Eye movement desensitization and reprocessing (EMDR) is one of the two most empirically supported treatments for adult populations with noncombat, single-episode posttraumatic stress disorder (PTSD), with the other being exposure therapy. This entry describes the unconventional origin, theoretical underpinnings, and treatment protocol of EMDR, including its distinctive use of bilateral stimulation (that is, dual-attention stimulation). Also discussed are possible contraindications, unresolved issues, and the need for more research regarding the effectiveness of EMDR with other populations with PTSD, such as children and individuals with combat PTSD and complex trauma.
Sheila H. Akabas
Employee assistance programs (EAPs), or membership assistance programs when sponsored by unions, are designed to improve worker productivity and motivation by responding to problems that workers experience which interfere with job performance and satisfaction. Now a ubiquitous characteristic of American workplaces, the programs are largely staffed by social workers. This entry discusses their historic development, extent, scope, structure, how they are perceived and utilized by different racial and gender populations, and the dilemmas and challenges facing EAPs as they try to define their role, function, and best practices amid emerging trends in the world of work.
Tonya Edmond and Karen Lawrence
Since its inception in 1987, eye movement desensitization and reprocessing (EMDR) therapy has been the subject of lively debate and controversy, rigorous research both nationally and internationally, and is now used by licensed practitioners across six continents as an effective treatment of trauma symptoms and posttraumatic stress disorder (PTSD). The aim of this entry is to provide social work practitioners and researchers with a description of the treatment approach for adults and children, EMDR’s development and theoretical basis, a review of controversial issues, and an overview of the evidence of effectiveness of EMDR across trauma types and populations.
Sandra Owens and Letha A. Chadiha
There is evidence that family caregiving in the United States has been increasing at an unprecedented rate as a result of various societal issues. This entry provides a summary of the scholarly literature regarding elder-caregiving trends, demographics, legislation, challenges, and racial and socioeconomic impacts, as well as the rewards of caregiving. Additionally, the entry provides empirical findings regarding evidence-based interventions associated with family caregiving of older adults.
Joan O. Weiss
The recent explosion of genetic knowledge that was a product of the Human Genome Project has extraordinary implications for social workers and their client population. It is imperative that social workers recognize how vital their role is in helping clients come to terms with being at risk for a genetic condition or facing the uncertainty of a genetic diagnosis in the family. Understanding the psychosocial and ethical implications of genetic testing is important for all social workers, no matter where they are practicing. Social workers must take an active part in ensuring that clients are protected against genetic discrimination and learn more about basic genetics and genetic resources.
Clayton T. Shorkey and Michael Uebel
The entry defines Gestalt therapy, including brief history, major influences, contributors, and current status of Gestalt therapy in terms of memberships and journals. Key concepts are outlined, and the effectiveness and potential for Gestalt therapy's status as an evidence-based practice is framed in relation to recent overviews of empirical research and to what is needed in the future for further research. While the current literature in social work does not reflect a strong emphasis on Gestalt, we emphasize some of the philosophical and ethical compatibilities between these approaches.
Sara Sanders, Matthew Tvedte, and Mercedes Espinal-Lujan
This article summarizes the history of grief theory and provides an overview of major theoretical frameworks for understanding grief and grief work. Specific types of losses are defined and described, including the newer concept of community grief and loss. Interventions for individuals, groups, and communities are outlined, followed by a discussion of the role of social workers in addressing grief and loss.
This entry provides an overview of the state of health care in the United States. Service delivery problems such as access and affordability issues are examined, and health care disparities and the populations affected are identified. A discussion of two primary government-sponsored health care programs—Title XVIII (Medicare) and Title XIX (Medicaid), and the Patient Protection and Affordable Health Care Act—are reviewed along with various health care programs and major existing service delivery systems. Ethical conflicts in providing health care, and new directions and challenges are discussed, along with future roles for social workers.
Lois F. Cowles
Social work in health care emerged with immigration and urbanization associated with industrialization, and the resultant shift from physician visits to the patient's home and workplace to hospital-centered care. This change is alleged to have resulted in a loss of the doctor's perspective of the psychosocial influences on physical health. Originally, some nurses were assigned the function of addressing this loss. But eventually, the function became recognized as that of a social worker. From its beginnings in the general hospital setting in the late 1800s, social work in health care, that is, medical social work, has expanded into multiple settings of health care, and the role of the social worker from being a nurse to requiring a Master's Degree in Social Work (MSW) from a university. However, the broad function of social work in health care remains much the same, that is, “to remove the obstacles in the patient's surroundings or in his mental attitude that interfere with successful treatment, thus freeing him to aid in his own recovery” (Cannon, 1923. p 15). Health care social workers are trained to work across the range of “methods,” that is, work with individuals, small groups, and communities (social work “methods” are called “casework”, “group work” and “community organization”). They work to assist the patient, using a broad range of interventions, including, when indicated, speaking on behalf of the client (advocacy), helping clients to assert themselves, to modify undesirable behaviors, to link with needed resources, to face their challenges, to cope with crises, to develop improved understanding of their health-related thought processes and habits, to build needed self confidence to do what is required to help themselves deal with their health problem, to gain insight and support from others who are in a similar situation, to gain strength from humor, or from a supportive environment, and through spiritual experience, and from practicing tasks that are needed to deal with their health-related problems or from joining forces with others in the community to modify it in the interest of improved health status for all, or to gradually restore a sense of stability and normalcy after a traumatic experience. Most important of all, perhaps, is the “helping relationship” between client and social worker, which needs to be one of total understanding and acceptance of the client as a person. A sizable portion of the U.S. population lacks financial access to health care, where health care is regarded as a privilege rather than a right, as it is seen in all other industrial nations (except South Africa). Current trends in the U.S. health care system reflect efforts to control rising health care costs without dealing with the “real problems,” which are: (1) the lack of a single-payer health care system and: (2) the lack of focus on “public health.”
Health social work is a subspecialization of social work concerned with a person's adjustment to changes in one's health and the impact this has on that person's social network. Social workers in every setting must be ready to assist individuals and families adjusting to illness and coping with medical crises. This entry provides a brief overview and history of health social work and describes the settings and roles where this work is practiced. Significant challenges and opportunities in clinical care, research, education, and policy are discussed. Standards and guidelines for quality practice are then noted.
Jessica Grogan and Frank C. Richardson
The Humanistic Psychology Movement, which began in 1962 and flourished throughout the 1960s and 1970s, exercised a strong influence over the development of social work assessment and practice. Defined by its distinctive research methodologies, based on the phenomenology of Husserl and Heidegger and in the consideration of subjective, experiential elements, humanistic psychology contributed to the modern practice of qualitative and survey-oriented research. Its health and growth orientation, antihierarchical emphases, and affirmation of the inherent strengths of human nature also greatly impacted therapeutic practice. Specific therapeutic orientations that arose from the movement include person-centered counseling, existential therapy, Gestalt counseling, transactional analysis, and the strengths perspective.
Frederic G. Reamer
The possibility of practitioner impairment exists in every profession. Stress related to employment, illness or death of family members, marital or relationship problems, financial problems, midlife crises, personal physical or mental illness, legal problems, substance abuse, and professional education can lead to impairment. This article provides an overview of the nature and extent of impairment in social work, practitioners’ coping strategies, responses to impairment, and rehabilitation options and protocols. Particular attention is paid to the problem of sexual misconduct in social workers’ relationships with clients. The author reviews relevant ethical standards and presents a model assessment and action plan for social workers who encounter an impaired colleague.
Sarah E. Bledsoe, Brianna M. Lombardi, Brittney Chesworth, and Samuel Lawrence
This article discusses interpersonal psychotherapy (IPT), a psychotherapeutic intervention developed by Gerald Klerman, Myrna Weissman, and colleagues in the 1970s as an outpatient treatment for major depression in adults. Based on the theories of Harry Stack Sullivan and Adolph Meyer, IPT is a manualized, time-limited intervention that addresses the underlying interpersonal antecedents and correlates of psychiatric illness. The goal of IPT as originally developed is to reduce depressive symptoms and improve interpersonal relationships. IPT has been widely tested in adults and adolescents and is an empirically supported treatment for major depression. IPT has been adapted for a variety of psychiatric illnesses and problems of living including perinatal depression, anxiety, and trauma-related disorders. Current evidence detailed below supports the use of IPT across cultures, illnesses, and populations.
Rates of depression increase during adolescence and may put youth at risk for suicidality, future episodes, and impaired functioning in multiple life domains. Increased vulnerability for depression during this stage may occur because it is when the cognitive capacity for personal reflection, abstract reasoning, and formal operational thought develop; depressive styles for attributing events may hence form, along with hopelessness about the future. However, other biological and social influences may also interact with the increased cognitive vulnerability. Latino ethnicity and female gender appear to exert particular influence. Treatment for adolescent depression includes medication (mainly Prozac and Zoloft), cognitive-behavioral therapy, interpersonal therapy, and family therapy. Medication and psychosocial treatment is also combined, particularly for treatment-resistant depression.
Kathleen Coulborn Faller
Social workers play a vital role in helping physically and sexually abused children. In order to play this role, they need knowledge about the nature of the problem: (1) legal definitions of physical and sexual abuse, (2) its incidence and prevalence, and (3) its signs and symptoms. Social workers have three major roles to play: (1) identifying and reporting child abuse to agencies mandated to intervene; (2) investigating and assessing children and families involved in child abuse; and (3) providing evidence-based interventions, both case management and treatment, to physically and sexually abused children.
Michelle S. Ballan, Molly Burke Freyer, and Lauren Powledge
Evidence-based interventions for students with autism spectrum disorder (ASD) are explored, and trends and changes in the diagnosis of ASD in the United States are examined. Evidence-based interventions in various settings and modalities are discussed, with detailed descriptions of several effective evidence-based interventions including joint attention training, video modeling, story-based interventions, and activity schedules. The integral role of social workers in the lives of children with ASD in multiple settings, particularly the classroom, is emphasized. Social work must be vigilant to keep pace with the ever-changing field of autism, with its frequent improvements in understanding, diagnosis, and treatment.
Amanda Duffy Randall and Donna DeAngelis
Social work regulation protects the public by establishing the qualifications that a professional must possess, by establishing a means of holding professionals accountable, and by having a system for the public to make complaints against allegedly incompetent or unethical practitioners and have them investigated and adjudicated. Certification also exists in various specialty areas of social work practice, as is a function of professional organizations versus governmental regulatory agencies.
Nancy P. Kropf
Although the terms older adult and senior citizen are commonly defined as individuals 60 years and above, later adulthood contains various life-course phases and developmental periods. The “young-old,” defined as individuals in the age range of 60–75 years, often experience various health, social, and economic transitions. Both the individual and family systems must negotiate some of the concomitant changes that accompany the journey into later life. Therefore, this first decade of older adulthood is one that can simultaneously be enjoyable, exciting, demanding, and stressful for aging persons and their family.
Karen Kyeunghae Lee
Depression and bipolar mood disorders are mental disorders that are characterized by mood disturbance combined with decreased functioning of the affected individuals. This entry focuses on major depressive disorder and bipolar I and II disorders among adults in the United States. Bipolar disorder has unique clinical features and intervention options, and so it is discussed in a separate section after depression. Diagnosis, prevalence, comorbidity, risk factors, course, assessment, treatment, service utilization, and international perspectives are reviewed for each disorder. The implications for social work are briefly addressed at the end of this entry.
Vikki L. Vandiver
Since the mid-1980s, managed care has been one approach used to address the economic crisis in the American health-care system. This entry overviews managed care from the perspective of policy, procedure, practice, and system. Specifically, emphasis is given to understanding the emergence and history of managed care, multiple definitions, how it works, and examples of managed care plans, key legislation, existing research, its future, and implications for social-work practitioners.