Role of The Professional Social Worker - United States

United States

In the United States of America, leaders and scholars in the field of social work have debated the purpose and nature of the profession since its beginning in the late 19th century. Workers, beginning with the settlement house movement, have argued for a focus on social reform, political activism, and systemic causes of poverty. Social workers of the Settlement House Movement were primarily young women from middle-income families and chose to live in lower-income neighbourhoods to engage in community organizing. These workers sometimes received stipends from charitable organizations and sometimes worked for free. In contrast to the settlement house movement, the friendly visitors were women from middle-income families who visited (but did not reside among) families in lower-income neighbourhoods. Friendly visitors emphasized conventional morality (such as thrift and abstinence from alcohol) rather than social activism. Others (notably Mary Richmond) have advocated an emphasis on direct practice, aid to individual clients and families with targeted material assistance or interventions using the diagnostic and statistical manual of mental diseases DSM-IV. While social work has been defined as direct, individual practice in the last quarter of the 20th century, there is a growing resurgence of community practice in social work. Of broad and growing significance are the relationship counseling and Relationship Education movements which seek to assist in interpersonal social skill building which can be of great societal value in promoting marriage and family stability. Relationship education and counseling primarily aid the majority of individuals who are free of pathology or who have found that DSM-IV based services are ineffectual. This majority can benefit from education and exposure to relationship skills that have not otherwise been discussed and distributed by social services in this time of weakened family, church, and societal conventions. Another new development in social work is the focus on informatics (Parker-Oliver & Demiris, 2006). For many social workers, the use of any online technology is problematic due to persistent concerns about privacy. However, other social workers recognize that clients are going on line for many purposes. Some schools of social work, such as University of Southern California are offering courses to build informatics skills at the graduate level. Community practice is the new term of art for what used to be known as "macro practice" social work. Community practice includes working for change at the systems level, including human services management (administration, planning, marketing, and program development); community organizing (community development, grassroots organizing, policy advocacy); social policy and politics; and international social development. The National Association of Social Workers (NASW) is the largest and most recognized membership organization of professional social workers in the world. Representing 150,000 members from 56 chapters in the United States and abroad, the association promotes, develops and protects the practice of social work and social workers. NASW also seeks to enhance the well-being of individuals, families, and communities through its work and advocacy. Although membership is generally not required for licensure, NASW survey data give a rough idea of how social workers are employed in the US. According to NASW:

Nearly 40% of NASW members say that mental health is their primary practice area. The health sector employs 8% of NASW’s members, and 8% practice in child welfare or family organizations. Six percent of NASW members say school social work is their primary practice area, and another 3% work primarily with adolescents. (NASW, 2005) These figures are significantly confounded by the fact that NASW members are primarily licensed practitioners working in the clinical arena, and the fact that many social workers in the field do not actually hold a degree in social work. NASW is usually concerned with issues like licensing, reimbursement, etc., that are not relevant to child welfare practice, for instance.

Within the mental health field, social workers may work in private practice, much like members of other counselling professions. Social workers are often in the position of recommending the use of psychopharmaceutical agents, though not prescribing them. The increasingly widespread usage of these agents in the U.S. has received little scrutiny by the NASW, despite that fact that these drugs are prescribed far more heavily in the U.S. than anywhere else in the world. Social workers in private practice may take direct payments from clients and may also receive third-party reimbursement from insurance companies or government programs such as Medicaid. Insurance reimbursement for mental health services involves the designation of the recipient of services as mentally ill, or more specifically a label is assigned from the DSM-IV, the diagnostic and statistical manual of mental illness. This assignment, when recorded to an individual's medical history can prove to be a significant impediment to future pursuits. It can raise the cost to the individual for health or nursing home insurance; it can be the basis of denial for life insurance; and it can limit an individual's professional choices, such as in health care, motor vehicle operation, or airplane piloting. Private practice was not part of the social work profession when it began in the late 19th century. It has been controversial among social workers, some of whom feel that the more lucrative opportunities of private practice have led many social workers to abandon the field's historic mission of assisting disadvantaged populations. The private practice model can be at odds with the community development and political activism strains of social work. Social workers in mental health may also work for an agency, whether publicly funded, supported by private charity, or some combination of the two. These agencies provide a range of mental health services to disadvantaged populations in the US. Some social workers are child welfare workers, a role that looms large in the public's perception of social work. This role contributes to a negative view of social work in the U.S., since child welfare authorities can remove abused or neglected children from the custody of their parents, a practice that is fraught with controversy and sometimes with scandalous incompetence. Many child welfare workers in the US do not in fact have social work degrees (though all caseworkers in most states have at least a Bachelor's degree in a related field). Some states restrict the use of the title social worker to licensed practitioners, who must hold a degree in the field. Such restrictions are a high legislative priority of NASW.