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with individual clients,
families, couples, groups,

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organizations or communities,
and I want to add also

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with our colleagues.

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And then finally, the last
value is to be competent.

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And again, I think that's critical.

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We really need to know what we're doing

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and not to practice outside
of our areas of expertise.

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00:13:12.710 --> 00:13:14.420
And as if the value
aspects weren't enough,

259
00:13:14.420 --> 00:13:17.400
there are other components to
doing clinical social work.

260
00:13:18.140 --> 00:13:21.360
Clinical social work
draws on numerous theories

261
00:13:21.360 --> 00:13:24.830
of human development, of
interpersonal interactions,

262
00:13:24.830 --> 00:13:27.610
and also theories of intervention.

263
00:13:29.400 --> 00:13:32.230
To make sense of these, we have
to apply critical thinking,

264
00:13:32.230 --> 00:13:35.670
and critical thinking in
clinical social work has both

265
00:13:35.670 --> 00:13:38.240
internal aspects about our use of self

266
00:13:38.240 --> 00:13:40.740
and our self reflection
and our mindfulness,

267
00:13:40.740 --> 00:13:45.460
and it also has external
conceptual and empirical aspects.

268
00:13:46.710 --> 00:13:48.940
And finally, we do draw
on research knowledge,

269
00:13:48.940 --> 00:13:51.250
though I think probably
social workers generally could

270
00:13:51.250 --> 00:13:52.740
do a better job of that one.

271
00:13:54.120 --> 00:13:57.190
All of this is to say that
clinical social work fits easily

272
00:13:57.190 --> 00:14:00.090
within the social work
profession and when we get

273
00:14:00.090 --> 00:14:02.530
into looking at the relative
merits and limitations

274
00:14:02.530 --> 00:14:06.800
of any form of social work
practice, we have nothing

275
00:14:06.800 --> 00:14:08.190
to be ashamed of.

276
00:14:11.340 --> 00:14:13.640
Now my goal is to take a
look at clinical social work

277
00:14:13.640 --> 00:14:17.260
from different perspectives
and multiple levels of scale.

278
00:14:17.970 --> 00:14:19.950
So let me start by
looking at the environment

279
00:14:19.950 --> 00:14:22.480
in which we live and
work right now and take

280
00:14:22.480 --> 00:14:25.840
a macro-perspective on
clinical social work.

281
00:14:28.160 --> 00:14:30.160
The director of NIMH, Tom Insel,

282
00:14:31.270 --> 00:14:34.900
reminds us that US mental healthcare costs

283
00:14:34.900 --> 00:14:38.400
are about 6% of total healthcare costs

284
00:14:38.400 --> 00:14:42.440
and that over 32,000,000
people paid for services

285
00:14:42.440 --> 00:14:46.260
nearly $58,000,000,000 in cost.

286
00:14:47.110 --> 00:14:49.560
That's a big chunk of our economy.

287
00:14:49.910 --> 00:14:53.450
I should also point out
that those 36,000,000 people

288
00:14:53.450 --> 00:14:57.030
are about 12% of the US population.

289
00:14:58.220 --> 00:15:00.920
Mental health expenditures
are the third costliest

290
00:15:00.920 --> 00:15:04.430
medical condition as of 2006, only behind

291
00:15:04.430 --> 00:15:07.420
heart conditions and trauma, and are tied

292
00:15:07.420 --> 00:15:08.750
with cancer.

293
00:15:09.760 --> 00:15:11.600
Serious mental illness,
according to Insel,

294
00:15:11.600 --> 00:15:16.600
costs 193.2 billion in lost
earnings in the year 2007.

295
00:15:18.840 --> 00:15:20.940
These are tremendously large numbers

296
00:15:20.940 --> 00:15:24.360
that show the impact and
the importance of our work.

297
00:15:24.710 --> 00:15:26.850
And this, of course, is from a large scale

298
00:15:26.850 --> 00:15:28.600
policy perspective.

299
00:15:30.180 --> 00:15:32.250
If we stand back even
further the World Health

300
00:15:32.250 --> 00:15:36.420
Organization estimates
that by 2020, six years

301
00:15:36.420 --> 00:15:39.720
from now, mental health
disorders will surpass

302
00:15:39.720 --> 00:15:44.720
all physical diseases as the
cause of disability worldwide,

303
00:15:45.900 --> 00:15:47.600
so that mental health
disorders will become

304
00:15:47.600 --> 00:15:49.770
a growing part of our mental healthcare

305
00:15:49.770 --> 00:15:51.960
and healthcare expenditures.

306
00:15:53.070 --> 00:15:56.960
Mental health is a major and
growing economic influence.

307
00:15:59.110 --> 00:16:03.320
Just looking at the public
sector, $37,000,000,000 a year

308
00:16:03.320 --> 00:16:06.360
are spent to serve
nearly 7,000,000 people.

309
00:16:06.890 --> 00:16:10.590
Notice how small a percentage
of the 36,000,000 total

310
00:16:10.590 --> 00:16:12.340
are publicly funded?

311
00:16:12.960 --> 00:16:14.310
Isn't that surprising?

312
00:16:14.930 --> 00:16:17.110
You'd think that there ought
to be a larger percentage.

313
00:16:19.160 --> 00:16:21.640
And the public services address 7,000,000

314
00:16:21.640 --> 00:16:23.820
people in all of the 50 states.

315
00:16:24.670 --> 00:16:27.170
But while we hear things about
the role of mental health

316
00:16:27.170 --> 00:16:31.280
and prevention in solving
shootings like we have had

317
00:16:31.280 --> 00:16:35.080
in California and in
Connecticut, state mental health

318
00:16:35.080 --> 00:16:39.820
facilities were cut $4.6
billion for federal funding,

319
00:16:39.820 --> 00:16:44.820
about 12%, over the last four years.

320
00:16:46.130 --> 00:16:48.330
So it's one thing to talk
the talk about how important

321
00:16:48.330 --> 00:16:50.760
we are, and it's another to walk the walk

322
00:16:50.760 --> 00:16:53.350
and put the money where their mouths are.

323
00:16:53.800 --> 00:16:56.200
And in fact, what's
happening is we're being cut

324
00:16:56.200 --> 00:16:58.320
while we're being asked to do more.

325
00:16:58.910 --> 00:17:00.980
Now, that's not unusual in these political

326
00:17:00.980 --> 00:17:03.910
and economic times, but
it's a serious reality

327
00:17:03.910 --> 00:17:06.960
that effects who we can serve
and how well we can do it.

328
00:17:10.080 --> 00:17:12.320
Now if there was real
reason to be concerned

329
00:17:12.320 --> 00:17:14.480
that mental health
services weren't effective,

330
00:17:14.480 --> 00:17:17.560
there might be more reason
to consider these cuts.

331
00:17:17.560 --> 00:17:20.490
But there's great evidence
that mental health treatments

332
00:17:20.490 --> 00:17:23.200
are generally effective
and this was supported

333
00:17:23.200 --> 00:17:27.260
by the US Surgeon General in
1999, and by many studies,

334
00:17:27.260 --> 00:17:29.700
many of which authored by Michael Lambert,

335
00:17:29.700 --> 00:17:34.700
a psychologist from Brigham
Young in 2004 and 2013.

336
00:17:36.980 --> 00:17:39.650
Beyond being generally
effective, it turns out

337
00:17:39.650 --> 00:17:42.050
that mental health
treatments provide a return

338
00:17:42.050 --> 00:17:44.940
on their initial investment, so to speak.

339
00:17:46.220 --> 00:17:48.090
Economic analysis show for a dollar spent

340
00:17:48.090 --> 00:17:52.050
in diagnosis of depression,
$7.00 is returned

341
00:17:52.050 --> 00:17:53.400
to the economy.

342
00:17:54.290 --> 00:17:56.230
In public schools
substance abuse prevention,

343
00:17:56.230 --> 00:18:00.170
$1.00 spent returned $21.00,

344
00:18:00.170 --> 00:18:02.070
and in several studies

345
00:18:02.070 --> 00:18:04.870
of particular states between $4 to $7.00

346
00:18:04.870 --> 00:18:08.230
return was found on public
adult substance abuse

347
00:18:08.230 --> 00:18:09.790
treatment services.

348
00:18:10.600 --> 00:18:12.750
So what we do is not only effective,

349
00:18:12.750 --> 00:18:16.180
but it's also cost effective,
which may matter a lot

350
00:18:16.180 --> 00:18:17.800
in today's politics.

351
00:18:18.620 --> 00:18:21.560
And it's important that we,
as clinical social workers,

352
00:18:21.560 --> 00:18:25.890
understand this, that
what we do has support,

353
00:18:25.890 --> 00:18:29.260
it appears to be cost
effective and at the same time

354
00:18:29.260 --> 00:18:31.620
we're being cut in funding.

355
00:18:32.130 --> 00:18:33.730
How do you put that together?

356
00:18:33.730 --> 00:18:35.290
It just doesn't make sense.

357
00:18:36.300 --> 00:18:37.840
And then we find, according to Insel,

358
00:18:37.840 --> 00:18:42.340
3/4 of mental illnesses
emerge before age 24,

359
00:18:42.340 --> 00:18:46.100
but fewer than one in five
youths receive treatment.

360
00:18:47.080 --> 00:18:49.840
According to Reuters,
of 45,000,000 americans

361
00:18:49.840 --> 00:18:54.440
with mental illnesses each
year, only 38% get treatment.

362
00:18:55.320 --> 00:18:58.130
We could do a whole lot better,
but it takes a commitment,

363
00:18:58.130 --> 00:19:00.960
and it takes funding, and
it takes good education

364
00:19:00.960 --> 00:19:04.790
to create a workforce that
can provide good services.

365
00:19:05.890 --> 00:19:09.020
So mental health issues
are a major part of

366
00:19:09.020 --> 00:19:12.640
our total US healthcare
costs, they are important

367
00:19:12.640 --> 00:19:16.640
in terms of lost productivity,
and social workers

368
00:19:16.640 --> 00:19:19.240
turn out to be the largest
providers of mental health

369
00:19:19.240 --> 00:19:20.900
services in the US.

370
00:19:21.440 --> 00:19:22.750
I assume that most of you know this,

371
00:19:22.750 --> 00:19:25.250
we provide more services
than all the other

372
00:19:25.250 --> 00:19:27.440
mental health professions combined.

373
00:19:29.220 --> 00:19:33.030
Ironically, in academe,
there's been tremendous effort

374
00:19:33.030 --> 00:19:36.100
on raising the research
profile of social work

375
00:19:36.100 --> 00:19:40.170
and bringing in external money
for social work programs,

376
00:19:40.170 --> 00:19:42.670
which in turn does provide
scholarship dollars

377
00:19:42.670 --> 00:19:46.170
for students, but there
hasn't been a consistent,

378
00:19:46.170 --> 00:19:49.610
well-organized professional
effort to build

379
00:19:49.610 --> 00:19:52.330
and support clinical social work services.

380
00:19:53.050 --> 00:19:55.350
In fact, the old federation of societies

381
00:19:55.350 --> 00:19:58.400
of clinical social work
essentially fell apart.

382
00:19:59.290 --> 00:20:01.380
And when I recently
went on to its website,

383
00:20:01.380 --> 00:20:05.380
it was an ad for paid
substance abuse services.

384
00:20:07.190 --> 00:20:09.010
Some of this stuff is just appalling.

385
00:20:09.730 --> 00:20:10.600
But don't worry,

386
00:20:10.600 --> 00:20:12.780
I'll turn the corner, things
will look a little better.

387
00:20:15.060 --> 00:20:16.690
So what do social workers do?

388
00:20:17.060 --> 00:20:18.790
Another piece of the macro perspective.

389
00:20:19.710 --> 00:20:22.410
According to NASW and the
Bureau of Labor Statistics,

390
00:20:22.410 --> 00:20:25.080
social workers work in three main areas,

391
00:20:25.080 --> 00:20:29.380
children, family, and schools
about 290,000 social workers,

392
00:20:29.380 --> 00:20:33.720
medical and public health
139,000, mental health

393
00:20:33.720 --> 00:20:37.890
and substance abuse 137,000,
and in all other areas

394
00:20:37.890 --> 00:20:40.000
a little over 73,000.

395
00:20:40.850 --> 00:20:43.100
So out of 640,000 social workers

396
00:20:43.100 --> 00:20:46.650
in the US 89% are practitioners.

397
00:20:47.600 --> 00:20:51.220
Social work is largely
a practice profession.

398
00:20:52.240 --> 00:20:54.310
According to Laura Groshong, who looked

399
00:20:54.310 --> 00:20:58.110
at the 404,000 state
licensed social workers

400
00:20:58.110 --> 00:21:02.470
in the United States,
96% do direct practice.

401
00:21:03.250 --> 00:21:05.550
It would be very difficult
to make an argument

402
00:21:05.550 --> 00:21:08.320
that social work education
doesn't have to train

403
00:21:08.320 --> 00:21:12.450
for excellence in practice,
and it would be very hard

404
00:21:12.450 --> 00:21:15.460
to ignore the needs of
clinical social workers

405
00:21:15.460 --> 00:21:18.780
and other social work
practitioners doing this work.

406
00:21:19.870 --> 00:21:21.800
And I want to point out to
you, because in some respects

407
00:21:21.800 --> 00:21:24.040
I think these numbers, or at
least the three divisions,

408
00:21:24.040 --> 00:21:25.390
are a little misleading.

409
00:21:26.370 --> 00:21:29.210
You can work in child,
family, and school settings

410
00:21:29.210 --> 00:21:31.700
and do clinical social work.

411
00:21:32.550 --> 00:21:34.550
I worked for years in
public school settings

412
00:21:34.550 --> 00:21:37.480
and called myself a clinical social worker

413
00:21:37.480 --> 00:21:41.190
and the theories and
positions that I drew on

414
00:21:41.190 --> 00:21:43.330
were from clinical social work.

415
00:21:43.960 --> 00:21:46.630
I didn't think of myself
as a school social worker

416
00:21:46.630 --> 00:21:49.900
because I had training to
do something a little more

417
00:21:49.900 --> 00:21:53.330
and I think out of my
education here at Smith

418
00:21:53.330 --> 00:21:55.900
and also at Boston
College, my vision of what

419
00:21:55.900 --> 00:21:58.810
I was doing was bigger than
just working in schools,

420
00:21:58.810 --> 00:22:01.670
and for me that was profoundly helpful

421
00:22:01.670 --> 00:22:03.290
and really motivating.

422
00:22:05.910 --> 00:22:08.530
So where are we in the
political and economic context?

423
00:22:09.380 --> 00:22:12.250
Policy efforts are trying
to reduce healthcare costs,

424
00:22:12.250 --> 00:22:14.970
this is important, we're
all paying for them.

425
00:22:15.960 --> 00:22:18.930
But in meso practice,
agencies are reimbursed

426
00:22:18.930 --> 00:22:21.870
less than it costs to
deliver a unit of service.

427
00:22:22.430 --> 00:22:25.230
Forgive a "unit of
service" because we provide

428
00:22:25.230 --> 00:22:27.960
so many different services
it's hard to give you

429
00:22:27.960 --> 00:22:30.050
a specific example.

430
00:22:30.970 --> 00:22:33.510
But I did some work recently
for Mount Tom Mental Health

431
00:22:33.510 --> 00:22:35.340
and in talking to administrators there,

432
00:22:35.340 --> 00:22:39.710
in effect they were telling
me they were costing $51.00

433
00:22:39.710 --> 00:22:41.930
to provide a unit of service.

434
00:22:42.820 --> 00:22:46.040
But their typical
reimbursement was $47.00.

435
00:22:46.950 --> 00:22:50.110
You can't run a business when
you can't even break even.

436
00:22:51.420 --> 00:22:54.330
And what happens because of
this is that social workers

437
00:22:54.330 --> 00:22:56.890
and other practitioners
get nickel and dimed

438
00:22:56.890 --> 00:23:00.400
by their agencies, and it's
not out of thoughtlessness,

439
00:23:00.400 --> 00:23:03.350
it's not out of lack of concern.

440
00:23:03.940 --> 00:23:06.920
These folks running these
agencies have no other choice.

441
00:23:07.810 --> 00:23:10.130
They have to do this
to keep the doors open.

442
00:23:11.010 --> 00:23:11.910
So what do we get?

443
00:23:11.910 --> 00:23:14.150
Piecework payments rather than salaries,

444
00:23:14.150 --> 00:23:16.720
reduced pay rates, reduced benefits,

445
00:23:16.720 --> 00:23:19.820
productivity demands that are high,

446
00:23:19.820 --> 00:23:22.370
and in turn very large case loads.

447
00:23:23.160 --> 00:23:25.390
That may not help us provide the best kind

448
00:23:25.390 --> 00:23:27.080
of services that we can provide.

449
00:23:28.290 --> 00:23:29.760
And in turn, supervision for staff

450
00:23:29.760 --> 00:23:31.730
and for students is less frequent,

451
00:23:31.730 --> 00:23:33.530
more administrative in nature,

452
00:23:33.530 --> 00:23:35.800
and it seems to be focused on documenting

453
00:23:35.800 --> 00:23:38.810
risk reduction, not on the development

454
00:23:38.810 --> 00:23:40.710
of clinicians and on understanding

455
00:23:40.710 --> 00:23:42.050
their cases.

456
00:23:43.010 --> 00:23:44.680
So training opportunities for staff

457
00:23:44.680 --> 00:23:46.910
and for students are being reduced,

458
00:23:46.910 --> 00:23:48.290
and may be limited.

459
00:23:49.010 --> 00:23:51.180
And where they are
provided, your supervisor's

460
00:23:51.180 --> 00:23:53.690
doing this out of love of the profession

461
00:23:53.690 --> 00:23:56.130
and personal and professional commitment.

462
00:23:56.590 --> 00:23:58.860
They're not doing it out of status.

463
00:23:58.860 --> 00:24:00.930
They don't gain much for doing it.

464
00:24:00.930 --> 00:24:02.700
They do it out of their own passion

465
00:24:02.700 --> 00:24:05.100
and their own willingness to give back

466
00:24:05.100 --> 00:24:07.590
to the folks in a similar way to those

467
00:24:07.590 --> 00:24:08.920
who trained them.

468
00:24:09.540 --> 00:24:11.530
Student supervision is more and more

469
00:24:11.530 --> 00:24:13.910
a labor of love and a real challenge,

470
00:24:13.910 --> 00:24:16.510
and without support for supervisors

471
00:24:16.510 --> 00:24:19.610
and research and
scholarship on supervision

472
00:24:19.610 --> 00:24:21.380
and field advisement, we may not

473
00:24:21.380 --> 00:24:24.230
be doing the best we can
to support our students.

474
00:24:26.750 --> 00:24:30.190
At the same time as the
recession and other issues

475
00:24:30.190 --> 00:24:33.830
have led to cutback in
costs, there's been the rise

476
00:24:33.830 --> 00:24:36.310
of the evidence-based practice movement.

477
00:24:37.760 --> 00:24:39.330
The idea here is to bring research

478
00:24:39.330 --> 00:24:42.250
into a more useful
connection with practice.

479
00:24:42.800 --> 00:24:44.590
It's basically quite a good idea.

480
00:24:45.510 --> 00:24:47.910
But it's been used
administratively in a way

481
00:24:47.910 --> 00:24:50.440
where research evidence of varying quality

482
00:24:50.440 --> 00:24:52.110
and comprehensiveness, and even,

483
00:24:52.110 --> 00:24:54.880
I would say reasonableness, is used

484
00:24:54.880 --> 00:24:57.700
as a rationale for
reducing healthcare costs.

485
00:24:58.820 --> 00:25:02.160
Agencies may be only
allowed to do certain lists

486
00:25:02.160 --> 00:25:04.190
of treatments that are set up by states,

487
00:25:04.190 --> 00:25:08.230
or by payors, that they
claim have an evidence base,

488
00:25:08.230 --> 00:25:11.050
and ironically, when you look
carefully at these lists,

489
00:25:11.050 --> 00:25:14.600
they may not be the same
lists of efficacious practices

490
00:25:14.600 --> 00:25:17.000
that are determined by professional

491
00:25:17.000 --> 00:25:19.290
international organizations.

492
00:25:19.940 --> 00:25:23.180
I find this one really
appalling, but I understand

493
00:25:23.180 --> 00:25:27.710
they're using this as a
vehicle to limit practices

494
00:25:27.710 --> 00:25:29.800
and in turn limit costs.

495
00:25:30.640 --> 00:25:32.620
Whether or not that's helpful for clients

496
00:25:32.620 --> 00:25:34.370
has yet to be determined.

497
00:25:35.590 --> 00:25:37.560
I think one of the things
that social workers need to do

498
00:25:37.560 --> 00:25:40.390
is to bring our clinical
vision into research

499
00:25:40.390 --> 00:25:43.360
so that we ask questions
that fully reflect

500
00:25:43.360 --> 00:25:45.800
the needs of clients, we
don't just look at a list

501
00:25:45.800 --> 00:25:48.170
of a couple of symptoms,
but we think about

502
00:25:48.170 --> 00:25:51.570
functioning, commitment to family, ability

503
00:25:51.570 --> 00:25:55.990
to serve community, and
basically, overall well-being.

504
00:25:56.510 --> 00:25:58.410
And many of these studies don't look

505
00:25:58.410 --> 00:26:00.730
at these kinds of ideas.

506
00:26:02.920 --> 00:26:05.690
So from my point of view,
there's a serious low-visibility

507
00:26:05.690 --> 00:26:08.420
crisis in the public's understanding

508
00:26:08.420 --> 00:26:10.470
of clinical social work.

509
00:26:11.250 --> 00:26:13.190
And, in turn, both the
public and I think we

510
00:26:13.190 --> 00:26:16.590
as professionals, are doing
less to voice our needs

511
00:26:16.590 --> 00:26:19.330
and to garner the kind of public support

512
00:26:19.330 --> 00:26:21.820
we need to do a better job.

513
00:26:23.440 --> 00:26:28.440
We need to do more work jointly
as a clinical social work

514
00:26:28.580 --> 00:26:32.210
organization to be advocates
for better funding,

515
00:26:32.210 --> 00:26:36.180
for cost effective and
socially just programs,

516
00:26:36.180 --> 00:26:39.650
and we need to make sure that the public

517
00:26:39.650 --> 00:26:42.060
is educated about changing social needs

518
00:26:42.060 --> 00:26:44.240
and the context of our services.

519
00:26:44.990 --> 00:26:47.880
We need to support ourselves
better as professionals.

520
00:26:49.500 --> 00:26:51.880
Now let me shift over to
the micro-perspective.

521
00:26:54.330 --> 00:26:56.600
Clinical social work for those
of you who are new to it,

522
00:26:56.600 --> 00:27:00.040
emerged as a specialty
in the 1970s replacing

523
00:27:00.040 --> 00:27:03.090
social case work and
psychiatric social work.

524
00:27:03.910 --> 00:27:06.050
And one key issue was
that in medical settings

525
00:27:06.050 --> 00:27:08.780
social workers felt
undervalued for their expertise

526
00:27:08.780 --> 00:27:11.180
and skills, particularly in the assessment

527
00:27:11.180 --> 00:27:13.870
and treatment of families and children.

528
00:27:14.980 --> 00:27:18.060
In addition, they knew
how to do placements

529
00:27:18.060 --> 00:27:20.520
and referrals, but they had treatment

530
00:27:20.520 --> 00:27:22.860
and assessment expertise that wasn't being

531
00:27:22.860 --> 00:27:24.910
acknowledged or rewarded.

532
00:27:25.790 --> 00:27:27.730
That was one of the motivators for moving

533
00:27:27.730 --> 00:27:31.440
to a clinical social work approach

534
00:27:31.440 --> 00:27:33.840
that separated us from a medical model

535
00:27:33.840 --> 00:27:35.680
and from psychiatry.

536
00:27:36.540 --> 00:27:39.350
And it's interesting to me that
in the White House briefing

537
00:27:39.350 --> 00:27:42.070
when I heard the Obama
administrators talking

538
00:27:42.070 --> 00:27:44.480
about social workers as case managers

539
00:27:44.480 --> 00:27:46.690
who would basically be doing the bidding

540
00:27:46.690 --> 00:27:50.420
of physicians who ran medical homes,

541
00:27:50.420 --> 00:27:52.990
it felt like there we are again,

542
00:27:52.990 --> 00:27:54.680
a kind of deja vu.

543
00:27:55.430 --> 00:27:58.270
And we need to speak up for
what we're trained to do.

544
00:27:59.600 --> 00:28:03.200
And of course another issue for
us is professional autonomy,

545
00:28:03.200 --> 00:28:05.410
to be able to bring the
theories and approaches

546
00:28:05.410 --> 00:28:08.490
that we believe are
effective into our work.

547
00:28:09.810 --> 00:28:10.780
Now when you look at the definitions

548
00:28:10.780 --> 00:28:14.210
of clinical social work
given by the 50 states,

549
00:28:14.210 --> 00:28:16.220
and they're all different,
but they're all variations

550
00:28:16.220 --> 00:28:17.270
on a theme.

551
00:28:17.820 --> 00:28:20.450
We apply theory and clinical
knowledge to assess,

552
00:28:20.450 --> 00:28:23.320
diagnose, and prevent mental, emotional,

553
00:28:23.320 --> 00:28:26.830
and behavioral disorders,
conditions and addictions,

554
00:28:26.830 --> 00:28:30.660
and you do this through
a variety of therapies

555
00:28:30.660 --> 00:28:32.520
of a non-medical nature.

556
00:28:33.330 --> 00:28:36.100
It's actually a very broad
and encompassing definition,

557
00:28:36.100 --> 00:28:39.460
but given this kind of
definition of what we can do,

558
00:28:39.460 --> 00:28:42.180
there's no plausible reason, other than

559
00:28:42.180 --> 00:28:45.080
the need for medication,
why we should be second

560
00:28:45.080 --> 00:28:48.970
to physicians or to psychologists.

561
00:28:49.580 --> 00:28:52.640
We're legal authorized to
do exactly the same work

562
00:28:52.640 --> 00:28:54.740
of a non-medical nature.

563
00:28:55.690 --> 00:28:56.700
Okay?

564
00:28:59.060 --> 00:29:01.260
Now, because we're
basically set up to work

565
00:29:01.260 --> 00:29:04.660
with mental disorders
and behavioral disorders,

566
00:29:04.660 --> 00:29:06.330
I want to take a moment to think about

567
00:29:06.330 --> 00:29:10.410
what's mental health and also
what's behavioral health.

568
00:29:11.700 --> 00:29:13.570
When I came into this profession, I did it

569
00:29:13.570 --> 00:29:15.640
because I wanted to work in mental health,

570
00:29:15.640 --> 00:29:17.640
and I did it because of
a vision very much like

571
00:29:17.640 --> 00:29:20.140
this one from the World
Health Organization,

572
00:29:20.140 --> 00:29:22.880
mental health represents
a state of well being

573
00:29:22.880 --> 00:29:25.350
in which every individual
realizes his or her

574
00:29:25.350 --> 00:29:28.020
own profession, or excuse me, potential,

575
00:29:28.020 --> 00:29:30.560
can cope with the normal stresses of life,

576
00:29:30.560 --> 00:29:32.930
including giving public presentations,

577
00:29:34.010 --> 00:29:35.830
can work productively and fruitfully

578
00:29:35.830 --> 00:29:37.360
and is able to make a contribution

579
00:29:37.360 --> 00:29:39.420
to her or his community.

580
00:29:40.670 --> 00:29:44.150
It's a really aspirational definition.

581
00:29:44.760 --> 00:29:47.970
It's not just bringing people
back from some disorder

582
00:29:47.970 --> 00:29:49.980
to where they were originally,

583
00:29:49.980 --> 00:29:53.510
it's moving them forward
to give more to themselves

584
00:29:53.510 --> 00:29:56.880
to realize their abilities,
to support their families,

585
00:29:56.880 --> 00:29:59.270
and to be parts of their communities.

586
00:29:59.950 --> 00:30:01.520
That was something that motivated me

587
00:30:01.520 --> 00:30:03.710
to get up in the morning and do this work.

588
00:30:05.190 --> 00:30:08.530
And it's also interesting
that WHO, and the US

589
00:30:08.530 --> 00:30:11.900
is a signatory to these agreements,

590
00:30:11.900 --> 00:30:14.300
says that health is the state of mental,

591
00:30:14.300 --> 00:30:17.470
physical, and social well
being, and not merely

592
00:30:17.470 --> 00:30:20.290
the absence of disease and infirmity.

593
00:30:21.070 --> 00:30:23.710
Okay, so their aspiration is to be bigger

594
00:30:23.710 --> 00:30:26.820
than just being good enough healthy,

595
00:30:27.850 --> 00:30:30.220
and I think this fits well
with what social work values

596
00:30:30.220 --> 00:30:31.630
propel us to do.

597
00:30:33.150 --> 00:30:36.820
Behavioral health, which has
come in the last 10, 15 years,

598
00:30:37.950 --> 00:30:40.730
is a philosophy that stresses
individual responsibility

599
00:30:40.730 --> 00:30:42.800
to apply behavioral science knowledge

600
00:30:42.800 --> 00:30:45.930
to maintain health and prevent illness

601
00:30:45.930 --> 00:30:49.540
through a variety of
self-initiated individual

602
00:30:49.540 --> 00:30:50.920
or shared activities.

603
00:30:51.570 --> 00:30:53.490
It's almost like do-it-yourself.

604
00:30:56.000 --> 00:30:59.050
And this is a definition from this group,

605
00:30:59.050 --> 00:31:00.180
from the Behavioral Health Group,

606
00:31:00.180 --> 00:31:01.360
I'm not making it up.

607
00:31:02.280 --> 00:31:03.980
So it focuses on preventing illness

608
00:31:03.980 --> 00:31:05.340
and on health maintenance.

609
00:31:05.850 --> 00:31:08.660
Those are important
pieces of mental health

610
00:31:08.660 --> 00:31:11.170
and of what clinical
social work should do.

611
00:31:11.960 --> 00:31:13.630
The idea was that somehow mental health

612
00:31:13.630 --> 00:31:16.750
had become so stigmatizing
we needed a new label.

613
00:31:17.500 --> 00:31:20.670
But the problem is the label
only looks at behavior,

614
00:31:20.670 --> 00:31:23.240
it puts the responsibility
on the individual,

615
00:31:23.240 --> 00:31:27.140
and I would argue, basically
prioritizes behavioral

616
00:31:27.140 --> 00:31:30.110
and cognitive theories of
health and of treatment

617
00:31:30.110 --> 00:31:34.560
in a way that privilege
them for no rational basis.

618
00:31:35.380 --> 00:31:38.670
It's a much narrower bring
people back to baseline approach.

619
00:31:40.090 --> 00:31:43.220
I would prefer that we stay
with a larger aspirational

620
00:31:43.220 --> 00:31:47.960
model of clinical social
work as providing a basis

621
00:31:47.960 --> 00:31:50.960
for mental health and promoting well being

622
00:31:50.960 --> 00:31:55.320
and helping people being
contributors to their communities.

623
00:31:57.000 --> 00:31:58.420
So what's clinical social work?

624
00:31:59.210 --> 00:32:02.940
In a recent definition, we
see that clinical social work

625
00:32:02.940 --> 00:32:05.910
seeks to restore and
enhance the bio psychosocial

626
00:32:05.910 --> 00:32:07.480
functioning of individuals,
couples, families

627
00:32:07.480 --> 00:32:10.430
through prevention,
assessment and treatment.

628
00:32:11.420 --> 00:32:13.890
Prevention, as in behavioral
health, is emphasized

629
00:32:13.890 --> 00:32:16.610
but so is assessment and treatment.

630
00:32:17.720 --> 00:32:18.830
And it's important to bear in mind

631
00:32:18.830 --> 00:32:20.630
that treatment covers many roles

632
00:32:20.630 --> 00:32:23.060
and service activities,
we're not just talking

633
00:32:23.060 --> 00:32:25.300
about psychotherapy here, although

634
00:32:25.300 --> 00:32:28.580
that is certainly one
legitimate social work role.

635
00:32:31.100 --> 00:32:32.240
And in thinking about what it takes

636
00:32:32.240 --> 00:32:34.660
to do clinical social work well,

637
00:32:35.740 --> 00:32:37.310
Etta Goldstein said that, professional

638
00:32:37.310 --> 00:32:39.210
ethics and values have to mastered,

639
00:32:39.210 --> 00:32:42.620
bio psychosocial developmental theories,

640
00:32:42.620 --> 00:32:46.750
theories of psychopathology,
of psychodynamics,

641
00:32:46.750 --> 00:32:48.820
of interpersonal
relationships, of environmental

642
00:32:48.820 --> 00:32:50.970
determinants, and clinical methods.

643
00:32:52.330 --> 00:32:54.580
That's enough to take
three summers right there.

644
00:32:56.330 --> 00:32:59.170
Simpson and other people
also added to that

645
00:32:59.170 --> 00:33:02.100
attention to prevention and to resiliency,

646
00:33:02.100 --> 00:33:03.750
and I think those are good additions.

647
00:33:04.800 --> 00:33:07.930
And I'd add to that racial
and cultural sensitivity,

648
00:33:07.930 --> 00:33:11.380
attention to societal oppressions, though

649
00:33:11.380 --> 00:33:13.040
I'm not clear whether or not that's part

650
00:33:13.040 --> 00:33:15.150
of environmental determinants, and it

651
00:33:15.150 --> 00:33:17.230
may well be that Etta
Goldstein had already put

652
00:33:17.230 --> 00:33:18.070
them in there.

653
00:33:18.790 --> 00:33:20.120
But I think, too, we
need to know some basic

654
00:33:20.120 --> 00:33:22.610
neurobiology, we need
to appraise strengths,

655
00:33:22.610 --> 00:33:24.720
we need to understand
evidence-based practice,

656
00:33:24.720 --> 00:33:27.690
and to be able to do
basic evaluation research

657
00:33:27.690 --> 00:33:29.250
on our practices.

658
00:33:30.200 --> 00:33:32.750
And then critical thinking
has to be applied to it all.

659
00:33:33.500 --> 00:33:36.770
We ask a lot of clinical
social workers and in turn,

660
00:33:36.770 --> 00:33:39.880
we have to do a lot in
clinical social work education.

661
00:33:41.430 --> 00:33:43.940
Etta Goldstein, a clinical
social worker and professor

662
00:33:43.940 --> 00:33:46.580
at New York University, who
unfortunately passed away

663
00:33:46.580 --> 00:33:50.620
a couple of years ago,
wrote in 2007 that educating

664
00:33:50.620 --> 00:33:52.990
students for clinical practice
is more and more daunting,

665
00:33:53.870 --> 00:33:57.580
and social work education
for clinical practice is

666
00:33:57.580 --> 00:34:01.280
in considerable disarray,
if not in a state of crisis.

667
00:34:02.260 --> 00:34:04.000
There's little agreement
among practitioners

668
00:34:04.000 --> 00:34:06.670
and academic faculty about
what students need to know

669
00:34:07.840 --> 00:34:10.000
and more knowledge to be
mastered, greater questioning

670
00:34:10.000 --> 00:34:12.440
of what seemed to be valuable in the past,

671
00:34:12.440 --> 00:34:14.840
and increasing necessity to help students

672
00:34:14.840 --> 00:34:18.960
critically evaluate both
traditional and emerging theories.

673
00:34:20.350 --> 00:34:23.480
So Goldstein, seven
years ago was saying that

674
00:34:23.480 --> 00:34:25.890
she thought we needed to
be paying more attention

675
00:34:25.890 --> 00:34:28.120
to what are we doing in
social work education

676
00:34:28.120 --> 00:34:30.460
and what kind of supports
do we need to provide

677
00:34:30.460 --> 00:34:32.540
to clinical social workers?

678
00:34:33.760 --> 00:34:35.300
She went on to say that
schools of social work

679
00:34:35.300 --> 00:34:38.160
are not providing students with
in depth clinical knowledge

680
00:34:38.160 --> 00:34:40.970
and critical thinking skills, and that our

681
00:34:40.970 --> 00:34:43.170
academic and professional
organizations aren't

682
00:34:43.170 --> 00:34:45.050
providing needed leadership.

683
00:34:45.910 --> 00:34:48.140
There continues to be a low key crisis

684
00:34:48.140 --> 00:34:51.340
in clinical social work and
many unanswered questions

685
00:34:51.340 --> 00:34:54.230
about the optimal education
of clinical social workers.

686
00:34:55.080 --> 00:34:56.550
And I'm going to argue
that I think this crisis

687
00:34:56.550 --> 00:34:59.120
has deepened in the recession and the lack

688
00:34:59.120 --> 00:35:01.290
of funding has only
made it more pronounced

689
00:35:01.290 --> 00:35:04.290
and it's also been
exacerbated by the decline

690
00:35:04.290 --> 00:35:07.410
of clinical social work
societies and organizations.

691
00:35:08.360 --> 00:35:12.110
There are now three, where
there used to be one.

692
00:35:12.700 --> 00:35:14.630
And unfortunately each
of these organizations

693
00:35:14.630 --> 00:35:17.640
seems to represent a
different set of states,

694
00:35:17.640 --> 00:35:20.510
rather than being a truly
national collaborative

695
00:35:20.510 --> 00:35:23.280
operation and in turn it makes it harder

696
00:35:23.280 --> 00:35:26.850
for us as clinical social
workers to join in a truly

697
00:35:26.850 --> 00:35:29.010
national effort to support our work

698
00:35:29.010 --> 00:35:31.900
and work on behalf of our clients.

699
00:35:33.590 --> 00:35:35.860
But I do want to say there is a diamond

700
00:35:35.860 --> 00:35:37.760
in this story, and it's the Smith College

701
00:35:37.760 --> 00:35:39.010
School for Social Work.

702
00:35:40.760 --> 00:35:42.560
Don't worry, a little further in

703
00:35:42.560 --> 00:35:44.430
I'm going to come back to being humble

704
00:35:44.430 --> 00:35:47.830
about the state of the Smith College

705
00:35:47.830 --> 00:35:49.190
School of Social Work.

706
00:35:50.100 --> 00:35:51.370
But we've always been a source

707
00:35:51.370 --> 00:35:54.040
of advocacy for social work education,

708
00:35:54.040 --> 00:35:56.630
and that's been true from 1918 on.

709
00:35:57.040 --> 00:35:58.810
Smith is the home of the Diagnostic School

710
00:35:58.810 --> 00:36:01.380
and there's been a consistent focus

711
00:36:01.380 --> 00:36:03.580
on the mission on excellence on clinical

712
00:36:03.580 --> 00:36:05.030
social work education.

713
00:36:05.890 --> 00:36:08.450
We offer in depth clinical
and theoretical knowledge

714
00:36:08.450 --> 00:36:11.620
and not only do we teach practice, but we

715
00:36:11.620 --> 00:36:15.230
also emphasize advocacy,
policy, and research,

716
00:36:15.230 --> 00:36:18.060
and we actually do all
of those things in depth,

717
00:36:18.060 --> 00:36:21.030
which is one of the great opportunities

718
00:36:21.030 --> 00:36:23.890
provided by our three
summer block program.

719
00:36:25.200 --> 00:36:27.510
In training folks in practice in the field

720
00:36:27.510 --> 00:36:30.710
we have twice the minimum
required standards

721
00:36:30.710 --> 00:36:34.270
for internships, a lot
of support for students

722
00:36:34.270 --> 00:36:37.150
for different forms of faculty advisement,

723
00:36:37.150 --> 00:36:39.720
and we provide more elective opportunities

724
00:36:39.720 --> 00:36:42.360
at least at the Master's
level than any other

725
00:36:42.360 --> 00:36:44.720
school I know of, and by comparison

726
00:36:44.720 --> 00:36:46.660
you should know that as a commissioner

727
00:36:46.660 --> 00:36:48.920
on the Accreditation Commission it seems

728
00:36:48.920 --> 00:36:51.660
like one elective is the average in most

729
00:36:51.660 --> 00:36:54.020
traditional social work programs.

730
00:36:55.400 --> 00:36:56.900
And at Smith most of your third summer

731
00:36:56.900 --> 00:36:59.320
in the Master's program is electives.

732
00:37:00.440 --> 00:37:01.940
All of this said, I
think Smith needs to be

733
00:37:01.940 --> 00:37:05.080
yet more active as individual faculty

734
00:37:05.080 --> 00:37:08.410
and as a community in support

735
00:37:08.410 --> 00:37:11.500
of clinical social work education.

736
00:37:13.520 --> 00:37:15.150
So having taken a look at the background,

737
00:37:15.150 --> 00:37:18.170
let's take a little look
at what we need to do.

738
00:37:20.860 --> 00:37:23.030
I've tried to define seven competencies

739
00:37:23.030 --> 00:37:24.470
for clinical social work.

740
00:37:24.960 --> 00:37:26.170
They have different parts.

741
00:37:26.170 --> 00:37:28.660
But the first is, we need to know theory,

742
00:37:28.660 --> 00:37:31.240
and this is something that
we do differently as Smith

743
00:37:31.240 --> 00:37:33.920
than is true for most other
schools of social work.

744
00:37:34.870 --> 00:37:37.540
In most other schools of
social work, a human behavior

745
00:37:37.540 --> 00:37:41.380
course might be a two-part
life span development course,

746
00:37:41.380 --> 00:37:44.840
and here at Smith we have
many individual courses

747
00:37:44.840 --> 00:37:48.220
on family theory, theories of development,

748
00:37:48.220 --> 00:37:50.660
in second summer child development,

749
00:37:50.660 --> 00:37:53.160
and it's equally true at doctoral level,

750
00:37:53.160 --> 00:37:54.930
different forms of theory are used

751
00:37:54.930 --> 00:37:56.870
to guide our practice.

752
00:37:58.030 --> 00:38:00.060
And the idea is to make
sure that you're trained

753
00:38:00.060 --> 00:38:03.200
to have a background
with multiple approaches,

754
00:38:03.200 --> 00:38:06.190
not just wedded to one
theoretical perspective.

755
00:38:07.410 --> 00:38:10.340
Smith is often seen as
the psychodynamics school,

756
00:38:10.340 --> 00:38:11.880
and I think there's a
lot of truth to that.

757
00:38:11.880 --> 00:38:14.240
We teach psychodynamic theory in depth,

758
00:38:15.460 --> 00:38:17.080
but in the first year of Master's practice

759
00:38:17.080 --> 00:38:20.370
we're also teaching family
theory and family practice.

760
00:38:21.190 --> 00:38:22.890
And we all so have courses on group theory

761
00:38:22.890 --> 00:38:24.400
and group practice.

762
00:38:25.290 --> 00:38:27.320
When you stop and think
what we actually do

763
00:38:27.320 --> 00:38:32.320
just by surveying our
curriculum, psychodynamic

764
00:38:32.400 --> 00:38:35.600
theory is one of several
theories that are taught here

765
00:38:35.600 --> 00:38:38.620
in depth and also in breadth.

766
00:38:39.440 --> 00:38:41.770
Clinical social workers need
to know multiple theories

767
00:38:41.770 --> 00:38:44.910
to choose those tools that guide you best

768
00:38:44.910 --> 00:38:46.930
in different practice situations.

769
00:38:47.780 --> 00:38:51.910
So we need multiple theory
education with attention

770
00:38:51.910 --> 00:38:54.660
to relationship and
conscience use of self,

771
00:38:55.150 --> 00:38:57.080
but theory has to come back to practice

772
00:38:57.080 --> 00:39:00.380
and practice theory is a
part of our theoretical base.

773
00:39:01.560 --> 00:39:04.060
And this also needs to be
tied to professional values,

774
00:39:04.060 --> 00:39:06.130
critical thinking, and the ability

775
00:39:06.130 --> 00:39:07.950
to communicate effectively.

776
00:39:08.600 --> 00:39:11.170
It can be very important to doing healing

777
00:39:11.170 --> 00:39:13.700
to help people understand the rationale

778
00:39:13.700 --> 00:39:15.790
for the services that we provide.

779
00:39:17.440 --> 00:39:20.180
Part two, competency two.

780
00:39:20.180 --> 00:39:22.650
Clinical social workers
have to be able to engage

781
00:39:22.650 --> 00:39:25.330
with a wide variety of clientele.

782
00:39:25.920 --> 00:39:28.190
We have to have strong
and flexible engagement

783
00:39:28.190 --> 00:39:30.720
skills that can be applied
in clinics, in outreach

784
00:39:30.720 --> 00:39:33.760
with mandated clients,
with resistant clients

785
00:39:33.760 --> 00:39:37.200
and with actively hostile clients, and yes

786
00:39:37.200 --> 00:39:39.450
you will see them all
if you haven't already.

787
00:39:40.900 --> 00:39:42.540
Despite that, we need to show respect

788
00:39:42.540 --> 00:39:44.540
and active appreciation for the dignity

789
00:39:44.540 --> 00:39:46.510
and worth, the potential and the strength

790
00:39:46.510 --> 00:39:49.140
of each client in our practice efforts

791
00:39:49.140 --> 00:39:52.550
and also in administrative
and policy work.

792
00:39:53.910 --> 00:39:56.520
All relationships take time and a key part

793
00:39:56.520 --> 00:39:59.270
of what makes them work
is rupture and repair.

794
00:39:59.950 --> 00:40:02.690
So part of engagement
may be to make mistakes

795
00:40:02.690 --> 00:40:06.060
that are almost inevitable,
but to recover from them

796
00:40:06.060 --> 00:40:09.030
with some grace, and
to work collaboratively

797
00:40:09.030 --> 00:40:11.460
with your client in a
theoretically informed way

798
00:40:11.460 --> 00:40:13.740
to enhance the relationship.

799
00:40:15.400 --> 00:40:17.740
Carolyn du Bois says, and
this is probably a quote

800
00:40:17.740 --> 00:40:19.640
from Yale Child Guidance somewhere,

801
00:40:19.640 --> 00:40:22.610
that everything you say and
do as a clinical social worker

802
00:40:22.610 --> 00:40:24.860
has to be done on behalf of the client.

803
00:40:26.110 --> 00:40:28.450
And I think that's really
true and it limits,

804
00:40:28.450 --> 00:40:31.430
but in focuses what we can do.

805
00:40:32.320 --> 00:40:34.120
When we're working with
clients on their behalf

806
00:40:34.120 --> 00:40:36.990
everything we do needs to be thoughtful,

807
00:40:36.990 --> 00:40:39.570
theory guided, and on
behalf of the client.

808
00:40:40.660 --> 00:40:43.120
And of course, we have to
start where the client is,

809
00:40:43.120 --> 00:40:45.330
and that may be a hostile, or resistant,

810
00:40:45.330 --> 00:40:46.820
or impatient client.

811
00:40:47.570 --> 00:40:50.230
This piece of wisdom which
I don't know if we can

812
00:40:50.230 --> 00:40:53.640
cite a source for, it's
traditional, still fits,

813
00:40:53.640 --> 00:40:57.060
still works, and still is
vital to doing good practice.

814
00:40:58.140 --> 00:41:00.680
Clients are going to
inevitably vary in motivation

815
00:41:00.680 --> 00:41:02.740
and in readiness to use services.

816
00:41:02.740 --> 00:41:04.870
We get people who are window shoppers.

817
00:41:05.180 --> 00:41:07.320
We get people who are
distrustful and can't make

818
00:41:07.320 --> 00:41:10.060
use of our services, and it's important

819
00:41:10.060 --> 00:41:11.960
that we can distinguish where they are

820
00:41:11.960 --> 00:41:13.760
so we can tune in to what they need

821
00:41:13.760 --> 00:41:15.210
and start where they're at.

822
00:41:16.400 --> 00:41:18.220
Clients can also be extremely vulnerable

823
00:41:18.220 --> 00:41:21.100
and anxious, which comes
across in many kinds

824
00:41:21.100 --> 00:41:25.240
of responses, but the
surface is not all there is,

825
00:41:25.240 --> 00:41:28.260
that there's both manifest
and latent content.

826
00:41:29.480 --> 00:41:32.220
And, again, integrity in our
work is always important.

827
00:41:34.050 --> 00:41:37.180
Third part, attention to
race, culture, gender,

828
00:41:37.180 --> 00:41:40.220
class, sexual orientation,
age, and other forms

829
00:41:40.220 --> 00:41:43.190
of human diversity have to be considered

830
00:41:43.190 --> 00:41:46.640
as an intersectionality
of multiple factors.

831
00:41:47.750 --> 00:41:50.420
That our sensitivity to
oppression must be active

832
00:41:50.420 --> 00:41:53.070
and continuous, it's a
piece of our anti-racism

833
00:41:53.070 --> 00:41:56.370
commitment, but it goes further from race

834
00:41:56.370 --> 00:41:58.420
to other forms of social diversity.

835
00:41:59.270 --> 00:42:00.610
And we need to bear in
mind that our clients

836
00:42:00.610 --> 00:42:03.610
aren't us, even if they
look like us and they share

837
00:42:03.610 --> 00:42:05.330
some of our demographics.

838
00:42:05.980 --> 00:42:08.150
The mere fact that we
share social identities

839
00:42:08.150 --> 00:42:10.850
doesn't mean that what they think and how

840
00:42:10.850 --> 00:42:14.200
they view these things are
the same as any of us do.

841
00:42:15.420 --> 00:42:17.890
And, we need to acknowledge our openness

842
00:42:17.890 --> 00:42:20.720
to differences because
to do so may be a spark

843
00:42:20.720 --> 00:42:22.710
to open up relationship.

844
00:42:25.100 --> 00:42:27.230
Competency four, clinical
social workers need

845
00:42:27.230 --> 00:42:29.270
to have wide-ranging assessment skills,

846
00:42:29.270 --> 00:42:32.040
including the appraisal
of the whole person

847
00:42:32.040 --> 00:42:33.960
and situation.

848
00:42:35.070 --> 00:42:37.840
I don't know how you
do this in 45 minutes,

849
00:42:39.110 --> 00:42:41.650
and I was talking to
another faculty member,

850
00:42:41.650 --> 00:42:43.580
a colleague today, and she was saying

851
00:42:43.580 --> 00:42:45.280
that one of the things
that she got called on

852
00:42:45.280 --> 00:42:49.840
was not checking off all
the boxes on an assessment.

853
00:42:50.990 --> 00:42:52.760
And as we talked about
that, they weren't about

854
00:42:52.760 --> 00:42:56.110
suicidal ideation or risk of self harm.

855
00:42:56.960 --> 00:42:58.360
They were about whether or not you knew

856
00:42:58.360 --> 00:43:01.520
the developmental history,
let's say, of a client.

857
00:43:02.640 --> 00:43:04.540
I don't know how you
do that in 45 minutes,

858
00:43:04.540 --> 00:43:06.270
find out everything you need to know,

859
00:43:06.270 --> 00:43:09.090
start where they're at and
get it all in one session.

860
00:43:09.710 --> 00:43:12.510
We've set public policies
up that don't allow us

861
00:43:12.510 --> 00:43:15.470
to live up to our
aspiration to get to know

862
00:43:15.470 --> 00:43:17.600
people in situations.

863
00:43:18.350 --> 00:43:20.560
I just argue it's simply not possible.

864
00:43:21.690 --> 00:43:23.310
One of the things that
goes is understanding

865
00:43:23.310 --> 00:43:25.640
the client's view of the problem.

866
00:43:25.960 --> 00:43:28.630
I work with children and
families and I'm stunned

867
00:43:28.630 --> 00:43:31.930
by reading the write up
where the teacher says,

868
00:43:31.930 --> 00:43:34.820
or the parent says
here's the kid's problem,

869
00:43:35.530 --> 00:43:37.470
but nobody tells us what the kid's view

870
00:43:37.470 --> 00:43:41.340
of the problem is, and the
kid's the identified patient.

871
00:43:41.340 --> 00:43:42.830
The identified client.

872
00:43:44.080 --> 00:43:45.870
Why wouldn't we ask the
person who's the focus

873
00:43:45.870 --> 00:43:49.230
of our service for their
view of what's going on?

874
00:43:49.970 --> 00:43:52.050
It just seems to lack dignity and respect

875
00:43:52.050 --> 00:43:55.210
and it basically doesn't
inform us adequately

876
00:43:55.210 --> 00:43:57.940
about what our client's needs are.

877
00:43:59.390 --> 00:44:01.230
We always have to keep
attention to strengths

878
00:44:01.230 --> 00:44:04.430
and ultimately to formulate
the client's dilemma

879
00:44:04.430 --> 00:44:05.670
in plain language.

880
00:44:06.330 --> 00:44:09.170
This is really, really
hard and what we're hearing

881
00:44:09.170 --> 00:44:11.570
from our placement sites,
and it's true of other

882
00:44:11.570 --> 00:44:13.810
social work programs,
at least in New England,

883
00:44:13.810 --> 00:44:17.140
is that skills in assessment
and skills in formulation

884
00:44:17.140 --> 00:44:20.810
among students, and also
among new clinicians,

885
00:44:20.810 --> 00:44:22.770
has really declined.

886
00:44:23.850 --> 00:44:25.650
That folks have become so symptom focused

887
00:44:25.650 --> 00:44:28.150
that they don't seem to
be able to crystallize

888
00:44:28.150 --> 00:44:31.090
the dilemma of a client in plain language,

889
00:44:31.090 --> 00:44:33.590
which is really important for showing them

890
00:44:33.590 --> 00:44:35.690
you understand what's going on and

891
00:44:35.690 --> 00:44:38.110
for guiding our interventions.

892
00:44:39.560 --> 00:44:42.350
The detail matters in very important ways.

893
00:44:43.340 --> 00:44:46.220
So our assessment skills
have to be wide-ranging.

894
00:44:47.470 --> 00:44:49.280
And then we have to
actively engage the client

895
00:44:49.280 --> 00:44:51.140
in treatment planning, which is also part

896
00:44:51.140 --> 00:44:53.680
of evidence-based
practice, in order to build

897
00:44:53.680 --> 00:44:55.500
their investment in the work.

898
00:44:57.250 --> 00:44:59.420
Then I want to add on
something that's a little hard

899
00:44:59.420 --> 00:45:02.490
to articulate, but I
think that going beyond

900
00:45:02.490 --> 00:45:06.490
what the client tells us, to interrogate

901
00:45:06.490 --> 00:45:09.730
what we wonder about, what's unstated

902
00:45:09.730 --> 00:45:13.150
but implicit is actually part
of our job as clinicians.

903
00:45:14.030 --> 00:45:16.720
To encourage them to aspire to more.

904
00:45:17.300 --> 00:45:18.800
To ask them to think about problems

905
00:45:18.800 --> 00:45:20.820
from other people's perspective.

906
00:45:21.430 --> 00:45:23.340
To wonder about how things might look

907
00:45:24.150 --> 00:45:26.680
and again, to do this in very focused,

908
00:45:26.680 --> 00:45:29.740
symptom-oriented treatments
is very difficult

909
00:45:29.740 --> 00:45:33.720
and it may be disallowed
by lists of evidence-

910
00:45:33.720 --> 00:45:35.300
supported treatments.

911
00:45:35.790 --> 00:45:38.360
But it's necessary for
us to help clients aim

912
00:45:38.360 --> 00:45:40.830
to be more and to live
up to a full definition

913
00:45:40.830 --> 00:45:41.980
of mental health.

914
00:45:42.960 --> 00:45:45.460
We have to create room for change

915
00:45:45.460 --> 00:45:48.270
and to continuously apply
our assessment skills

916
00:45:48.270 --> 00:45:51.020
because assessment is not a one-shot deal.

917
00:45:52.670 --> 00:45:54.440
Another thing we have to
attend to is our ability

918
00:45:54.440 --> 00:45:57.940
to develop and act and
discuss and to change

919
00:45:57.940 --> 00:46:01.030
therapeutic relationships
across varied settings.

920
00:46:01.880 --> 00:46:05.140
What you do in crisis
intervention or in stabilization,

921
00:46:05.140 --> 00:46:07.420
or in outreach may be
different than what you do

922
00:46:07.420 --> 00:46:10.170
in a longer term therapy situation.

923
00:46:11.160 --> 00:46:14.030
We have to find ways to
repackage what we're doing

924
00:46:14.030 --> 00:46:18.450
to fit to the needs of
particular clinical settings.

925
00:46:19.990 --> 00:46:22.060
We need of course to
listen, to be empathic,

926
00:46:22.060 --> 00:46:25.160
to tolerate and make use of ambiguity,

927
00:46:25.160 --> 00:46:28.620
painful affect, silence, and enactments.

928
00:46:29.440 --> 00:46:31.180
And this I think is something that unless

929
00:46:31.180 --> 00:46:33.910
we think dynamically
and about interpersonal

930
00:46:33.910 --> 00:46:36.780
interaction we will simply fail to see,

931
00:46:36.780 --> 00:46:40.350
and many of our advisers and supervisors

932
00:46:40.350 --> 00:46:43.190
note that in discussions with colleagues

933
00:46:43.190 --> 00:46:46.260
folks don't see how enactments are useful

934
00:46:46.260 --> 00:46:48.940
clinical communications.

935
00:46:50.060 --> 00:46:51.930
And to lose that source of information

936
00:46:51.930 --> 00:46:55.030
when we deal with anxious
clients who may not

937
00:46:55.030 --> 00:46:58.000
be able to state their needs really limits

938
00:46:58.000 --> 00:47:01.360
what we can bring to
the clinical situation.

939
00:47:02.340 --> 00:47:05.280
We need to be authentic
and sometimes vulnerable,

940
00:47:05.280 --> 00:47:08.410
and at the same time, we
need to be clearly bounded

941
00:47:08.410 --> 00:47:12.320
and to selectively withhold
our own reactions and ideas

942
00:47:12.320 --> 00:47:14.340
on behalf of better hearing the client.

943
00:47:16.590 --> 00:47:19.830
All of this takes self
awareness and ability

944
00:47:19.830 --> 00:47:22.430
to articulate our understandings of

945
00:47:22.430 --> 00:47:24.150
interpersonal interactions.

946
00:47:24.960 --> 00:47:27.000
It's necessary to do that with clients

947
00:47:27.000 --> 00:47:29.230
and it's also necessary to do that

948
00:47:29.230 --> 00:47:32.240
to bring in supervision
the kinds of questions

949
00:47:32.240 --> 00:47:34.560
you may have as a clinician.

950
00:47:35.140 --> 00:47:36.680
And this is true whether it's consultation

951
00:47:36.680 --> 00:47:40.260
for a senior clinician or
supervision for a student.

952
00:47:43.520 --> 00:47:45.740
All of this is based on
understanding different

953
00:47:45.740 --> 00:47:48.350
theories well enough
to have them be guides

954
00:47:48.350 --> 00:47:50.340
for you in practice situations.

955
00:47:52.460 --> 00:47:55.230
We need to stay open to
diversity of many kinds

956
00:47:55.230 --> 00:47:57.950
and to show our cultural sensitivity.

957
00:47:59.160 --> 00:48:01.500
And then, finally we
need to show awareness

958
00:48:01.500 --> 00:48:03.900
of the overt and internalized effects

959
00:48:03.900 --> 00:48:06.290
of social oppressions.

960
00:48:07.260 --> 00:48:10.310
All of that is to say that
when we see internalized

961
00:48:10.310 --> 00:48:14.180
homophobia or racism, we need to have ways

962
00:48:14.180 --> 00:48:17.650
to maintaining the dignity
and respect that we show

963
00:48:17.650 --> 00:48:20.250
for our clients to call into question some

964
00:48:20.250 --> 00:48:22.190
of their own views about themselves

965
00:48:22.190 --> 00:48:23.510
and about other people.

966
00:48:27.560 --> 00:48:29.210
Looking at the time, let me move on.

967
00:48:29.690 --> 00:48:32.260
Part six, we need to
evaluate our practices.

968
00:48:32.260 --> 00:48:34.740
We need to understand the basics

969
00:48:34.740 --> 00:48:36.840
of case-based practice evaluation

970
00:48:36.840 --> 00:48:39.640
in order to demonstrate
accountability, and also

971
00:48:39.640 --> 00:48:42.660
to build knowledge for
other social workers to use.

972
00:48:43.440 --> 00:48:47.170
This has become a huge
effort and it's an area

973
00:48:47.170 --> 00:48:50.380
where clinical practice
is being researched

974
00:48:50.380 --> 00:48:52.890
by people who don't understand the work

975
00:48:52.890 --> 00:48:57.320
and impose a more limited
perspective on it,

976
00:48:57.320 --> 00:49:01.530
and unless we bring to practice
evaluation the theories

977
00:49:01.530 --> 00:49:03.700
and views and perspectives and knowledge

978
00:49:03.700 --> 00:49:06.000
that we've developed,
it's going to be done

979
00:49:06.000 --> 00:49:07.980
in ways that further limit us.

980
00:49:08.870 --> 00:49:12.000
So another demand on
clinical social workers is

981
00:49:12.000 --> 00:49:13.540
to think about evaluating your practice

982
00:49:13.540 --> 00:49:15.120
and sharing your knowledge.

983
00:49:15.770 --> 00:49:17.110
One of the great things here at Smith is

984
00:49:17.110 --> 00:49:20.010
to have a thesis or
dissertation obligates you

985
00:49:20.010 --> 00:49:21.980
to do some of that and
gives you the opportunity

986
00:49:21.980 --> 00:49:25.890
to do it, and it's also part
of Master's case summaries.

987
00:49:27.810 --> 00:49:30.810
Part seven, I actually think
that clinical social workers

988
00:49:30.810 --> 00:49:32.540
need to be advocates.

989
00:49:33.060 --> 00:49:34.730
And I was thinking about
this and it's not clear

990
00:49:34.730 --> 00:49:36.900
that policy planners need to be able to do

991
00:49:36.900 --> 00:49:38.570
clinical practice,

992
00:49:39.960 --> 00:49:41.730
but it's going to be a requirement on us

993
00:49:41.730 --> 00:49:44.020
as clinicians that we can do advocacy.

994
00:49:44.540 --> 00:49:46.270
We need to advocate for our clients

995
00:49:46.270 --> 00:49:49.340
at the organizational
level, at the system level,

996
00:49:49.340 --> 00:49:51.610
but I'm going to argue that we also need

997
00:49:51.610 --> 00:49:54.880
to advocate for ourselves
as clinical social workers

998
00:49:54.880 --> 00:49:56.780
because one of the things
that's happening now

999
00:49:56.780 --> 00:49:59.030
is we don't have a unified voice.

1000
00:49:59.380 --> 00:50:02.050
And unless we develop one
other people will speak

1001
00:50:02.050 --> 00:50:05.620
for us, or they will
ignore us, neither of which

1002
00:50:05.620 --> 00:50:07.040
is to our advantage.

1003
00:50:07.860 --> 00:50:09.700
So we need to advocate from case to cause

1004
00:50:09.700 --> 00:50:13.370
for the profession to join
together and to do advocacy,

1005
00:50:13.370 --> 00:50:16.960
and to promote the kinds
of theories and thinking

1006
00:50:16.960 --> 00:50:20.570
and practices and the kinds
of supports for good practice

1007
00:50:20.570 --> 00:50:23.480
that we think fully realizes our idea

1008
00:50:23.480 --> 00:50:24.960
of clinical social work.

1009
00:50:26.110 --> 00:50:27.860
So those are the competencies

1010
00:50:28.970 --> 00:50:30.650
and it turns out that
there is an evidence base

1011
00:50:30.650 --> 00:50:32.320
to support these, and I'm basically going

1012
00:50:32.320 --> 00:50:34.720
to blow through this
and I'm going to set up

1013
00:50:34.720 --> 00:50:37.120
my colleague, Liz
Keenan, who's going to do

1014
00:50:37.120 --> 00:50:39.240
next Monday's lecture.

1015
00:50:40.130 --> 00:50:43.430
Some of the evidence base
supporting these ideas

1016
00:50:43.430 --> 00:50:45.860
that clinical concepts
and theories and a focus

1017
00:50:45.860 --> 00:50:50.200
on relationship is key to change comes out

1018
00:50:50.200 --> 00:50:52.090
of the common factors model.

1019
00:50:52.740 --> 00:50:54.440
And let me just highlight
a couple of simple

1020
00:50:54.440 --> 00:50:55.660
aspects of it.

1021
00:50:56.480 --> 00:51:01.080
In the latest work, about
30% of what researchers find

1022
00:51:01.080 --> 00:51:04.350
can be explained change in therapy is due

1023
00:51:04.350 --> 00:51:07.020
to client factors, and if
you're a clinician this makes

1024
00:51:07.020 --> 00:51:08.330
perfect sense.

1025
00:51:09.020 --> 00:51:11.420
If your client goes home
and their partner says

1026
00:51:11.420 --> 00:51:14.360
it's stupid that you're
doing that therapy stuff,

1027
00:51:14.360 --> 00:51:17.480
they are less likely to be invested in it.

1028
00:51:18.100 --> 00:51:21.160
On the other hand, if they
go home and the partner says

1029
00:51:21.160 --> 00:51:24.080
it's brave of you to take this on,

1030
00:51:25.170 --> 00:51:26.860
they may be more invested.

1031
00:51:27.540 --> 00:51:30.440
So the client's world
inevitably shapes as much

1032
00:51:30.440 --> 00:51:33.010
as anything what happens in therapy,

1033
00:51:33.010 --> 00:51:35.580
and we don't have a whole
lot of purchase on that

1034
00:51:35.580 --> 00:51:37.150
and we don't have a whole lot of power

1035
00:51:37.150 --> 00:51:40.550
to alter or support it,
unless we're doing work

1036
00:51:40.550 --> 00:51:44.640
in systems like schools or
inpatient or residential units.

1037
00:51:46.060 --> 00:51:48.560
12% of the variation in outcome is due

1038
00:51:48.560 --> 00:51:50.480
to the therapeutic relationship.

1039
00:51:51.390 --> 00:51:53.600
It's the biggest single interactive factor

1040
00:51:53.600 --> 00:51:56.020
that's been identified
in outcome research.

1041
00:51:57.570 --> 00:52:00.560
8% has to do with specific
therapies and this

1042
00:52:00.560 --> 00:52:02.610
would be the choice of psychodynamic

1043
00:52:02.610 --> 00:52:07.610
or cognitive-behavioral,
or MBSR, mindfulness-based

1044
00:52:08.610 --> 00:52:12.130
stress reduction, or
family systems theory.

1045
00:52:13.590 --> 00:52:17.910
7% has to do with our own
characteristics as clinicians.

1046
00:52:18.860 --> 00:52:21.860
This is when we ought to
really pay attention to,

1047
00:52:22.940 --> 00:52:25.130
there are pieces of what
we do that we may not

1048
00:52:25.130 --> 00:52:28.200
be flexible enough to alter
in ways that are actually

1049
00:52:28.200 --> 00:52:29.990
helpful to our clients.

1050
00:52:30.900 --> 00:52:33.360
And another 3% relate to other factors.

1051
00:52:34.640 --> 00:52:37.030
Now this research is
based on interdisciplinary

1052
00:52:37.030 --> 00:52:39.810
psychotherapy research, but there's been

1053
00:52:39.810 --> 00:52:42.450
recent research by
social workers that show

1054
00:52:42.450 --> 00:52:45.550
that variation in case
management is similar,

1055
00:52:45.550 --> 00:52:49.029
that 11% of outcomes in case management

1056
00:52:49.029 --> 00:52:51.320
are based on the quality of the client

1057
00:52:51.320 --> 00:52:54.800
and worker alliance and some other work

1058
00:52:54.800 --> 00:52:57.200
that I heard last year at SWER suggests

1059
00:52:57.200 --> 00:53:00.120
that that's equally true for
other social work services.

1060
00:53:00.970 --> 00:53:04.670
So what we do may be more based on what

1061
00:53:04.670 --> 00:53:07.740
we bring as clinicians
and our ability to develop

1062
00:53:07.740 --> 00:53:11.640
alliances with clients then
with choice of specific

1063
00:53:11.640 --> 00:53:14.200
therapeutic techniques.

1064
00:53:15.810 --> 00:53:18.750
And there's another model
which looks at the nature

1065
00:53:18.750 --> 00:53:21.420
of the therapeutic
relationship and this group

1066
00:53:21.420 --> 00:53:24.920
with Louis Castonguay, Lloyd Butler,

1067
00:53:24.920 --> 00:53:27.430
and also Marsha Linehan have looked at

1068
00:53:27.430 --> 00:53:30.820
what pieces of therapy lead to

1069
00:53:30.820 --> 00:53:32.280
good outcomes.

1070
00:53:33.030 --> 00:53:35.500
Most of it is the kind of stuff
you look at as a clinician

1071
00:53:35.500 --> 00:53:37.490
and you say, well yes of course.

1072
00:53:38.600 --> 00:53:42.260
So client expectations
play a lot in outcomes.

1073
00:53:42.840 --> 00:53:44.440
Well yeah, we all know that and in fact,

1074
00:53:44.440 --> 00:53:47.400
that's what the common
factors material shows.

1075
00:53:48.450 --> 00:53:50.580
Clients with higher levels of impairments

1076
00:53:50.580 --> 00:53:52.680
or who have personality disorders

1077
00:53:52.680 --> 00:53:54.620
or interpersonal problems early in life

1078
00:53:54.620 --> 00:53:56.740
are likely to have poorer outcomes.

1079
00:53:58.360 --> 00:54:00.340
Right, there's no rocket
science in that one.

1080
00:54:00.890 --> 00:54:03.260
What these folks have
worked out empirical support

1081
00:54:03.260 --> 00:54:05.930
by using quantitative research methods

1082
00:54:05.930 --> 00:54:07.480
to come to these conclusions.

1083
00:54:08.170 --> 00:54:10.670
Which these days is very
helpful in terms of the kinds

1084
00:54:10.670 --> 00:54:12.420
of evidence that are most honored.

1085
00:54:13.340 --> 00:54:15.070
There are more of these,
but I'm going to just

1086
00:54:15.070 --> 00:54:18.380
pass through them if you'd
like the full Powerpoint

1087
00:54:18.380 --> 00:54:21.200
I'm happy to share it with you.

1088
00:54:22.210 --> 00:54:24.150
Another thing that amazes
me is there's very little

1089
00:54:24.150 --> 00:54:27.750
research on supervision,
but some that's done,

1090
00:54:27.750 --> 00:54:30.410
and I'm pitching this
as an idea for theses

1091
00:54:30.410 --> 00:54:32.840
and for dissertations, I
think it's a great one.

1092
00:54:33.960 --> 00:54:35.760
Laura Berenson, one of our students,

1093
00:54:35.760 --> 00:54:38.900
is working on a dissertation
related to field advising,

1094
00:54:38.900 --> 00:54:41.300
and I wish there was
more research being done

1095
00:54:41.300 --> 00:54:42.600
in this area because it's really important

1096
00:54:42.600 --> 00:54:43.950
and we don't know much.

1097
00:54:44.840 --> 00:54:47.270
But in a great study by
Knight, who's a researcher

1098
00:54:47.270 --> 00:54:49.940
out at University of
Maryland, what does she find?

1099
00:54:49.940 --> 00:54:52.240
Frequent, regular
supervision of good duration,

1100
00:54:52.240 --> 00:54:55.010
plus unscheduled access
aided student learning.

1101
00:54:55.010 --> 00:54:56.840
(chuckling)

1102
00:54:58.520 --> 00:55:00.550
All right, it's duh, right?

1103
00:55:00.550 --> 00:55:02.820
We all understand this,
but on the other hand,

1104
00:55:02.820 --> 00:55:07.060
if we don't support
supervisors and supervisors

1105
00:55:07.060 --> 00:55:09.660
are doing this in addition
to all of their work,

1106
00:55:09.660 --> 00:55:11.560
they're not going to be able to provide

1107
00:55:11.560 --> 00:55:12.780
this kind of support.

1108
00:55:13.530 --> 00:55:14.490
What else helps?

1109
00:55:14.490 --> 00:55:17.340
Reviewing cases, doing process recording,

1110
00:55:17.340 --> 00:55:19.810
and having process
recordings carefully read

1111
00:55:19.810 --> 00:55:22.370
by supervisors were seen as really useful

1112
00:55:22.370 --> 00:55:24.010
for improving student self-awareness

1113
00:55:24.010 --> 00:55:25.990
and integrating theory in practice.

1114
00:55:27.080 --> 00:55:28.180
And then the biggie.

1115
00:55:28.180 --> 00:55:32.400
Clear roles, openness to
affect and taboo subjects.

1116
00:55:33.420 --> 00:55:34.390
You wonder what that is,

1117
00:55:34.390 --> 00:55:36.770
but I think we can all guess, right?

1118
00:55:37.560 --> 00:55:38.960
Support for feelings and encouragement

1119
00:55:38.960 --> 00:55:42.590
of autonomy and
self-criticism all enhanced

1120
00:55:42.590 --> 00:55:43.880
student learning.

1121
00:55:44.660 --> 00:55:46.160
Now we should know more about how

1122
00:55:46.160 --> 00:55:48.130
this stuff works and which is relatively

1123
00:55:48.130 --> 00:55:50.250
more important than other pieces.

1124
00:55:51.070 --> 00:55:52.440
But there is evidence to support

1125
00:55:52.440 --> 00:55:55.470
that attention to theory and use of self

1126
00:55:55.470 --> 00:55:58.560
is critical to good social work education.

1127
00:55:59.610 --> 00:56:02.700
So what's clinical social
work in the 21st century?

1128
00:56:03.580 --> 00:56:04.920
It's a perspective.

1129
00:56:05.650 --> 00:56:07.390
It's a way of understanding
and serving other people

1130
00:56:07.390 --> 00:56:09.800
based on our knowledge,
values, and skills.

1131
00:56:11.020 --> 00:56:13.150
The clients that we
serve can be informally

1132
00:56:13.150 --> 00:56:15.710
or formally defined.

1133
00:56:16.600 --> 00:56:18.130
Sometimes in working in school systems

1134
00:56:18.130 --> 00:56:20.400
I began to think that the client was just

1135
00:56:20.400 --> 00:56:22.300
the person standing in front of me,

1136
00:56:22.300 --> 00:56:24.540
and I know I would insult many

1137
00:56:24.540 --> 00:56:27.070
of the really fine
teachers that I worked with

1138
00:56:27.070 --> 00:56:29.020
by thinking of them as clients.

1139
00:56:29.710 --> 00:56:31.480
But it became clear to
me that some of what

1140
00:56:31.480 --> 00:56:34.880
I could do would be to
take a therapeutic tact,

1141
00:56:34.880 --> 00:56:39.650
not to treat them any less
as professional colleagues,

1142
00:56:39.650 --> 00:56:42.750
but to use my professional
knowledge and skill

1143
00:56:42.750 --> 00:56:45.090
to help them get through a situation,

1144
00:56:45.090 --> 00:56:46.950
or to better understand one of the kids

1145
00:56:46.950 --> 00:56:49.240
that was posing difficulty for them.

1146
00:56:50.400 --> 00:56:51.920
So I think we need to be wide ranging

1147
00:56:51.920 --> 00:56:54.680
in how we apply what we know.

1148
00:56:55.300 --> 00:56:56.870
And in a lot of settings like schools

1149
00:56:56.870 --> 00:57:00.040
and especially inpatient
units, residential facilities

1150
00:57:00.040 --> 00:57:04.580
where parallel process is
often enacted and reenacted

1151
00:57:04.580 --> 00:57:09.010
to apply our clinical skills
to look at our colleagues

1152
00:57:09.010 --> 00:57:11.330
and even ourselves is really important.

1153
00:57:12.820 --> 00:57:14.390
Thorough assessment is a vital part

1154
00:57:14.390 --> 00:57:16.860
of clinical social work
and is increasingly,

1155
00:57:16.860 --> 00:57:19.270
I think, being eroded and limited.

1156
00:57:21.160 --> 00:57:23.950
Interventions should
always be based on a plan.

1157
00:57:25.800 --> 00:57:27.170
Okay, and notice that
I'm not trying to say

1158
00:57:27.170 --> 00:57:29.090
what kind of a plan, because
I think we can be informed

1159
00:57:29.090 --> 00:57:31.800
about a lot of theories
and a lot of purposes,

1160
00:57:31.800 --> 00:57:34.640
but it's interesting that
I speak to supervisors

1161
00:57:34.640 --> 00:57:38.330
who tell me they don't think
that students have a plan.

1162
00:57:39.040 --> 00:57:40.750
Now part of the job is
that, we as educators

1163
00:57:40.750 --> 00:57:42.550
and they as supervisors,
should help the students

1164
00:57:42.550 --> 00:57:45.620
develop those plans, but what we do should

1165
00:57:45.620 --> 00:57:47.820
be based on our theory and there should

1166
00:57:47.820 --> 00:57:49.570
be a plan for what you're doing.

1167
00:57:50.910 --> 00:57:53.620
Clinical social work is
also a portable perspective.

1168
00:57:53.620 --> 00:57:55.760
It doesn't have to be
applied only in an office

1169
00:57:55.760 --> 00:57:58.660
in a 50-minute hour,
it's applicable to a lot

1170
00:57:58.660 --> 00:58:01.350
of different roles and client situations.

1171
00:58:03.030 --> 00:58:05.960
So we can take the heart of
what clinical social work is,

1172
00:58:05.960 --> 00:58:08.340
the competencies that
I've kind of mapped out

1173
00:58:08.340 --> 00:58:11.600
for you and apply them
in a variety of settings

1174
00:58:12.380 --> 00:58:15.350
to restore and enhance the
functioning of individuals,

1175
00:58:15.350 --> 00:58:20.150
couples, groups, families,
through prevention

1176
00:58:20.150 --> 00:58:22.870
diagnosis, treatment and advocacy.

1177
00:58:23.680 --> 00:58:25.720
And I'm going to argue
that linking brokering,

1178
00:58:25.720 --> 00:58:28.830
advocacy, and mediating
are all important parts

1179
00:58:28.830 --> 00:58:30.110
of clinical social work.

1180
00:58:30.830 --> 00:58:32.160
One of the things that
I've come to think about

1181
00:58:32.160 --> 00:58:34.570
is almost everything in social work

1182
00:58:34.570 --> 00:58:37.050
has a place in clinical social work.

1183
00:58:37.900 --> 00:58:39.570
And I'm not sure that
works the other way around,

1184
00:58:39.570 --> 00:58:41.770
because I don't think
policy people have to do

1185
00:58:41.770 --> 00:58:44.290
some of the things we
do in clinical practice.

1186
00:58:45.140 --> 00:58:47.780
But I think that in clinical
social work we have to be

1187
00:58:47.780 --> 00:58:49.700
Jacks and Jills of all trade.

1188
00:58:50.120 --> 00:58:52.350
We have to be able to
do all of these things

1189
00:58:52.350 --> 00:58:54.200
when they're necessary and helpful.

1190
00:58:55.350 --> 00:58:57.020
Right now, I think we really need to work

1191
00:58:57.020 --> 00:58:59.490
to be advocates for our profession,

1192
00:58:59.490 --> 00:59:02.040
and in turn for the needs of our clients.

1193
00:59:04.280 --> 00:59:05.790
Carolyn du Bois took a look at this

1194
00:59:05.790 --> 00:59:07.490
and she said, Jim, you have to be careful

1195
00:59:07.490 --> 00:59:08.800
that this thing doesn't come across

1196
00:59:08.800 --> 00:59:10.080
just as a downer.

1197
00:59:12.100 --> 00:59:13.510
It's important that we recognize

1198
00:59:13.510 --> 00:59:16.190
there are the bright spots.

1199
00:59:17.140 --> 00:59:19.180
One of the things here at Smith is that

1200
00:59:19.180 --> 00:59:21.550
MSW interns at Smith, I'm just looking

1201
00:59:21.550 --> 00:59:23.550
at MSWs because it's easier to count,

1202
00:59:23.550 --> 00:59:27.720
provide annually more than 150,000 hours

1203
00:59:27.720 --> 00:59:29.140
of service to clients.

1204
00:59:29.880 --> 00:59:32.010
It's a tremendous amount of service.

1205
00:59:33.080 --> 00:59:34.590
It's a wonderful thing and it fits with

1206
00:59:34.590 --> 00:59:37.780
our primary social work value on service.

1207
00:59:38.700 --> 00:59:40.100
We provide needed supports for people

1208
00:59:40.100 --> 00:59:41.830
with mental illnesses, medical conditions,

1209
00:59:41.830 --> 00:59:43.400
trauma and depression histories,

1210
00:59:43.400 --> 00:59:45.170
and adjustment challenges.

1211
00:59:45.170 --> 00:59:47.770
In schools, in hospitals,
in all kinds of different

1212
00:59:47.770 --> 00:59:51.640
settings, in jails, in
prisons, in client's homes

1213
00:59:51.640 --> 00:59:53.230
and even on the street if needed.

1214
00:59:54.510 --> 00:59:57.020
The program and Smith
students really help people

1215
00:59:57.020 --> 01:00:00.450
realize their potential, cope
with the stresses of life,

1216
01:00:00.450 --> 01:00:03.590
to work productively and
fruitfully, and make meaningful

1217
01:00:03.590 --> 01:00:06.070
contributions to their
families and their communities.

1218
01:00:06.660 --> 01:00:10.100
That's the WHO definition
of mental health,

1219
01:00:10.100 --> 01:00:12.360
and I think we should be aspiring to

1220
01:00:12.360 --> 01:00:13.930
and I am pleased to work in an institution

1221
01:00:13.930 --> 01:00:15.420
that still seeks that.

1222
01:00:17.160 --> 01:00:18.300
You also should know that the school

1223
01:00:18.300 --> 01:00:21.400
was rated number one
in social work programs

1224
01:00:21.400 --> 01:00:23.840
in a national survey of
social work students,

1225
01:00:23.840 --> 01:00:25.600
and this is across all different schools

1226
01:00:25.600 --> 01:00:27.090
of social work in the United States.

1227
01:00:29.010 --> 01:00:31.380
So that other people appreciate
that what we offer here

1228
01:00:31.380 --> 01:00:34.100
at Smith is special and
is somewhat different.

1229
01:00:35.250 --> 01:00:37.390
And also, in a similar poll by

1230
01:00:37.390 --> 01:00:39.090
the same Columbia researchers,

1231
01:00:39.090 --> 01:00:40.790
we rank number one in a survey

1232
01:00:40.790 --> 01:00:43.280
of graduate social work practitioners.

1233
01:00:45.000 --> 01:00:46.760
People do understand what Smith offers

1234
01:00:46.760 --> 01:00:48.250
and it is honored.

1235
01:00:49.070 --> 01:00:50.900
We're number 16 now in the US News

1236
01:00:50.900 --> 01:00:55.900
and World News and Reports ranking

1237
01:00:56.140 --> 01:00:57.590
of schools.

1238
01:00:58.440 --> 01:01:01.350
But of the nine university
schools of social work

1239
01:01:01.350 --> 01:01:03.430
we're the only one in the top 30.

1240
01:01:04.480 --> 01:01:05.680
All the rest of them are big universities

1241
01:01:05.680 --> 01:01:07.870
with a much larger research focus.

1242
01:01:09.490 --> 01:01:11.180
And our graduates provide services,

1243
01:01:11.180 --> 01:01:13.220
supervision, and administrative leadership

1244
01:01:13.220 --> 01:01:15.310
nationally and internationally.

1245
01:01:16.230 --> 01:01:17.690
And a lot of our PhD graduates serve

1246
01:01:17.690 --> 01:01:19.360
as faculty members in programs also

1247
01:01:19.360 --> 01:01:21.380
nationally and internationally.

1248
01:01:22.470 --> 01:01:24.240
And our faculty do all kinds of clinical

1249
01:01:24.240 --> 01:01:26.770
and policy practice, as well as research

1250
01:01:26.770 --> 01:01:29.060
and service of many kinds.

1251
01:01:29.770 --> 01:01:31.780
So I don't want to lose
sight of what we do,

1252
01:01:31.780 --> 01:01:34.510
but notice that some of
what we do in teaching

1253
01:01:34.510 --> 01:01:36.950
and in research, in
service and in scholarship

1254
01:01:36.950 --> 01:01:38.920
goes beyond what most people think

1255
01:01:38.920 --> 01:01:43.740
of the traditional roles of
clinical social work per se.

1256
01:01:45.390 --> 01:01:47.790
As next steps, let me ask
you to really thing about

1257
01:01:47.790 --> 01:01:51.480
what you can do to support
clinical social work.

1258
01:01:52.500 --> 01:01:54.170
I think we need to better organize

1259
01:01:54.170 --> 01:01:57.200
and to advocate for services and on behalf

1260
01:01:57.200 --> 01:02:01.010
of social work titles, and for definitions

1261
01:02:01.010 --> 01:02:03.040
of the services we can provide,

1262
01:02:03.040 --> 01:02:07.080
for better payment and for expanding

1263
01:02:07.080 --> 01:02:08.810
the public's awareness and understanding

1264
01:02:08.810 --> 01:02:12.712
of the work we do to
support diverse populations.

1265
01:02:13.280 --> 01:02:14.920
I think it's an important
and special thing

1266
01:02:14.920 --> 01:02:17.740
and we should stand up
more for what we do.

1267
01:02:18.790 --> 01:02:20.790
So I ask you to think
about being more active

1268
01:02:20.790 --> 01:02:22.510
and being more involved.

1269
01:02:23.420 --> 01:02:26.260
Part of that is to keep
learning, do the best you can,

1270
01:02:26.260 --> 01:02:28.570
if you are a student,
then continuing learning,

1271
01:02:28.570 --> 01:02:31.540
to apply critical and creative thinking,

1272
01:02:31.540 --> 01:02:35.000
build relationships,
build your competence,

1273
01:02:35.000 --> 01:02:37.710
build knowledge, and
according to my colleague,

1274
01:02:37.710 --> 01:02:41.260
Joan Berzoff, keep it
complicated, because it is.

1275
01:02:43.270 --> 01:02:45.620
This is unbelievably complicated stuff

1276
01:02:45.620 --> 01:02:46.970
we're asking you to do.

1277
01:02:48.490 --> 01:02:51.160
Now, in closing let me
say one thing about Smith.

1278
01:02:53.320 --> 01:02:56.790
If you look at our ads,
Smith is the leader

1279
01:02:56.790 --> 01:02:58.780
in clinical social work.

1280
01:02:59.660 --> 01:03:01.270
I look at that and I have to tell you

1281
01:03:01.270 --> 01:03:04.800
with my Mainer background,
as a New England

1282
01:03:04.800 --> 01:03:08.810
Anglo guy, it's so lacking in humility

1283
01:03:08.810 --> 01:03:10.980
that sometimes it makes me cringe,

1284
01:03:10.980 --> 01:03:12.910
this is just not what you do.

1285
01:03:12.910 --> 01:03:14.900
You don't self-promote
in that kind of way,

1286
01:03:17.440 --> 01:03:19.280
but lo and behold, Smith is the leader

1287
01:03:19.280 --> 01:03:22.020
in clinical social work
and we do need to honor

1288
01:03:22.020 --> 01:03:23.370
what we do.

1289
01:03:24.220 --> 01:03:25.960
And when I think what's provided here

1290
01:03:25.960 --> 01:03:28.290
and how different and
how increasingly special

1291
01:03:28.290 --> 01:03:31.460
what we do has become,
we should take credit

1292
01:03:31.460 --> 01:03:34.440
in being the leaders in
clinical social work.

1293
01:03:35.290 --> 01:03:38.520
That said, I think we do
need to do a whole lot more.

1294
01:03:39.100 --> 01:03:41.370
We need to be the source
of a national movement

1295
01:03:41.370 --> 01:03:45.580
in support of excellence
in clinical social work

1296
01:03:45.580 --> 01:03:48.910
to live up to our mission
fully, and to make sure

1297
01:03:48.910 --> 01:03:51.280
that it doesn't just rest here at Smith,

1298
01:03:51.280 --> 01:03:54.740
but that it goes national
and international.

1299
01:03:55.490 --> 01:03:57.760
I want to give a quick
shout out to Yvette Colon,

1300
01:03:57.760 --> 01:04:02.760
my colleague and friend who's
here as part-time faculty

1301
01:04:02.860 --> 01:04:06.130
and has served in many roles
on our Alumni Committee,

1302
01:04:07.530 --> 01:04:09.570
and also as faculty
and is a faculty member

1303
01:04:09.570 --> 01:04:11.690
at another distinguished
school of social work.

1304
01:04:12.500 --> 01:04:16.040
Yvette is one of the
leaders of one of the three

1305
01:04:16.040 --> 01:04:18.310
clinical social work organizations,

1306
01:04:18.310 --> 01:04:21.350
and I want to point her
out because if you want

1307
01:04:21.350 --> 01:04:24.870
to become more involved that
may be one avenue to do it.

1308
01:04:25.750 --> 01:04:28.320
And together, maybe we
can see, over the summer,

1309
01:04:28.320 --> 01:04:30.720
if we can make sure in
the bulletin and in other

1310
01:04:30.720 --> 01:04:33.260
announcements to our alumni and beyond

1311
01:04:33.260 --> 01:04:36.030
this immediate community,
we make people aware

1312
01:04:36.030 --> 01:04:38.720
of what organizations are
available, and help you

1313
01:04:38.720 --> 01:04:40.720
find a way to be part of this activity.

1314
01:04:41.230 --> 01:04:42.270
So Yvette, would you mind just standing up

1315
01:04:42.270 --> 01:04:43.580
so they can see who you are?

1316
01:04:44.300 --> 01:04:47.610
- I (mumbles) as president of the board

1317
01:04:47.610 --> 01:04:49.210
for the Center for Clinical Social Work

1318
01:04:49.210 --> 01:04:51.680
one of the (mumbles) we
have done in the past year

1319
01:04:51.680 --> 01:04:55.850
is to create an entire
online student center

1320
01:04:55.850 --> 01:04:57.850
and provide student memberships,

1321
01:04:57.850 --> 01:05:00.340
so hopefully you'll be able
to hear more about that.

1322
01:05:00.340 --> 01:05:01.490
Thank you.

1323
01:05:04.090 --> 01:05:05.840
- So I thank you for bearing with me.

1324
01:05:06.420 --> 01:05:07.980
I was thinking about this
and you know, Carolyn

1325
01:05:07.980 --> 01:05:09.330
says make sure you're not a downer,

1326
01:05:09.330 --> 01:05:12.120
I was thinking this may be very heady

1327
01:05:12.120 --> 01:05:13.360
and intellectual and it is,

1328
01:05:13.360 --> 01:05:15.330
and part of that is
because I'm in this role

1329
01:05:15.330 --> 01:05:17.750
as a commissioner on the

1330
01:05:19.430 --> 01:05:22.510
CSWE Accreditation Commission and one

1331
01:05:22.510 --> 01:05:24.330
of the things we're doing
now is to figure out

1332
01:05:24.330 --> 01:05:26.740
what are the competencies
that will be required

1333
01:05:26.740 --> 01:05:31.280
at BSW and MSW level social work education

1334
01:05:31.280 --> 01:05:32.870
for the next eight years.

1335
01:05:33.650 --> 01:05:35.050
So I've been immersed in this stuff

1336
01:05:35.050 --> 01:05:38.220
and I thank you for
bearing with me and helping

1337
01:05:38.220 --> 01:05:40.960
me think it through and
I'm now really interested

1338
01:05:40.960 --> 01:05:44.100
to see if you have thoughts or questions

1339
01:05:44.100 --> 01:05:47.650
or different points of view
to expand the conversation.

1340
01:05:48.330 --> 01:05:49.280
So, thank you.

1341
01:05:49.700 --> 01:05:52.190
(applause)

1342
01:06:07.050 --> 01:06:08.190
Any comments?

1343
01:06:14.750 --> 01:06:15.440
Devina.

1344
01:06:15.990 --> 01:06:19.780
(No microphone being used, unable to hear)

1345
01:07:04.080 --> 01:07:05.680
So I don't know if you
all heard the question,

1346
01:07:05.680 --> 01:07:07.370
but it's basically, why
haven't you emphasized

1347
01:07:07.370 --> 01:07:11.180
DBT and other

1348
01:07:11.650 --> 01:07:14.370
contemporary approaches to therapy.

1349
01:07:15.150 --> 01:07:16.820
And basically, one of the
things I've tried to do here

1350
01:07:16.820 --> 01:07:20.570
is not to look at any
individual kind of therapy.

1351
01:07:21.490 --> 01:07:23.790
Part of that is because as
we look at the research,

1352
01:07:23.790 --> 01:07:26.620
the outcome shows that
the impact of therapy

1353
01:07:26.620 --> 01:07:30.940
is about 8% of the overall cause of change

1354
01:07:30.940 --> 01:07:34.470
and that that's less than what's caused

1355
01:07:34.470 --> 01:07:37.790
by the alliance or the
factors based on the client.

1356
01:07:38.880 --> 01:07:41.050
So I haven't tried to call out, you know,

1357
01:07:41.050 --> 01:07:44.530
family systems theory or EMDR, or DBT.

1358
01:07:45.480 --> 01:07:47.350
That said, Devina, I
agree with you and I think

1359
01:07:47.350 --> 01:07:50.150
part of what we have to do is to educate

1360
01:07:50.150 --> 01:07:53.160
students in the theories
behind these approaches,

1361
01:07:53.160 --> 01:07:57.400
and also to note that in
some of them like DBT,

1362
01:07:57.400 --> 01:08:00.150
there is actually a range of theories

1363
01:08:01.220 --> 01:08:03.030
and that there's no one theory that guides

1364
01:08:03.030 --> 01:08:04.870
the intervention, there
are actually several

1365
01:08:04.870 --> 01:08:07.860
different components,
each of which is based

1366
01:08:07.860 --> 01:08:09.620
on a somewhat different take.

1367
01:08:10.410 --> 01:08:13.040
So in no way do I mean
to devalue attention

1368
01:08:13.040 --> 01:08:15.630
to those theories and to those practices.

1369
01:08:16.150 --> 01:08:18.480
I think, in fact, they
are increasingly part

1370
01:08:18.480 --> 01:08:20.530
of what we're providing here,

1371
01:08:21.620 --> 01:08:23.310
but it was not my intention tonight

1372
01:08:23.310 --> 01:08:26.190
to really identify any specific theory,

1373
01:08:26.190 --> 01:08:29.660
other than to speak to
what I think is a slightly

1374
01:08:29.660 --> 01:08:31.690
off target understanding of Smith

1375
01:08:31.690 --> 01:08:35.650
that we're so psychodynamic
that we're nothing else.

1376
01:08:37.130 --> 01:08:41.560
And in my view, that hasn't
been true for decades.

1377
01:08:42.470 --> 01:08:44.730
I was hired by Ann
Hartman and at that point,

1378
01:08:44.730 --> 01:08:47.570
looking at what was
offered, there was equal

1379
01:08:47.570 --> 01:08:50.410
attention to individual
theories, family theories

1380
01:08:50.410 --> 01:08:51.730
and groups.

1381
01:08:53.720 --> 01:08:55.320
So, you know, the idea
was to provide people

1382
01:08:55.320 --> 01:08:58.410
multiple exposures and
multiple opportunities

1383
01:08:58.410 --> 01:09:01.030
because there's no just one single way

1384
01:09:01.030 --> 01:09:02.480
to do anything.

1385
01:09:03.990 --> 01:09:06.530
I think I'm answering your
question, but I don't know

1386
01:09:06.530 --> 01:09:08.170
if I'm doing it fully.

1387
01:09:09.530 --> 01:09:12.300
So there was no intention
to devalue any contemporary,

1388
01:09:12.300 --> 01:09:14.110
empirically supported treatment,

1389
01:09:15.290 --> 01:09:16.870
though one of the things
I think we do have to do

1390
01:09:16.870 --> 01:09:21.210
is to be critical thinkers
about them and I run

1391
01:09:21.210 --> 01:09:23.870
a doctoral course for
third summer students

1392
01:09:23.870 --> 01:09:26.320
where we look at the empirical support

1393
01:09:26.320 --> 01:09:27.820
for some of these treatments,

1394
01:09:27.820 --> 01:09:30.740
and in fact it's a whole lot
thinner than you might think.

1395
01:09:32.120 --> 01:09:33.690
And one of the big
problems, especially with

1396
01:09:33.690 --> 01:09:36.290
something like DBT, is that
almost all the research

1397
01:09:36.290 --> 01:09:40.120
is done by Linehan, and what happens is

1398
01:09:40.120 --> 01:09:42.470
when people research their own treatments,

1399
01:09:42.470 --> 01:09:45.470
it tends to look better
than when other people

1400
01:09:45.470 --> 01:09:48.790
research it, which is
know as attribution by us.

1401
01:09:49.640 --> 01:09:51.140
And don't misunderstand me, I'm not saying

1402
01:09:51.140 --> 01:09:53.960
that DBT is not helpful to lots of people.

1403
01:09:54.710 --> 01:09:57.640
I think that it can be, but
I also think that we need

1404
01:09:57.640 --> 01:09:59.680
to be both aware of these theories

1405
01:09:59.680 --> 01:10:01.300
and critical about them.

1406
01:10:02.520 --> 01:10:03.740
Barbara.

1407
01:10:04.360 --> 01:10:06.420
- [Voiceover] You make
a very compelling case

1408
01:10:06.420 --> 01:10:11.250
for a national clinical social work voice.

1409
01:10:12.760 --> 01:10:15.900
I sort of wonder how
you see that in regard

1410
01:10:15.900 --> 01:10:20.500
to say NASW and the idea that some people

1411
01:10:20.500 --> 01:10:22.570
consider themselves social workers

1412
01:10:22.570 --> 01:10:27.570
but might not have identified
as clinical social workers

1413
01:10:27.980 --> 01:10:31.550
and, I'm just looking
forward, I just wonder

1414
01:10:31.550 --> 01:10:33.470
how you see that?

1415
01:10:34.850 --> 01:10:38.260
I mean should all social workers be ...

1416
01:10:40.240 --> 01:10:43.430
do you that there's another group

1417
01:10:43.430 --> 01:10:45.800
of social workers that
are not clinical or ...

1418
01:10:45.800 --> 01:10:48.580
how would that work on a national level?

1419
01:10:48.930 --> 01:10:49.630
- That's a great question.

1420
01:10:49.630 --> 01:10:51.400
So you know as everybody
who does social work

1421
01:10:51.400 --> 01:10:53.390
practice a clinical social worker?

1422
01:10:54.240 --> 01:10:57.520
Well I don't think a lot
imagine themselves that way,

1423
01:10:58.080 --> 01:11:00.540
and I think part of that is
that many social work programs

1424
01:11:00.540 --> 01:11:03.180
In the United States at
the Master's level train

1425
01:11:03.180 --> 01:11:04.930
advanced generalists.

1426
01:11:06.520 --> 01:11:08.110
When you ask those people
what they're trained

1427
01:11:08.110 --> 01:11:10.770
to do it's like everything.

1428
01:11:11.860 --> 01:11:14.810
- [Voiceover] What community
organization (mumbles).

1429
01:11:15.160 --> 01:11:16.860
- Oh, I have no quarrel
with we should have groups,

1430
01:11:16.860 --> 01:11:19.590
in fact, the COSA for community organizers

1431
01:11:19.590 --> 01:11:23.400
is very active group and
there are active groups

1432
01:11:23.400 --> 01:11:24.890
for policy planners.

1433
01:11:25.770 --> 01:11:27.100
The interesting thing to me is that

1434
01:11:27.100 --> 01:11:31.280
there's no single group
for clinical social work,

1435
01:11:31.280 --> 01:11:32.490
there are several.

1436
01:11:33.280 --> 01:11:35.410
And what's the alternative, I mean

1437
01:11:35.410 --> 01:11:37.030
to be a direct practitioner?

1438
01:11:38.580 --> 01:11:41.050
I'm not sure that people aspire to be

1439
01:11:41.050 --> 01:11:44.270
you know, social work
direct practitioners.

1440
01:11:44.780 --> 01:11:45.860
Now some of this has to do with how

1441
01:11:45.860 --> 01:11:49.010
we imagine ourselves and
how we label ourselves,

1442
01:11:50.350 --> 01:11:52.210
and I'm not sure there's
an easy answer to that.

1443
01:11:52.900 --> 01:11:53.900
You know when we look at the numbers

1444
01:11:53.900 --> 01:11:56.370
of what people do, children,
families and schools

1445
01:11:56.370 --> 01:11:59.300
has more than mental
health for medical settings

1446
01:11:59.300 --> 01:12:01.060
in terms of practitioners.

1447
01:12:02.070 --> 01:12:06.240
School social workers have
small scale organizations,

1448
01:12:06.240 --> 01:12:08.900
but they don't do national advocacy.

1449
01:12:09.640 --> 01:12:11.650
There might be some way to
tuck these groups together,

1450
01:12:11.650 --> 01:12:14.590
but I'm going to argue that
I think the first thing

1451
01:12:14.590 --> 01:12:17.000
we ought to do is to
get our house in order,

1452
01:12:17.680 --> 01:12:18.960
and I think we do know enough about

1453
01:12:18.960 --> 01:12:22.030
clinical social work to
support it and affirm it.

1454
01:12:22.530 --> 01:12:24.380
And we ought to do a better job of that

1455
01:12:24.900 --> 01:12:27.330
and we need to work with
our friends in advocacy

1456
01:12:27.330 --> 01:12:30.320
to take it on and do a better job.

1457
01:12:32.270 --> 01:12:34.260
I've been a board member for Mass NASW,

1458
01:12:34.260 --> 01:12:36.200
I'm a member, I'm committed to it.

1459
01:12:36.200 --> 01:12:39.610
I've been part of the
Massachusetts board's

1460
01:12:39.610 --> 01:12:42.930
group to do strategic planning
for the next three years.

1461
01:12:43.950 --> 01:12:45.550
We surveyed the membership
in Massachusetts,

1462
01:12:46.620 --> 01:12:48.140
what came back from the survey?

1463
01:12:48.620 --> 01:12:50.100
We need title protection.

1464
01:12:50.920 --> 01:12:52.490
Many of you are not from Massachusetts,

1465
01:12:52.490 --> 01:12:55.090
but recently we had a
couple of highly publicized

1466
01:12:55.090 --> 01:12:57.960
deaths of kids in the
care of the Department

1467
01:12:57.960 --> 01:12:59.910
of Child and Family Services.

1468
01:13:01.000 --> 01:13:02.820
The solution was to fire the director,

1469
01:13:03.370 --> 01:13:05.780
as if that was going to change services.

1470
01:13:07.440 --> 01:13:08.960
You know, may be it was
an appropriate step,

1471
01:13:08.960 --> 01:13:10.670
I'm not questioning that, but I'm not sure

1472
01:13:10.670 --> 01:13:12.060
it's the solution.

1473
01:13:14.350 --> 01:13:16.180
The interesting thing
is the social workers

1474
01:13:16.180 --> 01:13:20.280
through Protective
Services in Massachusetts

1475
01:13:20.280 --> 01:13:22.170
are called social workers.

1476
01:13:23.090 --> 01:13:25.490
So the public doesn't
understand the distinction

1477
01:13:25.490 --> 01:13:28.160
between what clinical social workers do

1478
01:13:28.160 --> 01:13:30.560
that requires a different value set

1479
01:13:30.560 --> 01:13:32.280
and basis in training.

1480
01:13:33.000 --> 01:13:34.360
So what does the survey say

1481
01:13:34.360 --> 01:13:36.080
from Massachusetts social workers?

1482
01:13:37.000 --> 01:13:39.600
Protect our title, make sure that people

1483
01:13:39.600 --> 01:13:42.210
better know what we do, that maybe

1484
01:13:42.210 --> 01:13:44.610
the people who work for
Child and Family Services

1485
01:13:44.610 --> 01:13:47.710
ought to be Protective
workers or something else

1486
01:13:47.710 --> 01:13:49.950
that doesn't call on
the same thing as people

1487
01:13:49.950 --> 01:13:52.840
with licensure in the
state, and I don't think

1488
01:13:52.840 --> 01:13:54.020
this is a unique idea.

1489
01:13:54.020 --> 01:13:56.240
I think this is probably true
in a lot of different states.

1490
01:13:57.050 --> 01:13:58.220
The other thing they asked for was to

1491
01:13:58.220 --> 01:14:01.430
be more effective in supports for better

1492
01:14:01.430 --> 01:14:04.080
working conditions and rates of payment.

1493
01:14:06.830 --> 01:14:08.850
Now those are entirely reasonable things.

1494
01:14:09.770 --> 01:14:11.740
But how do you organize
that without thinking

1495
01:14:11.740 --> 01:14:14.520
about what kinds of
services are we providing?

1496
01:14:15.240 --> 01:14:16.970
And one of the challenges for NASW,

1497
01:14:16.970 --> 01:14:18.980
and I think there are tremendous people

1498
01:14:18.980 --> 01:14:21.050
working for NASW and in support of it,

1499
01:14:21.050 --> 01:14:24.580
is how do you focus these
efforts to make them

1500
01:14:24.580 --> 01:14:26.570
effective in specific areas?

1501
01:14:27.450 --> 01:14:30.600
I'm going to argue we haven't
been effective in ACA.

1502
01:14:31.660 --> 01:14:33.980
That in Obamacare the
role of social workers

1503
01:14:33.980 --> 01:14:36.270
is not good, this is not going to help us.

1504
01:14:37.190 --> 01:14:41.100
I'm not saying I'm not in
favor of what it offers,

1505
01:14:41.100 --> 01:14:43.150
I think it offers wonderful opportunities.

1506
01:14:44.100 --> 01:14:45.740
But one of the things I
heard at a strategic planning

1507
01:14:45.740 --> 01:14:48.970
meeting was by an social
worker who is a policy

1508
01:14:48.970 --> 01:14:53.180
planner and economist, and
lo and behold, it turns out

1509
01:14:53.180 --> 01:14:56.150
that in the ACA, the payment
rates for administrators

1510
01:14:56.150 --> 01:14:58.420
are a totally separate money line

1511
01:14:58.420 --> 01:15:00.700
than for direct practitioners.

1512
01:15:02.520 --> 01:15:04.050
And if you look at the payment rates,

1513
01:15:04.050 --> 01:15:06.340
looking at the New York
Times, they did a survey.

1514
01:15:07.190 --> 01:15:09.840
There was a small mental
health center in New Jersey.

1515
01:15:10.630 --> 01:15:13.050
The director was paid $22,000.

1516
01:15:15.030 --> 01:15:16.300
You'd think that'd be appalling,

1517
01:15:16.300 --> 01:15:19.940
but the person made $20,000,000

1518
01:15:19.940 --> 01:15:22.360
in side income.

1519
01:15:24.110 --> 01:15:25.990
Okay, in non-direct payments.

1520
01:15:26.680 --> 01:15:27.810
That stuff is actually allowed

1521
01:15:27.810 --> 01:15:30.150
under ACA and the whole rules

1522
01:15:30.150 --> 01:15:31.950
and regulations for administrators

1523
01:15:31.950 --> 01:15:34.430
is a separate funding
source from practitioners.

1524
01:15:34.790 --> 01:15:37.520
It makes no sense that we have folks

1525
01:15:37.520 --> 01:15:42.520
being paid 200 times, 400
times what line workers are.

1526
01:15:43.490 --> 01:15:45.670
So I think we need to be much more active.

1527
01:15:45.930 --> 01:15:47.120
I'm not sure I'm answering your question,

1528
01:15:47.120 --> 01:15:49.530
but it's a great one and
it would be wonderful

1529
01:15:49.530 --> 01:15:51.900
if we could work not only
as clinical social workers

1530
01:15:51.900 --> 01:15:55.460
but to be more effective as
social workers as a whole.

1531
01:15:56.840 --> 01:15:58.880
And what I hear from NASW national,

1532
01:15:58.880 --> 01:16:01.980
and Jeane Anastas, who was faculty here,

1533
01:16:01.980 --> 01:16:05.280
is our current president of NASW

1534
01:16:05.280 --> 01:16:06.770
and just ending her term.

1535
01:16:07.550 --> 01:16:09.220
And Jeane said basically
one of the big problems is

1536
01:16:09.220 --> 01:16:11.220
we don't have enough funding support

1537
01:16:11.220 --> 01:16:14.390
from our members to do
the kinds of lobbying

1538
01:16:14.390 --> 01:16:15.530
they want to do.

1539
01:16:17.860 --> 01:16:20.630
So some of it is we have
to provide better support

1540
01:16:20.630 --> 01:16:23.680
for people to have the
voice in our own support.

1541
01:16:24.500 --> 01:16:26.440
And that's a dilemma
because we're not rich,

1542
01:16:26.440 --> 01:16:28.020
we don't have deep pockets.

1543
01:16:28.870 --> 01:16:30.160
So how do you do that?

1544
01:16:30.870 --> 01:16:33.170
But maybe numerous voices is a solution

1545
01:16:33.170 --> 01:16:36.400
where money, per se, can't be.

1546
01:16:38.680 --> 01:16:39.770
Anybody else?

1547
01:16:40.380 --> 01:16:41.250
You sir.

1548
01:16:41.250 --> 01:16:42.240
Go back.

1549
01:16:43.150 --> 01:16:44.190
- [Voiceover] I guess
I sort of want to stay

1550
01:16:44.190 --> 01:16:46.690
with the discussion of what
is a clinical social worker

1551
01:16:47.880 --> 01:16:50.930
because it seems to be sort of central

1552
01:16:50.930 --> 01:16:55.030
and you know the clearest ...

1553
01:16:55.030 --> 01:16:57.200
I guess I'm sitting here wondering,

1554
01:16:59.580 --> 01:17:00.870
I'm a little confused what a clinical

1555
01:17:00.870 --> 01:17:01.860
social worker is still.

1556
01:17:03.440 --> 01:17:05.380
And wondering if that is not part

1557
01:17:05.380 --> 01:17:07.340
of the problem here in many ways.

1558
01:17:07.340 --> 01:17:08.550
How do you advocate for something

1559
01:17:09.510 --> 01:17:12.420
if it is unclear what the thing is,

1560
01:17:12.420 --> 01:17:13.880
your advocating (mumbles),

1561
01:17:13.880 --> 01:17:16.390
and I get really uncomfortable

1562
01:17:16.390 --> 01:17:17.670
listening to

1563
01:17:19.620 --> 01:17:21.830
conversations that happen here, let's say,

1564
01:17:21.830 --> 01:17:24.560
or in other places that seriously tries

1565
01:17:24.560 --> 01:17:27.000
to distinguish, we'll
say well that's just,

1566
01:17:27.000 --> 01:17:30.350
that's just case management.

1567
01:17:32.460 --> 01:17:34.770
Yeah, it's the sense that there's

1568
01:17:34.770 --> 01:17:36.540
a kind of elitism that says if you're

1569
01:17:36.540 --> 01:17:39.440
doing that then it's not real social work,

1570
01:17:39.440 --> 01:17:42.210
and I mean as a historian

1571
01:17:42.210 --> 01:17:44.510
I go back to looking at case work,

1572
01:17:44.510 --> 01:17:45.880
the beginnings of case work

1573
01:17:45.880 --> 01:17:48.220
and case management and going into

1574
01:17:48.220 --> 01:17:49.710
people's homes and working in the homes

1575
01:17:49.710 --> 01:17:51.990
and trying to help people find jobs,

1576
01:17:51.990 --> 01:17:55.590
and enough food, and doing clinical work

1577
01:17:55.590 --> 01:17:58.180
in those settings is what social work was.

1578
01:17:58.860 --> 01:18:01.100
So it seems to me that perhaps we should

1579
01:18:01.100 --> 01:18:03.500
spend some time trying to reconfigure

1580
01:18:03.500 --> 01:18:05.700
or reimagine what the borders of

1581
01:18:05.700 --> 01:18:07.940
clinical social work really is and

1582
01:18:07.940 --> 01:18:09.160
we might have a better time arguing

1583
01:18:09.160 --> 01:18:11.170
for ourselves if we had a better

1584
01:18:11.170 --> 01:18:14.580
definition brought, or some more clarity,

1585
01:18:14.580 --> 01:18:15.560
something.

1586
01:18:15.800 --> 01:18:16.930
- Are you all hearing this?

1587
01:18:18.340 --> 01:18:20.820
I have no quarrel with what you're saying

1588
01:18:20.820 --> 01:18:21.860
at all.

1589
01:18:22.290 --> 01:18:23.350
I actually think one of the things about

1590
01:18:23.350 --> 01:18:25.120
being a clinical social worker is

1591
01:18:25.120 --> 01:18:26.990
a perspective and a portable one,

1592
01:18:26.990 --> 01:18:29.530
but it also requires having a background

1593
01:18:29.530 --> 01:18:31.830
in multiple theories and approaches

1594
01:18:31.830 --> 01:18:34.630
and particular ways of using yourself

1595
01:18:34.630 --> 01:18:37.670
that allow you to do more in situations

1596
01:18:37.670 --> 01:18:39.340
that people without that background

1597
01:18:39.340 --> 01:18:40.720
may be able to do.

1598
01:18:41.360 --> 01:18:44.230
It's not necessary in all cases,

1599
01:18:44.230 --> 01:18:46.510
but in some situations it's really, really

1600
01:18:46.510 --> 01:18:49.600
important, and it does may a difference.

1601
01:18:50.370 --> 01:18:53.080
So I in no way mean to devalue, you know,

1602
01:18:53.080 --> 01:18:56.190
social work that doesn't have a more

1603
01:18:59.380 --> 01:19:00.540
specialized focus.

1604
01:19:01.260 --> 01:19:02.430
In fact, I think what we're looking at

1605
01:19:02.430 --> 01:19:05.710
is both, and, and, and, and.

1606
01:19:06.360 --> 01:19:07.870
And clinical social workers just do

1607
01:19:07.870 --> 01:19:12.390
more stuff than some
other social workers do.

1608
01:19:12.800 --> 01:19:14.390
That's a crumby definition, right?

1609
01:19:14.610 --> 01:19:15.870
- [Voiceover] Yeah, because I mean what

1610
01:19:15.870 --> 01:19:17.900
the context of that more stuff is exactly

1611
01:19:17.900 --> 01:19:19.410
this is what ...

1612
01:19:19.410 --> 01:19:22.610
- Well let me go back to looking at

1613
01:19:22.610 --> 01:19:26.820
how state law has formulated what

1614
01:19:26.820 --> 01:19:29.390
clinical social work is, it's basically

1615
01:19:29.390 --> 01:19:32.190
in terms of mental, emotional,

1616
01:19:32.190 --> 01:19:34.690
and behavioral disorders and their

1617
01:19:34.690 --> 01:19:37.810
assessment, prevention, and treatment.

1618
01:19:39.300 --> 01:19:41.160
So in some respects, it really is

1619
01:19:41.160 --> 01:19:42.550
a specific skill set.

1620
01:19:43.530 --> 01:19:44.870
But to do that work and to be,

1621
01:19:47.150 --> 01:19:48.970
to not be cognizant of your client

1622
01:19:48.970 --> 01:19:52.040
doesn't get three square meals,

1623
01:19:52.040 --> 01:19:54.310
or Carolyn du Bois presented a case

1624
01:19:54.310 --> 01:19:57.310
at orientation where a young boy

1625
01:19:57.310 --> 01:19:58.690
kicked his teacher.

1626
01:19:59.620 --> 01:20:01.720
And part of the story basically goes

1627
01:20:01.720 --> 01:20:04.950
that later they find
out this kid has dental

1628
01:20:04.950 --> 01:20:07.020
problems and abscesses all through

1629
01:20:07.020 --> 01:20:10.060
his mouth and the teacher says something

1630
01:20:10.060 --> 01:20:12.230
to the effect of when I reached out

1631
01:20:12.230 --> 01:20:15.170
to him I might have appeared to be

1632
01:20:15.170 --> 01:20:16.880
going towards his face.

1633
01:20:17.970 --> 01:20:19.670
The kid may have kicked her because

1634
01:20:19.670 --> 01:20:22.320
he was trying to keep
her from hurting him.

1635
01:20:24.010 --> 01:20:25.210
Now the teacher didn't know this

1636
01:20:25.210 --> 01:20:27.100
and it took like months of understanding

1637
01:20:27.100 --> 01:20:30.650
the kid's broader needs to make sense

1638
01:20:30.650 --> 01:20:32.030
of this whole situation.

1639
01:20:32.640 --> 01:20:33.950
But nobody had done it before

1640
01:20:33.950 --> 01:20:36.150
and I think some of what we do

1641
01:20:36.150 --> 01:20:39.020
does come back down to this isn't

1642
01:20:39.020 --> 01:20:41.480
a mental illness or a disorder,

1643
01:20:41.480 --> 01:20:43.690
this was a physical problem

1644
01:20:43.690 --> 01:20:46.580
that had interpersonal consequences.

1645
01:20:49.030 --> 01:20:50.530
I don't know how much skill that takes,

1646
01:20:50.530 --> 01:20:52.300
but I think there are a lot of situations

1647
01:20:52.300 --> 01:20:55.570
with clients where you do need

1648
01:20:55.570 --> 01:20:57.770
an extensive theory background

1649
01:20:57.770 --> 01:21:00.400
and terrific use of self, and I fear

1650
01:21:00.400 --> 01:21:02.210
that a lot of social work programs

1651
01:21:02.210 --> 01:21:04.280
don't aim for excellence in that,

1652
01:21:04.280 --> 01:21:06.480
and it's really tough to pull off.

1653
01:21:06.480 --> 01:21:09.020
Each of us will have areas of strength

1654
01:21:09.020 --> 01:21:10.050
and limitation.

1655
01:21:10.050 --> 01:21:12.290
We're not all good at everything,

1656
01:21:12.290 --> 01:21:13.940
even with advanced training.

1657
01:21:14.890 --> 01:21:16.540
But you're asking a great question.

1658
01:21:18.130 --> 01:21:19.660
I'm looking at the time and maybe

1659
01:21:19.660 --> 01:21:20.680
we can take one more?

1660
01:21:21.630 --> 01:21:26.630
(No microphone being used, unable to hear)

1661
01:22:10.610 --> 01:22:13.790
- You know, and that's a
really, really tough area.

1662
01:22:14.420 --> 01:22:17.050
The issue is, you know, what constitutes

1663
01:22:17.050 --> 01:22:20.370
a quality review for clinical
social work practice?

1664
01:22:21.220 --> 01:22:22.830
And increasingly insurance companies

1665
01:22:22.830 --> 01:22:25.000
and providers are asking us to

1666
01:22:25.000 --> 01:22:27.360
be accountable and interestingly,

1667
01:22:27.360 --> 01:22:28.800
kind of like a lot of research,

1668
01:22:28.800 --> 01:22:32.150
much of this reduces to symptom profiles.

1669
01:22:33.440 --> 01:22:35.740
And one of the dilemmas I
think that clinicians face

1670
01:22:35.740 --> 01:22:38.040
is that it seems to suck
the life out of what

1671
01:22:38.040 --> 01:22:39.860
the work is actually about,

1672
01:22:41.340 --> 01:22:42.580
and when I think about clients that I've

1673
01:22:42.580 --> 01:22:45.650
worked with, it's
progress when a particular

1674
01:22:45.650 --> 01:22:47.750
woman who I've seen several times

1675
01:22:47.750 --> 01:22:51.250
and sits tight and
anxious, takes her purse

1676
01:22:51.250 --> 01:22:53.420
off her lap and puts it down on the floor

1677
01:22:53.420 --> 01:22:54.640
for the first time.

1678
01:22:55.560 --> 01:22:57.030
I mean, how can I justify that for

1679
01:22:57.030 --> 01:22:58.480
an insurance company?

1680
01:22:59.330 --> 01:23:01.530
But it's a step in a direction toward

1681
01:23:01.530 --> 01:23:02.780
something larger.

1682
01:23:03.470 --> 01:23:05.070
And I think many of the small victories

1683
01:23:05.070 --> 01:23:06.970
that we find as clinical social workers

1684
01:23:06.970 --> 01:23:10.320
are totally unrecognized
in quality review,

1685
01:23:11.370 --> 01:23:13.270
and then you get into bigger issues

1686
01:23:13.270 --> 01:23:15.370
of what should we pay for and what

1687
01:23:15.370 --> 01:23:17.300
kind of success do we require?

1688
01:23:18.010 --> 01:23:19.180
Let me just say one other thing here,

1689
01:23:19.180 --> 01:23:22.450
research on the efficacy of psychotherapy,

1690
01:23:22.450 --> 01:23:24.590
the magnitude of what's gained

1691
01:23:24.590 --> 01:23:27.160
by being in therapy, basically shows

1692
01:23:27.160 --> 01:23:28.620
that often therapy has

1693
01:23:28.620 --> 01:23:32.630
probably twice the gain of many

1694
01:23:32.630 --> 01:23:34.110
medical procedures.

1695
01:23:35.530 --> 01:23:37.030
So when you look at actual outcome

1696
01:23:37.030 --> 01:23:40.240
numbers, what we do is more efficacious

1697
01:23:40.240 --> 01:23:42.170
than all kinds of medical procedures

1698
01:23:42.170 --> 01:23:43.660
and medications.

1699
01:23:44.810 --> 01:23:46.040
Which I think is something most people

1700
01:23:46.040 --> 01:23:48.550
are not even aware of, but when

1701
01:23:48.550 --> 01:23:50.410
you look at what quality's about,

1702
01:23:50.410 --> 01:23:52.550
and then there are disorders that

1703
01:23:52.550 --> 01:23:54.770
are mind boggling.

1704
01:23:56.190 --> 01:23:58.420
I think the stats from the New York Times

1705
01:23:58.420 --> 01:24:00.950
were in the United States we pay

1706
01:24:00.950 --> 01:24:05.950
$420,000,000,000 annually
for back pain treatment,

1707
01:24:07.320 --> 01:24:10.910
most of which produces no useful result.

1708
01:24:11.800 --> 01:24:14.790
$420,000,000,000.

1709
01:24:17.240 --> 01:24:18.710
So when you're looking at quality review

1710
01:24:18.710 --> 01:24:20.030
I think there's several issues.

1711
01:24:20.540 --> 01:24:22.300
What constitutes quality?

1712
01:24:22.300 --> 01:24:23.880
How fine grain is it?

1713
01:24:23.880 --> 01:24:25.620
How big a sweep does it take?

1714
01:24:25.620 --> 01:24:27.750
And again, I think clinical social work

1715
01:24:27.750 --> 01:24:29.820
organizations have to help providers

1716
01:24:29.820 --> 01:24:32.860
understand what are the parameters

1717
01:24:32.860 --> 01:24:34.560
of our success and what are

1718
01:24:34.560 --> 01:24:35.960
we aspiring to do,

1719
01:24:35.960 --> 01:24:37.960
but it's a really tough nut to crack,

1720
01:24:37.960 --> 01:24:42.050
so I appreciate the profound difficulty.

1721
01:24:42.700 --> 01:24:43.390
Nick.

1722
01:24:43.390 --> 01:24:44.770
- [Voiceover] I just want to acknowledge

1723
01:24:44.770 --> 01:24:47.850
you gave a more upbeat piece to it.

1724
01:24:48.640 --> 01:24:50.990
We've needed (mumbles)
for about two years.

1725
01:24:51.270 --> 01:24:54.710
I want to say that the
social work students

1726
01:24:54.710 --> 01:24:58.010
that we get, and when I think about

1727
01:24:58.010 --> 01:25:01.720
what I learned I don't
think that (mumbles)

1728
01:25:01.720 --> 01:25:03.040
what I learned is wrong.

1729
01:25:03.650 --> 01:25:06.720
I think the theory (mumbles), I think

1730
01:25:06.720 --> 01:25:09.330
the critical thinking skills is what

1731
01:25:09.330 --> 01:25:13.160
differentiates the social
work from (mumbles)

1732
01:25:13.160 --> 01:25:17.300
and I've always felt it's been

1733
01:25:17.300 --> 01:25:19.600
far better than the other schools.

1734
01:25:19.600 --> 01:25:22.170
Smith is good, but there's other good

1735
01:25:22.170 --> 01:25:23.360
schools too.

1736
01:25:24.110 --> 01:25:25.330
(laughing)

1737
01:25:25.880 --> 01:25:26.910
- Absolutely.

1738
01:25:26.910 --> 01:25:28.140
- [Voiceover] But I want to say I think

1739
01:25:28.140 --> 01:25:30.780
the social workers have the best

1740
01:25:30.780 --> 01:25:32.880
critical thinking skills and I really

1741
01:25:32.880 --> 01:25:36.750
like the term that says
keep it complicated.

1742
01:25:36.750 --> 01:25:39.490
I know that sounds weird, but people

1743
01:25:39.490 --> 01:25:41.460
come in thinking they're going

1744
01:25:41.460 --> 01:25:44.260
to summarize the person in a sentence

1745
01:25:44.260 --> 01:25:46.550
and it just isn't likely.

1746
01:25:48.090 --> 01:25:50.430
- I have to point out
that Nick Flescher and I

1747
01:25:50.430 --> 01:25:53.270
were students here together at Smith

1748
01:25:53.270 --> 01:25:55.230
in the Master's program and

1749
01:25:55.230 --> 01:25:59.480
Nick and his wife Peggy have both

1750
01:25:59.480 --> 01:26:00.900
served as supervisors for a lot

1751
01:26:00.900 --> 01:26:01.960
of our students.

1752
01:26:03.080 --> 01:26:05.350
I hope I haven't maligned administrators

1753
01:26:05.350 --> 01:26:08.420
tonight, because actually I think

1754
01:26:08.420 --> 01:26:11.210
that to be a social
service administrator now

1755
01:26:11.210 --> 01:26:13.590
is very, very difficult and I go back

1756
01:26:13.590 --> 01:26:16.450
to that little vignette of we don't

1757
01:26:16.450 --> 01:26:18.260
get paid enough to cover the cost

1758
01:26:18.260 --> 01:26:19.450
of services.

1759
01:26:20.060 --> 01:26:21.310
How do you deal with that?

1760
01:26:21.890 --> 01:26:23.120
- [Voiceover] Well I think that people

1761
01:26:23.120 --> 01:26:25.740
(mumbles) I said many of you will

1762
01:26:25.740 --> 01:26:27.070
be going into administration

1763
01:26:27.070 --> 01:26:30.170
because (laughing drowns out words)

1764
01:26:30.170 --> 01:26:32.170
care act there's going to be a lot

1765
01:26:32.170 --> 01:26:35.510
of money coming towards the kind

1766
01:26:35.510 --> 01:26:37.580
of work that we do, but it's going

1767
01:26:37.580 --> 01:26:40.620
to be coming at Bachelor's level,

1768
01:26:40.620 --> 01:26:42.790
there's going to be supervisors

1769
01:26:42.790 --> 01:26:46.880
and coordinators and planners (mumbles)

1770
01:26:46.880 --> 01:26:50.110
and I think (mumbles).

1771
01:26:51.560 --> 01:26:53.720
- And indeed nationally,

1772
01:26:53.720 --> 01:26:56.180
(two people talking over each other)

1773
01:26:57.230 --> 01:27:01.400
- [Voiceover] There is a new appreciation

1774
01:27:01.400 --> 01:27:05.240
that integrating (mumbles)
behavioral health

1775
01:27:05.240 --> 01:27:08.810
(mumbles) integrate behavioral health

1776
01:27:08.810 --> 01:27:12.420
with medical care and that's going to be

1777
01:27:14.490 --> 01:27:16.220
you know, the kind of
direction things are going,

1778
01:27:16.220 --> 01:27:21.220
and so that social workers
are putting (mumbles).

1779
01:27:24.490 --> 01:27:27.060
- I hope it plays out in that way,

1780
01:27:27.060 --> 01:27:29.170
I do want to point out that I don't think

1781
01:27:29.170 --> 01:27:31.100
that all of the reasons that folks come

1782
01:27:31.100 --> 01:27:34.720
to us are medical conditions,

1783
01:27:36.470 --> 01:27:39.780
and you know, philosophically we all

1784
01:27:39.780 --> 01:27:41.580
have different positions on, you know,

1785
01:27:41.580 --> 01:27:42.350
the role of medication.

1786
01:27:42.350 --> 01:27:45.390
Maybe it all is medical at some level.

1787
01:27:46.150 --> 01:27:47.580
But I'm not sure we have the technology,

1788
01:27:47.580 --> 01:27:49.840
the expertise to go their quite yet.

1789
01:27:50.950 --> 01:27:52.790
I think Nick is also making another point.

1790
01:27:52.790 --> 01:27:55.860
Roger Miller who is now
professor emeritus here

1791
01:27:55.860 --> 01:28:00.060
and some of you may know, one of Roger's

1792
01:28:00.060 --> 01:28:02.430
favorite lines was, you know all theories

1793
01:28:02.430 --> 01:28:03.550
are wrong.

1794
01:28:04.670 --> 01:28:06.700
And it's true, all theories are wrong

1795
01:28:06.700 --> 01:28:08.840
that's why they're theories, but their

1796
01:28:08.840 --> 01:28:10.920
purpose is to guide our thinking.

1797
01:28:11.510 --> 01:28:12.630
It's not that they're always right,

1798
01:28:12.630 --> 01:28:14.040
and as Nick is saying, we do have

1799
01:28:14.040 --> 01:28:16.610
to be critical thinkers about their

1800
01:28:16.610 --> 01:28:18.850
application, but we also need to

1801
01:28:18.850 --> 01:28:21.950
have ways to imagine other people

1802
01:28:23.200 --> 01:28:25.510
and to open things up
and to think further.

1803
01:28:26.190 --> 01:28:27.620
But thank you for that ray of sunshine,

1804
01:28:27.620 --> 01:28:29.860
hopefully we can, through Obamacare,

1805
01:28:29.860 --> 01:28:32.240
find ways to better integrate services.

1806
01:28:33.400 --> 01:28:34.500
Thank you all very much.

1807
01:28:34.500 --> 01:28:37.120
(applause)