Advanced Practitioners in Clinical Social Work: A Profile

Abstract

Over the past 25 years, growing interest in advancing clinical social work practice has led social workers and their professional organizations to invest time, effort, and finances in obtaining clinical social work licensure in 52 states and jurisdictions, vendorship third-party payments in 28 states, and voluntary advanced clinical social work credentialing through peer review and examination by professional membership and credentialing organizations. More recently, however, the context of clinical social work practice in both the public and private sectors is changing. Policies and practices of funding sources - whether federal or state governments, managed care organizations, or self-insured organizations - increasingly emphasize practice accountability and cost containment by specifying preferred intervention modalities for diagnosis-related groups and requiring documentation of intervention effectiveness and efficiency. In this changing context of practice, clinical social workers are experiencing more than ever the impact of vendorship regulations, cost containment measures, increased competition among a variety of service providers, and service delivery in changing practice domains (Brown, 1994; Chodoff, 1987; Field & Gray, 1989; Lieberman, Shatkin, & McGuire, 1988). Concerned about the lack of information about clinical social workers and their practices in the present context (Cocozzelli, 1986; Jayaratne, 1982; Kolevzon & Maykranz, 1982; Strom, 1994), the authors used data from a larger study (Timberlake & Sabatino, 1994) to analyze four dimensions of the self-reported clinical practices of a national random sample of experienced clinical social workers having state licensure and certification credentials at the advanced practice level and providing clinical services in public, nonprofit, and for-profit settings. First, the authors developed profiles of practitioner characteristics and practice structures, the problems and diagnoses of the client populations served, the practice theories and perspectives used, and the service time frames and intervention techniques used. Next, they explored the interrelatedness among two sets of factors: (1) theoretical practice perspective factors, client problem and diagnosis factors, targeted client system, and service time frame and (2) time-framed intervention techniques, client problem and diagnosis factors, targeted client system, client mental health insurance coverage, and date of MSW education. Finally, the authors consider advanced practitioners in clinical social work in light of the study findings. Method The mail survey instrument of this ex post facto study included factual items (demographic characteristics of clinical social workers and practice characteristics and structure) and five-point Likert scales identifying diagnostic categories and problems of clients served (52 items), clinical social work theories and perspectives used (19 items), and clinical techniques (45 items) likely to be used in three time-framed practice models - short term, of up to 12 appointments; moderate, time limited, of up to 20 appointments; and longer term with no pre-established time limits. To strengthen the reliability and validity of the data, the mail survey instrument was developed from earlier studies of the demographic characteristics and practice models of school social workers (Timberlake, Sabatino, & Hooper, 1982), military social workers (Hamlin, Timberlake, & Jentsch, 1982), and clinical social workers (National Institute for Clinical Social Work Advancement [NICSWA], 1990). The initial draft was reviewed for clarity and face validity by a 12-member panel of social work experts who represented different geographic areas of the country, varied job profiles, diverse gender and race or ethnicity, and extensive clinical social work practice and supervisory experience. An abbreviated field test was conducted with a voluntary sample of 23 clinical social work practitioners who had been practicing for three to 15 years in a large urban area and were diverse in terms of race and ethnicity, gender, and job profile. …