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An Educator's Guide to the Development of Advanced Practice Competencies in Clinical Social Work

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Title: An Educator's Guide to the Development of Advanced Practice Competencies in Clinical Social Work
Language: English
Authors: Singer, Jonathan B., Gray, Susan W., Miehls, Dennis
Source: Journal of Teaching in Social Work. 2012 32(5):451-470.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Physical Description: PDF
Page Count: 20
Publication Date: 2012
Document Type: Journal Articles
Reports - Descriptive
Education Level: Higher Education
Descriptors: Educational Policy, Social Work, Counselor Training, Competence, Graduates, Masters Programs, Values, Standards, Models, Counselor Qualifications
DOI: 10.1080/08841233.2012.726206
ISSN: 0884-1233
Abstract: The 2008 Educational Policy and Accreditation Standards identified 10 core competencies that all social work graduates should master. MSW programs found themselves with a need to identify knowledge, values, and skill statements that reflected what concentration-year students were expected to know and be able to do. In 2009 a group of educators convened at the Council on Social Work Education in Alexandria, VA to develop a model of advanced practice in clinical social work. This article describes the work group's process; identifies and describes the resulting advanced clinical knowledge, values, and skills statements; discusses the key debates and issues that arose during the development of the statements; and concludes with the implications for social work education and practice.
Abstractor: As Provided
Number of References: 44
Entry Date: 2012
Accession Number: EJ983551
Database: ERIC
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  Value: <anid>AN0082703962;8am01nov.12;2019Feb28.13:40;v2.2.500</anid> <title id="AN0082703962-1">An Educator's Guide to the Development of Advanced Practice Competencies in Clinical Social Work. </title> <p>The 2008 Educational Policy and Accreditation Standards identified 10 core competencies that all social work graduates should master. MSW programs found themselves with a need to identify knowledge, values, and skill statements that reflected what concentration-year students were expected to know and be able to do. In 2009 a group of educators convened at the Council on Social Work Education in Alexandria, VA to develop a model of advanced practice in clinical social work. This article describes the work group's process; identifies and describes the resulting advanced clinical knowledge, values, and skills statements; discusses the key debates and issues that arose during the development of the statements; and concludes with the implications for social work education and practice.</p> <p>Keywords: advanced social work practice; CSWE EPAS Standards; Advanced Critical Social Work Competencies; curriculum; accreditation standards; MSW</p> <p>In 1915, Abraham Flexner suggested that social work was not a profession. He argued that social work programs did not have a well-defined set of educational practices with which to prepare students for the diversity of roles social workers are called upon to undertake. [<reflink idref="bib18" id="ref1">18</reflink>] noted that a</p> <p>[l]ack of specificity in aim affects seriously the problem of training social workers. Professions that are able to define their objects precisely can work out educational procedures capable of accomplishing a desired result. But the occupations of social workers are so numerous and diverse that no compact, purposefully organized educational discipline is feasible. (p. 163)</p> <p>Contemporary social work is considerably more diverse than it was in 1915, but is Flexner's critique relevant to present-day practice? The Council on Social Work Education (CSWE) made a significant shift in its accreditation standards in 2008 with the introduction of Educational Policy and Accreditation Standards (EPAS) that establish 10 core competencies "common to all social work practice. Each competency is composed of knowledge, values, and skills that define what social workers must know and be able to do to practice effectively" ([<reflink idref="bib14" id="ref2">14</reflink>], p. 1). In addition, every accredited MSW program is required to identify how students—in their concentration year—have mastered the knowledge, values, and skills. This combination of a standardized core and program-specific advanced competencies provide social work programs with the "educational procedures" that Flexner identified as essential to professional training.</p> <p>Although the practical concerns of implementing these new competency-based standards in BSW and MSW program curricula have been addressed elsewhere ([<reflink idref="bib33" id="ref3">33</reflink>], [<reflink idref="bib34" id="ref4">34</reflink>]), educators in MSW programs have few resources to guide them when translating core competencies into advanced competencies. Responding to concerns by educators about the lack of guidance in this matter, the CSWE convened social work educators and representatives from professional organizations specializing in clinical practice from around the country to develop models of advanced competencies for MSW programs. These meetings have resulted in published models of advanced competencies in clinical social work, gerontology, military social work, and prevention of substance use disorders (see <ulink href="http://www.cswe.org/Accreditation/EPASImplementation.aspx">http://www.cswe.org/Accreditation/EPASImplementation.aspx</ulink> for the most current models). Each publication is intended to serve as a model for extending the 10 core competencies into advanced practice. These models, however, do not provide social work educators with guidelines on how to develop their own advanced competencies.</p> <p>The purpose of this article, therefore, is to describe the process that resulted specifically in the development of the model of advanced clinical social work competencies ([<reflink idref="bib14" id="ref5">14</reflink>]). The authors were participants in the two-day meeting and the subsequent work group that finalized these competencies. Our hope is that by discussing the work group's process, graduate faculty responsible for establishing advanced clinical competencies will have a guide for their own process. We begin by describing the process of organizing the work group and developing the definition of advanced clinical practice. We then detail the conceptual issues that arose in establishing advanced competencies for each of the 10 core competencies. We conclude with a brief presentation of the "lessons learned."</p> <hd id="AN0082703962-2">DEVELOPING ADVANCED CLINICAL COMPETENCIES</hd> <p>In August 2009, CSWE sent an invitation to all graduate social work programs with a clinical practice concentration to form a work group to develop a set of clinical competencies. Representatives from the National Association of Social Workers (NASW), the Association of Social Work Boards, the Clinical Social Work Society, and the American Board of Examiners in Clinical Social Work were also invited. The work group initially met in person and reached a consensus that all successful social work students would be expected to have mastered the 10 core competencies identified in the 2008 EPAS document before moving into their concentration year. Ira Colby, former president of the CSWE, asked the work group to consider, "What should clinical concentration MSW students know and be able to do by the time they graduate?" (personal communication, August 3, 2009). The result was a set of 10 advanced clinical social work practice knowledge and value statements, along with corresponding practice behaviors and skills ([<reflink idref="bib14" id="ref6">14</reflink>]). In keeping with an outcomes orientation, each of the advanced competencies was developed so that it might easily be adopted in any school's curriculum and be used in the assessment of student competency in clinical practice.</p> <hd id="AN0082703962-3">CRAFTING A DEFINITION OF CLINICAL SOCIAL WORK</hd> <p>The first step in identifying advanced clinical competencies was for the work group to develop a definition of clinical social work. Specialty organizations within social work such as the Clinical Social Work Society and the American Board of Examiners in Clinical Social Work already had developed definitions of clinical social work targeted at social workers at the post-graduate level. The work group reviewed these definitions and crafted a definition of clinical social work that described the unique features of clinical practice but also would be relevant to individual graduate social work programs, which ultimately have the responsibility for assessing their students' competence. Thus, the definition identifies from where such specialty practice is drawn and how it overlaps with the core content areas of social work education.</p> <p>According to the definition, clinical social workers (CSWs) are expected to promote social and economic justice; demonstrate professional use-of-self; conduct multidimensional assessment and differential diagnosis; use individual, family, and group modalities to treat emotional, mental, and behavioral disorders, addictions, and conditions, using best practices and evidence-based guidelines; provide crisis intervention, counseling, and psychotherapy; respond to all dimensions of diversity within the context of the therapeutic relationship; and use clinical supervision (see [<reflink idref="bib14" id="ref7">14</reflink>], p. 2, for the complete definition).</p> <p>The work group debated both the concepts and specific words that make up the definition of clinical social work. For example, we decided against including "transference" and "evidence-based practice" but decided in favor of "diagnosis" and "crisis intervention." Although there is no expectation that each program need develop its own definition of clinical social work, we thought it would be useful to briefly describe how these discussions informed our thinking about the competencies.</p> <p>Although the work group agreed that strong interpersonal relationships were essential for effective social work practice at all levels, some members argued that CSWs were engaged in therapeutic relationships best characterized by the terms <emph>transference</emph> and <emph>countertransference</emph>. We decided against those terms because they are strongly identified with a psychodynamic perspective and instead went with the more theoretically neutral <emph>therapeutic relationship</emph>. This particular debate helped the work group clarify the importance of avoiding concepts or words with strong theoretical biases. Schools of social work that are strongly affiliated with a specific practice perspective (e.g., psychodynamic, cognitive-behavioral narrative, or solution-focused) can decide how to shape the advanced competencies to reflect their perspectives, particularly for competencies 2.1.1, 2.1.2, 2.1.4, 2.1.7, and 2.1.10 (a–d).</p> <p>The work group did not spend much time debating whether or not to include the term <emph>diagnosis</emph> in the definition. We acknowledged that many social workers must use the <emph>Diagnostic and Statistical Manual of Mental Disorders IV-TR</emph> (DSM; [<reflink idref="bib3" id="ref8">3</reflink>]; [<reflink idref="bib36" id="ref9">36</reflink>]), and that diagnosis is one of the skills that distinguishes CSWs from BSW-level or MSW-level community organizing, management, and planning concentration graduates. Instead, we debated what it meant for "diagnosis" to be included in CSWs' skill set. We decided that knowledge of and skills with diagnosis are essential for social workers if they are to function as effective advocates for their clients, participate as equal partners in or lead treatment teams, and serve professional gatekeeper functions. The work group also decided that the concept of "diagnosis" is not the exclusive domain of the DSM (see discussions in 2.1.3, 2.1.7, and 2.1.10 [a–d]). There was less agreement on the role of diagnosis in clinical treatment. It was felt that this was an example of a topic that might best be decided on a school-by-school basis.</p> <p>The definition notes that social workers will use "best practices" and "evidence-based guidelines" but not "evidence-based practice" or "empirically supported (or validated) treatments." After an intense debate concerning the definition and role of "evidence" in social work practice, the work group decided that privileging empirically supported treatments would devalue other forms of evidence (e.g., case studies, ethnographies, and much of the qualitative literature) and ignore the fact that social workers address many problems for which interventions do not yet have empirical support. Instead, the work group agreed that social workers should be familiar with the process of evidence-based practice ([<reflink idref="bib32" id="ref10">32</reflink>]), resources such as expert consensus guidelines, evidence-based practice registries, common elements, and common factors ([<reflink idref="bib8" id="ref11">8</reflink>]), and strive to use the most effective research-based interventions available ([<reflink idref="bib41" id="ref12">41</reflink>]). (The issues associated with "evidence" are described in more detail in sections 2.1.6 and 2.1.8.)</p> <p>The work group debated whether "crisis intervention" should be a separate category of intervention, or if it was a form of counseling or psychotherapy. Some argued that crisis work is often the domain of crisis hotlines, case managers, and others such as emergency medical technicians and police officers, and that CSWs focus primarily on post-crisis services. Others felt that CSWs should be prepared to provide crisis intervention because many clients seek services during a crisis. We decided that crisis intervention (i.e., short-term and intensive work with the goal of helping service users to reattain their precrisis level of functioning [[<reflink idref="bib38" id="ref13">38</reflink>]]) is a legitimate and distinct skill set. Furthermore, the inclusion of crisis intervention in the definition of clinical social work sets it apart from definitions of clinical work in psychology, counseling, and psychiatry.</p> <p>We believe that this definition of clinical social work provides social work educators with a starting point from which to debate their school's articulation of clinical social work. For example, clinical concentrations with more explicit theoretical allegiances might decide to include theory-specific terms in their advanced clinical competencies. The remainder of this article will discuss the debates and issues that arose during the development of the statements 2.1.1–2.1.10 (a–d). We make an effort to acknowledge the overlap between competencies by placing sections in parentheses when concepts in one competency relate to concepts in others.</p> <hd id="AN0082703962-4">EDUCATIONAL POLICIES</hd> <p></p> <hd id="AN0082703962-5">Identify as a Professional Social Worker and Conduct Oneself Accordingly (2.1.1)</hd> <p>Upon graduation, all social work students are expected to identify as social workers and with the social work profession ([<reflink idref="bib13" id="ref14">13</reflink>]). CSWs understand that being a social worker means recognizing the importance of the therapeutic relationship; using the person-in-environment and strengths perspective to frame professional interactions; demonstrating a professional use of self with clients; and acknowledging one's strengths and limitations ([<reflink idref="bib14" id="ref15">14</reflink>]).</p> <hd id="AN0082703962-6">Implications</hd> <p>This competency speaks to the importance of CSWs thinking of themselves, and publicly identifying themselves, as social workers. The work group discussed the reality of CSWs, particularly those licensed as independent practitioners, choosing the professional label of "clinician" or "therapist" rather than "clinical social worker." Clearly, there is no ethical violation in identifying oneself as a therapist because CSWs do provide therapeutic services. The issue is ensuring that social work values and practices are consistently maintained, regardless of the setting (2.1.9). Educators can encourage their students' identification as social workers by emphasizing the value of their training in person-in-environment and strengths perspectives (2.1.7) and in clinical engagement, assessment, intervention, and evaluation (2.1.10 a–d).</p> <hd id="AN0082703962-7">Apply Social Work Ethical Principles to Guide Professional Practice (2.1.2)</hd> <p>There was some deliberation about how ethical decision making differed between the generalist and advanced clinical levels. The work group agreed that ethical decision-making models, such as those discussed by [<reflink idref="bib7" id="ref16">7</reflink>]), [<reflink idref="bib37" id="ref17">37</reflink>]), and others, apply to social workers at all levels. Advanced clinical level social work students are set apart by their ability to recognize and manage personal biases and power differentials as they influence the therapeutic relationship and by "the use of technology in clinical practice and its effects on client rights" ([<reflink idref="bib14" id="ref18">14</reflink>], p. 4).</p> <hd id="AN0082703962-8">Implications</hd> <p>This standard encourages educators to train CSWs to use ethical reasoning to address the treatment possibilities and ethical challenges that technology presents in contemporary clinical practice ([<reflink idref="bib42" id="ref19">42</reflink>]). The following are some technology-related ethical dilemmas that clinical social work instructors could and should address with their students:</p> <p></p> <ulist> <item> 1. What are the ethical and legal implications of checking confidential emails from clients using a smart phone in public, or, on a laptop over an unsecured Wi-Fi network at a coffee shop?</item> <p></p> <item> 2. Is it ethical to "Google" a client to gather information not presented in session?</item> <p></p> <item> 3. Can texting be therapeutic? If so, how should it be documented and billed?</item> <p></p> <item> 4. What should clinicians do if they realize their client is Facebook friends with one of the clinician's friends?</item> <p></p> <item> 5. Should social workers provide e-therapy to treat Internet addiction?</item> </ulist> <p>These dilemmas illustrate the need to recognize and manage personal biases and power differentials that may arise in clinical therapeutic relationships.</p> <hd id="AN0082703962-9">Apply Critical Thinking to Inform and Communicate Professional Judgments (2.1.3)</hd> <p>Critical thinking is considered an essential function of clinical social work practice. CSWs are expected to articulate client strengths and vulnerabilities; critically evaluate the clinical relationship and approaches to assessment, treatment, and intervention; appraise multiple sources of knowledge, practice strategies and wisdom; and be able to "communicate professional judgments with other social workers and to professionals in other disciplines in written and verbal formats" ([<reflink idref="bib14" id="ref20">14</reflink>], p. 5).</p> <hd id="AN0082703962-10">Implications</hd> <p>Competency in critical thinking, scientific inquiry, and reasoned discernment are requisite to effectively engage in the core tasks of clinical social work at all levels of practice. A social worker using critical thinking attempts to arrive at a judgment or decision after evaluating alternatives based on available evidence. The emergence of new technologies makes large amounts of information readily available and creates challenges for the advanced clinical practitioner when judging the credibility of an information source ([<reflink idref="bib5" id="ref21">5</reflink>]; [<reflink idref="bib23" id="ref22">23</reflink>]). When students have instant access to journals, articles, Wikis, and so forth, they tend to focus on collecting citations rather than thinking critically about the multiple sources of knowledge, or the actual quality and relevance of the materials. By the time they graduate, CSWs should be able to critically evaluate the authority, quality, relevance, timeliness, and veracity of their sources. If CSWs fail to develop this capacity for critical appraisal and an ability to sort through the limitless amount of information available over the Internet, it would be unreasonable to expect them to be able to analyze of the efficacy of theoretical models (2.1.7), scientific inquiry (2.1.6), and/or outcome data (2.1.10d) for effective practice.</p> <hd id="AN0082703962-11">Engage Diversity and Difference in Practice (2.1.4)</hd> <p>The core social work value of respecting the worth and dignity of all persons ([<reflink idref="bib31" id="ref23">31</reflink>]) strongly undergirds the EP 2.1.4 core competency. This level of respect for another requires dismantling of one's own biases and perceived negativity in assessing difference. During the foundation year of professional education, it is anticipated that generalist practitioners-in-training will struggle with the de-emphasis (even dismantling) of their own culture bound perspectives as they come to understand and internalize the reality that difference is not negative—just different. By graduation, it is anticipated that the shift from culture bound personal biases to a deeper level of self-awareness will permit students to reshape their thinking and practice in a manner that will facilitate meaningful connections with their clients. Comparatively, the CSW is expected not only to have recognized and experienced this shift in attitude and response, but to use difference to promote greater effectiveness in clinical practice situations from a strengths-based perspective. Further, CSWs should be able to assemble an enhanced capacity for critical thinking (2.1.3), scientific inquiry (2.1.6), reasoned discernment, and the analysis of research and application of knowledge of diversity in order to enhance their clinical practice.</p> <hd id="AN0082703962-12">Implications</hd> <p>The working group had a lively discussion about what educators should do when a student does not respect the dignity and worth of clients. At the heart of the discussion was the question of whether students had a right to not provide services to certain clients, or in certain settings. For example, should a student who opposes abortion be allowed to decline a field placement that provides abortion services? If a student does not respect the dignity and worth of a client because of that client's sexual orientation, should she or he be allowed to "opt out" of providing services to such a client? What if the reason is because the client is a convicted rapist, murder, or drug dealer? Mastering the knowledge, values, and skills for this advanced competency is not about a "right" answer. Rather, the expectation is that CSWs will be able to recognize that their beliefs and values at times may be culture-bound, that meaningful connection is possible despite differences, and that an ongoing inquiry into how to best provide services to diverse population cohorts is essential for advanced clinical practice.</p> <hd id="AN0082703962-13">Advance Human Rights and Social and Economic Justice (2.1.5)</hd> <p>CSWs are expected to work toward basic human rights such as safety and health care, and advocate for the equitable distribution of resources. CSWs recognize that injustice and inequality challenges the economic, social, and cultural realities in the lives of clients and client systems. This recognition should be accompanied by an understanding of internalized and public shame and stigma frequently associated with diagnostic labels (2.1.3, 2.1.7, 2.1.10b). CSWs should use this knowledge to "guide treatment planning and intervention; and advocate at multiple levels for mental health parity and reduction of health disparities for diverse populations" ([<reflink idref="bib14" id="ref24">14</reflink>], p. 7).</p> <hd id="AN0082703962-14">Implications</hd> <p>Educators must decide which perspectives can best inform the practitioner's knowledge of diverse populations (2.1.4) and related help-seeking behaviors. Perhaps the practitioner's treatment planning and interventions may need to be more holistic, combining neurobiological, psychological, social, and cultural data and theories ([<reflink idref="bib4" id="ref25">4</reflink>]; [<reflink idref="bib11" id="ref26">11</reflink>]; [<reflink idref="bib12" id="ref27">12</reflink>]; [<reflink idref="bib26" id="ref28">26</reflink>]; [<reflink idref="bib29" id="ref29">29</reflink>]; [<reflink idref="bib43" id="ref30">43</reflink>]). In this way, the advanced clinical social work practitioner will be able to demonstrate a greater understanding of the client's experiences with oppression, discrimination and historical trauma rather than simply working toward overcoming obstacles to needed services. This approach will set the stage for advocacy focused on the client's perspectives, social context, and cultural identity. The challenge to the educator is to find ways to engage students in using practice behaviors that demonstrate advocacy efforts characterized by an appreciation for each unique individual's life and which avoid overly simplistic explanations of their lived experiences.</p> <hd id="AN0082703962-15">Engage in Research-Informed Practice and Practice-Informed Research (2.1.6)</hd> <p>This competency speaks to being knowledgeable about evidence-based interventions, best practices, and the evidence-based research process. The practitioner should be able to "use the evidence-based practice process in the clinical assessment and intervention with clients; [and] participate in the generation of new clinical knowledge through research and practice, and use research methodology" ([<reflink idref="bib14" id="ref31">14</reflink>], p. 7).</p> <p>As managed care continues to emphasize cost reduction and accountability, the social work profession has experienced pressure to demonstrate the efficacy of interventions. In the face of concerns that the profession has become overly bureaucratized, with professionals reduced to mere technicians ([<reflink idref="bib16" id="ref32">16</reflink>]), the profession has continued to move toward a focus on evaluating and demonstrating the effectiveness of clinical interventions ([<reflink idref="bib35" id="ref33">35</reflink>]). [<reflink idref="bib19" id="ref34">19</reflink>]), proponents of an evidence-based approach to practice, suggested that decisions about clients should be based on a critical review of available research findings. In other words, the clinical social work practitioner should be able to scan existing research data to find the demonstrably best ways to help a client with a particular problem. Clinical practice behaviors informed by research findings; the generation of knowledge through research and practice; and using research methods to evaluate effectiveness of outcomes all will promote the foundation for providing the best professional services to clients.</p> <hd id="AN0082703962-16">Implications</hd> <p>CSWs are expected not only to understand research, but also know how to apply research tested "best practices" to clinical engagement, assessment, treatment, and evaluation (2.1.10 a–d). This poses a challenge when evidence-based practice "can only be as good as the research on which decisions are to be made" ([<reflink idref="bib27" id="ref35">27</reflink>], p. 174). The work group members thought it important to distinguish the process of evidence-based practice from empirically supported treatments. Although there was consensus that CSWs should provide research-informed practice, it also was acknowledged that CSWs will not always work with people for whom off-the-shelf empirically supported treatments were designed (2.1.10c). CSWs therefore are responsible for critically evaluating (2.1.3) clinical research and fitting the findings with the difficult—and often messy—struggles found in the real world lives of clients. Hence, educators need to balance instruction on empirically supported treatment with the process of evidence-based practice ([<reflink idref="bib40" id="ref36">40</reflink>]).</p> <hd id="AN0082703962-17">Apply Knowledge of Human Behavior and the Social Environment (2.1.7)</hd> <p>This competency accentuates the advanced clinical social work practitioner's need to understand how to "synthesize and differentially apply theories of human behavior and the social environment (biological, developmental, psychological, social, cultural, and spiritual)" ([<reflink idref="bib14" id="ref37">14</reflink>], p. 7). When formulating a differential assessment, the advanced clinical practitioner should demonstrate familiarity with different diagnostic classification systems and understand how sociocultural contexts influence the way in which psychopathology is defined. Advanced practitioners also must have a working knowledge of the range of psychotropic medications typically used in treating mental health disorders. In addition, the CSW should be comfortable consulting with medical professionals, when needed, to confirm a diagnosis and monitor medication in a client's treatment process.</p> <hd id="AN0082703962-18">Implications</hd> <p>Competency 2.1.7 speaks to the student making the transition from a receiver of knowledge to a CSW who is expected to differentially apply theories of human behavior and the social environment in assessment and intervention. This poses a number of challenges for educators, including how to balance instruction in person-in-environment and the strengths perspective with training in the medical model approach, diagnostic classification systems and pharmacotherapy. The work group recognized that many social workers equate the term <emph>diagnosis</emph> with the most well-known diagnostic classification system, the DSM (APA, 2000), and with the conceptual frameworks of illness and pathology ([<reflink idref="bib6" id="ref38">6</reflink>]). Thus, the work group consciously conceptualized diagnosis as a part of a broader strengths-based assessment process and emphasized that knowledge of diagnostic classification systems be designed to understand the client, mental disorders, and symptoms. Acknowledging that diagnosis is not limited to the DSM provides educators with the flexibility to teach additional classification systems (e.g., the International Statistical Classification of Diseases and Related Health Problems [[<reflink idref="bib44" id="ref39">44</reflink>]], Person-in-Environment System [[<reflink idref="bib25" id="ref40">25</reflink>]], and the <emph>Psychodynamic Diagnostic Manual</emph> [[<reflink idref="bib2" id="ref41">2</reflink>]]). Expanding the advanced CSW's consideration of various assessment tools is a way of supporting a truly comprehensive assessment, which requires the practitioner to balance the limitations inherent in the different classification systems (including the DSM), consider multiple theories of human behavior and the social environment, and understand the cultural meanings that influence the ways in which pathology may be defined and evaluated ([<reflink idref="bib21" id="ref42">21</reflink>]; [<reflink idref="bib20" id="ref43">20</reflink>]).</p> <hd id="AN0082703962-19">Engage in Policy Practice to Advance Social and Economic Well-Being and to Deliver Effective...</hd> <p>Knowing about the factors that influence the development of legislation, policies, program services, and funding at all levels of our political system is an essential component of this competency. In addition, a CSW is expected to know about advocacy methods that support effective policies that advance the social and economic well-being of their clients. Clinical practice behaviors include the ability to "communicate to stakeholders the implication of policies and policy change in the lives of clients; use of evidence-based practice and practice-based evidence in advocacy for policies that advance social and economic well-being; and advocate with and inform administrators and legislators to influence policies that impact clients and service" ([<reflink idref="bib14" id="ref44">14</reflink>], p. 8).</p> <hd id="AN0082703962-20">Implications</hd> <p>There are several definitions of policy practice, ranging from advocacy initiatives focusing on firmly held values, such as social justice, to constituency-based patterns of influence to the formal process of influencing legislative and judicial decision making ([<reflink idref="bib10" id="ref45">10</reflink>]; [<reflink idref="bib17" id="ref46">17</reflink>]; [<reflink idref="bib22" id="ref47">22</reflink>]; [<reflink idref="bib24" id="ref48">24</reflink>]). Although there is not complete agreement on what constitutes policy practice ([<reflink idref="bib39" id="ref49">39</reflink>]), there is a general consensus that social workers must assume policy roles and must recognize policy practice as one of the skills of a practicing social worker. Regardless of the distinctions among the various approaches to policy practice, this competency emphasizes an advocacy framework by including practice behaviors that involve communicating with stakeholders as a part of a process to shape and implement policy choices (2.1.3).</p> <p>The competent practitioner is expected to be able to analyze and apply knowledge of the biological, psychological, social, and spiritual variables that generate or perpetuate problems involving multiple systems (e.g., communities, organizations, and legislative, bureaucratic, and judicial levels of government). For example, a student might be counseling a predelinquent adolescent and discover that the local school system does not provide after-school activities. By connecting policy to clinical practice, the student will be able to find out how this problem is defined by others in the client's larger community, what other services may be available, and how well these services are integrated (2.1.9). Engaging in policy practice serves to bridge the gap between the individual and political policy practice initiatives. By definition, this means that policy practice must be an integral part of the advanced practitioner's clinical skills ([<reflink idref="bib28" id="ref50">28</reflink>]).</p> <hd id="AN0082703962-21">Respond to Contexts That Shape Practice (2.1.9)</hd> <p>The profession of social work historically has been plagued with artificial distinctions between micro-, macro-, and mezzo-practice. With few exceptions, advanced clinical education focuses on micro-level contexts (e.g., the individual, family, and group). Contemporary theory suggest that this trichotomization is false and that social work practice, including advanced clinical practice, needs to understand the recursive nature of person and environment. Although the current practice climate emphasizes the micro-level context (e.g., neurobiology, medication, personality, interpersonal relations), this educational policy requires that CSWs understand how mezzo-level (e.g., neighborhood and community) and macro-level (e.g., federal legislation) contexts shape clinical practice.</p> <p>The advanced CSW recognizes the reciprocal nature of context and practice; in other words, the practitioner keeps contextual factors in mind while designing and implementing services, recognizing that interventions also shape context. For example, a social worker who designs a group for transgender youth will offer direct service while also indirectly "legitimizing" transgender individuals in society's eyes simply by offering the service (2.1.7). As noted in this policy, "Advanced practitioners in clinical social work are knowledgeable about how relational, organization, and community systems may impact clients. They anticipate and react to evolving cultural, technological, geographical, political, legal, economic, and environmental contexts. They encourage clients to effect changes within these contexts" (CWSE, 2009, p. 8).</p> <hd id="AN0082703962-22">Implications</hd> <p>Given that today's social workers can be found practicing in an expanding and fluid community, from diverse social locations, this educational policy becomes ever more important. Consider clients who are situated in a vulnerable or oppressed position within the dominant culture, and who often are subject to discriminatory practices. CSWs have a professional responsibility to challenge the dominant discourse, and any policy that marginalizes any individual or group such as the emergent transgendered community in the United States. A CSW will keep in mind the micro-level contexts, such as which mode of treatment will best address the client's presenting problem, needs, and preferences, and the clients' strengths and resources (2.1.10 a–d). In addition, [<reflink idref="bib9" id="ref51">9</reflink>]) suggested that social workers need to understand the mezzo-, macro-, and exo-level contexts that shape practice. Returning to our earlier example, the advanced clinical competencies recognize that CSWs are responsible for challenging rigid binary gender classifications, presenting a transgender identity as a viable option for questioning individuals, confronting gender stereotyping, and educating the public on gender diversity (2.1.2, 2.1.7). "Whatever the forum, we must be capable of sophisticated conversations on gender if we hope to cure the social disease of sexism, homophobia, heterosexism, and transphobia" ([<reflink idref="bib9" id="ref52">9</reflink>], p. 269).</p> <p>Social work educators and their students need to adopt a pattern of inquiry that deconstructs the dominant paradigms so that potentially marginalized individuals and groups are respected in classroom discussions and clinical practice settings (2.1.3). Not only does this educational policy encourage students and practitioners to respond to contexts that shape practice, it also encourages social workers to shape contexts. Social work students need to adopt a reflective practice stance ([<reflink idref="bib30" id="ref53">30</reflink>]), allowing themselves to shape and be shaped by the voices of marginalized client.</p> <hd id="AN0082703962-23">Engagement (2.1.10a)</hd> <p>Engagement with a broad range of client groups is a fundamental skill imbedded in social work practice. The engagement process sets the tone of the future clinical relationship, and a solid beginning leads to the possibility of a fruitful relationship throughout the course of the therapeutic engagement.</p> <hd id="AN0082703962-24">Implications</hd> <p>The competencies suggest that CSWs will attend to the interpersonal dynamics and contextual realities that both strengthen and potentially threaten the therapeutic alliance. CSWs need to understand clients' paradoxical behaviors. Often, they seek our assistance only to seemingly sabotage the engagement process, or have no interest in participating. CSWs need to appreciate that any client has both a wish to engage as well as a feeling of shame or doubt that is often precipitated when asking for help. CSWs understand that such struggles around the engagement process are normal and must be addressed in a skillful manner. Understanding the complexity of interpersonal dynamics is especially important when CSWs engage nonvoluntary clients.</p> <p>CSWs must be familiar with relationally based theories that position clients and workers on an equal footing. The CSW knows about the dynamics of human behavior and is aware of how development can be thwarted within clients. Nevertheless, advanced practitioners do not set themselves up as "all-knowing experts" in the engagement process. They encourage clients to become full participants in the therapeutic process.</p> <hd id="AN0082703962-25">Assessment (2.1.10b)</hd> <p>The clinical interview is an excellent tool for assessing clients' current situations. Contemporary CSWs will be knowledgeable about current literature on assessment procedures, including neurobiology and attachment theories. CSWs are reasserting the "bio" portion of the biopsychosocial assessment. Work group members recognized that aspects of spirituality are increasingly important to assessment as well.</p> <hd id="AN0082703962-26">Implications</hd> <p>CSWs understand that clients have made many successful adaptations to stressors that they have experienced throughout their lives. A thorough assessment recognizes that a client's current level of functioning is not necessarily the best adaptation to those stressors. Rather, advanced practitioners look for previously used strengths and adaptations and convey to clients that they understand that they may have many good coping strategies within themselves. It is also important, however, to empathize with the current distress of the client.</p> <p>CSWs recognize that the client will evolve over the course of the intervention. One shapes one's assessment and responses to clients in a continuous manner. The discussions among members of the work group emphasized that assessment and intervention therefore are reciprocally influential in the clinical process. Effective clinical work assumes that the CSWs assessment will evolve as the treatment progresses.</p> <hd id="AN0082703962-27">Intervention (2.1.10c)</hd> <p>The work group discussions of this competency echoed a number of the controversies currently prevalent in the field, including professional differences with respect to the definition and role of evidence-based practice ([<reflink idref="bib1" id="ref54">1</reflink>]; [<reflink idref="bib15" id="ref55">15</reflink>]; [<reflink idref="bib40" id="ref56">40</reflink>]).</p> <hd id="AN0082703962-28">Implications</hd> <p>To "critically evaluate, select, and apply best practices and evidence-based interventions" ([<reflink idref="bib14" id="ref57">14</reflink>], p. 10), CSWs first should be aware that the terms <emph>best practices</emph> and <emph>evidence-based interventions</emph> are not synonymous. Educators should encourage critical thinking by emphasizing that there is no standard definition of what constitutes a "best practice" intervention. Some best practices are based on empirically supported treatments, others are based on expert consensus, and still others on practice wisdom. Some evidence-based practices are also empirically supported treatments, which [<reflink idref="bib15" id="ref58">15</reflink>]) defined as "(<reflink idref="bib1" id="ref59">1</reflink>) those whose efficacy is supported by two or more experiments using a treatment manual done by different researchers or (<reflink idref="bib2" id="ref60">2</reflink>) those whose efficacy is supported by four or more single-case studies done by different practitioner-researchers using a manualized treatment" (p. 728). CSWs also should evaluate for whom is there evidence of effectiveness (e.g., adults but not children; Latino(a)s but not Whites). Finally, because CSWs often provide or coordinate services for clients who require multidimensional interventions, they should be aware of and able to critically appraise interventions provided by other service providers.</p> <hd id="AN0082703962-29">Evaluation (2.1.10d)</hd> <p>It is useful to recognize that evidence-based practice models (and similar forms of evaluation) frequently need to be adapted and personalized for individuals based upon race, culture, gender, class, and other sociocultural factors. Our work group consistently integrated concepts of social identity with the development of advanced social work practice competencies, including evaluation. The incidence, meaning, and understanding of mental health symptoms vary from culture to culture. Consequently, it is important that CSWs be culturally competent when evaluating clinical processes and outcomes.</p> <p>Social work professionals frequently downplay their own abilities to contribute to the growing theoretical and knowledge base that is the foundation of clinical practice and all too often rely on other disciplines to expand the knowledge base in mental health. By adding the evaluation competency, our work group seeks to encourage the contributions of advanced clinical social work practitioners in expanding theoretical understandings of clinical practice.</p> <hd id="AN0082703962-30">CONCLUSION</hd> <p>The shift from content-based to competency-based educational and accreditation standards (CSWE, 2008) created an opportunity for schools to establish outcome measures that reflect each program's legitimate approach to educating students. Although CSWE's 10 core competencies provided guidance for baccalaureate and foundation-year social work curriculum, MSW programs were left to identify knowledge, values, and skills that would reflect what advanced concentration-year students were expected to know and be able to do. Our intention has been to describe some of the process and issues that were a part of creating the 10 arenas of knowledge, values, and skills for advanced clinical social work graduate students. The document published by CSWE was intended as a model but not a standard. Each social work faculty needs to decide if the advanced clinical competencies described in that document fit their approach to clinical social work education.</p> <p>We offer a few "lessons learned" from our involvement in the work group. We hope that sharing our experiences will be useful to other social work educators who are considering adopting, creating, and modifying competency statements for their school's advanced clinical social work practice curriculum.</p> <p></p> <ulist> <item> • Have a retreat. Leave campus and go somewhere nice for a full day. Remind yourself that the work you do matters. Use this occasion as an opportunity to get excited and reenergized about the potential of clinical social work education.</item> <p></p> <item> • Divide and conquer. Follow the process described in the introduction of this article to tackle the core competencies. An alternative is to follow the same process, but use the advanced statements and skills as a starting point for talking about what best fits your school.</item> <p></p> <item> • Scrutinize the clinical competencies. Recognize that your struggles are no different from those of the "experts" from around the country who came together to develop standards for clinical social work. What we all have in common is a commitment to excellence in education for practice.</item> <p></p> <item> • Use a thought experiment. Answer the question posed to the members of work group: "What do we expect our clinical practice concentration graduates to know and be able to do upon graduation?"</item> <p></p> <item> • Words matter. Work group members spent a great deal of time debating the meaning and association of specific words, such as <emph>transference</emph> and <emph>evidence-based practice</emph>.</item> <p></p> <item> • Consensus is important. At the end of the day, the members of the work group were able to come together on virtually all the content in the document. Although it might not have been any one member's vision of a perfect document, it was the most perfect document we could create.</item> <p></p> <item> • Think operationally. At each step of the way, ask yourself, "How would a program measure this?" Lively debates and discussions will ensue about how each social work program is unique, and that "difference" will influence the way that competence will and can be measured.</item> </ulist> <p>We conclude with a renewed sense of optimism about the future of clinical social work education, and with a response to Flexner's 1915 critique. We agree with Flexner that it would be impossible to establish a single set of educational practices with which to prepare students for the diversity of roles that social workers are called upon to perform. We disagree, however, with his view that it is impossible to train social workers for this diversity of roles. By requiring schools of social work to develop advanced competencies consistent with the 2008 core competencies and the specific teachings of a particular school, CSWE has set up a system whereby educational practices can (and will) be responsive to the diverse roles that graduates of that program are most likely to encounter. Only if the model of advanced clinical competencies discussed in this article were taken as the single standard, rather than one possible interpretation of advanced clinical competencies, would Flexner's critique regain credibility. The model presented here cannot, for example, adequately represent the various ways that competencies build upon each other in successive courses (i.e., vertical integration) and complement one another during a single semester (i.e., horizontal integration). Even among the authors' three institutions, there is a different vertical and horizontal integration. However, if one has the administrative support to evaluate course content, then one should be able to create a document that demonstrates how your school properly presents, integrates, and teaches the skills, knowledge, and values associated with the competencies. Although the prospect of developing an advanced clinical competency statement may feel daunting, our experience with the CSWE working group and our writing partnership has provided us with a clearer vision of what clinical social work looks like, and our work together has strengthened our resolve to continue to train competent CSWs in our schools. We trust this resolve is shared in all graduate schools across the country.</p> <hd id="AN0082703962-31">Acknowledgments</hd> <p>We thank the members of the CSWE work group with whom we developed the model of Advanced Social Work Practice in Clinical Social Work discussed in this article. 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  Data: <searchLink fieldCode="DE" term="%22Educational+Policy%22">Educational Policy</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Work%22">Social Work</searchLink><br /><searchLink fieldCode="DE" term="%22Counselor+Training%22">Counselor Training</searchLink><br /><searchLink fieldCode="DE" term="%22Competence%22">Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Graduates%22">Graduates</searchLink><br /><searchLink fieldCode="DE" term="%22Masters+Programs%22">Masters Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Values%22">Values</searchLink><br /><searchLink fieldCode="DE" term="%22Standards%22">Standards</searchLink><br /><searchLink fieldCode="DE" term="%22Models%22">Models</searchLink><br /><searchLink fieldCode="DE" term="%22Counselor+Qualifications%22">Counselor Qualifications</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/08841233.2012.726206
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0884-1233
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The 2008 Educational Policy and Accreditation Standards identified 10 core competencies that all social work graduates should master. MSW programs found themselves with a need to identify knowledge, values, and skill statements that reflected what concentration-year students were expected to know and be able to do. In 2009 a group of educators convened at the Council on Social Work Education in Alexandria, VA to develop a model of advanced practice in clinical social work. This article describes the work group's process; identifies and describes the resulting advanced clinical knowledge, values, and skills statements; discusses the key debates and issues that arose during the development of the statements; and concludes with the implications for social work education and practice.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 44
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2012
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ983551
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ983551
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/08841233.2012.726206
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 20
        StartPage: 451
    Subjects:
      – SubjectFull: Educational Policy
        Type: general
      – SubjectFull: Social Work
        Type: general
      – SubjectFull: Counselor Training
        Type: general
      – SubjectFull: Competence
        Type: general
      – SubjectFull: Graduates
        Type: general
      – SubjectFull: Masters Programs
        Type: general
      – SubjectFull: Values
        Type: general
      – SubjectFull: Standards
        Type: general
      – SubjectFull: Models
        Type: general
      – SubjectFull: Counselor Qualifications
        Type: general
    Titles:
      – TitleFull: An Educator's Guide to the Development of Advanced Practice Competencies in Clinical Social Work
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Singer, Jonathan B.
      – PersonEntity:
          Name:
            NameFull: Gray, Susan W.
      – PersonEntity:
          Name:
            NameFull: Miehls, Dennis
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2012
          Identifiers:
            – Type: issn-print
              Value: 0884-1233
          Numbering:
            – Type: volume
              Value: 32
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Journal of Teaching in Social Work
              Type: main
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