The multiplicity of disability definitions can be attributed to the heterogeneity of disability, its multifactoral nature, and its effects across the life span. Of particular concern to the social work profession are those persons with neurocognitive disabilities. Neurocognitive disabilities are ones where a problem with the brain or neural pathways causes a condition (or conditions) that impairs learning or mental/physical functioning or both. Some examples are intellectual disabilities, autism spectrum disorders, and savant syndrome. Neurocognitive disabilities are the most difficult to diagnose often times because of their invisibility. Providing services for people with neurocognitive disabilities is very difficult, and people with these disabilities are among the most vulnerable populations in today's society. This entry discusses neurocognitive disabilities and current and future trends in social work disability practice.
Disability: Neurocognitive Disabilities
Lisa S. Patchner and Kevin L. DeWeaver
Disability: Psychiatric Disabilities
W. Patrick Sullivan
The psychosocial catastrophe that accompanies serious mental illness negatively impacts individual performance and success in all key life domains. A person-in-environment perspective, and with a traditional and inherent interest in consumer and community strengths, is well positioned to address psychiatric disabilities. This entry describes a select set of habilitation and rehabilitation services that are ideally designed to address the challenges faced by persons with mental illness. In addition, it is argued that emphasis on a recovery model serves as an important framework for developing effective interventions.
Disaster Mental Health
Leia Y. Saltzman, Regardt J. Ferreira, and Tonya C. Hansel
Disaster mental health refers to the provision of psychological and substance use services in environments coping with and recovering from disasters. In addition, disaster mental health refers to the study of the psychological and emotional impacts of disasters on individuals, families, and communities. Disasters—including climate-related, human-caused, biological, technological, and infrastructure failure—have documented impacts on the mental health of survivors. Disasters do not equitably impact individuals, families, and communities but rather may exacerbate existing disparities, worsening health and mental health outcomes and limiting access to mental health care. As societal and environmental factors continue to evolve, communities that previously were not impacted by disasters have begun to feel the effects. Simultaneously, communities that have previously been impacted by disasters are now facing recurring or compounding disaster experiences—for example, repeated wildfires, hurricanes, or flooding. The 2020 COVID-19 pandemic has also increased concerns about protracted and lengthy disaster experiences and the impact these events may have on new and/or worsening mental health symptoms. Social workers have a unique perspective that can contribute to the practice of disaster mental health with individuals, families and communities—from the provision of clinical services to policy and preparedness, to research. The system approach coupled with a strengthsbased perspective which is the hallmark of social work is imperative when working with individuals, families, and communities impacted by disasters and those who face mental health challenges in the wake of these experiences.
Dissociative Identity Disorder
Gregory L. Nooney
Individuals with the diagnosis of dissociative identity disorder (DID) developed a myriad of methods, including the creation of an intricate inner world of alternate identities, or alters, to creatively survive the devastating effects of early childhood trauma and attachment wounds. Unfortunately, a belief in its rarity even by mental health professionals, the perceived difficulty in diagnosing and treating dissociation, and a fear of the unknown have resulted in DID’s being underdiagnosed. The result has been that many with this condition have been ineffectively treated for co-occurring disorders and have been inaccurately perceived as resistive to treatment. Detailed methods of diagnosing DID, specific steps to help stabilize clients with DID, and in-depth trauma-specific protocols are summarized, along with ways to minimize the elevated risks of compassion fatigue and countertransference in working with this population.
Drug Policy Reform
Sheila P. Vakharia
Social workers are uniquely qualified to be effective drug policy advocates for effective and equitable policies through their commitment to advancing social welfare and promoting social justice. The prohibitionist antidrug policies that began at the turn of the 20th century have been a key driver for the criminalization of millions of Americans over time, a disproportionate number of whom have been people of color. The period beginning with President Richard Nixon’s “War on Drugs,” in addition to contributing to inequality and marginalization, has exacerbated a number of public health and safety harms, suggesting that past policy approaches have not met their intended aims. The North American opioid overdose crisis in the early 21st century is presented as an illustrative case study because its persistence and mounting death toll exemplify the challenges with the current model of drug prohibition. Areas for macro social work interventions include legislative advocacy through lobbying, provision of expert testimony in legislative hearings, engagement in reform through litigation, involvement in social action, and performing policy analysis and research.
Early Brain Development for Social Work Practice
Development of the brain in the first 3 years of life is genetically programmed but occurs in response to environmental stimuli. The brain is organized “from the bottom up,” that is, from simpler to more complex structures and functions, so the experiences and environment that shape early development have consequences that reach far into the future. This entry describes the ontogeny and processes of fetal and infant brain development, as well as major risks to early brain development (during pregnancy and after birth), with emphasis on the factors seen in social-work practice. Neuroscience research is changing social work practice, and understanding early brain development and the contributors to poor development is critical for social workers in medical, mental health, child welfare, and other practice settings.
Elizabeth C. Pomeroy and Polly Y. Browning
Eating disorders involve maladaptive eating patterns accompanied by a wide range of physical complications likely to require extensive treatment. In addition, “eating disorders” frequently occur with other mental disorders, such as depression, substance abuse, and anxiety disorders. The earlier these disorders are diagnosed and treated, the better the chances are for full recovery” (NIMH, 2011). As of 2013, lifetime prevalence rates for anorexia nervosa, bulimia nervosa, and binge eating disorder are 0.9%, 1.5%, and 3.5% among females, and 0.3%, 0.5%, and 2.0% among males respectively (Hudson, Hiripi, Pope, & Kessler, 2007). Early diagnosis is imperative; the National Institute of Mental Health estimates that the mortality rate for anorexia is 0.56% per year, one of the highest mortality rates of any mental illness, including depression (NIMH, 2006). More recent research (Crow et al., 2009) indicates mortality rates as high as 4.0% for anorexia nervosa, 3.9% for bulimia nervosa and 5.2% for eating disorders not otherwise specified. Current research and treatment options are discussed.
EMDR Treatment for Trauma
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.
Employee Assistance Programs
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.
Eye Movement Desensitization and Reprocessing
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 and genomic knowledge that was a product of the Human Genome Project has extraordinary implications for social workers and their client population. Genetics and genomics are interdisciplinary fields. Their scope reaches beyond the doctor’s office and beyond medical professionals. Social workers must 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 need to know the basics of genetics and genomics and take an active part in protecting their clients from genetic discrimination.
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.
Grief and Loss
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.
Health Care: Overview
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.
Health Care: Practice Interventions
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 Care Social Work
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.
Homelessness and Macro Interventions
Eva M. Moya, Amy Joyce-Ponder, Jacquelin I. Cordero, Silvia M. Chávez-Baray, and Margie Rodriguez LeSage
The emergence of social work and macro practice is often associated with the eradication of poverty and prevention of homelessness through the efforts of 19th century settlement houses. Structural violence and social determinants of homelessness are often grounded in unequal social, political, and economic conditions. Health and mental health were affected by the lack of stable housing, causing and increasing the complexity of health and human service needs and services. Furthermore, due to inequities, some populations are inadvertently more likely to face chronic homelessness, which can be mitigated through the role community-engagement and macro practice interventions.
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.
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.