The Role of Social Work in Pediatrics and Child Psychology

Susan Horky, LCSWPediatric Pulmonary Division

University of Florida

Overview

What does a SocialWhat does a SocialWorker do??Worker do??

Social Work Social Work in healthcarein healthcare

Comparison ofComparison ofSocial Work andSocial Work and

PsychologyPsychology

http://www.socialworkers.org/pubs/choices/default.asp

What does a Social Worker do?

• concrete services• resource information• case management• discharge planning• advocacy/policy• social welfare

BSW, MSW

MSW,LCSWPhD

• psychotherapy• research• medical social work• administration

MSWsmay do someor all of these

History of Social Work

Medical S

ocial W

ork

Child Welfare/Social Policy Child Welfare/Social Policy

Child Guidance/Psychiatric Social Work

1890

s

Early

1900

s

1920

s

2007

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”

History of Social Work-Child Guidance/Psychiatric Social Work

Child Guidance Model:

• Psychiatris

t sees child

• Social w

ork works with family

1930s1930s

WWII- Social W

orkers

do more therapy:

• Psychiatrists at w

ar

• Psychiatrists doing meds

1940s1940s

Some Social Workers

trained in psychoanalysis

1950s1950s

http://ucommphoto.nmsu.edu/newsphoto/whittlesey-jerome_wanda.jpg

Social Work • Mental health:Mental health:

– Depression, anxiety– Major Mental Illness– Personality Disorders– Adjustment problems– Grief and Loss– Relationship problems– Anger management– Family problems

• Specific populations:Specific populations:– Chronically Ill– Substance Abusers– Children, Elderly– Pregnant teens– Abused Children– Juvenile Offenders– Developmentally

Delayed– Homeless

Social Work Job Settings• Community agencies• Hospitals/clinics• Schools• Private practice• Mental Health• Judicial System

• Prisons• Academic settings

– Research projects– Teaching– Unique clinical settings

• Government agencies

Setting depends on interests, program attended and experience

Main tenets of social work:“Start where the client is”

The relationshipThe relationship is the foundation of all work

Bio-psycho-social, systems approach

Strengths based: Nonjudgmental

Self-determination

Social equality

Psychodynamic/Object Relations

Cognitive/Behavioral

Task Centered

Developmental

Person-in-Environment;Systems Theory

Health Prevention andPromotion

Narrative

Bereavement

Motivational Interviewing

Rogerian

Sample of Models used by Social Workers

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

Social Work in PediatricHealth Care (cont’d)

• 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)

John is a four year old boy with cystic fibrosis. He and his familyare well known to the pulmonary service. Charlie and his grand-mother attended clinic today. Charlie’s grandmother indicated thatCharlie’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 careand 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 physicianreports that his lungs seem clear.

Grandmother reports that Charlie is doing “ok” at daycare but thathe sometimes cries for his mother. Grandmother feels that thedaycare is not very supportive. She also reports that they haverefused to give Charlie nutritional supplements.

Aside from these concerns, Grandmother reports that Charlie isdoing well and seems happy. She reports occasional behavioralstruggles but indicates that these are relatively rare. She alsoreports that Charlie’s mother is less stressed at the last visitas she has found a fulltime job. According to Grandmother,Charlie’s behavior and mood appear to have improved, now thathis mother is feeling better.

Overall, the family is doing well. I will call the daycare to educatethem about CF, so that hopefully they will agree to give Charliesupplements. I also plan to learn a little more about his separationproblems. I will also call his mother to see if I can assist in helping her get time off from work.

Social Work NotePediatric Pulmonary Division

Name: John BillingsDate: 8/9/2006

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

Social Work AssessmentPediatric Pulmonary Division

Name: Jean BishopDate: 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. Bishopis 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. Jeanis 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. Bishophad apparently refused to let Jean see her friends that after-noon. Ms. Bishop states that she likes Jean’s friends andhad no concerns about them. “I just wanted her to stay homewith 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.

History of Presenting Problem

Ms. Bishop reports that Jean was “a darling little baby” butthat starting at the age of two, she “had a mind of her own.”However, Mrs. Bishop reports having “taught Jean a thing ortwo,” stating that “I’ve never been afraid to take charge—mymother used the belt, and I turned out just fine” When furtherquestioned, she reports having spanked Jean with her handfrequently, but states that she rarely used an object. Ms.Bishop states that with “appropriate discipline” Jean becamea “pretty good girl, kind of quiet…I hadn’t had too many prob-lems with her until this year. But now she’s angry and moody.”

Family History Developmental HistoryMedical HistorySchoolSubstance AbuseSexual HistoryFamily Discipline

Impressions

Based on this interview, it is difficult to assess the level or type ofJean’s difficulties. While clearly there are relationship challengesbetween Jean and her mother, these may relate, at least in partto Ms. Bishop’s parenting beliefs and personal style. WithoutJean’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 isexhibiting 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 theabandonment by her father and her intensive, and perhaps in-consistent, relationship with her mother. It is possible that Jean isafraid 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 Training

Bachelors in Social Work

Masters in Social Work

PhD in Social Work or DSW

Social Work Training: Clinical MSW• 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)

Psychology vs. Social Work

AssessmentAssessmentandand

PsychotherapyPsychotherapy

Psychologicaltesting

Strongerresearch base

More neurological

training

Wide varietyof settings and

roles

Integration ofsocial and

psychological

Psychology vs. Social WorkPsychology Social Work

Perceived asless formal