Racial inequality negatively influences the lives of people of color in the United States. Although race refers to differential concentrations of specific genes, the impacts are confined to physical characteristics such as skin color, hair type, and eye color. Rather than designating meaningful biological categories, race is a social construct. Yet, where there are inevitable intersections with institutional structures and interpersonal health relationships, race and racism produce inequities.
Racism occurs within and permeates the overarching political, social, cultural, and economic systems of American society. It can take several forms: structural, institutional, interpersonal, and internalized. Institutional racism in the healthcare system yields adverse effects on the physical and mental health and well-being of racialized individuals and communities. These inequities are well documented.
Recommendations are offered for creating a fairer and more just healthcare system in America. Equality and equity in the country’s healthcare system will be achieved only if racism is challenged in all its forms.
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Institutional Racism and Effects on Health and Well-Being
Valire Carr Copeland, Betty Braxter, and Sandra Wexler
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Special Education
Annahita Ball and Candra Skrzypek
The special education system in the United States serves youth with disabilities in the public schools. After decades of marginalization and oppression, federal and state policies established in the 1970s created a complex policy and service delivery system that serves more than 15% of youth in schools. Under federal law, disabled youths are entitled to a free and appropriate public education (FAPE) in the least restrictive setting. At the federal level, the Individuals with Disabilities Education Act (IDEA) is the guiding policy for special education. Under IDEA, key features of special education include the identification and evaluation of disabled youths, the least restrictive environment, Individualized Education Plans (IEP), procedural safeguards, and shared decision-making. To be eligible for services, a youth’s disability must directly and adversely impact their education as demonstrated by a comprehensive evaluation. Following the evaluation, a student will receive an educational placement in the least restrictive environment meaning the student must be included with students who are nondisabled to the maximum extent possible. The student will also receive an IEP, or a written document that specifies how the school or district will provide FAPE for the student as well as measurable annual goals. Students and their families should be involved throughout this process, and procedures are in place to ensure that any disputes are resolved.
Vast inequities and disproportionalities have been identified within the special education system. Specifically, inequity spans the identification, evaluation, and discipline of youths with disabilities. Some youths are overidentified in special education, while others are underidentified. Black, Native, and Hispanic youths are more likely to be identified for special education services and are more likely to be placed in restrictive and segregated settings. Disabled youths, especially racialized youths, are also at increased risk of exclusionary discipline (e.g., suspensions and expulsions). Policy changes identify and rectify disproportionality in special education. States and districts are required to report on disproportionality and those that have significant disproportionality by race or ethnicity must provide early intervening services to eliminate the disproportionality. Debate persists on whether the current special education system can truly be equitable though continued advocacy, policy changes, and innovation to ensure that special education practices meet the needs of all students.
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Psychosocial Support in Emergency Settings
Maryanne Loughry
The integration of psychosocial support into emergency responses is a recent development. In the 1990s, the need to address the mental health and psychosocial well-being of individuals and communities affected by emergencies became clear following the breakup of the former Yugoslavia (1991–1992) and the Rwandan genocide (1994). Prior to this, mental health in emergencies was primarily addressed in clinical settings. However, the humanitarian field was divided between the medical sector, which asserted that psychiatric clinical intervention was best, and many nonmedical actors, who preferred a person-in-environment approach. The need for consensus resulted in the Inter-Agency Standing Committee (IASC) working group’s establishment of the framework of Mental Health and Psychosocial Support (MHPSS), which combined both approaches. The IASC Guidelines on MHPSS in Emergency Settings, published in 2007, are widely recognized as explaining how best to administer psychosocial support in emergencies. This ended decades of tension between mental health and psychosocial experts in emergency and humanitarian settings.
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Indian Americans: Overview
Rachel John, Vithya Murugan, and Isha Desai
Indian Americans have immigrated to the United States since the 19th century. This population is one of the fastest growing and the second largest immigrant group in the United States. Understanding the Indian American experience in the United States requires knowledge of Indian histories, such as British colonialism, immigration policies, and casteism, that have shaped the lived experiences of this population. Significant values and cultural norms, such as being a collectivist and the importance of family, are central to the Indian American experience.
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Home Visits and Family Engagement
Barbara Wasik and Donna Bryant
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.
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Critical Race Studies
Larry Ortiz and Susan Nakaoka
Critical race theory originated in law as a framework for legal studies analyzing the United States’ persistent racial divide. As an upstream theory, it focuses on the underlying social structures and cultural assumptions upholding White supremacy. Since the early 2000s, social work scholars have begun to apply critical race theory tenets to all aspects of the profession, from education to practice. Considering social work’s historic commitment to social justice, and the most recent declarations of the Council on Social Work Education as committed to antiracist education, this article advances the idea that critical race studies in social work is necessary, but the relationship requires serious and ongoing interrogation to unearth the profession’s White supremist roots.
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Queer Communities, LGBTQIA2S+ Populations, and Macro Practice
Michael P. Dentato
Related to understanding queer identities, an ongoing need exists for the expansion of competency among social workers across micro and macro practice frameworks. Practitioners must be aware of their own positionality and use of cultural humility associated with practice and advocacy for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and two-spirit+ (LGBTQIA2S+) communities, which include those identifying as demisexual, omnisexual, and pansexual, among others. Relatedly, social workers must be attentive to evolving terminology and contexts through which the term queer has been defined over the years, as well as relevant challenges with connectedness to (or separation from) the larger LGBTQIA2S+ community. Age cohort associations and the role of intersectionality also have relevance and underscore the multidimensional discourse necessary to develop effective competency and the ability to engage in affirming macro practice with queer communities. Social work practitioners must understand the implications for best practices associated with establishing and maintaining an affirming alliance with queer clients via policy practice efforts, advocacy efforts, community organizing, service provision, or therapeutic context. In addition, there remains a continued need for ongoing research associated with understanding the unique needs of queer identities and the queer community at large.
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Community Resilience
Cindy Sousa and Tamarah Moss
Community resilience describes the dynamic, ongoing process of coping and recovery in the face of collective stressors and trauma. Social and monetary capital, technological expertise, and strong physical and organizational infrastructure all undergird strong systematic responses to massive hardships. Other factors that underlie community resilience, such as shared philosophies; patterns and cultures of survival and meaning-making; emotional qualities such as optimism and trust; and norms around cooperation and interdependence, are more ethereal. Our world faces continual onslaughts to collective well-being. Thus, notions and practice models around community resilience are increasingly urgent to develop, with implications for macro practice across multiple methods - including community organization, policy practice, and management/administration.
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Digital Technology
Gina Griffin
As technological advances continue to develop, delivering macro human service through social work innovations becomes a new priority for the discipline. Digital technologies offer potential applications using tablets, smartphones, cloud computing, artificial intelligence, and wearable technology to enable whole new possibilities for human services. As a result, policymakers and community organizers alike can access the existing information much faster, and potentially connect with hard-to-reach communities to make meaningful decisions. Incorporating the latest digital trends from business and industry settings to macro social work practice are highlighted. By utilizing digital technology, human service organizations can become more proactive and citizen-centered, potentially transforming personal and economic capacity.
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Immigrant Communities in the United States and Macro Practice
Laura Folkwein
Macro social work practice with immigrant organizations and communities in the United States requires a basic understanding of the underlying values and history of U.S. immigration laws and policy. U.S. immigration policy frequently reflects multiple and conflicting interests and values in labor needs, global politics, family unification, and national security, and policies often shift in response to political leadership, ideology, and public opinion. Some areas of the history of U.S. immigration laws and various macro social work approaches to U.S. immigration policy include (a) advocacy at local, state, and federal levels; (b) anti-immigrant legislation proposed at the state level; and (c) collaboration between grassroots organizations and local leaders to build policies and practices that support immigrants.
