EDUCATIONAL QUALIFICATIONS OF SOCIAL WORKERS IN

EDUCATIONAL QUALIFICATIONS OF SOCIAL WORKERS IN PUBLIC HEALTH PROGRAMS 1. General Scope of the Field SINCE early in the 20th century, social workers have been on the staffs of hospitals and clinics for the purpose of assisting individuals and groups in solving those social problems which impede people's health and their use of medical care resources. Growing emphasis on the comprehensive approach to health and medical care has led to the inclusion of social workers in public health and mental health programs. Advances in psychiatric knowledge resulted in an increased understanding of human behavior and were applied by the health professions for deeper insight into the individual's or group's use of health services. With the passage of the Social Security Act in 1935 and of the National Mental Health Act of 1946, social work has been included as an integral part of these expanded programs. Public health programs, for purposes of this statement, are those programs administered by agencies which have as a primary focus broad responsibility for community health and for medical care and treatment. These programs are currently found in official health departments, crippled children's programs, voluntary health agencies, and community mental health programs. Public health and social work have the same broad goals. The functions of social work are complementary to those of public health. "Social work seeks to enhance the social functioning of individuals, singly or in groups, by activities focused upon the social relationships which constitute the interaction between man and his environment. These activities can be arranged into three functions: restoration of impaired capacity; provision of individual and social resources; and prevention of social dysfunction."' Public health is "the science and the art of preventing disease, prolonging life and promoting physical and mental health and efficiency through organized community efforts."2 The recognition that society contributes to inadequate social functioning has increased the demand for social workers, who are able to study and analyze social problems and social causation and to assist individuals, families, and groups to work out problems, whether the cause for these arises within their own feelings or attitudes or within the larger community in which they function. Of major concern to social workers in public health today are such problems as stresses arising from acute or chronic illness; families with multiple difficulties; financial insecurity; social and emotional stresses contributing to dependency, disability, or delinquency; and children at risk because of family ill-health. Social workers employed in public health programs apply the social work methods of social case work, social group work, community organization, research, and administration to the removal, lessening, or prevention of social and personal obstacles to health and medical care. They help in the development of the varied services necessary for the maintenance and utilization of comprehensive health services. Adaptation in social work methods may be made to meet requirements of particular agencies. FEBRUARY. 19962 317

11. Statement of Functions and Qualifications A. Duties Performed The services of social workers in public health and mental health are directed toward the identification and modification of social, psychological, and environmental factors which contribute to health problems or influence the use of health services. The social worker in the health agency discharges his responsibilities as a member of an interprofessional group in close collaboration with other public health personnel. Emphases in social work practice depend on the scope and organization of the total public health agency and the level of operation. Emphasis shifts in relation to changing needs and priorities, the availability of social work personnel, and the changing goals of the health agency. The specific functions of social workers in public health and mental health are: 1. Social Work Consultation Services -Consultation is a major responsibility of social workers in public health. It is often available on any aspect of the health department's program. More commonly it is related to the social problems of an individual or family, to problems met by other agencies, to social needs within the community, to coordination of the services of the health department with other community services, to agency administration, and to program and policy development within the department. Depending on the situation, the social worker may provide consultation service alone or as a member of an interprofessional team, as in evaluation of particular aspects of a community or institutional program. 2. Program Planning, Implementation, and Policy Formulation-Social workers in public health usually have responsibility for participating in program planning and policy development 318 in the agency. On the basis of their professional equipment and the cumulative evidence from day-to-day activity, they are generally in a position to know how policies affect individuals or groups, or what standards and programs need to be strengthened, modified, or developed. Social workers participate, with other personnel, in the development of joint projects; in the stimulation of activity on problems which fall within the jurisdiction of the health agency; and in the determination of program priorities. As a member of an interprofessional staff, social workers have the added responsibility of conferring with and advising health officers and program chiefs and supervisors in other professional areas on appropriate matters, or help in determining the most satisfactory solutions to social problems. In most health agencies, administrative and supervisory responsibilities for the social work services are assigned to one person, who is often designated chief social worker, director of social work, or chief social work program consultant. In some instances, primarily in mental health agencies, social workers carry out the major administrative responsibility for development of the total program of the agency. 3. Social Work Services to Individuals and Families, Social Case Work- Social case work in public health involves social study and evaluation leading to services for individuals or families who are having difficulty in social functioning, primarily as it affects their health and their ability to use health services. The problems may be those "which impinge upon the family unit or individual from the social or physical environment" or those "which the individual brings into being, in whole or in part, by modes of behavior and interaction between himself and other persons and situations."3 Individuals or families VOL. 52, NO. 2. A.J.P.H.

EDUCATIONAL QUALIFICATIONS OF SOCIAL WORKERS needing social case work may be brought to the attention of the social case worker by the members of the health team, by other agencies, by the individual or family, or they may belong to a group already identified, needing social case work on the basis of diagnosis or the type of situation. Persons within selected categories may be routinely referred for the purpose of identifying social factors which affect the individual's health problems or his use of needed health and medical services. The social worker initiates case work services in instances where resolution of social and emotional problems helps to prevent problems or facilitates care. Collaboration with other professional staff is an essential part of the case work process. Social case work service may be provided temporarily for the purposes of demonstration, in order to develop methods of effective referrals to appropriate agencies, or to facilitate more comprehensive study and treatment by the health agency. Opportunity for direct case work services is most often provided in local agencies, less frequently in state programs, and least often in programs at the national level. 4. Social Work Services to Groups- Increased use of the group process in resolving social problems is a definite trend in social work in public health. The social worker in public health may act as leader of groups of patients or family members, or as a consultant or resource person to groups or to their leaders. This group process may be used by social workers with patients in a single diagnostic category, with relatives of patients who have the same health problem, or with other groups where there is a health need. Social group workers, especially trained in social group work methods, have been used more frequently in hospitals and mental health programs than in other public health programs, although the opportunities in all are apparent. 5. Social Work Services to the Community-All members of the public health team contribute to the provision of community services. In public health, the social worker places a major emphasis on this activity, in which he applies his social work knowledge of individuals, groups, and communities and of community process, his understanding of social welfare as a social institution, and his knowledge of social work organization to the task of community planning. The social worker in public health is in a strategic position to identify, evaluate, and document social problems relating to health needs, to discover ways of preventing them, and to plan new services or to strengthen those already in existence. He serves also as an interpreter of social resources to other team members and of health services to social agencies. He thus assists in improving collaboration and in coordination of programs for health and social welfare, and in modifying or developing services to meet new needs. Social workers especially trained in the social work method of community organization have been used more often in voluntary health programs than in public health departments. 6. Research, Studies, and Surveys- Research is carried on by social workers, both independently and in collaboration with other professions in public health, mental health, and medical care programs. 7. Educational Responsibilities-The social worker is responsible for the supervision of social work students assigned to the agency for field instruction. He also participates in the preparation of students from other professions with respect to promoting an understanding of the social and health needs of individuals, groups, and com- FEBRUARY, 1962 319

munities, and ways of preventing and meeting these needs. He contributes to and benefits from the educational program of the health agency by participation in programs of staff education within the agency and in the community. B. Qualifications for Social Workers in Public Health: Professional and Personal The minimum educational qualification for all social work practice in public health and mental health programs is a master's degree from an accredited school of social work. In addition to this qualification, the social worker in public health and mental health also needs to have (or be able to develop through supervision and experience) certain personal qualities and abilities which enable him: (a) to establish and maintain effective working relationships with administrators, physicians, nurses, and other professional groups; (b) to differentiate and integrate social work services in a collaborative relationship with other professional staff; (c) to maintain his professional identity within the public health program; (d) to relate social work concepts and functions to the needs of the program and the groups served; (e) to appreciate different emphases in social work in health programs for the various levels of prevention of physical and emotional illness and disability and for the promotion of health; (f) to discern new or changing needs and to devise ways of meeting them; (g) to work with other community groups in coordinating existing services and developing new services; (h) to be skilled in analysis of situations, in expression of ideas, and in preparation and presentation of material; and (i) to participate appropriately in educational activities. He should be able to identify with the people being served in the health programs. to understand their problems of living and of sociocultural stress, to 320 determine ways of helping them toward better social functioning, and to use his knowledge imaginatively toward the development of improved health services. Social workers also need to be able to work alone, since frequently no other social worker is in the same department, program, or geographical unit. C. Classification of Different Grades of Social Work Practice The number and categories of social workers in any health department will depend on the size and scope of the agency's program. For specific increased responsibilities of a given position, particular requirements may be needed, such as additional knowledge, education, or experience. In establishing a "new" social work program in a health department, a social worker who is at least at the supervisory or senior consultant level should be employed. 1. Staff Social Worker (Junior)- The junior staff social worker should be part of a social work unit, accountable to its director for carrying out its policies, procedures, and standards. Experience in a local health department or in a district or state health department which operates programs of direct services may provide the practice in direct services to families and communities which is essential and appropriate for the beginning worker. Junior staff workers should practice under direct supervision of a social worker who meets the qualifications for senior social work consultant or supervisor. Education-A master's degree from an accredited school* of social work. Experience-No experience subsequent to graduate social work education is required. It is preferable that some of the field experience required by the school of social work will have been in a public health agency. * The Council on Social Work Education is recognized by the National Commission on Accrediting as the accrediting body for social work education. VOL. 52, NO. 2, A.J.P.H.

EDUCATIONAL QUALIFICATIONS OF SOCIAL WORKERS 2. Staff Social Worker (Senior) or Social Work Consultant - The senior staff worker may be a member of a social work unit working under the technical direction of another social worker, or in some situations he may operate more independently without supervision, but with social work consultation available regularly or occasionally. Education-A master's degree from an accredited school of social work. Experience-A minimum of two years' experience in the practice of social work in agencies maintaining acceptable standards is desirable. One of the two years should be under supervision of a qualified social worker, and preferably one year should be in a public health program. The nature of staff responsibility of this category of social worker requires ability to exercise independent judgment. It does not usually provide the type of supervision needed by inexperienced workers. Essential Knowledge, Skills, and Abilities- Included are: knowledge of all social work methods and skill in one of these methods; general understanding of the organizational structure and functions of public health agencies and of personnel operating within these programs; beginning skill in consultation; ability to establish good working relationships with other professions; and ability to collaborate effectively with community agencies. 3. Senior Social Work Consultant or Social Work Supervisor - A social worker at this level functions in a situation where he receives only broad technical direction and/or consultation from a social worker on a higher level, or in a situation where he is the only social worker in a public health program. In agencies with several social workers, the responsibilities of this position are usually supervision and coordination of a group of social workers assigned to a particular bureau, division, or program and may also include other assistance to the chief social worker or director of social work. Education-A master's degree from an accredited school of social work. Experience-In addition to the two years' experience required for senior staff worker, at least two additional years of experience in the practice of social work in agencies maintaining acceptable standards, including progressive responsibility for consultative, supervisory, or administrative activities, and including one year's experience in a public health agency. Essential Knowledge, Skills, and Abilities- In addition to the requirements for the staff worker classification, he should have: ability to adapt this knowledge to the demands of the public health setting; some knowledge and understanding of the principles of public health administration and practice; ability to function in collaboration with other professions; and skill in the consultative process. 4. Chief Social Worker, Director of Social Work, or Social Work Program Consultant-The chief social worker or director of social work is administratively related not only to the person to whom he is responsible, but also (in relation to program) to the directors of programs to which social workers are assigned. He determines selection and assignments of personnel, taking into consideration the social work needs within the total health department and the agency's program priorities. He plans and develops social work services within the agency, determining coverage and quality. He establishes policies and procedures for social work activities, and evaluates and reports on these services. As the representative of his profession in the health department, he participates in the development of overall agency policy and programs. He represents the health department in its relations to community social agencies and to other agencies when delegated the responsibility. A social work program consultant functions at a national, regional, state, or district level. He has responsibility for consultation within the health agency, or to the staffs of state and community social and health agencies, and for the development of ways of meeting social needs within the designated geographical or categorical program areas. FEBRUARY, 1962 321

Education-A master's degree from an accredited school of social work. A year's graduate study in a school of public health leading to M.P.H. or equivalent degree is also highly desirable. Experience-In addition to that experience required for a senior social work consultant or social work supervisor, at least one additional year on a consultant, administrative, or supervisory level-with responsibility for program planning, policy formulation, interpretation of professional standards, and maintenance of community contacts. Two of the five years should have been in a public health agency. Essential Knowledge, Skills, and Abilities- In addition to the requirements for the senior worker, he should have thorough knowledge of the practice of social work in public health agencies, ability to develop effective collaborative relationships with other professions, and ability to promote constructive working relationships with other agencies. For the chief social worker (or director of social work), ability to recruit and provide leadership to social work staff and to make an effective contribution to the total public health program in which this staff is involved is essential. Ill. Broad Educational Background (Undergraduate) Admission to a school of social work requires a bachelor's degree from an accredited university or college. Undergraduate students who wish to prepare for graduate education in social work usually take a broad liberal arts program. Curriculum content should include the behavioral and biological sciences and the humanities. IV. Graduate Education Basic Professional Knowledge, Skills, and Experiences 1. Basic Social Work Education (The Curriculum) - The two-year graduate social work curriculum leading to a master's degree is an integrated program of classroom and field instruction and research. This basic professional education for social work prepares students for professional practice and responsibilities in the variety of programs, services, and agencies which fall within the general field of social work. Special competence in a particular field of practice grows out of basic professional education for social work and continuing successful work-experience in that field, and/or further professional education. Since social work practice is based on scientific knowledge about society and human behavior, and on the methodology, scope, and philosophy of social work, the social worker needs to be thoroughly familiar with the nature and dynamics of human relationships, the significance in personal and social growth of the interaction between inner and external forces, the process of change both in individuals and society, the obstacles, strengths, and changing quality of the social structure, and the social work methods used. The curriculum is designed to equip students with this knowledge which falls roughly into three broad classifications arranged sequentially throughout the two-year program. (a) Social Welfare Policy and Social Services-Opportunity in class and field instruction is afforded for the student (1) to learn about the range, variety, historical development, and interrelationships of the social services that have been established to promote individual and communily welfare; (2) to understand the relationships between social services and social organization in meeting changing needs, including social legislation; (3) to acquire the knowledge, perspective, and ability to make critical appraisal of needs and priorities of present-day social welfare programs within their sociocultural context; (4) to understand the relationship of social work to other professions and programs; and (5) to accept the philosophy and value system on which social work rests. (b) Human Growth and Behavior- In the social work curriculum, knowledge is organized with a focus on social functioning of individuals, singly and in 322 VOL. 52. NO. 2, A.J.P.H.

EDUCATIONAL QUALIFICATIONS OF SOCIAL WORKERS groups. Within this framework, emphasis is placed on normal growth and development as well as on deviations from the normal, including psychopathology and physical disease and disability. The interrelationship between psychological, physiological, and social changes in the maintenance and development of health throughout the life cycle is stressed. Emphasis is given also to group behavior and group relationships, as they affect and are affected by the needs and interests of individuals. Opportunity is offered in class and field instruction for the student: (1) to integrate and utilize, in helping people to deal with social problems, an understanding of man as a purposeful sociobiopsychological organism, interacting from birth through old age with other individuals, the family, and other groups in the sociocultural milieu; (2) to develop a respect for the human individual; and (3) to understand the concepts of personal and social change as essential to social work. (c) Social Work Practice - The methods developed to carry out social work tasks are social case work, social group work, community organization, administration in social work, and research in social work. Beginning skill in the practice of social work is acquired through a planned sequence of classroom courses and field instruction in the method in which the student chooses to concentrate. Provision is made in classroom instruction for all students to become familiar with the common objectives, principles, and the unique elements of all the above mentioned social work methods, although each student concentrates in one-most of them in either social case work or social group work, though some choose community organization. All students devote some time to research method and participation in a research project. A substantial period of time in the total curriculum is devoted to field instruction in a social work agency or department which meets established criteria for quality of practice and skilled supervision of students. Field instruction in social work education is planned, as is supervised experience in the practice of social work as carried on currently by recognized social work programs, both always under the educational direction of a school of social work. The aim of field instruction in the curriculum is thus to offer the student a practice experience in the application of theory under skilled supervision and is not an apprenticeship that teaches what is already known in a way that is already known. Field instruction experience is intended to lead to the development of the student as a creative professional person applying basic principles as he works to find solutions to the increasingly complex and changing problems with which social workers deal. In the second year of professional study, whenever possible, a student has field instruction assigned in accord with his interest in a particular field of practice. Agencies or services for practice frequently used for field instruction are: medical, including public health; psychiatric and mental health; child welfare; corrections; education; family; public assistance; group service; and community planning services. Opportunity is provided in the curriculum for students to obtain an understanding of the philosophy of public health as a concept having major importance in social and economic development and change. In this context, content identified particularly with mental health and public health is increasingly being included in the three major categories of the curriculum. In addition, mental health and public health may be the subject of student research projects. 2. Post-Master's Degree Education for FEBRUARY, 1962 323

Social Workers-Social work education beyond the two years required for the master's degree is established in third year and doctoral programs in a number of schools of social work. These programs seek to broaden and deepen knowledge in all the basic areas of social work and to offer opportunity for concentration in a particular area. Advanced education in some schools of public health and advanced training in community mental health programs are also available to social workers. Social workers operating in public health programs need knowledge and skill, beyond that received in their basic preparation, in consultation, administration, community organization, work with groups, teaching and research methodology, and public health philosophy and content. Various approaches are being explored for the development of advanced training opportunities. Some schools of social work have developed advanced curricula in community mental health. A few universities have developed joint programs between schools of social work and schools of public health. Most schools of public health admit experienced social workers as full-time degree candidates. Other special training experiences are being developed in public health and mental health centers on an internship or residency basis. Many opportunities also exist for acquiring the necessary knowledge of public health philosophy and program content through continuing inservice education. REFERENCES 1. Boehm, Werner. The Curriculum Study. New York, N. Y.: Council on Social Work Education, 1959. 2. Winslow, C.-E. A. The Untilled Fields of Public Health. Mod. Med. 2:183-191, 1920. 3. Perlman, Helen Harris. Social Case Work. Social Work Yearbook. New York, N. Y.: National Association of Social Workers, 1960, p. 535. COMMITTEE ON PROFESSIONAL EDUCATION (1961) THOMAS PARRAN, M.D., Chairman BERWYN F. MATTISON, M.D., Secretary JAMES L. TROUPIN, M.D., Associate Secretary JESSIE M. BIERMAN, M.D. RALPH H. BOATMAN, Ph.D. ROBERT E. COKER, M.D. ROBERT H. FEux, M.D. DONALD J. GALAcAN, D.D.S. GEORGE JAMES, M.D. KARL M. MASON, M.P.H. MARION I. MURPHY, Ph.D. GEORGE G. READER, M.D. RAY E. TRUSSELL, M.D. W. HARDING LE RICHE, M.D., Consultant WILSON G. SMILLIE, M.D., Consultant The Committee on Professional Education expresses grateful appreciation to the Subcommittee on Educational Qualifications of Social Workers in Public Health Programs which assisted with the preparation of this report. This subcommittee consists of: ELZABETH P. RICE, M.S., Chairman CATHERINE M. CASEY ANTONIO CIocco, D.Sc. BEATRICE HALL ELMER L. HI.LL, M.D. RUTH I. KNEE LYNDELL SCOTT, Ph.D. MILDRED SIKKEMA RUTH TAYLOR 324 VOL. 52. NO. 2, A.J.P.H.