The Role of Social Work in Pediatrics and Child Psychology

The Role of Social Work in Pediatrics and Child Psychology Susan Horky, LCSW Pediatric Pulmonary Division University of Florida

Overview What does a Social Worker do?? Social Work in healthcare Comparison of Social Work and Psychology

What does a social worker do? http://www.socialworkers.org/pubs/choices/default.asp

What does a Social Worker do? MSW,LCSW PhD BSW, MSW MSWs may do some or all of these • concrete services • resource information • case management • discharge planning • advocacy/policy • social welfare • psychotherapy • research • medical social work • administration

History of Social Work Child Guidance/Psychiatric Social Work Early 1900s Medical Social Work 1890s 1920s 2007 Child Welfare/Social Policy Child Welfare/Social Policy

History of Social Work- Child Welfare • Providing food/shelter • Job training • Child labor laws • Public health • Federal programs for the poor

History of Social Work - Medical “to make medical care effective”

Child Guidance Model: • Psychiatrist sees child • Social work works with family 1930s 1940s 1950s • WWII- Social Workers • do more therapy: • Psychiatrists at war • Psychiatrists doing meds Some Social Workers trained in psychoanalysis History of Social Work-Child Guidance/Psychiatric Social Work

Most Social Work jobs combine social and psychological aspects

Mental health: Depression, anxiety Major Mental Illness Personality Disorders Adjustment problems Grief and Loss Relationship problems Anger management Family problems Specific populations: Chronically Ill Substance Abusers Children, Elderly Pregnant teens Abused Children Juvenile Offenders Developmentally Delayed Homeless Social Work

Community agencies Hospitals/clinics Schools Private practice Mental Health Judicial System Prisons Academic settings Research projects Teaching Unique clinical settings Government agencies Social Work Job Settings Setting depends on interests, program attended and experience

Main tenets of social work: “Start where the client is” The relationship is the foundation of all work Bio-psycho-social, systems approach Strengths based: Nonjudgmental Self-determination Social equality

Sample of Models used by Social Workers Psychodynamic/ Object Relations Health Prevention and Promotion Cognitive/Behavioral Narrative Person-in-Environment; Systems Theory Rogerian Task Centered Bereavement Developmental Motivational Interviewing

Social Work in PediatricHealth Care • Setting: Hospital or outpatient health clinic • Roles: • Psychosocial Assessment • Child and family functioning • Concrete needs • Emotional needs • May depend on roles of other team members

Interventions: Support to child and/or family members Ongoing psychotherapy or referral for same (child or family members) Behavioral interventions Child behavior Parenting Adherence Assistance with concrete issues Community resources: WIC, Food Stamps,SSI Case Management: Agencies involved with child: school, afterschool, outside therapist Conveying families’ views to team Discharge planning (has varied over time) Social Work in PediatricHealth Care (cont’d)

Social Work Note Pediatric Pulmonary Division Name: John Billings Date: 8/9/2006 John is a four year old boy with cystic fibrosis. He and his family are well known to the pulmonary service. Charlie and his grandmother attended clinic today. Charlie’s grandmother indicated that Charlie’s mother was not able to get out of work to bring Charlie. Charlie’s weight has increased since his last visit. As Charlie’s grandmother appeared not to know much about Charlie’s care and his mother was not at the visit, it was difficult to discern what changes had assisted in the weight gain. It was also difficult to assess how Charlie’s symptoms had been since the last visit or how regularly he is getting treatments. However, the physician reports that his lungs seem clear. Grandmother reports that Charlie is doing “ok” at daycare but that he sometimes cries for his mother. Grandmother feels that the daycare is not very supportive. She also reports that they have refused to give Charlie nutritional supplements. Aside from these concerns, Grandmother reports that Charlie is doing well and seems happy. She reports occasional behavioral struggles but indicates that these are relatively rare. She also reports that Charlie’s mother is less stressed at the last visit as she has found a fulltime job. According to Grandmother, Charlie’s behavior and mood appear to have improved, now that his mother is feeling better. Overall, the family is doing well. I will call the daycare to educate them about CF, so that hopefully they will agree to give Charlie supplements. I also plan to learn a little more about his separation problems. I will also call his mother to see if I can assist in helping her get time off from work.

Social Work in Mental Health • Settings: • Private practice • Family service agency • Outpatient hospital or health center

Social Work in Mental Health • Roles: • Psychosocial Assessment • Child and family functioning • Emotional needs • Child and/or family therapy • Group therapy

History of Presenting Problem Ms. Bishop reports that Jean was “a darling little baby” but that starting at the age of two, she “had a mind of her own.” However, Mrs. Bishop reports having “taught Jean a thing or two,” stating that “I’ve never been afraid to take charge—my mother used the belt, and I turned out just fine” When further questioned, she reports having spanked Jean with her hand frequently, but states that she rarely used an object. Ms. Bishop states that with “appropriate discipline” Jean became a “pretty good girl, kind of quiet…I hadn’t had too many problems with her until this year. But now she’s angry and moody.” Family History Developmental History Medical History School Substance Abuse Sexual History Family Discipline Impressions Based on this interview, it is difficult to assess the level or type of Jean’s difficulties. While clearly there are relationship challenges between Jean and her mother, these may relate, at least in part to Ms. Bishop’s parenting beliefs and personal style. Without Jean’s input, it is difficult to assess what her role is in the dynamic. While it is possible that Jean is has significant behavioral problems (as suggested by her mother) it is also possible that she is exhibiting usual teen behavior, which her mother may experience as abnormal. It is also possible that her reported anger and depression relate to longstanding issues including the abandonment by her father and her intensive, and perhaps in- consistent, relationship with her mother. It is possible that Jean is afraid that a therapist will trust mother’s view more than her own. Plan: 1) Offer Ms. Bishop counseling with another therapist; 2) Attempt to engage Jean for further assessment and treatment. Social Work Assessment Pediatric Pulmonary Division Name: Jean Bishop Date: 12/3/2004 Presenting Problem: Jean is a 17 year old girl who was brought to the clinic by her mother for behavioral problems. Specifically, Ms. Bishop is concerned that Jean has been having angry outbursts, and occasionally throws objects. Jean was reluctant to par- ticipate in the initial evaluation, so the intake was done with her mother. Identifying Information/Social Situation Jean is an only child. Her mother was not married to Jean’s father and he left when she became pregnant. Ms. Bishop works in a department store, making dress alterations. Jean is a senior in High School and is a National Merit Scholar. There are no extended family members in the area. Ms.Bishop’s father is deceased and she “does not talk to” her mother, who lives on the West Coast. Precipitant Ms. Bishop reports that she decided Jean “needed therapy” after she had an angry outburst last weekend. Ms. Bishop had apparently refused to let Jean see her friends that after- noon. Ms. Bishop states that she likes Jean’s friends and had no concerns about them. “I just wanted her to stay home with me. Upon further questioning about physical violence, she indicated that Jean had thrown a pillow on the ground while she and her mother were arguing.

Social Work Training Bachelors in Social Work Masters in Social Work PhD in Social Work or DSW

Human Behavior in the Social Environment Policies and Programs in Social Services Social Work Practice Social Work Research Theories and Models of SW Practice Graduate Field Instruction I and II (internships) Advanced Seminar in SW Practice (includes ethics) Psychopathology in SW practice Evaluation of SW practice Five electives (e.g., child, diverse populations, group, crisis intervention, family therapy, loss and bereavement, advocacy, administration) Social Work Training: Clinical MSW

Psychology vs. Social Work The differences within Psychology and within Social Work may be bigger than the differences between Psychology and Social Work

Psychology vs. Social Work Psychology Social Work Wide variety of settings and roles Psychological testing Integration of social and psychological Assessment and Psychotherapy Stronger research base More neurological training Perceived as less formal

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The Role of Social Work in Pediatrics and Child Psychology