The importance of engaging families in home visiting was recognized more than a century ago as M. E. Richmond provided guidelines for involving families in the visiting process. She stressed individualizing services and helping families develop skills that would serve them after the home visiting services ended. During the 20th century, early organized efforts in home visiting in the United States built on methods used in other countries, especially European countries. Although interest fluctuated in the United States during the past century, since 2010 interest has increased due primarily to the passage of the Patient Protection and Affordable Care Act that provided for home visiting services to respond to the needs of children and families in order to improve health and development outcomes for vulnerable children and their families. Engaging families is essential for a productive home visiting experience requiring thoughtful program activities as well as knowledge and skills on the part of the visitor. Program responsibilities begin with the need to make good employment decisions regarding home visitors and then to provide effective training, supervision, and ongoing professional development. Providing professional training in helping skills such as observation, listening, and ways of asking questions to gain or clarify information is essential to ensure visitors can engage families. Using principles for effective home visiting—including establishing a collaborative relationship with the family; individualizing services; being responsive to family culture, language, and values; and prompting problem-solving skills—can enhance the ability of the visitor to engage the family. Programs can provide opportunities for visitors to enhance their skills in developing relationships with and engaging families. Engaging families is a reciprocal process. Some families will have a positive orientation toward working with visitors to accomplish their own goals and objectives; others may be less willing to engage. Although the program and visitors have the main responsibility for engagement, they will face challenges with some families and may need to seek creative solutions to actively engage. Just as home visitors need to engage parents in order to facilitate new knowledge and skills, parents need to engage their children to foster development. Recent research identified a set of parent–child interactions that visitors can incorporate to foster parent engagement with young children. These challenges are shared across home visit programs, as well as across cultures and countries, regardless of the professional training of the visitors or the goals and procedures of the programs.
Barbara Wasik and Donna Bryant
Valire C. Copeland and Betty Braxter
The upward trend in the number of Black maternal deaths between 2005 and 2020 warrants an in-depth assessment of risk factors associated with the increased maternal mortality rate in the United States for this subgroup population. The risk factors are multifactorial and, in part, have been organized into several categories: demographics, social determinants of health (SDOH), medical conditions, and the quality-of-care interventions by health systems providers. In addition, the overall trends, causes, and solutions to decrease maternal mortality current rates reflect the social inequities in our society. Black maternal deaths have been rising in recent years due to complex causes which stem from structural and systemic health inequities. In part, unvaccinated pregnant women were at greater risk of severe illness and hospitalization and even death if they were diagnosed with COVID-19. While Black Americans were disproportionately impacted by the pandemic, the disparities in maternal mortality predate and extend beyond the pandemic. In part, and together, the leading causes of pregnancy-related deaths include cardiovascular disease, other medical conditions and infections, cardiomyopathy, blood clots in the lung hypertensive disorders related to pregnancy, adverse pregnancy outcomes, racial bias of providers, and perceived racial discrimination from patients. In addition, an overview of nonmedical factors referred to as SDOH, which intersect with health status outcomes, will be discussed. An overview of Black women’s maternal mortality and morbidity, factors contributing to poor maternal health status outcomes, and intervention strategies at the provider, health systems, and policy levels are provided. Social workers in health care systems function as health care providers and clinicians. Therefore, contributing medical and nonmedical issues are factors to consider for a holistic perspective during engagement, assessment, and intervention. The terms Black women and Black birthing persons are used interchangeably.
Steven P. Segal
The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as trans-institutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, expanding admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase and model programs illustrating what can be done; yet, it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness. It has been documented, from political, economic, legal, and social perspectives, how this policy has affected the care and control of populations such as older adults, children, people with mental illness or developmental disabilities, people under correctional-system supervision, and, more recently, individuals without a home. Suggestions for a truer implementation of deinstitutionalization’s initial aspirations are available.
Megan G. Sage
Indigenous populations have experienced hundreds of years of historical trauma, systemic racism, and oppression since colonization began in the Americas, Australia, and New Zealand. Settler colonialism has created and continues to perpetuate historical and ongoing trauma and systemic racism in Indigenous populations. Despite considerable diversity and resilience among Indigenous populations globally, there is a clear pattern of significant disparities and disproportionate burden of disease compared to other non-Indigenous populations, including higher rates of poverty, mortality, substance use, mental health and health issues, suicide, and lower life expectancy at birth. Substantial gaps related to access to healthcare and service utilization exist, particularly in low-income Indigenous communities. Implementation and sustainment of White dominant-culture frameworks of care in Indigenous communities perpetuate these systems of oppression. Development and implementation of culturally informed services that address historical trauma and oppression, and systematically integrate concepts of resiliency, empowerment, and self-determination into care, are issues of policy as well as practice in social work. The co-creation and subsequent implementation, monitoring, and sustainment of effective systems of care with Indigenous populations are essential in addressing health disparities and improving outcomes among Indigenous populations globally.
A pandemic contains three key components: extensiveness, novelty, and severity. For the past century, humankind experienced the Spanish flu in 1918 and COVID-19 in 2020 as major pandemics. The global impact has been extensive in terms of their origin, international transmission, and mortality rates. Public health measures to slow and stop pandemics have been implemented. During the COVID-19 pandemic, disparate impacts on health in different populations have been witnessed due to existing social inequalities, detriments of health, and structured racism. The interests of social workers have been adversely impacted in those pandemic times. Spanish flu bolstered social work with a professional presence. COVID-19 has confirmed the need for community engagement and community development to follow large-scale social policy reforms as a response to the disproportionate impact on diverse marginalized communities, which is the core of macro social work practice and would be more strongly called on to prepare for future pandemics.
Janelle Stanley and Sarah Strole
The historical context of suicidal behavior and public policies addressing suicide arose simultaneously within the United States, and both reflect a culture of discrimination and economic disenfranchisement. Systems of oppression including anti-Black racism, restrictive immigration policy, displacement of American Indigenous communities, religious moralism, and the capitalist economic structure perpetuate high-risk categories of suicidality. Suicidal behavior, protective factors, and risk factors, including firearms, are examined in the context of twentieth and early twenty first century public policy. Recommendations for public policy will be discussed with consideration for policies that impact communities disproportionately and social work ethics, such as right to die laws and inconsistent standards of care.
Stacy S. Remke
As a relatively new arena of practice, social work in pediatric palliative care (PPC) is evolving and being shaped by social work practitioners, as well as physician leaders, clinicians from other disciplines, and institutions. PPC practice requires a wide array of social work skills, knowledge, and insights to accomplish the many tasks and address the many issues that can arise when caring for children with life-threatening conditions. Family-centered, team-based care is the standard approach. Knowledge of childhood diseases, family systems, health care delivery, mental health assessment and interventions, child development, and bereavement care is required for best practice. The provision of effective care over time, across sites, and in the context of team-based specialty care requires skilled social work intervention.
Hee Yun Lee, William Hasenbein, and Priscilla Gibson
As the older adult population continues to grow at a rapid rate, with an estimated 2.1 billion older adults in 2050, social welfare researchers are determined to fill the shortage of gerontological social workers and structural lag to best serve the baby boomers who are expected to need different services than previous generations. Mental illness impacts over 20% of older adults in the world and the United States. The major mental health issues in older adults include depression, anxiety, loneliness, and social isolation. Depression is considered one of the most common mental health issues among this population; however, the prevalence could be underestimated due to older adults linking relevant symptoms to other causes, such as old age, instead of as possible depression. Like depression, anxiety symptoms are often mistaken as results of aging. It is also difficult for providers to diagnose anxiety in this population due to anxiety frequently being coupled with other illnesses and the psychological stress that comes with old age. Because the presence of loneliness or social isolation can manifest depression and anxiety symptoms in older adults, it is also difficult to separate these two issues. With the anticipated increase of the older adult population within the next few years, measurement tools have been created to assess depression and anxiety specifically for older adults. In addition to adapting assessment tools, interventions tailored to older adults are essential to ensure treatment coherence, even though medications are the go-to treatment option.
M. Aryana Bryan, Valerie Hruschak, Cory Dennis, Daniel Rosen, and Gerald Cochran
Opioid-related deaths by overdoses quadrupled in the United States from the years 1999 to 2015. This rise in mortality predominately occurred in the wake of historic changes in pain management practices and aggressive marketing of opioid medications such as oxycontin. Prescription opioid misuse and subsequent addiction spilled over to heroin and fentanyl for many. This drug epidemic differed from others in its impact among non-Hispanic whites, leading to drastic changes in how the United States views addiction and chooses to respond. This article offers an overview of opioid use disorder (OUD), its treatment and its relationship with pain. It also discusses special populations affected and provides insight into future directions for research and social work practice surrounding opioid management in the United States. Because of the profession’s emphasis on the person and social environment as well as its focus on vulnerable and oppressed populations, social work plays a critical role in addressing the crisis.
Shelley Cohen Konrad
The World Health Organization defines interprofessional collaborative practice (IPCP) as when multiple health workers from different professional backgrounds provide comprehensive health services working with patients/clients, families, caregivers, and communities to deliver quality health care across settings. IPCP has long been considered a best practice model to improve effective health-care delivery; however, implementation of collaborative practice models and evidence to support their efficacy have been relatively slow to develop. IPCP is inextricably linked to interprofessional education and practice (IPEP), which brings together students and practitioners across disciplines and practices, and includes direct care workforce, people/patients/clients, families, and communities to learn with, from, and about each other to prepare them for integrated workplace practice. The article will explore national and global interprofessional collaborative practice initiatives; outline core competencies and evidence for collaborative practice; provide examples of IPCP implementation; and discuss the role social work plays in the development and leadership of collaborative practice.