How Clinical Social Workers Are Using the DSM-IV: A National Study

Abstract

ABSTRACT The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is both dominant and controversial as a clinical tool for social workers. However, few studies have assessed how social workers actually use DSM-IV in their clinical practice. A national study using a 72-item questionnaire was conducted with a random sample of 558 of the 7,000 social workers listed in the 1999 Register of Clinical Social Workers. The questionnaire assessed frequency and importance of using DSM-IV. Findings reflected that 78.9% of social workers used DSM often to always, 85.9% gave a DSM diagnosis often to always, but only 50% of social workers would use DSM if not required. Most common reasons for using DSM were to bill insurance (92.6% rated often to always) and to assess clients (78% rated often to always). Likewise, when rating importance of using DSM, the two most important reasons were to bill insurance (90.9% rated very to extremely important) and to assess clients (58% rated very to extremely important). Agency social workers rated 6 of 11 reasons more important than private practice social workers although both settings rated billing for insurance as most important. Study confirms the importance of DSM in assessing clients and billing for insurance. The authors recommend research to better understand how social workers define assessment and clarify insurance/employer pressure to use DSM.