Social Work Encounters Research Articles

Side-lined by the Side Eye: Exploring the Effects of Nonverbal Communication in 2SLGBTQI+ Clinical Social Work Encounters

Side-lined by the Side Eye: Exploring the Effects of Nonverbal Communication in 2SLGBTQI+ Clinical Social Work Encounters

Differential effects of a social work staffing intervention on social work access among rural and highly rural Veterans: A cohort study.

To evaluate the impact on rural Veterans' access to social work services of a Department of Veterans Affairs (VA) national program to increase social work staffing, by Veterans' rurality, race, and complex care needs. Data obtained from VA Corporate Data Warehouse, including sites that participated in the social work program between October 1, 2016 and September 30, 2021. The study outcome was monthly number of Veterans per 1000 individuals with 1+ social work encounters. We used difference-in-differences to estimate the program effect on urban, rural, and highly rural Veterans. Among rural and highly rural Veterans, we stratified by race (American Indian or Alaskan Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White) and complex care needs (homelessness, high hospitalization risk, and dementia). We defined a cohort of 740,669 Veterans (32,434,001 monthly observations) who received primary care at a participating site. Average monthly social work use was 8.7 Veterans per 1000 individuals. The program increased access by 49% (4.3 per 1000; 95% confidence interval, 2.2-6.3). Rural Veterans' social work access increased by 57% (5.0; 3.6-6.3). Among rural/highly rural Veterans, the program increased social work access for those with high hospitalization risk by 63% (24.5; 18.2-30.9), and for Veterans experiencing homelessness, 35% (13.4; 5.2-21.7). By race, the program increased access for Black Veterans by 53% (6.1; 2.1-10.2) and for Asian Veterans by 82% (5.1; 2.2-7.9). At rural VA primary care sites with social work staffing below recommended levels, Black and Asian Veterans and those experiencing homelessness and high hospitalization risk may have unmet needs warranting social work services.

Clients’ first names in social work encounters: maintaining and mitigating asymmetry in institutional interaction

ABSTRACT In encounters between social workers and clients, social workers occasionally address clients by their first name, while clients more rarely use social workers’ names. In this article, we examine uses of clients’ first names in social work encounters set in public employment services. Drawing on conversation analytic findings and methods, we focus particularly on the sequential environment surrounding the use of clients’ names to discuss their role in the interaction. The article offers new contributions in two main respects: one is to the field of social work by exploring in detail how a recurrent practice such as the use of clients’ first names is involved in the production and maintenance of institutional roles and in managing power and asymmetry in the client–worker relationship. The second is that the analyses demonstrate how first name address terms are involved in performing context-specific functions in encounters between social workers and clients in a welfare-to-work setting.

Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic.

The purpose of this study was to describe the frequency of psychosocial risk and its associations with glycemic levels in youth with type 1 diabetes (T1D) seen by social work staff during regular clinical care. A retrospective longitudinal analysis of observational clinical data was conducted. Individuals (1-26 years) with known T1D who were seen at a pediatric diabetes clinic in a US academic medical center between 2014 and 2021 were included. Variables included psychosocial acuity, A1C, and demographic characteristics. Chi-square tests, Wilcoxon rank sum tests, and mixed linear regressions were used to examine associations between demographic variables, psychosocial acuity, and A1C. Of 966 patients, 513 (53.1%) were male, 76 (7.9%) were non-Hispanic Black, and 804 (83.2%) were non-Hispanic White. There was a mean of 6.9 annual social work encounters per patient, with 3 psychosocial domains measured at each visit. Results showed that as psychosocial acuity level increased, glycemic control decreased. There were significant differences in A1C according to race/ethnicity, insurance, age, and psychosocial acuity. In a real-world clinical population, psychosocial acuity was associated with glycemic control. Presenting for psychosocial issues in their diabetes clinic was associated with reduced glycemic control among youth with T1D. There is an opportunity to connect pediatric patients with appropriate mental health services and psychosocial supports.

Benefits and challenges in the use of RE-AIM for evaluation of a national social work staffing program in the veterans health administration.

In the Department of Veterans Affairs (VA) Veterans Health Administration (VHA), social workers embedded in primary care teams address social and emotional needs that are associated with health outcomes. The mission of the National Social Work PACT Staffing Program is to improve access to social work services for rural Veterans by supporting additional social work staffing in VA medical centers serving rural areas. We obtained data from the VA corporate data warehouse on Veterans' characteristics and health care use from 2016 to 2022 for all Veterans who received primary care at a Veterans Affairs Medical Center (VAMC) or associated clinic that received funding from the program. We evaluated the program according to RE-AIM constructs as follows: Reach [total number of Veterans who engaged with PACT social work and representativeness with regard to race, rural residence, chronic conditions and health behaviors, and hospital and emergency department (ED) use in the previous 12 months]; Effectiveness (impact of the program on key health care use outcomes which include hospitalizations, emergency department visits, and palliative care); Adoption (number of VA medical centers and outpatient clinics serving rural Veterans that have participated in the program, and number and representativeness of sites eligible for program participation that have not yet received funding); Implementation (adherence to standardized note templates), and Maintenance (permanent social work positions created by the program and continued technical support). In 2022, the program engaged with 30,982 Veterans, 65% of whom lived in rural areas. The program increased social work encounters, reduce hospital and emergency department use, and increase use of palliative care services among Veterans. Key elements of implementation include proactive outreach to Veterans with high-risk indicators and assessment for social risk factors using standardized, national note templates. In terms of maintenance, the program continues to provide data and technical assistance to 23 sites and has created 171 permanent social work positions. The Social Work PACT Staffing Program demonstrates positive outcomes and program sustainment. The RE-AIM framework was a useful tool to evaluate the program, but additional adaption was needed to fit the program's needs.

Designing and developing interprofessional education – an example involving social work and interpreting students in Sweden

ABSTRACT This paper contributes to the research field of interprofessional education by reporting on an ongoing collaboration between a Social Work Study Programme and two Public Service Interpreting programs located at three universities in Sweden. The article explores the question of what is required to establish a sustainable curriculum for interprofessional education to prepare social work and interpreting students to manage interpreter-mediated social work encounters. Based on experiences made from six IPE sessions over the past three years, two important perspectives are identified and discussed. Firstly, is the pedagogical perspective, where the IPE seen as a situated learning activity, offering a learning space in which awareness of communicative skills such as the organization of turns and division of labour in interpreter-mediated social work encounters are made visible, practiced and reflected upon. The communicative skills relate both to professional and interprofessional expectations and duties of these groups of students. Secondly, is the organizational perspective, where the IPE is regarded as an example of educational collaboration. At a general overall level, the crucial aspects identified for establishing a sustainable IPE are the actual needs-basis, persistence over time and small-scaleness of the development process. The online format, close collaboration between the interpreting programs and the specific IPE team are other crucial aspects identified in the organization of this collaborative venture. The feedback from students have so far been very positive and with an IPE in place, there are now good opportunities to develop these training sessions in different directions and systematically assess the IPE.

Assisting clients’ departure: On the multimodal organization of closings in social work

Interactional closings constitute a crucial aspect of social interaction and, in social work practice, are organized around participants’ orientation to an asymmetrical distribution of tasks between professional and client, informed by a “dialectics of care and control.” Proceeding from a conversation analytic framework, and grounded on video recordings of encounters between social workers and clients in diverse institutional settings in Portugal, the present paper investigates how the routine of closing social work encounters is carried out through professionals’ and clients’ joint and progressive orientation toward bringing the encounter to an end, and examines some of the interactional and embodied practices mobilized by them for accomplishing this task. By providing a detailed analysis of participants’ audible and visible conduct and their interactional practices, this study shows how social workers orchestrate clients’ leave-taking through the concerted mobilization of linguistic, bodily and material resources, shedding light into how the dialectics of care and control are managed in the everyday exercise of social intervention.

Co-producing a social workable matter: Topics and collaborating in social work encounters

A common task in encounters with professionals is to identify a matter warranting professional assistance. Co-producing a ‘social workable’ matter in social work encounters as an interactional achievement is yet to be explored. Specifying this as an institutional and interactional project creates the opportunity to analyse how topics are collaboratively used in social work encounters to achieve a joint understanding of the work for the session. Such projects offer insights into the social actions involved in identifying matters that are relevant to the service, setting and professional encounter. Conversation analysis (CA) of real-world social work sessions offers a way to understand how social workers and clients produce, elaborate and pursue topics as a collaborative achievement. This detailed analytic approach illuminates how social workable matters are co-produced in interaction and creates an opportunity to examine and improve collaboration in interpersonal practice contexts.

When Mental Health Social Work Encounters Positive and Transcultural Psychotherapy: Cases of Social Work Service for Patients with Bipolar Disorders

This article shows the application of positive and transcultural psychotherapy as a theoretical guide to intervene in the social work case service case of a bipolar disorder rehabilitation patient with a 15-year medical history. Our service and our confusion before the application of positive and transcultural psychotherapy, and the surprises and results after its application are presented. The paper shows the real conflict in the four areas in the life of the client and his conflict response model, based on the analysis of the services provided by combining social work methods and positive and transcultural psychotherapy, and the results and the change in our service obtained by the client.

The ethical performance of access and consent in ethnographic research on social work encounters with migrant-background service users

In this article, we contribute to an emerging body of literature concerning the often-overlooked topics of access and consent in research. We posit our understanding of access and consent as continuous ethical reflection and negotiation, conceptualised here as ethical performance, which is particularly valuable in research in institutional contexts defined by numerous power asymmetries. We draw empirically from research on street-level institutional encounters between social work practitioners and migrant-background service users in the Helsinki capital region. Access in this research was a multi-stage process including various stage-related negotiations, and the previous stages always influenced the stages that followed. Nevertheless, access and consent were always erratic and subject to revision. We describe how the need for ethical reflexivity arises in various concrete, often unpredictable, situations, and argue for the importance of paying explicit analytical attention to negotiations regarding access and consent.

Expanding Access to Social Support in Primary Care via Telemedicine: A Pilot Study.

The coronavirus pandemic quickly exposed the need for efficient and widespread implementation of telehealth services. Additionally, it further unveiled the impact of social and environmental barriers to healthcare in underserved, rural populations. This in-practice pilot study tested the utility of a geographically centralized social worker providing services between a patient and a primary care provider via telecommunication at two high volume rural outpatient family practice clinics. Outcome measures included patient and provider satisfaction. Twenty-two telehealth social work encounters occurred spanning both adult and pediatric patients. Data collected from patients, primary care providers, and social work staff revealed positive feedback. The data from our small pilot study demonstrated that social work triage delivered via a tablet was an acceptable and valued resource in busy primary care practices.

Integrating Telepsychiatry Into Rural Primary Care for Upstream Prevention: Feasibility Case Study of the Faith Net Program.

IntroductionFor decades, there has been a deficit of mental health services in rural areas of the United States. Beyond that longstanding need, the COVID-19 pandemic has reportedly increased the prevalence of unmet mental health needs among adults. Presently, many non-critical but urgent mental health concerns are first identified in rural emergency departments. This report describes the results of a 6-month feasibility case study of a program to integrate telepsychiatric triage “upstream” from emergency departments in rural primary care.MethodsAt routine primary care encounters in a single midwestern rural county, patients at risk for moderate-severe or severe depression, expressing thoughts of self-harm, or otherwise presenting in a way that raised clinical concern for mental or behavioral health, were referred to on-site telepsychiatric triage. Patients whose triage indicated further concern were provided six psychiatric and/or social work encounters for stabilization and treatment.Results68 patients were referred to telepsychiatric triage during the pilot study (.85% of the estimated adult population in the county). Of those, only two had a documented mental/behavioral health diagnosis prior to triage, but 46 were diagnosed with at least one psychiatric disorder during the program.ConclusionsThis model of telepsychiatric triage was feasible in rural primary care and may support identification and mitigation of unmet mental health needs.

Simulating the context of interpreter-mediated social work interactions via interprofessional education

Interpreters and social workers frequently work together. They share some common goals and there is some similarity between the ethical guidelines that both professions follow. Despite this, interpreter-mediated social work encounters are rarely described, especially from the perspective of interpreting studies. Even more infrequent are studies that focus on trainee interpreters’ and social workers’ engagement in interprofessional education (IPE). Details of the design and delivery of IPE training sessions for interpreting and social work students, at Monash University from May 2017 to May 2019, are provided. The sessions featured two role-plays that simulated typical interactions in which interpreters and social workers work together. To assess the effectiveness of the IPE training in meeting both general and specific learning outcomes, three research questions were posed and the responses are reported in this article. The questions relate to the reported usefulness of role-plays in enabling the acquisition of desirable skills and knowledge; an increase in the level of knowledge of the other professional group, one’s own group and the perceived benefits for service-users; and the usefulness of pre- and post-interactional activities, such as briefing and debriefing. Responses to questionnaires were received from 218 of the 442 participating students. On a Likert scale with five gradings the average levels of agreement regarding the usefulness of role-plays are high, as are the levels of agreement about increases in knowledge of the other professional group and those of the students’ own professional group. The student informants reported that the skills they gained are likely to be beneficial to clients and patients with limited English proficiency. The trainees’ responses to their pre- and post-interactional interactions show that both groups registered a high level of agreement that briefings and debriefings are useful.

Presenting documents to clients in Social Work encounters

In service encounters between social workers and clients, professionals introduce clients to specific bureaucratic procedures required by the institution and provide assistance in handling problems related to their institutional affairs. Here, paper-based documents are treated by the participants as relevant objects containing important textual information about clients’ rights and obligations, and duly presented by professionals to clients so to inform them of relevant matters at hand. Based on a corpus of video recordings of Social Work encounters in Portugal, and taking a multimodal conversation analytical approach, this study examines how social workers present paper documents to clients and how, through talk and bodily conduct, they ensure clients’ ability to inspect and make sense of relevant information, managing practical problems concerning clients’ access to documents and knowledge of the information contained therein.

Developing holistic competence in cross-cultural social work practice: Simulation-based learning optimized by blended teaching approach

ABSTRACT Integrating anti-oppressive practice (AOP) into clinical interactions is critical for embodying social justice values and promoting equitable and socially just interventions in social work practice. Therefore, training social work students to perform this task is invaluable and pedagogically challenging. Social work education scholars note that students’ knowledge and attitudes are not automatically translated into well-demonstrated professional behaviors and thus encourage to develop the holistic competence inclusive of both meta- and procedural competencies in students. Toward this pedagogical goal, this paper elaborates the development of a cross-cultural social work practice course to foster students’ holistic competence. Following the Council of Social Work Education’s Education Policy and Accreditation Standards and AOP scholarship, we outline students’ learning outcomes and the expected competencies in embodying socially just and culturally competent practice (SJCCP). Using blended learning, this course maximizes both online and in-person interfaces to foster social work students’ competencies in SJCCP. We provide details of how we incorporated simulation-based learning into various teaching methods (i.e., intergroup dialogue, digital storytelling, and role plays) and present a case illustration that highlights cross-cultural social work encounters. We close with discussing challenges and new lessons learned from teaching AOP in clinical practice and future teaching recommendations.

Social work and telehealth: How Patient Aligned Care Team (PACT) social workers in the Veterans Health Administration responded to COVID-19

ABSTRACT In March 2020, the Veterans Health Administration (VA) responded to pandemic shutdowns with a rapid pivot toward providing services via telehealth. Using data on Veterans who received interventions from social workers between 2019 and 2020 at sites that participated in a national program to increase social work staffing in primary care, we examined changes in frequency and modality of social work encounters that occurred with the onset of the COVID-19 pandemic. We found that primary care social workers maintained a consistent level of engagement, with increases in telephone and video telehealth encounters as in-person visits decreased. Through front-line perspectives, we discuss the practical innovations and policies that enabled those changes in care from VA primary care social workers.

How do users with comorbidity perceive participation in social services? A qualitative interview study

ABSTRACT Purpose: This study aims to construct a theoretical framework that explains how users with comorbidity of substance use and mental illness/neuropsychiatric disorders portray user participation in social work encounters. Methods: To construct this framework a constructivist grounded theory approach was used with semi-structured qualitative interviews with 12 users. Results: The main concern of the participants was the low trust in the social services and perceiving that this lack of trust is mutual. Establishing mutual trust is a social process that cuts through the whole framework. In the framework, prerequisites for participation are explained. The prerequisites are users being motivated and having the willingness to stop using drugs and receiving support, making use of user and staff knowledge and decision-making abilities and accessing help and support. Conclusion: Unlike previous frameworks, the model describes participation as a social process and does not explain participation at different levels of power. The results suggest that staff need to be aware of low trust perceptions and work on establishing mutual trust. In addition, the staff need to see each user as an individual and consider how the user would prefer to be involved in decision-making.

Embedding Social Workers In Veterans Health Administration Primary Care Teams Reduces Emergency Department Visits.

While an emerging body of evidence suggests that medical homes may yield more benefits than traditional care models do, the role of social workers within medical homes has yet to be evaluated separately. We assessed the impact of an initiative to add social workers to rural primary care teams in the Veterans Health Administration on patients' use of social work services, hospital admissions, and emergency department visits. We found that introducing a social worker increased social work encounters by 33percent among all veterans who received care. Among high-risk patients, we observed a 4.4percent decrease in the number of veterans who had any acute hospital admission and a 3.0percent decrease in veterans who had any emergency department visit, after the introduction of a social worker. Investing in social workers is a key strategy for addressing the social determinants of health and managing care coordination for high-risk, high-need populations.

How to convey social workers’ understanding to clients in everyday interactions? Toward epistemic justice

ABSTRACTA client’s experience of being heard and understood by a social worker contributes to not only fostering alliance and positive outcomes in practice, but also positioning the client as the knower of their own experience. One’s capacity to be recognized as a trustworthy conveyer of knowledge is essential to achieving a sense of human value. Philosopher Miranda Fricker describes this recognition as epistemic justice. When the client’s experiences are discredited/marginalized, epistemic injustice occurs. We apply these constructs to clinical social work practice to explore how social workers accomplish or fail at the task of empathically listening and conveying understanding to clients and subsequently, accomplishing or failing epistemic justice. Using Conversation Analysis, we conduct a turn-by-turn analysis of videotaped social work encounters in a community mental health agency. Our findings identify and illustrate the moment-by-moment discursive patterns in both epistemically just and unjust clinical social work encounters. The identified discursive patterns can be used for the clinical training of social workers, encouraging critical reflection on their own everyday conversations toward promoting epistemic justice. This study thus has implications for social work education as an illustrative example of making a link between micro practice skills and macro justice issues in social work.

Predicting Psychiatric Hospitalizations among Elderly Veterans with a History of Mental Health Disease.

Introduction:Patient Aligned Care Team (PACT) care managers are tasked with identifying aging Veterans with psychiatric disease in attempt to prevent psychiatric crises. However, few resources exist that use real-time information on patient risk to prioritize coordinating appropriate care amongst a complex aging population.Objective:To develop and validate a model to predict psychiatric hospital admission, during a 90-day risk window, in Veterans ages 65 or older with a history of mental health disease.Methods:This study applied a cohort design to historical data available in the Veterans Affairs (VA) Corporate Data Warehouse (CDW). The Least Absolute Shrinkage and Selection Operator (LASSO) regularization regression technique was used for model development and variable selection. Individual predicted probabilities were estimated using logistic regression. A split-sample approach was used in performing external validation of the fitted model. The concordance statistic (C-statistic) was calculated to assess model performance.Results:Prior to modeling, 61 potential candidate predictors were identified and 27 variables remained after applying the LASSO method. The final model’s predictive accuracy is represented by a C-statistic of 0.903. The model’s predictive accuracy during external validation is represented by a C-statistic of 0.935. Having a previous psychiatric hospitalization, psychosis, bipolar disorder, and the number of mental-health related social work encounters were strong predictors of a geriatric psychiatric hospitalization.Conclusion:This predictive model is capable of quantifying the risk of a geriatric psychiatric hospitalization with acceptable performance and allows for the development of interventions that could potentially reduce such risk.