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    Licensed Social Workers Do Not Mean More Qualified

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    Recently, I came across a Boston Herald article questioning why 34 percent of the Boston Division of Children and Families (DCF) were unlicensed social workers. The tone of the article suggests that unlicensed workers are not qualified to perform their duties while indicating that licensed social workers equated to a higher standard.

    As a former Child Welfare Investigator, those who follow Social Work Helper is well aware that I am a strong advocate against the Licensed Clinical Social Worker (LCSW or equivalent) becoming the standard for all social workers especially in the public sector and child welfare. Many hear the word licensed and assume it means in compliance or adherence to a certain standard, and it does if you are providing mental health services. Until the LCSW, a doctorate in psychology was needed for diagnosing and treatment. Social Work Licensure Advocates for the LCSW changed that dynamic and have helped to make mental healthcare services more accessible. However, each state develops their own licensing requirements which often varies from state to state.

    As it relates to the Licensed Clinical Social Worker (LCSW) or the Licensed Independent Clinical Social Worker (LICSW) under Massachusetts’ licensing law, it means the individual social worker has a master degree in social work, and he/she is licensed to diagnosis clients with a mental health disorder and/or provide treatment to help improve their outcomes after being diagnosed with a mental health disorder. Additionally, Massachusetts provides licensing for Bachelors level social workers. However, this is not the standard in North Carolina or the majority of states.

    Currently, most Child Welfare Agencies require at minimum a bachelors degree in Social Work or related field. However, by requiring social work licensure, I believe it places additional financial burdens on social workers working in traditional social work roles while the Council for Social Work Education fails to address the barriers and challenges those in the public sector face in pursing a social work education.

    Both Child Welfare Social Workers and Police Officers are given powers by statutory law. However, child welfare agencies are not required to be accredited and maintain minimum training and standards certifications like police departments despite recommendations by the United States Government Accounting Office (GAO). Although studies show a social work degree is the recommended degree for a child welfare setting, studies also recommend accreditation as the best course of action to improve outcomes for children and families. Having licensed social workers do not guarantee their course work was specifically for working in child welfare nor does it institute transparency, accountability, program evaluation, and minimum standards of care as well as creating standards for the Agency’s administration of policy.

    Many social workers are deterred from pursing a social work education due to the barriers and oppressive polices against older, working practitioners, and/or the underpriviledged. Although I had a BSW degree and working as a Child Welfare Investigator, I had to quit my job and work for free at another human service agency in order to be in compliance with the internship requirements. Social Workers are finding themselves without health insurance and in economic turmoil in order to comply with a licensing standard that is geared towards clinical practice and not macro/public service.

    The Division of Child and Family Services and other child welfare agencies act under the authority of federal, state, and local statutory laws to investigate allegations of abuse, neglect, and dependency. These agencies are also charged with making recommendations and monitoring the fitness of parents once a determination has been made following a family assessment or investigation. As a result of this statutory authority, licensing law advocates have been unsuccessful in eliminating the licensing public sector exemption for child welfare and human service agencies. However, they have been successful in creating this mandate in the private sector.

    Governor Deval Patrick Addressing the Media on DCF

    Governor Deval Patrick Addressing the Media on Division of Children and Families

    As a Child Welfare Investigator, I brought a knowledge base of almost 14 years of interview and interrogation experience in addition to a Bachelor of Social Work. Later, I pursued a Master degree in Social Work with a concentration in management and community practice.

    However, without doing an additional two years in post graduate doing therapy, I am not eligible for licensing in the State of North Carolina. Because someone can go straight to undergrad, then to graduate school, and then work an additional two years post graduate doing therapy for less than minimal wages to get a LCSW in the State of North Carolina, it does not make them more qualified as a child welfare social worker. It makes them more privileged.

    Child Welfare social workers act as brokers when treatment services are needed or recommended. We connect families with community providers and resources who are trained to provide those services and make expert recommendations on their progress or lack of progress.

    Child Welfare Services must coordinate between schools, police department, hospitals, and other community providers in order to obtain information and coordinate services while maintaining case documentation and hourly billing for reimbursement from the federal government. Unlike private sector project managers, child welfare social workers must complete this high wire act with limited resources and access to technology while dealing with a load of bureaucracies in poor work environments. Child Welfare Social Workers live and work in fear because the bulk of your time doing triage and cases with low activity often get re-prioritized due to high caseloads and staff shortages.

    When I investigated cases, the police investigators relied on my evidence and case gathering to determine whether charges should be filed because social workers are more educated and are the experts in these cases. Social worker have both education and training in many aspects police investigators do not. Yet, often the police investigators that I interacted with had higher salaries than I did, received over-time pay or comp time in excess of a 40 hour week, and most only a high school diploma or at best a bachelor’s degree despite our jobs being classified as hazardous by both the county and the State.

    If there is a tragedy, the media is asking the wrong questions, and Agencies are not going to steer you into asking the right questions. Child Welfare and Human Services Directors answer only to their Board of Directors, and they operate independently of the county or State unless State legislation has addressed this. State oversight is limited because Child Welfare Agencies predominately operate by mandate of Federal law as adopted by State law.

    If you want to know why something happened, find out the case number ratios for each social worker and the amount of hours each worked. See how many children a social worker has on his/her caseload and their risk level which determines the amount of times each social worker must visit each child monthly. Look at the administrative time logged for each social worker which provides insight into actual days work,  time in meetings, time spent in case supervision, and training records. You will find the numbers won’t add up to what is humanly possible.

    Do you automatically assume that each case only has one or two children in the same household or go to the same school? Eight-teen cases don’t sound like a lot, but you could easily have over 55 children with moderate to high risk levels. Moderate risk requires bi-monthly visits and high-risk requires weekly visits. Low risks require monthly visits, but they are often not enough to keep a case open for services.  No matter how many children on your caseload, you don’t stop getting cases. 

    It is not uncommon for kids to leave for summer camp or go visit relatives especially when they are not in school, and a courtesy request home visit made to another Agency in another state could take months to occur. States are not connected, and sending out an alert on a missing child equates to an email and a report to law enforcement which often don’t go anywhere due to being out of their jurisdiction for investigation.  I believe the cases in Boston will expose systems failures if the right questions are answered. 

    Ask for the same records and standard operating procedures, you would seek if you want to know if a police officer or police department was malfeasance and whether proper in-service training was up to date. Under current federal mandates, it is statistically impossible for the best qualified social worker to adhere to every standard and best practices. Front-line staff often take the fall while policy and system failures are not being properly identified.

    Where are the supervisory case notes by each supervisor who is suppose to meet weekly with their subordinates to discuss all the children on their caseload? Are the checks and balances clearly defined by supervision and the administration to account for the whereabouts of children falling under the scope of child welfare services, and how is it monitored? 

    I challenge the media to ask the right questions. In the video below, the Governor addressed allegations relayed by the school superintendent after the fact. I could write another article on the improvements needed between child welfare social workers and teachers. Social Work investigators’ caseloads are tremendously exacerbated because teachers are not trained on the differences between abuse/neglect and poverty. However, I will have to address that at another time.

    [youtube]http://www.youtube.com/watch?v=Y6H638unwi0[/youtube]

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    Deona Hooper, MSW is the Founder and Editor-in-Chief of Social Work Helper, and she has experience in nonprofit communications, tech development and social media consulting. Deona has a Masters in Social Work with a concentration in Management and Community Practice as well as a Certificate in Nonprofit Management both from the University of North Carolina at Chapel Hill.

    Health

    Study Shows Immune Cells Against Covid-19 Stay High in Number Six Months After Vaccination

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    A recent study by Johns Hopkins Medicine researchers provides evidence that CD4+ T lymphocytes — immune system cells also known as helper T cells — produced by people who received either of the two available messenger RNA (mRNA) vaccines for COVID-19 persist six months after vaccination at only slightly reduced levels from two weeks after vaccination and are at significantly higher levels than for those who are unvaccinated.

    The researchers also found that the T cells they studied recognize and help protect against the delta variant of SARS-CoV-2, the virus that causes COVID-19. According to the U.S. Centers for Disease Control and Prevention, the delta variant — currently the predominant strain of SARS-CoV-2 in the United States — causes more infections and spreads faster than earlier forms of the virus.

    The study findings were first reported online Oct. 25, 2021, in the journal Clinical Infectious Diseases.

    “Previous research has suggested that humoral immune response — where the immune system circulates virus-neutralizing antibodies — can drop off at six months after vaccination, whereas our study indicates that cellular immunity — where the immune system directly attacks infected cells — remains strong,” says study senior author Joel Blankson, M.D., Ph.D., professor of medicine at the Johns Hopkins University School of Medicine. “The persistence of these vaccine-elicited T cells, along with the fact that they’re active against the delta variant, has important implications for guiding COVID vaccine development and determining the need for COVID boosters in the future.”

    To reach these findings, Blankson and his colleagues obtained blood from 15 study participants (10 men and five women) at three times: prior to vaccination, between seven and14 days after their second Pfizer/BioNTech or Moderna vaccine dose, and six months after vaccination. The median age of the participants was 41 and none had evidence of prior SARS-CoV-2 infection.

    CD4+ T lymphocytes get their nickname of helper T cells because they assist another type of immune system cell, the B lymphocyte (B cell), to respond to surface proteins — antigens — on viruses such as SARS-CoV-2. Activated by the CD4+ T cells, immature B cells become either plasma cells that produce antibodies to mark infected cells for disposal from the body or memory cells that “remember” the antigen’s biochemical structure for a faster response to future infections. Therefore, a CD4+ T cell response can serve as a measure of how well the immune system responds to a vaccine and yields humoral immunity.

    In their study, Blankson and colleagues found that the number of helper T cells recognizing SARS-CoV-2 spike proteins was extremely low prior to vaccination — with a median of 2.7 spot-forming units (SFUs, the level of which is a measure of T cell frequency) per million peripheral blood mononuclear cells (PBMCs, identified as any blood cell with a round nucleus, including lymphocytes). Between 7 and 14 days after vaccination, the T cell frequency rose to a median of 237 SFUs per million PBMCs. At six months after vaccination, the level dropped slightly to a median of 122 SFUs per million PBMCs — a T cell frequency still significantly higher than before vaccination.

    The researchers also looked six months after vaccination at the ability of CD4+ T cells to recognize spike proteins atop the SARS-CoV-2 delta variant. They discovered the number of T cells recognizing the delta variant spike protein was not significantly different from that of T cells attuned to the original virus strain’s protein.

    Although the study was limited because of the small number of participants, Blankson feels it pinpoints areas that merit further research.

    “The robust expansion of T cells in response to stimulation with spike proteins is certainly indicated, supporting the need for more study to show booster shots do successfully increase the frequency of SARS-CoV-2-specific T cells circulating in the blood,” says Blankson. “The added bonus is finding that this response also is likely strong for the delta variant.”

    Along with Blankson, the members of the study team from Johns Hopkins Medicine are study lead author Bezawit Woldemeskel and Caroline Garliss.

    This study was supported by the Johns Hopkins COVID-19 Vaccine-related Research Fund.

    The authors do not have financial or conflict of interest disclosures. 

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    Health

    Poverty, Racism and the Public Health Crisis in America

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    Although extreme poverty in the United States is low by global standards, the U.S. has the worst index of health and social problems as a function of income inequality. In a newly published article, Bettina Beech, clinical professor of population health in the Department of Health Systems and Population Health Sciences at the University of Houston College of Medicine and chief population health officer at UH, examines poverty and racism as factors influencing health.

    “A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe,” Beech reports in Frontiers in Public Health. “Racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. The U.S. has one of the highest rates of poverty in the developed world, but despite its collective wealth, the burden falls disproportionately on communities of color.” The goal of population health is to achieve health equity, so that every person can reach their full potential.

    Though overall wealth has risen in recent years, growth in economic and financial resources has not been equally distributed. Black families in the U.S. have about one-twentieth the wealth of their white peers on average. For every dollar of wealth in white families, the corresponding wealth in Black households is five cents.

    “Wealth inequality is not a function of work ethic or work hour difference between groups. Rather, the widening gap between the affluent and the poor can be linked to unjust policies and practices that favor the wealthy,” said Beech. “The impact of this form of inequality on health has come into sharp focus during the COVID-19 pandemic as the economically disadvantaged were more likely to get infected with SARS CoV-2 and die.”

    A Very Old Problem 

    In the mid-1800’s, Dr. James McCune Smith wrote one of the earliest descriptions of racism as the cause of health inequities and ultimately health disparities in America. He explained the health of a person “was not primarily a consequence of their innate constitution, but instead reflected their intrinsic membership in groups created by a race structured society.”

    Over 100 years later, the Heckler Report, the first government-sanctioned assessment of racial health disparities, was published. It noted mortality inequity was linked to six leading causes of preventable excess deaths for the Black compared to the white population (cancer, cardiovascular disease, diabetes, infant mortality, chemical dependency and homicide/unintentional injury).

    It and other reports led to a more robust focus on population health over the last few decades that has included a renewed interest in the impact of racism and social factors, such as poverty, on clinical outcomes.

    The Myth of Meritocracy

    Beech contends that structural racism harms marginalized populations at the expense of affording greater resources, opportunities and other privileges to the dominant white society.

    “Public discourse has been largely shaped by a narrative of meritocracy which is laced with ideals of opportunity without any consideration of the realities of racism and race-based inequities in structures and systems that have locked individuals, families and communities into poverty-stricken lives for generations,” she said. “Coupled with a lack of a national health program this condemns oppressed populations such as Black and Hispanic Americans, American Indians, and disproportionately non-English speaking immigrants and refugees to remain in poverty and suffer from suboptimal health.”

    Keys to Improvement

    The World Health Organization identified three keys to improving health at a global level that each reinforces the impact of socioeconomic factors: (1) improve the conditions of daily life; (2) tackle the inequitable distribution of power, money and resources; and (3) develop a workforce trained in and public awareness of the social determinants of health.

    The report’s findings highlight the need to implement health policies to increase access to care for lower-income individuals and highlight the need to ensure such policies and associated programs are reaching those in need.

    “Health care providers can directly address many of the factors crucial for closing the health disparities gap by recognizing and trying to mitigate the race-based implicit biases many physicians carry, as well as leveraging their privilege to address the elements of institutionalized racism entrenched within the fabric of our society, starting with social injustice and human indifference,” said Beech.

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    Mental Health

    When Giving Thanks, Don’t Forget Yourself

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    As we give thanks at the holidays, it’s easy to overlook someone important: your past self.

    While it’s well documented that gratitude toward others can improve wellbeing, two University of Florida scientists find that gratitude toward your past self also has benefits.

    Does thanking yourself seem a bit…selfish? The researchers, UF psychology professor Matt Baldwin, Ph.D., and undergraduate student Samantha Zaw, think not.

    “Despite the fact that past gratitude is self-focused, it reminds people that they’re part of a bigger story and that they have the power to grow,” Baldwin said. “It’s possible this promotes a pay-it-forward type of mentality.”

    Gratitude is what psychologists call a self-transcendent emotion, one that lifts us out of the everyday and expands our perspective, which can help us get along with each other better. In a recent experiment, Baldwin and Zaw asked participants to write brief gratitude letters. The first group thanked someone else, the second thanked themselves, while a third, the control condition, wrote about a positive experience they’d had. Zaw and Baldwin then surveyed the participants about their self-perception after writing the letter. Although the results are not yet published, early analysis shows that the exercise gave the other- and self-focused gratitude groups a sense of redemption and helped them feel they were morally good people. However, the group that wrote to themselves scored higher on both measures.

    The past-self group also saw a benefit the others didn’t: an increase in the self-awareness measures of clarity, authenticity and connectedness.

    “Unlike gratitude toward others, being appreciative of ourselves carries an added benefit of truly understanding who we are and feeling connected to ourselves,” said Zaw, a McNair Scholar who has been working with Baldwin since her freshman year as part of UF’s Emerging Scholars Program.

    Zaw and Baldwin’s research — the first known data gathered on past-self gratitude — was inspired by a Reese’s cup. When Baldwin’s co-worker, boredom researcher Erin Westgate, returned to the office after pandemic lockdown, she was delighted to discover a peanut butter cup she had squirreled away in her desk.

    “She texted me like, ‘Oh my gosh, my past self left my future self a Reese’s,’” Baldwin recalled. “I was like, ‘Wait a second. You’re expressing gratitude towards something your past self had done. We have to study this.’”

    As Zaw and Baldwin dug into previous studies, they found plenty on gratitude toward others and a few on self-compassion, but nothing on past-self gratitude. They designed the letter-writing experiment to test its effects, presenting their findings at the Society of Southeastern Social Psychologists in October and at the upcoming meeting of the Society for Personality and Social Psychology in February.

    If you’re curious about the benefits of self-gratitude, Zaw offered a way to try the experiment at home, maybe as a new Thanksgiving tradition. Take a few minutes to write a thank you message to someone else, and another to yourself for something you did in the past. Sharing what you wrote could foster connections between loved ones, she said, but the exercise can also pay dividends if you try it on your own.

    “At Thanksgiving and Christmas, we focus on other people, but self-care is really needed too, especially if we want to feel more clear about ourselves,” she said. “Maybe it can even lead to a better vision for ourselves for the next year.”

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