flexner and social work: implications moving forward

Analyzing the Plurality and Fragmentation of Social Work

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Plurality and Fragmentation in Social Work: Analyzing the Implications of Flexner Using

a Philosophy of Science Perspective

In Flexner’s 1915 speech to the National Conference of Charities and Corrections, which

included a large constituency of social workers, he explained that a legitimate profession must

possess some six properties. Intellectual operations in which individual members of the

profession took responsibility for carrying out the profession’s mission was for Flexner a

principal criterion. For Flexner a profession took its essence from science and learning deriving

its knowledge base from practical and scientific inquiry. In addition, for Flexner, a profession

would claim a definitive and communicable technique that others could identify as specific to

that profession. Flexner saw a profession as demonstrating a strong tendency towards being a

self-organized unit, and finally the members of a profession embrace altruism in their

motivations and work. Despite Flexner’s assertions that social work met some of these criteria,

he found that social work lacked a scientific knowledge base, was not easily communicated to

others in terms of what the practice of social work meant, and lacked the kind of unifying

organization and structure that most other professions possessed (Flexner, 1915).

Although social work has undoubtedly taken Flexner to task in the 100 years since his

famous speech, some social work scholars claim that Flexner was not entirely wrong nor was his

perspective put into proper context by the profession of social work (Kirk & Reid, 2002;

McGrath-Morris, 2008). Regardless of varying stances on Flexner’s characterization of social

work over the years, for the most part, the profession has taken his critique seriously and used it

as ammunition to inspire the professionalization of social work (Reisch, 2011; Wagner, 1990).

Over the past 100 years, social work has worked diligently to create structures to validate

its claims to professionalism, including professional organizations and entities tasked with

providing identity, regulation, visibility, and legitimization to the profession (Author; Fisher &

Shragge, 2000). The accreditation of social work programs, regulated licensure process, and


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major professional organizations have sought to lay to rest Flexner’s notion that social work is

something other than a profession because it lacks a true knowledge base and practices easily

communicable to others within society (McGrath-Morris, 2008). Although social work

continues to refute Flexner’s critique of the professional legitimacy of social work, it is hard to

argue against Flexner’s point that social work as a profession fails to incorporate a specific

technique, one easily communicated to lay people, and other professionals.

In this paper we argue that social work is not a unitary profession. There are multiple

forces working to instill within the profession considerable diversity that results in pluralism

difficult for social work to integrate into a unified framework of action and specific identity. For

social work, such plurality moves the profession away from a unified narrative and instead

induces fragmentation as a result of disciplines and practices that often occur across differing and

contradictory paradigms of practice. We analyze the properties of plurality and fragmentation in

social work using the philosophy of science as a guiding conceptual framework for analysis.

Additionally, we offer three contrasting paradigms for explaining the fragmentation of social

work, each rooted in competing and differing ontological and epistemological values about what

social work should be. Then we offer two potential scenarios for what professional social work

might envision for its development; one based on the current iteration of professional social

work, and the other based on a more radical reconceptualization of the profession.

Plurality and Fragmentation as Salient Properties of Contemporary Social Work

Perhaps what is at the base of Flexner’s criticism is now most salient within social work

and involves the apparent absence of a unitary or even uniform narrative of social work in which

its leaders and practitioners offer specific factors that underlie the issues people face. Unlike

medicine, a profession that commands a rationale argument for its relevance steeped in the

disease model, social work engages societal forces in which there are considerable differences in

how people and their institutions frame social issues (Brown, 2006; Kieffer, 1984). Thus, while


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medicine enjoys a unity steeped in the disease model, social work does not have such a luxury.

The profession’s plurality emerges from differences in how social workers conceive of and act

on social issues (Thomas, O'Connor, & Netting, 2011). Such pluralism imbues social work with

contrasting forms of action thereby reducing the integration of social work through what Cetina

(1999) considers epistemic culture in which knowledge emerges from science and its practice.

There is no unifying science of social work. Even in the face of a movement to engage

evidence-based practice, there remain numerous ways of framing social issues and enacting

action, which is influenced by diverse ways of knowing.

Pluralism is an apt descriptor of social work. The plurality of social work is evidenced

today in its multiple disciplines forming around community organization, management, policy,

and direct practice within the larger framework of social work (Gamble & Weil, 2010; Rothman,

2008). We invoke the idea of discipline here to capture a particular way of knowing and action

that in the case of social work and other professions, guides practice. It may be easy to dismiss

the unity of social work solely based upon recognizing its multi-disciplinary character, but most

professions including medicine, education, engineering, and public administration incorporate

diverse disciplines. What is important here, however, is that disciplines are rooted in a particular

worldview in which theoretical and empirical principles of the physical world stipulate practice.

For social work, disciplines whether direct practice, group work, or administration

emerge from the manner in which the profession sees its distinctive approach to action. Uniting

such disciplines will be a common narrative in which social workers come to see their shared

affinity organized around a particular world view. Fragmentation for us suggests that there is

something more profound operating in social work than the diversity multiple disciplines

introduce into the profession. Fragmentation suggests a pulling apart of structures from a central

idea or construct that otherwise could unite the profession. For us, that pulling apart is indicative

of different world views existing in social work thereby introducing a diversity of meaning


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systems. Paradigms capture differences in meaning systems when their adherents prescribe a

right way of seeing, understanding, explaining and taking action.

While many social workers likely embrace plurality—that is, they likely accept the

various disciplines that comprise the profession--others view this plurality as an expression of

the profession’s fragmentation (Author; Fisher & Shragge, 2000; Wagner, 1990). This

fragmentation may be indicative of the weakness in the underlying knowledge base of the

profession. A profession like medicine possesses a knowledge base situated in clinical medicine

involving disease, disorder, and impairment. Alternatively, the paradigms now existing in social

work likely are grounded in different and often times competing knowledge bases (Thomas,

O'Connor, & Netting, 2011). One hundred years post Flexner, social work remains a diverse

profession and characterizing this diversity are on the surface a plurality of disciplines. But more

deeply situated, and perhaps obfuscated by the profession’s search for unity, multiple paradigms

of social work create systemic differences fragmenting the profession and frustrating its search

for a common base, like that which is found in medicine’s disease model (Guba, 1990; Rothman,

2008).

Flexnerian Inspired Social Work over an Arc of 100 Years

Why did social work cohere around Flexner over the past 100 years? Since Flexner was

a physician perhaps it involves the status of what was then an emerging profession as he

articulated it from the authority of a medical professional (Morris P. , 2008). The medical model

emerges over the 20th century as a preeminent profession but less because of its altruism and

more because unlike other professions medicine addresses factors producing considerable

anxiety in a society that prizes beauty, youth, and vitality. Medicine comes to address disease,

illness, impairment, disability and ultimately death extending its institutions and purported

expertise to frame or reframe many conditions as involving disease. It is society’s acceptance of

the disease metaphor that likely imbues medicine with considerable power.


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Influence of Medicine on Social Work

Medicine continues to extend its disease model even though social and cultural factors

are highly influential in health and the advancement of human well-being can benefit from

improving people’s environments (White-Chu et al, 2009). Modern institutionalized medicine is

reframing its purpose as extending life (Binstock, 2003), curing aging (Finke, 2005), and

addressing aesthetic aspects of the human physique (Spear, 2010). This expansion of the medical

model is occurring even as international institutions, like the World Health Organization, are

calling for environmental approaches to health as serious disease persist globally, access to

medical care remains problematic across the globe, and environmental factors threaten well-

being (Larson, 1999). As far back as the 1960s, Dubos (1961) called for a new paradigm

involving environmental health.

In spite of institutionalized medicine, health gains are largely a product of public health

interventions having to do with accident prevention, mitigation of environmental factors

fostering infectious or communicable disease, improved nutrition, and better sanitation (Minkler,

2005). For public health the source of health involves addressing how environmental and agent

factors transmit disease to vulnerable hosts. Public health complements social work quite well.

The two professions share in their concerns for environmental factors influencing quality of life

and well-being, particularly of people in marginalized circumstances in which social forces

degrade essential systems of environment and quality of life thereby producing numerous

disparities manifest in health, well-being, and resources (Minkler, 2005). That social factors

create such degradation is undeniable even in the face of mounting evidence that environmental

conditions are influential in inducing illness (White-Chu et al, 2009). A focus on environmental

improvement may mitigate or eliminate the role of the individual practitioner in operationalizing

the profession through discrete practice encounters with individuals who bear the negative

effects of degraded environments.


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Flexner’s Imprint on Social Work

Flexner represented a profession committed to bringing a singular practitioner into

interaction with an individual. This approach to practice undergirds social treatment in social

work (Richmond, 1917). The approach itself may raise the status of a social service agency when

it embraces those features of clinical work in which social work practitioners carry caseloads and

follow well-structured procedures for enacting care across a host of medicalized settings

including mental health, rehabilitation, aging. The dominance of the social work professional

over the recipient in such settings, the well-structured interactions occurring largely within

protected office settings removed from the structures and environments in which social issues are

rooted, and an administrative framework incorporating risk management, utilization review, and

medical necessity align contemporary clinical social work as the dominant paradigm in social

work with the medical profession.

Given how social work now frames its dominant paradigm--and its central role in the

delivery of mental health care--there is unlikely enough practitioners to fulfill demand for

clinical services, especially since clinical practitioners do not address structural or environmental

factors in the production of mental health issues (Thomas et al., 2009). This is problematic given

how incarceration, homelessness, and limited mental health access in high need communities

make the provision of clinical care a complex social issue (Thomas et al., 2009).

Fragmentation in Social Work

Was such an alignment of social work with the medical model a result of the profession’s

interpretation of what Flexner envisioned for social work as a struggling profession? Or, did

social work leaders observe the emerging dominance of the medical profession early in the 20th

century and then began its emulation because of what it saw as the emerging legitimacy of

medicine, and the ground it gained in American culture? From a social learning perspective, was


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Flexner’s influence a product of social work’s mimicking of a profession that American society

was coming to favor?

Given the dominance of social treatment, interpersonal practice, and clinical social work

within the profession is there a unitary profession now even as minority voices call for elevated

respect and inclusion of Macro content and Macro professional identities within existing schools

of social work? If one calculates the numbers and distributions of practitioners, and examines

closely educational curriculum, that social work is a profession rooted in clinical conceptions of

disease and practice may be difficult for an observer to dispute. The reorganization of schools of

social work within health science campuses and in colleges with multiple health science

disciplines may be a sign of the alignment of social work as a health science discipline in spite of

the growing evidence that environmental and social factors are influential in health. Medical

social work may be more of a patient processing discipline than it is a profession central to the

treatment of disease and the alleviation of its consequences.

If our position is correct, that social work has embodied the medical model within its own

paradigm of clinical practice, then the properties Flexner articulates do make sense for a

profession searching for clinical legitimacy within the greater society, and within institutions

devoted to health and medical care. But what is the counter argument to this stance? Are there

alternative ways of thinking about professional social work in which diversification of paradigms

and related multiple disciplines imbue contemporary social work with considerable diversity in

its primary institutions, like NASW, so those institutions face considerable challenge in

integrating pluralistic conceptions of professional purpose and practice? Is there a fragmentation

now occurring rapidly within social work that divides its practitioners into disparate groups each

of which entertains its own conception of what constitutes social work and its social purpose?

Does the pluralization of social work run counter to what Flexnerians have sought in structuring


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a narrative of unity embedded in a paradigm in which the practitioner seeks to identify and

address if not resolve impairment at an individual level?

These questions go beyond what we see as Flexner’s criteria. For us, those criteria are

bounded within a certain world view and way of thinking about professional purpose. Propelling

us is a desire to go beyond Flexner and consider an alternative way of viewing social work—as

an approach to profession characterized in a social domain by multiple and diverse paradigms,

disciplines, and ways of approaching practice. The existence of multiple paradigms creates

tensions among practitioners and educators. Although these tensions may infuse social work with

disunity, these tensions may also catalyze much needed innovation to propel the profession

forward.

Flexner and Social Work’s Search for Legitimacy

When Abraham Flexner gave his original speech and critique of social work as a

profession, it is doubtful that he knew just how influential and enduring his words would be to

the professionalization of social work in the hundred years since his speech. Flexner himself

never claimed to know a great deal about social work nor did he feel as though he had the

expertise needed to critique the profession; however, he sought to outline in an objective manner

criteria he thought society needed to qualify something as a profession. Perhaps what was

missing from Flexner’s stance was a robust consideration of social change in the United States.

Working during the Progressive Era in the United States, Flexner was likely concerned

with linking the professions and professionalism to the realization of an orderly society. Of

course, social work gains ground in what is a tumultuous period and the tension within the

profession of social work itself was revealing: that there would be a division along professional

lines separating what would become clinical and community disciplines seeking to co-exist

within the same profession anticipated what would proliferate not only multiple disciplines but

multiple paradigms. Did Flexner recognize this emergent division inducing within the


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profession a chasm that was deep, yawning, and long lasting? Flexner’s difficulty in

understanding social work 100 years ago was not his challenge alone, but one that social work

itself was experiencing as it attempted to reconcile the settlement house community

empowerment focus of Jane Addams and others with the direct practice focus of Mary

Richmond, Dorthea Dix, and other social work notables.

Over the span of 100 years since Flexner, despite the efforts social work has invested in

professionalization, social work remains a multifaceted profession comprised of many separate

and competing disciplines. Flexner, an academic physician, answered that question offering

social work a way of framing itself in the image of what would subsequently become the

preeminent American profession. Notwithstanding its failure to garner considerable trust of the

American people, medicine stands for the systematic use of knowledge that has become both

rationalized and institutionalized within a society in which technology, that is, the production of

useful albeit acceptable solutions, is seen as a highly valued form of action. Operative here is

society’s expectation that a profession would produce solutions fitting its world view. Here

social work faced and does face considerable challenge.

Flexner brought social work the medical model and all of what that means either positive

or negative. Although there is nothing wrong for one profession to mimic another, why would

social work embrace the medical model to serve as its principal template guiding professionalism

and even professional action? Why not other models? And, why not one of its own invention?

Institutionalized social work legitimizes disease, whether individual or social, as the driver of

social work action, particularly in its clinical variant. By relieving those who bear the negative

effects of disease, and fortifying people against disease (even in ignoring environmental effects

of such disease), social work could establish itself as respectable in a society reluctant to

examine its own structural properties in perpetrating social issues negatively effecting certain

groups.


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Flexner failed to offer an encompassing theory of social work in a society undergoing

considerable change because he did not recognize the profession as a product of social change.

Flexner did offer a set of criteria for judging what constituted a profession as he himself sought

to professionalize medicine. But criteria do not beget theory. And indeed, as contemporary

social work has continued its journey (perhaps entitled “in search of legitimacy”) Flexner’s

criteria serve as a cognitive template for bringing social work into the mainstream: as a

profession that can produce benefits for a society unwilling to consider critically the influence of

social issues on people’s opportunities, life chances, and quality of life.

There is yet another question we consider emergent here: Given what Connolly (2013)

so aptly identifies as fragility operating at multiple levels of society and in the face of self-

organizing phemenomen that may defy prediction, such as profound alterations in climate and

weather that threaten human settlements in profoundly existential ways, what kind of social

profession does a society need at this time? Is it the kind that seeks to repair people in the face

of considerable toll? Or is it a profession that can build institutions at local levels—ones that can

offset fragility and create resilience in the face of unpredictable social and physical forces?

Flexner could not anticipate such chaotic forces since his focus was likely on how American

society could achieve order, particularly within a society undergoing considerable change

brought on by profound alterations in economy, urbanization, immigration, and institutional

purpose. Perhaps for Flexner, the test of a profession was inherent in the technology it could

bring about for the purposes of achieving order, certainty, and continuity.

Perspectives for Understanding the Fragmentation of Social Work

At the foundation of our critique and analysis of the fragmentation of social work are the

ontological and epistemological values and assumptions of the philosophy of science (Burrell &

Morgan, 1979; Guba, 1990). According to Guba (1990), paradigms in professions and disciplines

are value informed world views that guide practice, often at an unconscious level. More recently,


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Thomas, O’Connor, & Netting (2013), adapted Guba’s original philosophy of science framework

and applied it to examining the underlying values present in macro oriented social work practice.

Within this framework, the authors acknowledged the existence of three major paradigms of

community practice; traditional, collaborative, and radical.

Traditional community practice is guided by post-positivist philosophy that values

objectivity and social order. Collaborative community practice is rooted in a social constructivist

paradigm that values the importance of context and individual tacit knowledge. And the radical

paradigm of community practice is rooted in a critical stance that values radical change and

respects the complexity of transformative effects of individual, group, and societal action

(Thomas, O'Connor, & Netting, 2011). Within our critique and analysis of the fragmentation of

social work practice, we will expand upon the framework of multiple paradigms that Thomas

and colleagues use as a lens for understanding the underlying assumptions and values that guide

social work as well as the potential conflicts that can arise when paradigms are not understood or

acknowledged or even diminished in their importance within contemporary social work. We

offer this framework in Figure 1.


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Figure 1 The Multiparadigmatic Fragmentation of Social Work

Radical Change

Empowerment Paradigm

Transformative Paradigm

Neomedical Paradigm

Flexible Prescriptive

Social Order


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The framework incorporates a principal assumption that the profession of social work is

comprised of underlying values about what the knowledge base of the profession should consist

of, what social work practice should focus on, and the nature and degree to which the profession

should focus on social change ((Netting, O'Connor, & Fauri, 2008; Thomas, O'Connor, &

Netting, 2011; O'Connor & Netting, 2008). The framework provided here illustrates two

intersecting and related continua that represent underlying values guiding practice as well as

tensions surrounding the identity of the profession of social work.

The horizontal continuum represents the tension between disciplines of social work that

seek to emphasize more objective or expert forms of knowledge that, in turn, are utilized to

develop evidence-based practices to guide social work and those forms of practice that

emphasize and value local or individual client knowledge and the role of context in developing

interventions and practices.. The vertical continuum illustrates the tension forming between

social work disciplines. Those disciplines that seek to maintain social order through adapting

interventions across the micro-macro spectrum that incrementally lead to social change can

bump up against or even collide with those disciplines that seek to transform social systems,

societal structures, and individual consciousness by embracing radical change goals. While there

are many different ways to envision social work paradigmatically, not all of those visions are

compatible with one another according to the values, goals, and professional roles associated

with practice from within differing paradigms. It is the combination of social work’s plurality of

disciplines, which Flexner alluded to in 1915, along with differing and competing values of the

various paradigms in which these disciplines are embedded that result in the fragmentation of

social work.

Neomedical Paradigm


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The neomedical paradigm is the dominant paradigm of social work. It is grounded in the

direct practice origins of many early social workers, who used experts steeped in deviance theory

to develop theories and practices to work with individuals needing help, treatment, and

professional services to overcome personal and social defecits (Allen-Meares & Garvin, 2000;

Richmond, 1917). The neomedical paradigm is rooted in the medical model that views

individual and societal problems through a lens of prescriptive diagnosis and treatment. In this

paradigm, objective expert knowledge is valued most in the development, utilization, and

evaluation of evidence-based practices (Fay, 1996).

We invoke the term neomedical to suggest that what was the traditional medical model

has morphed to dominate societal explanations of how disease occurs at cultural, societal,

environmental, and individual levels even though individual treatment stands as the principal

intervention. The neomedical model offers salutary recognition to the social and behavioral

sciences, the helping professions, and environmental sciences as it supports interdisciplinary

inquiry and action. But still no matter what augmentation medicine offers principal actions focus

on the treatment of disease in individuals through specialized settings embodying most classical

elements of the clinic.

The knowledge base of the neomedical model is professionalized and removed from

control or even influence by people who experience social issues at individual, group or

community levels. The evidence-based posture of a practitioner reinforces the dominance of the

professional social worker in any interactions with those who experience social issues first hand.

(Drake & Johnson - Reid, 2008). Additionally, the practitioners’ evidence-based posture

legitimizes their autonomous action relative to those issues people identify. While society may

regulate the profession, what Flexner framed as the individual practitioner’s responsibility for

enacting the profession is well situated in contemporary social work practice.


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While social work may teach about and consider the importance of the knowledge,

perceptions, and agency of those who possess first person experience with social issues, these

more subjective dimensions are not the primary emphasis in most disciplines of social work.

Direct or clinical practice, top down social planning, community development, traditional social

administration, and policy practice within government sectors are very entrenched in the

assumptions of expert led interventions that emphasize objective and scientific knowledge, and

the belief in maintaining social order through small incremental changes whether at individual or

higher order systems levels (Guba, 1990).

While therapists, case workers, medical social workers, and other professionals doing

direct practice are the most easily identifiable examples of social work from a neomedical

paradigm, many other forms of social work also exhibit values consistent with this paradigm.

Historically community development efforts have emphasized expert driven top down processes

for addressing community issues and needs (Rothman, 2008; Thomas, O'Connor, & Netting,

2011). Many non-profit organizations also rely on hierarchical traditional business models of

governance that are consistent with the values of the neomedical paradigm (Netting, O'Connor,

& Fauri, 2008). Finally, social policy development and analysis within government systems and

institutions value both professional level expertise and the maintenance of social order, activities

consistent with the assumptions of the neomedical paradigm (O'Connor & Netting, 2008). Given

the roots of direct practice social work from within institutionalized settings as well as it’s

borrowing of theories and ideas from other disciplines (such as medicine, economics,

psychology, anthropology, and sociology) it is logical that the dominant paradigm of social work

is the post-positivist oriented neomedical paradigm.

Empowerment Paradigm

Empowerment is a paradigm competing with the neomedical model within social work.

The roots of social work here are within the settlement house approach to helping established by


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Jane Addams as well as in the pioneering work of social workers such as; Barbara Solomon and

others in communities of color (Addams, 1910; Solomon, 1976). In spite of social work

education’s engagement of empowerment, the use of the idea in idealized statements of

organizational mission and purpose, and in the rhetoric of the profession, true empowerment

theory implies that individuals, groups, and communities experiencing marginalization and not

experts have the insight and experience, primary expertise, resilience, and agency to create

profound change in the fabric of society (Checkoway, 1995; Freire, 1970; Kieffer, 1984).

In embracing a theoretically rooted empowerment lens for practice social workers must

respect the wisdom and insights those facing serious social issues acquire through their direct

engagement of or experience with social issues (Gutierrez & Lewis, 1994; Kahn, 2010). Such

practitioners respect the control individuals, groups, and communities seek to exercise in order to

meet their own identified goals and objectives (Morris A. D., 1984; Piven & Cloward, 1977). In

the empowerment paradigm, social work itself would not be primary but somewhat secondary to

the actions people take to address their own needs and bring about the wishes they seek for

themselves. Thus, social work within the empowerment-based paradigm emphasizes social

workers as facilitators with expertise who can offer considerable knowledge but who nonetheless

play important background, ancillary, collaborative or peripheral roles in promoting individual

and societal level change.

Grassroots community organizers, practitioners working on local level capacity building

and community building, direct service practitioners who primarily utilize interventions that are

person driven as opposed to those who view consumer needs through the lens of deficits and

problems, and policy advocates outside of large bureaucratic institutions, such as government,

may best represent social work from the empowerment paradigm (Brager, Specht, & Torezyner,

1987; Gamble & Weil, 2010). Social work from this stance may still value objective or

professional knowledge; however, there is a strong belief among practitioners who champion this


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paradigm that the knowledge, desires, and agency of individuals, families, groups, and

communities should take precedence over the knowledge and wishes of the expert (Lee, 2001).

Directing knowledge building in social work are substantive issues emanating from the

priorities set by people who themselves bear the negative effects of social issues. But here too

process factors become important when control of knowledge is a central value to the social

action people take on their own behalf. The practitioner’s intent is not to diagnose or treat a

problem, but to help facilitate processes that allow people who face social issues and their

communities to identify and work on those ends they wish to bring about using means they find

appropriate and relevant.

Transformative Paradigm

The transformative paradigm is a rare and perhaps impossible conceptualization, but

nonetheless it captures the imagination of those social workers who see the purpose of the

profession as bringing about institutional if not cultural transformations in how a society works.

Transformative social work would seek to use both tacit and expert knowledge to focus on

individual and societal change; however, practice in a transformative paradigm would seek

radical social change; the intent of which is a drastic alteration in the consciousness of

individuals, especially within groups, societal arrangements and structures, and the social order

of society (Burrell & Morgan, 1979; Thomas, O'Connor, & Netting, 2011).

Types of practices situated in a radical paradigm are activism and mass action

practitioners undertake to advance social movements, and direct practices, especially group or

community work, that promote critical consciousness (Walsh, 2006). That critical consciousness

can emerge as a prelude to or as a consequence of mass action implicate transformation of those

social structures that preclude or limits opportunities for certain groups, creation of new

structures supporting people’s expression of values central to their identities, or alteration of

existing structures so they achieve equity.


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Although normative social work often times seeks to factor into its framework radical

ambitions the realities they face in achieving legitimate status may make the realization of the

elements of this paradigm somewhat elusive. Social action and movements organize to create

new rights or defeat forces abridging rights, changing policies, or creating new opportunities

may be more part of the lore of the profession than a central and definitive part of it. Radical

efforts, both in the United States and internationally, are grass roots or bottom up movements

with little involvement from professional social work institutions, professionally educated social

workers, or social workers who are members of helping organizations based in communities in

which radical grass roots efforts crystallize (Adams & Horton, 1975; Piven & Cloward, 1977;

Wagner, 1990).

Radical change in the United States is in itself difficult to conceptualize, because of the

bureaucratic nature of our system of governance, which by nature and design favors social order,

incremental change, and rigidity of institutions (Alinsky, 1969; Aronowitz, 2003; Bobo, Kendall,

& Max, 2001; Fisher & Shragge, 2000; Tilly, 1978). In the modern era, large scale systemic

transformative change is best seen in international contexts such as found in the Arab Spring,

mass protest and agitation undertaken by a resurgent albeit relatively small labor movement, as

can be seen in the self-organizing efforts for wage equity by Walmart employees, or by efforts

undertaken by people with disabilities or HIV or AIDS who demonstrated historically the value

of conflict as a change method (Author).

Two Scenarios for Considering the Fragmentation of Social Work

Based upon our analysis of the fragmentation of social work, we offer two scenarios for

how professional social work might proceed in the next phase of its evolution. We identify these

two paradigms as seeking reconciliation, or fostering dissent.

The first scenario celebrates the plurality of social work with respect to where we are and

where we might go, if we continue our attempts to reconcile the fragmentation in social work,


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despite the difference in values and goals now separating social workers operating from within

differing and competing paradigms of practice. In the second scenario we ask the profession to

consider a more radical alternative to the current trend of reconciliation. What if social work not

only acknowledged the fragmentation within its profession, but also embraced it by splitting its

professional tree into two or more different groupings each with its orientation to a particular

paradigm and, as a result, incorporating its own socialization structures, practice guilds or

groups, and institutional expressions at group, organizational, and community levels?

What would Flexner have said about such splitting? Certainly Flexner assumes some

kind of homogeneity in the identity, knowledge base, and practice of a profession. Deviation

from such homogeneity could result in a deep splitting of the social work identity perhaps

producing in the long run disparate professions who find little in common across the spectrum of

social work outside of its own particular enclave. Social workers of whatever ilk would come to

see if not accept unity as an elusive aim. Diversity and related fragmentation could be an

outcome, one readily embraced by practitioners who identify with different ways of enacting

social work.

The Reconciliation Scenario

Given the move in helping professions and professional degree granting institutions and

programs to embrace the neomedical model, social work has attempted to also adapt curriculum

and practice to fit this paradigm. While social work’s self-regulated competencies and practice

behaviors continue to grow within institutions such as CSWE, the emergence of applied research

teams, centers, and institutes also reflects a value for disciplinary plurality in social work and

beyond through engagement of other disciplines outside of social work. A commitment to the

achievement of a united profession, despite the paradox in values between disciplines and modes

of practice, would continue to obfuscate profound differences in paradigm, and as a consequence

produce a majoritarian paradigm and two that possess minority status.


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Despite the influence and perpetuation of the neo-medical model in professional social

work, many schools are considering how better to link community and direct practice in what

would be integrated curricula, ones that seek to cross chasms created by differences in discipline

and even paradigm in the existing profession. In this scenario the plurality of social work is

embraced, but it is hard to refute the fact that the profession is one in which the medical model

holds considerable influence and, as a result, the shape and direction of professional social work,

including social work education, will undoubtedly be impacted by who is in control of

professional decision making within the major institutions of social work.

By continuing on the path of reconciliation, we are assuming that the plurality within the

profession is positive, that any historical or current fragmentation between differing traditions of

social work can be reconciled, and that reconciliation and a unified profession is the ideal goal

for professional social work. If all of these assumptions are in fact relevant then it is likely that

in the future more programs will try to integrate and reconcile the values of social work from a

neomedical model with those from empowerment and transformative paradigms. By continuing

to reconcile social work practice from within these different paradigms, the profession will likely

find itself increasingly in a state of paradox, considering that the values within each different

paradigm are contrary, and in conflict with one another (Thomas, O'Connor, & Netting, 2011).

If professional social work is unable to recognize the differing assumptions and values

emanating from diverse paradigms, continued conflicts and fragmentation will likely result as

tension churns within a profession seeking unity despite profound differences among groups

whose practitioners hold contrasting world views (Cameron, Quinn, DeGraff, & Thakor, 2007;

Stone, 2011).

If the dominant paradigm is the neomedical model and the majority of decision makers in

major social work institutions come from within this paradigm, it is unlikely that social work

from an empowerment or transformative perspective will ever receive equal attention in the


21

profession, meaning that the future of an interdisciplinary social work profession is no longer

unified around a salient and unitary definition of what constitutes social work. Although unity

here requires a dominant paradigm so the profession achieves cohesion and integrity, it will be at

the expense of marginalizing a good number of social workers who adhere to what are minority

paradigms. How does an entity that marginalizes its minority perspectives prosper in the long

run?

The Dissent Scenario

While it is likely difficult for many within professional social work to consider any

alternative to a unified profession of social work, another option beyond reconciliation is

available but unlikely. Despite attempts to downplay fragmentation since Flexner and promote

unity, the professionalization of social work has created even deeper divides between what one

could call the factions of the profession (Author; Fisher & Shragge, 2000). While decision

makers within professional institutions and bodies of social work take the politically neutral

stance that social work is and should be about both macro and micro level change as well as

about individual and community practice, professional trends continue to favor direct or clinical

practice as the primary and dominant discipline of social work (Author).

Despite the many scholarly contributions to discussing this divide between community

practice and direct practice disciplines in social work, few have developed alternatives to the

profession’s current efforts it invests in achieving reconciliation so visible in programs CSWE

endorses, or NASW seeks to pursue. While we do not refute the need for all of the various

disciplines that now comprise the social work profession, including clinical social work, social

administration, community development, community organizing, and policy practice, we do

question whether or not the many different disciplines and focus areas of social work are

paradigmatically compatible with one another. Would it be better for social work to further

embrace the neomedical paradigm that has become the dominant guiding force of the profession,


22

and for disciplines and social workers with values more consistent with the empowerment or

transformative paradigms, to move outside of social work and establish their own unique

knowledge bases, professional structures, and organizational expressions of practice?

Such withdraw of a sizable minority from social work could produce two principal

benefits. First it could energize those who align with the minority paradigms that they are

central to social change, and possess relevance in a world in which practitioners and others reject

the neo-medical model. Second, it could better focus the energy of those who remain within the

dominant institution. No longer would this group have to recognize their marginalized brothers

and sisters but could move forward mindful that their purpose fosters unity even though they

may still retain considerable diversity based on discipline, diverse methods of direct practice, and

alternative views of human functioning.

Playing Out the Scenarios

Can the social work profession achieve more unity if it were to adopt a neomedical model

in its entirety, vacate minority perspectives from its ranks, position direct service within a disease

framework and use it to shape social administration and community development, and continue

its evolution along the lines of Flexnerian inspired criteria? Such an alignment could strengthen

the focus of the direct practice discipline and its higher system levels forms of practice such as

social administration, and align it with other societal institutions favoring the prevention and

alleviation of disease. Additionally, such alignment would arm social work with a more

consistent grand narrative advancing how social work as a profession interprets other groups and

institutions. Here freeing society of the burden and expense of disease thereby achieving

hygiene and health, and ultimately order, would be a central focus of the profession’s narrative

of unity.

That disciplines and practitioners from inside empowerment and transformative

paradigms would separate themselves from mainstream social work rooted in the neomedical


23

model offers an alternative strategy. In this way adherents to alternative paradigms would

engage in a powerful form of how Hirschman (1970) conceives as dissent: they would exit from

what was their once parent profession and shift their loyalty to an alternative concept of social

work. Grass roots community organization, which more easily aligns with the empowerment

paradigm, and a structural critique of society, could join with professionals from community

psychology, economic development, urban planning, architecture and design, and other

disciplines to enact projects of local transformation. Those practitioners who desire to focus on

projects through local collaborative community development, social planning, and community

building, could join such once marginalized social workers who are willing to engage in a theory

and practice of change given little credence by their social work colleagues populating the

majoritarian stance in social work.

Community organizers, grass roots policy advocates, and other social work practitioners

who align more closely with the values of empowerment or transformative paradigms would

likely experience considerable growing pains early on as they define for themselves what their

goals, focus, and profession would look like. One of the realizations of those practitioners who

resist or criticize the neomedical paradigm would be the realization that social action and

activism is better served as mechanisms for social change carried out at the grassroots level by

local peoples (Freire 1970; 1998; Piven & Cloward, 1977). The principal commitment of those

community organizers and others breaking away from mainstream social work would be to

building the capacity of local communities and providing supports for delivering more culturally

humble social planning processes.

Some practitioners from current direct practice ranks in social work may also break away

from the profession in favor of establishing new roots for delivering empowerment focused

individual practice. Think about the role of individual counselors in domestic violence

programs, support group facilitators in mental health/substance abuse sectors, peer support


24

specialists, and critical adult education program staff, all of whom possess values and skill sets

quite relevant to bringing empowerment- or transformative-grounded social work into existence

but who often face dissent and critique from others within the neomedical paradigm of

mainstream social work. Those practitioners may not rely at all on established credentialing

systems recognizing that social work regulation is yet another strategy for the distorting the

character of practice steeped in social criticism.

Envisioning what newly created institutions rooted in an empowerment paradigm might

emerge; we can look to past and current institutions incorporating popular education and critical

pedagogy (Boal, 1979; Horton & Freire, 1990; Horton M. , 1998; Kahn, 2010). Highlander Folk

School has offered training and support to local leaders and movements for many decades.

Highlander created a place and spaces where people of different races, genders, and other

differing identities could come together as equals, both professionals and non-professionals

(Horton M. , 1998). Highlander was heavily funded through underground fundraising and

support from philanthropists who supported the capacity building and social justice mission of

Highlander (1998). Freedom schools were an important component of the civil rights movement

as they were spaces developed to teach literacy, leadership, history, and organizing to Blacks in

the south; however, many of these spaces were created with the support and help of privileged

whites (Morris A. D., 1984; Payne, 1995).

More current illustrations of similar spaces can be found in the Grace Lee Boggs School

in Detroit, MI, which uses a place-based model (PBM) of building the capacity of young people

through critical education and community empowerment initiatives (Dobbie & Richards-

Schuster, 2008). Additionally, Southern Echo, with offices throughout the south, is a youth/adult

partnership organization founded by civil rights era leaders, focusing on critical learning,

leadership development, and community empowerment (Payne, 1995). These organizations rely


25

on philanthropy as well as small and mid-size foundation grants. Their funding provides such

organizations with considerable freedom and flexibility in the types of activities they undertake.

Alternative paradigm practitioners would likely create a national network, using existing

smaller networks such as; ACOSA or SWAA, and others previously mentioned as a means to

establish a supportive community and mechanism to mobilize professionals around key policy

issues. Since the fragmentation that many community practitioners experience in professional

social work, psychology, and other disciplines, then it is likely that they would push back against

having a strong national regulatory body in favor of having greater independence, autonomy, and

local identity. While it may be difficult for many within social work to conceptualize the

profession without many disciplines, the historical and current legacy of fragmentation, which

Flexner held out as problematic some 100 years ago, may be creating voids in the profession that

are more harmful than helpful. By admitting that we are a fragmented profession, made up of

many separate and unique traditions and disciplines operating from different sets of values, we

have the ability to move beyond Flexner’s critique as well as the fragmentation of social work in

order to allow diverse paradigms within social work to thrive based on how their adherents

conceive of their own purpose, identity, and aims.

Conclusion

Although the rhetoric of professional social work claims that all of these areas encompass

what social work is all about, it continues to cause fragmentation and dissent within the

profession as the majority of the profession finds itself inspired by a hygienic paradigm in which

social treatment, direct practice, or clinical social work reflect a sole practitioner interacting with

a person whom a professional sees as impaired. Practitioners and educators who themselves are

embedded in curriculum paradigms prizing the hygienic may find themselves rooted in

organizations steeped in belief systems in which deviance is framed as undesirable. If social

work continues onward along the same path of reconciliation that it has taken, both before, and


26

since Flexner, it will likely continue to struggle with its identity thereby compromising its ability

to innovate and focus on what it is that makes social work a distinctive force for change in

society.

While the alternative dissent scenario we offer may seem radical or anarchist in

construction, it offers the reader an alternative perspective on what social work could look like, if

it embraced the current fragmenting forces within the profession rather than seeking unity.

Community organizers within social work ranks have regularly challenged their diminished

status in the profession as have other groups of macro focused practitioners. Perhaps the time

has come for these factions to leave the ranks of social work and begin their own quest to

develop alternative social practice disciplines finding unity in a minority paradigm of action and

informed by factors creating oppression in American society.

What are the consequences of a social work whose unification is founded on its

commitment to a particular paradigm and seeks purity in relationship to practice consistent with

this paradigm that stands alongside other forms of social practice such as radical or

transformative social work practice? What synergies could emerge, and what innovations would

result as those groups interact to shape positive human development for all within society?

Could they achieve a mutuality? Or would their division separate them into more discrete silos?

Flexner did not anticipate how a profession could splinter. At the heart of his perspective is

unity. But is unity within social work now elusive?

References

Adams, F., & Horton, M. (1975). Unearthing seeds of fire: The idea of highlander.

Winston-Salem, NC: Blair.

Addams, J. (1910). Twenty years at Hull-House. New York: MacMillian.

Alinsky, S. D. (1969). Reveille for radicals. New York: Random House.

Allen-Meares, P., & Garvin, C. D. (2000). The handbook of social work direct practice.


27

Thousand Oaks, CA: Sage.

Aronowitz, S. (2003). The new social movements and class. In S. Aronowitz, How class

works: Power and social movement (pp. 141-170). New Haven, CT: Yale

University Press.

Boal, A. (1979). Theatre of the oppressed. (C. McBride, & M. O. Leal-McBride, Trans.)

New York: Theatre Communications Group.

Bobo, K., Kendall, J., & Max, S. (2001). Organizing for social change: Midwest

Academy manual for activists. Washington D.C.: Seven Locks Press.

Binstock, R. H. (2003). The war on ‘anti-‐aging medicine.’ The Gerontologist, 43, 4-‐14. Brager, G., Specht, H., & Torezyner, J. L. (1987). Community organizing. New York:

Columbia University Press.

Brown, M. J. (2006). Building powerful community organizations. Arlington, MA: Long

Haul.

Burrell, G., & Morgan, G. (1979). Sociological paradigms and organisational analysis.

London: Heinneman.

Cameron, K., Quinn, R. E., DeGraff, J., & Thakor, A. V. (2007). Competing values

leadership: Creating value in organizations. North Hampton, MA: Edward Elgar.

Centina, K. Knorr (1999). Epistemic cultures: How the sciences make knowledge. Cambridge,

MA: Harvard.

Checkoway, B. (1995). Six strategies of community change. Community Development ,

30 (1), 2-20.

Connolly, W. E. (2013). The fragility of things: Self-organizing processes, neoliberal fantasies,

and democratic activism. Duke University Press.

Council on Social Work Education. (2012). 2008 Education and policy accredidation


28

standards. Retrieved 2012 йил 12-September from

http://www.cswe.org/Accreditation/2008EPASDescription.aspx

Dobbie, D., & Richards-Schuster, K. (2008). Building solidarity through difference: A

practice model for critical multicultural organizing. Journal of Community

Practice , 16, 317-340. doi:10.1080/10705420802255098

Drake, M., & Johnson-Reid, M. (2008). Social work research methods: From

conceptualization to dissemination. New York: Allyn Bacon.

Dubos, R. (1961). The mirage of health. New York City: Doubleday. Fay, B. (1996). Contemporary Philosophy of Social Science: A Multicultural Approach.

Malden: Blackwell.

Finke, T. (2005). Radical medicine: Treating ageing to cure disease. Nature News Molecular

Cell Biology, 6, 971-976.

Fisher, R., & Shragge, E. (2000). Challenging community organizing. Journal of Community

Practice , 8, 1-21. doi:10.1300/J125v08n03_01

Freire, P. (1998). Pedagogy of Freedom: Ethics, Democracy, and Courage. Lanham,

Maryland: Rowman & Littlefield Publishers Inc.

Freire, P. (1970). Pedagogy of the Oppressed. NewYork: Continuum International.

Guba, E. G. (1990). The Paradigm Dialog. Newbury Park: Sage Publications.

Gutierrez, L., & Lewis, E. A. (1994). Community organizing with women of color: A feminist

perspective. Journal of Community Practice , 1, 23-36. doi:10.1300/J125v01n0203

Hirschman, A. O. (1970). Exit, voice, and loyalty: Responses to decline in firms, organizations,

and states. Cambridge, MA: Harvard.

Horton, M. (1998). The long haul: An autobiography. New York: Teachers College

Press.

Horton, M., & Freire, P. (1990). We make the road by walking. In B. Bell, J. Gaventa, &


29

J. Peters (Eds.), Conversations on education and social change (pp. 227-249).

Philadelphia: Temple University Press.

Kahn, S. (2010). Creative community organizing: A guide for rabble-rousers, activists,

and quiet lovers of justice. San Francisco: Berrett Koehler.

Kieffer, C. H. (1984). Citizen empowerment: A developmental perspective. In J.

Rappaport, & R. Hess (Eds.), Studies in empowerment: Steps toward

understanding and action (pp. 9-36). New York: Hawthorne Press.

Larson, J. S. (1999). The conceptualization of health. Medical Care Research and Review,

56, 123-126. doi: 10.1177/107755879905600201

Lee, J. A. (2001). The empowerment approach to social work practice: Building the beloved community (2nd ed.). New York: Columbia University Press. Minkler, M. (2005). Community organizing and community building for health (2nd ed.).

New Brunswick, NJ: Rutgers University Press.

Morris, A. D. (1984). The origins of the civil rights movement: Black communities

organizing for change. New York: The Free Press.

Morris, P. (2008). Reinterpreting Abraham Flexner's speech. "Is social work a

profession? Its meaning and influence on the field's early professional

development. Social Service Review , 83, 29-60. Retrieved from:

http://search.ebscohost.com/PersistentLink.aspx?direct=true&db=aph&AN=31321268&

Netting, F. E., O'Connor, M. K., & Fauri, D. P. (2008). Comparative approaches to

program planning. Hoboken, NJ: John Wiley and Sons.

O'Connor, M., & Netting, F. E. (2008). Teaching policy analysis as research:

Consideration and extension of options. Journal of Social Work Education , 44

, 159-173. doi:10.5175/JSWE.2008.200700090

Payne, C. M. (1995). I've got the light of freedom: The organizing tradition and the


30

Mississippi freedom struggle. London: University of California Press.

Piven, F. F., & Cloward, R. (1977). Poor people's movements: Why they succeed and

how they fail. New York: Random House.

Reisch, M. (2011). Being a radical social worker in reactionary times. Key Note Address

to the 25th Annual Social Welfare Action Alliance (pp. 1-22). Washington D.C.:

Social Welfare Action Alliance.

Richmond, M. L. (1917). Social Diagnosis. New York: Russell Sage Foundation.

Rothman, J. (2008). Multi modes of intervention at the macro level. Journal of Community

Practice , 15 (4), 11-40. doi:10.1300/J125v15n04

Solomon, B. (1976). Black empowerment: Social work in oppressed communities. New

York: Columbia University Press.

Spear, M. (2010). The ethical dilemmas of aesthetic medicine: What every provider should

consider. Plastic Surgery Nursing, 30, 152-155. doi: 10.1097/PSN.0b013e3181ee1789

Stone, D. (2011). Policy paradox (3rd ed.). New York: W.W. Norton.

Thomas, K. L., Ellis, A. R., Konrad, T. R., Holzer, C., & Morrissey, J. P. (2009). County-level

estimates of mental health professional shortage in the United States. Psychiatric

Services, 60, 1323-1328. Retrieved from: http://www.ncmedicaljournal.com/wp-

content/uploads/2012/05/NCMJ_73302_FINAL.pdf

Thomas, M. L., O'Connor, M., & Netting, F. E. (2011). A framework for teaching community

practice. Journal of social work education , 47, 337-355.

doi:10.5175/JSWE.2011.200900081

Tilly, C. (1978). From Mobilization to Revolution. New York: McGraw-Hill.

Wagner, D. (1990). The quest for a radical profession: Social service careers and

political ideology. Lantham, MD: University Press of America.


31

Walsh, J. (2006). Theories for direct social work practice. Belmont, CA: Thomson.

White-Chu, E., Graves, W. J., Godfrey, S. M. Bonner, A., & Sloane, P. (2009). Beyond the

medical model: The culture change revolution in long-term care. Journal of the

American Medical Directors Association, 10, 370-376. doi: 10.1093/geront/gnt109

flexner and social work: implications moving forward

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