A Personal Practice Model. Deborah Nelson. Department of Social Work University of Minnesota, Duluth

Transcription

1 A Personal Practice Model By Deborah Nelson Department of Social Work University of Minnesota, Duluth Masters Project Supervisor: Don Carpenter, PhD Second Reader: Kathleen Heltzer, MSSW, LICSW Although the entirety of each student's Personal Practice Model Plan B paper is necessarily shared with the student's Master's Project been blanked-out by the author for protection of his/her personal privacy. Committee, some aspects can be of a personally sensitive nature that the author does not feel comfortable sharing with all others who may read his/her document. Therefore, any blankedout passages you may see in this paper have

2 Table of Contents Abstract Introduction My Understanding of the Personal Practice Model Concept My Area of Special Social Work Interest Seven Components of Social Work Practice Natural Helping Skills Learned Skills and Roles Preferred Conceptual Frameworks Views of Diversity and Cultural Competence Decision Making Values and Ethics Practice Efficacy Introduction to the MSW Interviews Qualitative Research Methodology Summary of Interviews Learning from Interviews Summary of Personal Practice Model My Understanding of the Advanced Generalist Perspective Future Growth References Page

3 1 Abstract Advanced Generalist social workers are expected to practice independently in complex systems with a variety of problems and populations. Advanced practitioners have a wider, more in depth, level of knowledge and skills that will allow for independent practice on a direct and indirect level. This Personal Practice Model is written by an MSW student in the UMD Social Work Program in an effort to identify and evaluate her current understanding of social work knowledge and to identify her uniqueness as a social work practitioner. Seven specific components of social work practice were separately discussed. These components are: natural helping skills, learned skills and roles, preferred conceptual frameworks, views of diversity and cultural competence, decision making, values and ethics, and practice efficacy. Special emphasis has been made on the role spirituality plays in social work practice. Each component, except for natural helping skills, includes a literature review and personal reflection in an effort to increase knowledge and understanding of the topic. Three practicing Master's level social workers were interviewed in an effort to gain a deeper understanding of the research process and insight into the experiences of practicing professionals. A description of the author's understanding of the Advanced Generalist approach is followed by a summary of her PPM and a section on how she views her future growth as a professional social worker.

4 2 Introduction The following document is my professional social work personal practice model (PPM). It originated from a previous paper completed in Advanced Practice with Individuals, Families, and Groups in which I identified the natural skills that I use when helping others. In addition to a discussion of my natural helping skills, my PPM has been expanded to include six other components of social work practice. These components are: learned skills and roles, preferred conceptual frameworks, views of diversity and cultural competence, decision making, values and ethics, and practice efficacy. A literature review has been conducted on each of these six components followed by my personal reflection. Qualitative research methodology is also included. Three practicing Master's level social workers were interviewed in an effort to obtain their thoughts on practice and the social work profession. All components of this PPM are viewed in relation to my special area of social work interest which is the role spirituality plays in social work practice. My Understanding of the "Personal Practice Model" Concept I must say I was thrilled when I was first introduced to the concept of developing a personal practice model. I knew instantly that this was the avenue I would take when completing my graduate studies. The primary purpose of a personal practice model is to help me identify, describe, evaluate, and further develop my own unique approach to social work practice. It is a highly personal

5 3 evaluation of my current social work knowledge, skills, assumptions, and understandings. Creating a personal practice model requires extensive selfexamination and reflection. It requires an honest appraisal of my personal and professional values and beliefs. I enjoyed this aspect of creating my PPM because I believe to be an effective, competent social worker, I must first know who I am, what I believe, and how my life experiences affect the way I look at life and interact with people. This PPM is a compilation of research, theory, practice wisdom, and personal experience. Certain components such as my natural helping skills, life experiences, and formal education will remain constant and serve as an anchor in the vast sea of learning. Other components will continue to change and develop with every wave of new knowledge, understanding, and experience. My Area of Special Social Work Interest Identifying an area of special social work interest proved to be the most difficult aspect of beginning my PPM. I can see myself working in a variety of settings with a diverse client population. I am interested in clinical, school, and hospital social work. I am comfortable working with children, adults, and the elderly. I am especially interested in working with women who are survivors of domestic and sexual abuse. I have had the privilege of interning in the areas of chemical dependency, neuroscience and trauma, and children's mental health. have loved all three of these placements.

6 4 A common thread that I have seen woven in all of these settings is the need for spiritually sensitive social work practice. The profession of social work developed out of a religious movement toward charity and community service. During the 1920s to 1970s there was increased skepticism of religiously based social work and professionalization and secularization of social work ideologies and institutions. Since the 1980s, there has been a return of attention to religion and spirituality in social work practice and an increase in related research and publication (Canda & Furman, 1999). In many ways social work can be considered a spiritual vocation-meaning there is an awareness of suffering and the possibility of transformation. Social workers are motivated by compassion to help people overcome obstacles and work for social justice. Many people report that spirituality and religion are their most significant strengths. Approximately 72 percent of the public agrees with the statement, "My whole life is based on my religion." For more than one-third of the general population, spirituality is the most important aspect of their existence. Among disadvantaged people of color, spirituality plays a more predominant role (Hodge, 2001 ). "The vast majority of Americans claim that religious beliefs and institutions are important to them, that they believe in a God, and that they have had personal religious or mystical experiences at some time (Canda & Furman, 1999, p. 69)." Undoubtedly, religion and spirituality play important roles in all cultures. Some people view their spirituality as being the core of who they are and

7 5 influencing all aspects of their lives. They regard their spirituality as being more important than race, class or gender. Many clients desire to integrate their spiritual belief systems into the counseling/intervention process. From what I have seen, addressing the client's spirituality can be an area social workers seem to shy away from. Fear of violating the norm of separation of church and state, lack of clarity about appropriate boundaries, personal biases, and insufficient formal education and training can cause practitioners to avoid tapping into a client's spiritual strengths despite a client's willingness to share this aspect of his or her life. Unfortunately, it can be quite difficult to agree upon a universal definition of spirituality. Spirituality and religion are often times used interchangeably. Some scholars have inadvertently deemed one superior to the other by viewing spirituality as good and religion as bad; while others have tended to treat them as identical entities. These subjects are far too complex to adopt such simplistic definitions. The issue is not "good" or "bad", but rather the definition of each and the distinctions between and overlap that exists. According to Canda & Furman, ( 1999), spirituality is defined as the human search for life meaning, morally fulfilling relationships, and an understanding of the reality that has greatest significance. This may or may not involve belief in a God or supernatural aspect of the world. These authors define religion as an organized set of beliefs, values, and practices shared by a community that

8 6 focuses on spirituality. Therefore, a person's spirituality may or may not be expressed through a religion. Spiritually sensitive practice is not merely a matter of discussing religion or spirituality with clients. It is a way of being and relating throughout the entire helping process. It stems from the social worker's close examination of self, the helping relationship, and the human service organization as the context for helping. In keeping with the Strengths Perspective, spiritually sensitive practice identifies people's talents, skills, capacities, and resources and mobilizes them in the service of both their immediate goals and their highest aspirations and potentials. Spiritually sensitive social work practice embraces a true respect of the client. It honors the client's aspirations, self-understandings, beliefs, and values. It goes beyond mere tolerance of spiritual diversity to appreciation and advocacy for the client's religious freedoms and spiritual self-determination and the many variations of spiritual expression (Canda & Furman, 1999). I chose this area of interest because I have seen the important role spirituality and religion has played in many clients' lives. My practice will reflect more of a holistic perspective to include not only the biological, psychological and social dimensions of the human experience, but the spiritual as well. I believe in order to best serve my clients, I must learn how to respond with sensitivity, respect, and competence to all forms of religious and nonreligious spirituality.

9 7 Seven Components of Social Work Practice Natural Helping Skills We all possess natural helping skills, some of which may be derived from genetic tendencies and others only from our socialization experiences. These strengths come naturally and are performed with little thought or awareness. Often we are cognizant of these natural helping skills and feel most effective when opportunities arise that call upon us to utilize them. Other times we come to the realization of these skills through the frequent comments of others. Developing Rapport Developing rapport is one of my strongest natural helping skills. I love meeting people and putting them at ease. As I look back, I think this must come with the desire to truly know and help others. Without even realizing it, I find myself trying to seek out ways to connect with those I come in contact with and to be worthy of their trust. I have always felt this way. Listening Listening is another of my natural helping skills. I have known long before my formal education that my primary role in helping someone is to listen and make suggestions, and that ultimately the decisions and the consequences thereof are in the hands of the individual. I am frequently told by family, friends, co-workers, and those whom I barely know that I am a good listener. It is a privilege when a person chooses to confide in me and I find myself working hard to truly listen. While this is a natural helping skill, I recognize it as being

10 8 something that takes a conscious effort on my part and one that I want to become better at. Empathy Empathy is another of my natural helping skills. The older I get the more empathetic I become. I am sure this is due to the fact that the older I get, the more pain and suffering I have seen. While it is true that one never completely knows what another person is feeling, enduring pain, disappointment, and sometimes the shame and embarrassment that accompanies various circumstances grants deeper insight and ability to show empathy and compassion. Encouragement Encouragement is another of my strongest natural helping skills. I saw at a young age the change in a person's countenance when words of encouragement were spoken. It was not until entering the social work program that I learned the concept of the strengths perspective. I guess I have been operating from this perspective all of my life. It gives me great joy to get to know a person and to draw out their strengths. It is amazing what words of encouragement can do to give a person hope and strength. Problem Solving The final natural helping skill I will discuss is problem solving. I am very organized and like to examine all aspects of a situation before making a decision. I have been often told by others that they admire my ability to look at a situation

11 9 logically and creatively and that I am the first person they think of going to when faced with a difficult situation. It is extremely rewarding to work with people and help them find solutions and positive ways of coping with their problems. Developing rapport, listening, empathy, encouragement, and problem solving are natural helping skills I will utilize in my professional practice. They provide the foundation of my confidence and skill as a practitioner. Learned Skills and Roles As an advanced generalist practitioner, I am prepared to work in a variety of settings, with a variety of client systems, utilizing a variety of social work roles. I am equipped to work with individuals, families, groups, and communities. My role may vary from advocate, counselor, or group facilitator, to researcher, program planner, or policy analyst (Sheafor, Horejsi & Horejsi, 2000). I will draw upon a wide range of skills and techniques and operate from an ever growing eclectic knowledge base. Learned Skills and Roles: Literature Review Depending upon the practice setting, I will utilize many micro, mezzo, and macro skills and assume many roles. Regardless of whether I am working with an individual, group, or community, the need for conducting an accurate assessment is paramount. Without an accurate assessment of the client situation, it is impossible to provide the best quality service and match helping techniques to the client's goals and desires.

12 10 Effective social work practice requires practitioners to be flexible enough to fill a variety of roles. I find this one of the most intriguing qualities of the profession. One role that is becoming more and more common is that of a case manager. I have chosen to focus my literature review on the skill of conducting an accurate assessment and on the role of case manager. Assessment Assessment is the process of determining the nature, cause, progression, and prognosis of a problem or situation. It is the social work function of acquiring an understanding of the problem or situation and deciding what causes it, and what can be done to changed, minimize, or resolve it (Barker, 2003; Kirst- Ashman & Hull Jr., 2002; Sheafor & Horejsi, 2003). Assessment should always include the micro, mezzo, and macro dimensions of a client situation. Assessment also needs to be done from a strengths perspective with attention on the behaviors and accomplishments, personal qualities and characteristics, and material and social resources of the client. As critical as assessment is for traditional practitioners, for workers operating within the strengths perspective, assessment plays a role of even greater significance. Without proper assessment, such workers cannot fully develop an awareness of client's strengths, which are the central ethos of the perspective (Hodge, 2001 ). Accurate assessment also needs to be done in the light of the client's cultural and spiritual context. Assessment should be client centered. The client has the primary role in defining and interpreting the meaning and value of his or

13 11 her spirituality. The client's experiences and behaviors should be understood within the context of his or her culture and spiritual perspective. (Canda & Furman, 1999). An individual's spirituality may be a key strength, facilitating coping, defeating loneliness, promoting a sense of mission and purpose, instilling a sense of personal worth and value, and providing hope for the future (Hodge, 2001). Tools, such as a spiritual life map, provide a pictorial narrative of a client's spiritual journey. A spiritual life map is an illustrated account of the client's relationship with God over time. Similar to a road map, spiritual life maps help explain where the client has come from, where he/she is now, and where he/she is going. The method is similar to approaches drawn from art and family therapy in which a client's history is depicted on a "lifeline" or genogram. The life map provides insight into how a client constructs his/her reality while providing a method to operationalize spiritual strengths. The goal is to help the client tell his/her story while nurturing an affirming, empathetic relationship. Spiritual life maps offer practitioners ways to integrate a client's spirituality into the therapeutic dialogue. They can be used as an assessment tool to plan spiritually based interventions, and they can stand alone as an intervention (Hodge, 2005). Case Manager Case managers are often viewed as providers and coordinators of social, informational, and physical resources. They work on behalf of a specific client to coordinate the needed services provided by any number of agencies,

14 12 organizations, or facilities (Kirst-Ashman & Hull, 2002). Case management may involve monitoring the progress of a client whose needs require the services of several professionals, agencies, health care facilities, and human service programs. Case management can occur within a single, large organization, or within a community program that coordinates services among agencies (Barker, 2003). Case managers network with other agencies and programs to provide a continuum of needed services for their clients. Most case managers are required to develop an individual service or treatment plan to identify each client's needs and appropriate use of resources. These plans help monitor clients' use of services and measure achievement of specified goals or outcomes. Case managers help to ensure the timely and adequate delivery of appropriate services (Rose & Moore, 1995). Depending upon the practice setting, there are several learned skills and roles that I will frequently use in my personal practice model. At this time, I can see myself in the role of counselor/therapist, educator, advocate, and case manager. Whether I am working in a medical, educational, or therapeutic setting, I am drawn to these roles. Effective communication, accurate assessment, and proficiency in group development and facilitation are some of the skills I have learned. Spirituality can be a tremendous source of strength, comfort, and hope in a client's life. It can be yet another strength I can build upon. Spirituality can also be an obstacle to overcome, a source of disappointment or guilt, or a hindrance to accepting professional services and

15 13 help. Including spirituality in the assessment gives me a deeper understanding of the whole person whom I am privileged to work with. Preferred Conceptual Frameworks I found this section of my PPM to be quite challenging. Perhaps it was because advanced social work practitioners rely upon such a broad knowledge base and perhaps because I find myself drawing upon a wide variety of methods, approaches, and theories without giving it a great deal of conscious thought. One element of a social worker's practice framework is his or her practice perspective(s). A practice perspective directs the worker's attention on certain factors when approaching a practice situation. Common perspectives include the Strengths, Generalist, General Systems, Ecosystems, and Feminist Perspectives (Sheafor & Horenjsi, 2003). Regardless of the particular client, I look at all situations through a strengths perspective. Whether I am counseling victims of sexual and/or domestic violence, comforting a patient on the Hospice Unit, or working with a client with developmental difficulties, I seek to identify and draw upon the unique strengths of the individual. Since a majority of my clients have been women or those who have been victims of oppression, I also operate largely from a Feminist Perspective. Theory is another component to my conceptual framework. Theory can be described as a group of related hypotheses, concepts, and constructs based on facts and observations that attempt to explain a particular phenomenon (Barker, 2003). The primary focus of theory is to seek to understand the complex

16 14 reality of the person-in environment. Practitioners use theory to give meaning to and assess client strengths, weaknesses, and resources. It is the basis on which diagnosis is built. It facilitates and gives direction to the process of decision making and intervention. Theory-based approaches also shift over time based on new empirical findings and conceptual advances (Turner, 1995). Explanatory theories such as the Psychoanalytic, Operant, and Human Relations Theory help provide and understanding of human functioning as it is thought to occur. Practice theories such as the Task-Centered and Life Models and Cognitive/Behavioral Theory focus more on changing behavior to how things should be based on a particular value system. At this stage of my professional development, the two most influential conceptual frameworks that guide my practice are Cognitive/Behavioral Theory and Ecological Systems Theory. The following literature review will delve deeper into the Strengths and Feminist Perspective and Cognitive/Behavioral and Ecological Systems Theory. Preferred Conceptual Frameworks: Literature Review Strengths Perspective Central to the profession of social work is the strengths perspective. It is based upon empowerment and emphasizes the client's resources, capabilities, support systems, and motivations to meet challenges and overcome adversity. It emphasizes the client's assets that are used to achieve and maintain individual

17 15 and social well-being (Barker, 2003; Kirst-Ashmun & Hull, Jr., 2002). This perspective operates from the belief that every individual, family, or community has strengths, assets, and resources. Trauma and abuse, illness and struggle may be devastating, but they also may provide opportunities for growth and opportunity. The strengths perspective seeks to identify, use, build, and reinforce the strengths and abilities that people have in contrast to the pathological perspective, which focuses on their deficiencies and inabilities (Leashore, 1995). The strengths perspective has been very important in helping social workers view clients as competent human beings who bring their own strengths to the social work consultation. Clients are not seen as bundles of pathology or as problems to be solved, but rather as partners in a collaborative process of shared power (Mattaina, Lowery, & Meyer, 2002). Feminist Perspective I also operate from a feminist perspective. The purpose of this perspective is to ensure that the effects of societal beliefs and stereotypes concerning gender and sex roles are addressed in social work practice (Sheafor & Horenjsi, 2003). I like this perspective because the client-social worker relationship is egalitarian. The social worker is viewed as a partner with the client, not as an expert or authority figure. Social work, spiritual, and feminist values and practices converge on a myriad of levels. The incorporation of spirituality into social work practice contributes to a more holistic perspective (Coholic, 2003). While this perspective is important when working with women, it

18 16 emphasizes empowerment, social justice, and political action that is conducive in all settings and with male clients as well. Cognitive/Behavioral Theory Cognitive Theory emphasizes the influence of thoughts and beliefs about self and the world on behavior and emotional states. Behavioral Theory looks at the environmental conditions that induce and maintain behaviors. The purpose of Cognitive/Behavioral Theory is to help clients learn more realistic and positive ways of perceiving, thinking about, and interpreting their experiences. It is especially useful in working with problems of depression, low self-esteem, and self-defeating thoughts (Beckett & Johnson, 1995; Sheafor & Horejsi, 2003). This theory can be used effectively with children and adults. Cognitive/Behavioral interventions based on the client's spiritual belief systems also have been empirically validated. Replacing counterproductive beliefs and behaviors with productive ones drawn from the client's spiritual worldview is often a beneficial intervention (Hodge, 2001 ). Ecological Systems Theory Ecological Systems Theory helps the practitioner understand how the social and physical aspects of the client impact self worth, personal empowerment, capacity to problem solve, and other concerns. This theory looks at the biological, economic, social, and cultural influences on clients. This is a holistic approach that takes on a person-in-environment perspective when working with clients. The environment consists of the biological, psychological,

19 17 cultural, emotional, and social forces which must be understood and utilized in helping clients adapt or "fit" into their own systems (Maguire, 2002). This perspective helps me remember that I cannot understand the functioning of an individual without first examining his or her environmental context. Social work interventions seek to enhance the growth, development, and adaptive capacities of people; to remove environmental obstacles to effective functioning; and to expand the availability of scarce resources. Social work aims to maintain or restore an adaptive balance between people and their environments by helping them adapt, by changing the environment, or both. (Sheafor & Horenjsi, 2003). This approach requires practitioners to possess strong knowledge of human behavior and how it is influenced by social, economic, and cultural factors. Assessment must be done within a multileveled context and practitioners are to view themselves as part of the systemic process and to identify their role in this process (Hopps & Collins, 1995). The social worker should be proficient at adapting interventions to meet the needs of a variety of client systems (Coggins & Hatchett, 2002). Practitioners will use a variety of skills, knowledge and techniques when utilizing this theory. This is conducive to the advanced generalist perspective. I desire to develop a moral and ethical framework that honors diversity. My practice framework will be flexible and continue to develop over time. Foundational components will be an emphasis on client strengths, providing a sense of hope, increasing my client's supports and enhancing client self

20 18 determination, competence, and independence. It will contain a comprehensive framework of evidence-based knowledge, skills, and values that are congruent with my own personal and professional values, commitments, and areas of practice. It also will include an effort to use a spiritually sensitive approach in my work. Views of Diversity and Cultural Competence One of the unexpected highlights of my formal educational experience has been an increased awareness of the impact that culture can have upon a client and society. It was not long ago that I was culturally blind and a believer in the "melting pot." I remember feeling a sense of pride and peace in seeing everyone as being equal. It is so true that white people can go through life giving little thought to the subject of racism or cultural issues. In order to be an effective social worker, I must continually work towards becoming culturally competent. Cultural Competence can be defined as the ability to apply knowledge and skills to social work practice with diverse groups. It includes specific knowledge about individual cultures, valuing of and sensitivity to cultural differences, awareness of the patterns of oppression experienced by those cultures, and skill to utilize culturally appropriate interventions (Kirst-Ashman & Hull, Jr., 2002). It is important to remember that cultural competence is a journey and that each person is walking at a different place along the path. For those whose hearts are open, the journey toward cultural competence can be a painful process but a liberating one.

21 19 Views of Diversity and Cultural Competence: Literature Review Cultural competence involves the possession of the knowledge, understanding, attitudes, and practice skills that enable a social work practitioner to serve clients from diverse socioethnic backgrounds. The NASW Code of Ethics (section 1.05) describes three components of cultural competency and social diversity: (a) that social workers should understand culture and its functions and the strengths that exist in all cultures, (b) that they should have knowledge about their clients' cultures and differences among cultural groups, and (c) that they should seek education and understanding about the nature of social diversity and oppression for all cultural groups (Barker, 2003). Diversity in cultural perspectives is critical to societal functioning. Social workers must possess an awareness and acceptance of cultural differences and an awareness of their own and dominant society's cultural values. They must recognize that those they work with-clients, program participants, community collaborators-see the world in different ways depending upon their cultural experiences (Mattaini, Lowery, & Meyer, 2002). Culturally competent practitioners seek to understand and appreciate each client's cultural background while recognizing that one can seldom acquire more than a superficial knowledge of another culture, especially when language differences are involved. Practitioners must be alert to human diversity and never assume that a client's physical features or ethnic identity will predict his/her values, beliefs, or behavior patterns.

22 20 Spiritually sensitive social work practice is in many ways analogous with culturally sensitive or culturally competent social work practice. Religious and spiritual beliefs and practices are a fundamental part of multicultural diversity (Sheridan, 2001 ). There is a need to adapt practice to the client's religious beliefs, and spirituality. One's ethnicity, culture and religion are often times tightly interwoven. Social workers can miss opportunities for meaningful and helpful relationships with their clients if they avoid the religious aspects of their client's lives (Sheafor & Horejsi, 2003). Culturally competent social work practice requires cooperation with religious community-based support systems and culturally specific forms of healing (Canda, 1997). Special sensitivity needs to be used when the historical relationship between cultural or religious groups represented by worker and client has been one of oppression, colonialism, genocide, slavery, racism, discrimination, exploitation, or any other form of systematic harm (Canda & Furman, 1999). Competent practice requires suspending assumptions and ethnocentric judgments while opening up to the stories of the clients. Social workers need to be open to learn about culture-specific beliefs addressing the spiritual causes and cures of physical, mental and social problems (Canda & Furman, 1999). Behaviors and beliefs held to be "normal'' in one religious or cultural context could be viewed as "abnormal" in another context. When a practitioner does not share the spiritual framework of the client, there is an increased danger of biased and inaccurate diagnosis related to the ethnocentrism, religious assumptions, and theoretical

23 21 beliefs of the practitioner. Diagnosis must take place with regard for the cultural, religious, and spiritual beliefs and practices of the person (Canda & Furman, 1999). When religious or spiritual beliefs are closely connected to a client's or community's basic culture, eliminating them from practice might also constitute a form of racial or ethnic discrimination (Canda & Furman, 1999). Lack of cultural competence can have serious ramifications, particularly when working with religious traditions that practitioners may not be familiar with. Cultural sensitivity is demonstrated by recognizing that Western enlightenmentderived theories are not universally applicable. Cultural Competence is predicated on developing an awareness of the two worldviews of the client and practitioner involved in the counseling dialogue. Not only should practitioners strive to develop an empathetic understanding of the client's reality, but they should also seek to acquire an awareness of their own culturally informed assumptions. Based on the new awareness, social workers can implement interventions that are congruent with the client's beliefs, values and practices (Hodge, 2004). It is important to differentiate between cultural comfort and cultural competence. Cultural comfort can be described as the limited objective of familiarization with material related to the culture of a limited number of minority or ethnic groups. At best, the practitioner will feel a sense of skill in intervention with perhaps one or two different cultural groups. Cultural competence, however, involves the areas of cultural awareness, knowledge acquisition, skill

24 22 development, and continuous inductive learning. It refers to knowledge, values, and skills that allow the social worker to engage in culturally appropriate and relevant interventions with clients from any number of cultural groups (Coggins & Hatchett, 2002). It is important to remember that each person has inherent dignity and worth and deserves unconditional positive regard. Respect for religious thought, the importance of critical thinking, valuing client self-determination, and drawing relevant boundaries for the discussion of religion and spirituality are key components to developing spiritually competent social work practice. I need to look through the critical lens of my client's needs, perspectives, goals, and values. To provide the best services for the clients I serve, it is imperative that I be not only culturally competent, but spiritually competent as well. The journey toward cultural competence is ongoing and evolving. I do not believe anyone can truly arrive. This is a process that involves much self reflection, respect, and humility. Cultural competence must also include spiritual competence. I must become more spiritually aware in an effort to better understand the clients I am privileged to serve. Decision Making Decision making is the activity of consciously choosing among available options. As an advanced generalist practitioner, I must be able to make difficult decisions and do so with a conscious awareness of the logic being used. I must be open to all evidence, avoid becoming overly committed to a particular

25 23 position, and give special attention to the arguments with which I disagree (Sheafor & Horejsi, 2003). Fundamental in my decision making process is the use of critical thinking, evidence-based practice, and practice wisdom. Before making a decision, I will do my best to look at all aspects of the situation, giving special attention to what is known from research and theory, what other professionals have learned, my professional and personal experience, and input from my client. I will take into consideration the cultural aspects of the situation and continue to operate from a keen sense of self-awareness of my own cultural, values and personal biases. Decision Making: Literature Review Critical Thinking Critical thinking skills are essential in the decision making process. Critical thinking involves the ability to carefully evaluate the validity of an assumption and even of a so called "fact". Critical thinking involves asking questions, evaluating arguments on both sides of an issue, and the use of scientific reasoning to analyze arguments. Critical thinking entails using my own judgment and not taking situations or stories at face value (Kirst-Ashman & Hull, 2002). Critical thinking involves a careful look at the claims and alternative views, and a willingness to change ones mind in light of evidence that refutes a cherished position (Netting & O'Connor, 2003). It helps to minimize errors in thinking such as the fundamental attribution error which attributes the cause of a

26 behavior or problem to the wrong systems level, the behavioral confirmation bias error which searches for evidence that supports a favorite position and ignores evidence to the contrary, and the procedural fidelity error which assumes that how "it ought to be" is how it really is. Critical thinking requires self-discipline. It requires the practitioner to take charge of his or her mental processes. According to Sheafor & Horejsi, (2003), Critical thinkers: are honest with themselves and acknowledge what their limitations are and cautious of errors in their own thinking. strive for understanding, remain patient, and are willing to invest the time needed to get the facts and carefully analyze an issue. set aside personal preferences and are willing to revise their judgments and conclusions when new evidence reveals the need to do so. seek a balanced view knowing extreme views are seldom correct. control their feelings and think before acting. Evidence-Based Practice Evidence-based practice will also be utilized when making a practice decision. Evidence-based practice can be described as the conscientious explicit and judicious use of current best evidence practice in making decisions about the care of clients. It involves integrating individual practice expertise with best external evidence from research as well as considering the values and expectations of clients (Mattaini, Lowery, & Meyer, 2002). Evidence-based practice ensures that practitioners use only knowledge that has been adequately 24

27 25 scientifically tested. It is opposite of authority-based practice which relies on opinions and testimonials to support specific interventions. Two primary principles of evidence-based practice are that practice should be grounded on prior findings that demonstrate empirically that certain actions performed with a particular type of client or client system are likely to produce predictable, beneficial, and effective results and that every client system, over time, should be individually evaluated to determine the extent to which the predicted results have been attained (Kirst-Ashman & Hull, Jr., 2002). Practice Wisdom Before making a decision I will also draw upon practice wisdom. Practice wisdom is often equated with "commonsense" and may or may not be validated empirically. It is the accumulation of information, assumptions, ideologies, and judgments that are practically useful in fulfilling professional duties. Practice wisdom can refer to explicit rules, handed down to others by experienced practitioners that appear to "work" and patterns of professional behavior which may or may not be articulated that have been shaped and refined during years of practice and often serve as models for other workers (Mattaini, Lowery, & Meyer, 2002). Personal and professional life experiences will also play a part in decision making, as will the NASW Code of Ethics, and agency policy and regulations. It is also important to remember that when choosing appropriate interventions and

28 26 specific techniques with clients, that the values of the client take precedent over those of the practitioner (Maguire, 2002). As an advanced generalist practitioner, I am capable of independent practice. I will be called upon to decide how to treat my clients by applying whatever approach I believe to be the most effective. Among the major factors that will influence my choice of interventions will be education and training, values and ethics, and experience. I will base my decisions on the needs and desires of the client, utilizing critical thinking, evidence based practice, and practice wisdom in an effort to provide the most effective intervention possible. All of my decisions will be in accordance with the values and ethics of the social work profession which leads to the next component of my PPM. Values and Ethics One of the many things I appreciate about being a social worker is the clear description of the values and ethics of the profession. Adherence to the NASW Code of Ethics helps ensure safety and integrity not only for the clients I serve, but also for myself as a professional. The code of ethics also adds credibility and insight into the social work profession. The code of ethics serves as a guide for decision making and conduct by offering a set of values, principles, and standards for practitioners to adhere to. One of the reasons I was drawn to the profession of social work was because the values and ethics of the profession closely reflect those of my own.

29 I am proud to be able to say my profession's primary goals are to help people in need, address social problems, and respect the inherent dignity and worth of all people. I am privileged to be able to enter into the lives of others and offer hope and services in a competent and trustworthy manner. I believe in a holistic practice approach that incorporates spirituality but does not emphasize it over other resources and aspects of a person's life (Coholic, 2003). Ethics states: Values and Ethics: Literature Review The preamble to the1996 National Association of Social Workers' Code of The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty... The mission of social work is rooted in a set of core values and principles. These core values, embraced by social workers throughout the profession's history, are the foundation of social work's unique purpose and perspective: Service Social justice Dignity and worth of the person Importance of human relationships Integrity Competence The code of ethics also describes ethical standards concerning social workers' responsibilities to clients and colleagues, in practice settings, as professionals, and to the profession and broader society. 27

30 28 Social work values and ethics are at the core of all professional social work practice. There are, however, times when a decision must be made under circumstances where ethical principles are in conflict. There are several ethical decision making models that are available to assist social workers facing an ethical dilemma. Kirst-Ashman & Hull, Jr. (2002) describe eight decision making steps when faced with an ethical dilemma: Recognize the problem. Investigate the variables involved. Get feedback from others. Appraise what values and ethical standards apply to the dilemma. Evaluate the dilemma on the basis of established ethical principles. Identify and think about possible alternatives to pursue. Weigh the pros and cons of each alternative. Make your decision. Ethical Principles Screen Another helpful tool Kirst-Ashman & Hull, Jr. (2002) describe in addressing ethical dilemmas and the decision making process is the "Ethical Principles Screen". This approach utilizes a hierarchy of ethical rights in which a principle takes precedence over the principles below it. The acronym ETHICS for U is used to aid in the remembrance of the principles' order. It states that people have the right to:

31 29 E exist with their basic needs met. T treatment that is fair and equal. H have free choice and freedom. injury that is minimal or nonexistent. C cultivate a good quality of life S secure their privacy and confidentiality. for U understand the truth and all available information. Addressing the subject of client spirituality often times evokes ethical concerns among practitioners. A social worker's, mission is to promote social justice and the bio-psycho-social and spiritual well-being of individual clients. The NASW Code of Ethics requires practitioners have established competency before applying any particular helping intervention (Mattaini, Lowery & Meyer, 2002). It is important to note that all social workers have personal values, whether "religious" or not, which they may be tempted to "impose" on clients. Competent practice requires all social workers to learn how to maintain integrity with their own values, the profession's values, and the values of their clients. This is not achieved by avoiding the issue or thinking that only 11 religious" people need to worry about it (Staral, 1999). I believe that spiritually sensitive social workers should strive to increase their professional knowledge and skills and to apply them in practice. They should learn how to cooperate and collaborate with community-based spiritual

32 30 support systems, helpers, and healers in a culturally competent manner. It is important for social workers to know and understand the views and practices of certain religions as relative to their clients. Obstacles can be identified as challenges and be addressed creatively and strengths and resources can be honored and utilized in the helping process (Canda & Furman, 1999). As I am sensitive to my client's spiritual beliefs I am respecting client selfdetermination by supporting their decision to include or exclude discussion regarding this area. My goal is to discover any religious or spiritual resources and not to debate religious or spiritual truths or to impose my personal beliefs upon others. Ethical practice prohibits prostelization but supports respectful dialogue with the client about religion and spirituality as relevant to the particular situation. Acting without relevant competency is a violation of the NASW Code of Ethics. If the social worker is not prepared, then referral or collaboration is an appropriate response (Canda & Furman, 1999). Since I am committed to understanding the whole person in their environment, I believe, when it is appropriate, that it would be unethical for me to exclude religion and spirituality when working with clients. The Code of Ethics states I have an ethical responsibility to understand my client's culture and seek to understand the nature of social diversity which includes religion. Spiritual values and beliefs can conflict with professional ethics regarding selfdetermination and non-judgmentalism and ethical dilemmas may arise. Selfexamination will be an ongoing process for me. It is also important to combine

33 31 this introspective process with productive collegial dialogue in order to maintain a balanced perspective. As stated earlier, I am grateful that the social work profession has a code of ethics to abide by. Ethical practice involves more than knowing and following this set of standards. Undoubtedly, ethical dilemmas will arise. There will be times in which there are no clear answers or solutions. I will treat each unique situation with the utmost professionalism utilizing a variety of ethical decision making models, taking into consideration the best interest of my client, the agency I work for, and my personal and professional values. Practice Efficacy Every dedicated social worker wonders if the intervention chosen for his/her client is truly effective. As a professional, I cannot practice ethically without knowing that I am operating in the most effective and efficient way possible. I must choose interventions that have a credible amount of research evidence as to their efficacy. I must include plans for monitoring and evaluating my practice. Plans for monitoring and evaluating vary depending upon the practice setting. They can include formal research studies, client input, single subject designs, program and practice evaluations and other means of evaluation. Practice efficacy is very important to me. I want to always remember that the client I am privileged to serve is often coming to me at a time of utmost need, usually after exhausting all other options. I want to review the success and or

34 32 failure of not only my client, but of myself. As uncomfortable as it may be at times, I want to always welcome being evaluated, for it will keep me humble and on my toes, and will ensure that I am providing the best possible service. When appropriate, I want to offer my clients the opportunity to participate in satisfaction surveys and have the freedom to speak from their hearts. I also want to welcome peer reviews and performance evaluations, for they will be a source of encouragement and challenge me to excellence. Practice Efficacy: Literature Review Empirically Based Practice Empirically Based Practice is a type of intervention in which the practitioner uses research as a practice and problem-solving tool; collects data systematically to monitor the intervention; specifies problems, techniques, and outcomes in measurable terms; and systematically evaluates the effectiveness of the intervention used (Barker, 2003). Empirically based practice has been given a higher priority within the profession, because of national, state, and local pressure demanding greater accountability. (Thyer, 2003) states that the evidence that professionally trained social workers can help clients more effectively than members of other human services, or even provide better care than that delivered by nonprofessionals is slim. He challenges social workers to demonstrate that clients with various difficulties who receive professional social work services not only improve, but improve more than they would have through the passage of time, through the receipt of a

35 33 placebo, or by a non professional. He believes the use of the best available scientific knowledge for guiding professional interventions and effective therapies, combined with professional ethical standards, practice wisdom, and clinical judgment has the potential to revolutionize the practice of social work to the betterment of clients' lives, the community as a whole, and the social work profession. Two types of research are especially relevant for determining practice efficacy. One involves the evaluation of individual practice interventions and the other involves the evaluation of programs. On the one hand, recognizing the limitations of a particular intervention can be important for developing a new program or changing an existing one. On the other hand, it is equally important to know when a program is successful (Mattaini, Lowery & Meyer, 2002). Practice Evaluation Practice evaluation seeks to determine how the intervention can be described, how the client's progress can be monitored, and how effective the intervention was in bringing about client change. Descriptive methods such as monitoring interventions and client progress and explanatory methods or singlesystem designs are two major approaches to evaluating practice (Marlow, 2001 ). Practice evaluation generates documentation necessary for an assessment of the progress being made with a client system. This documentation includes quantifiable information, concerning intrapsychic or situational factors that are systematically gathered as part of the intervention and

36 34 used to assess periodically the client system's functioning level as compared to a previous level of functioning. Thus, social workers are provided with a basis useful in formulating and, if necessary, modifying interventions, and in monitoring the extent to which outcome goals are achieved (Hopps & Collins, 1995). Program Evaluation Program evaluations seek to answer the questions of whether the program is needed, if the program is functioning as it should be, and if the program achieved its objectives (Weinbach & Grinnell, Jr.,2004) Summative evaluations are concerned with the success of a program and decisions about whether it should be continued. They are usually quantitative in approach. The results of a summative evaluation will often times determine whether a program may or may not continue. Formative evaluations, in comparison, are not concerned with testing the success of a program but focus on obtaining information that is helpful in planning the program and improving its implementation and performance. Formative evaluations may use quantitative and or qualitative methods (Rubin & Babbie, 2001 ). Introduction to the MSW Interviews One of the highlights of creating my PPM was the opportunity to further develop my qualitative research skills by interviewing three practicing masters level social workers. This was an important aspect of my PPM because it gave me the chance to hear the thoughts and opinions of seasoned professionals and

37 35 to compare their views with my own. It is one thing to read a textbook and obtain knowledge and yet another to put this knowledge into practice. Conducting qualitative interviews gave me the opportunity to gain a deeper understanding of what it means to be an advanced generalist practitioner. Qualitative Research Methodology In an effort to have the MSW interviews be as meaningful as possible, certain aspects of qualitative research methodology were utilized. The sample for this qualitative research was a purposive sample consisting of three practicing Masters level social workers. Those whom were not eligible for the sample were UMD faculty members, individuals in a supervisory relationship to myself, and those whom I have a relationship with that might, for any reason, influence the responses to the interview questions. I initially telephoned three respondents all of whom immediately agreed to be interviewed. Appointments were made and each participant received consent forms which were signed prior to the interview. In an effort to ensure validity and conduct a consistent and thorough interview with a minimum of interviewer effects and biases, a standardized open-ended interview was conducted. I asked each respondent the same four questions and used the same probes during each interview. Each face-to-face interview was tape recorded in an effort to accurately record the responses of the participants. Notes were also taken so I could easily refer back to important statements and key phrases. The goal of qualitative

38 36 research is to provide an in-depth understanding from the perspective of the research participants. The researcher's task is to identify themes, patterns, and any differences in the data and offer interpretations of them (Westerfelt, 2001 ). The interview was then transcribed into written form. The data were carefully analyzed to interpret observations. I transcribed the themes, patterns, and differences from each of the interviews in an effort to draw conclusions. I then compared the data with the respondents, my views on the subject matter, and the knowledge gleaned from the literature reviews. Summary of Interviews I conducted face-to-face interviews with three practicing Masters level social workers. To ensure confidentiality, I will refer to these individuals as respondent one, respondent two, and respondent three. Respondent one is a licensed independent clinical social worker specializing in children's mental health. Respondent two is a Masters level social worker who works for a local agency helping low income people find work and transition from public assistance to self sufficiency. Respondent two also leads a faith-based class for men who have been involved in domestic abuse. Respondent three is a licensed independent clinical social worker specializing in medical social work. All three respondents are graduates of the MSW program at the University of Minnesota, Duluth. They possess over twenty-five years of combined MSW experience. The first interview question asked was "what formal models, theories, and/or conceptual frameworks do you use to guide your practice?" All three of

39 37 the respondents stated they used an eclectic approach in their practice. Other common themes were the use of Systems Theory and a Strength's Based approach. Respondent one stated, "Being a generalist social worker, that question alone is a little bit hard because you kind of go with your gut, you kind of do what works, you kind of figure it out, so then to say ok what formal stuff do I use, it's like hmm let me think. So it's a little bit like, I didn't specifically choose to use this stuff; it's more that now that I have been working, as I look back this is what I do and Cognitive Behavior Therapy is probably the main thing... You really have to be able to adjust your style... to adjust to what they need." Respondent one also mentioned using Solution Focused and Narrative Therapy. Respondent one stressed the importance of rapport building for, 11 it is important that they see you as their ally'' and having a child focused rather than a parent focused approach. Respondent two stated, "Everyone has strengths and everyone has barriers. You have to assess where they are at and make referrals." Respondent three also stated, "I use an eclectic approach... I am never thinking, I think I'm going to pull out my Behavioral approach or Systems Theory right now, but I know that they are all in place. I use a lot of Crisis Intervention, helping people cope through the initial crisis that they are in... I use a lot of active listening." The second interview question asked was "how do you set goals and objectives for your cases?" All three respondents stressed the importance of conducting a thorough assessment for it is the foundation of developing proper

40 38 goals and objectives. Respondent one stated, 11 1 do all of my goals and objectives based on the diagnosis. A more informal goal and objective is to get them to come in, to get them to see this as a positive experience, to get them tied into this as a process to help them with their life." Respondent two stated 11 the broad goal is to move people into self sufficiency... the objectives are individualized for each person according to what they need... child care, transportation, and housing are big things." Respondent three stated, "My goals and objectives differ a little, but I use the nurse's goals and objectives to guide me. I want to be realistic with them (the patients) but I also don't want to take away all of their hope. I am not God so I don't know. Sometimes people I don't think will even get out of these doors go home and have a lot of quality left." Respondent three expressed frustration at the short time the patient is in the hospital due to Medicare's criteria. The third interview question asked was "Other than funding and personnel shortages, what major issues and challenges do you see in your field of practice, and how do you think these should be addressed?" Common themes were frustrations with agency policy, increased paperwork, and insurance and government regulations. Unfortunately there were no concrete answers to these issues and challenges. Respondent one did not hesitate a bit when asked this question and responded, "lncompetence... people who think they know what they are doing but they don't..., people who are on power trips, people who are threatened by other people, people who have pretty significant personal issues

41 39 that they are not willing to address. Everybody has personal issues, but in this field if you don't acknowledge them and if you don't have insight about your own stuff it's going to leech out into everything you do. It's ok to have them; it's not ok to deny them and I guess I see that a lot. Some of the other issues are turf issues... personalities... gaps in services." Respondents two and three mentioned the subject of burnout. When asked how they deal with the issue of burnout, both immediately referred to the importance of prayer and meditation. Respondent two stated, "I start my day with prayer and many times during the day I stop and I pray. I breathe deep; I always take my lunch; I leave the building; I walk." Respondent three expressed frustration with insurance regulations and states, "I think a huge issue for me is insurance. Insurances have become so hard to work with. They become these huge dictatorships. I think there should be some lobbyists to put them in their place. I see people who have paid huge amounts of money... there needs to be a line drawn when they (insurance companies) are dictating to the doctor what choice of medications that can be used. Respondent three also talked about burnout and stated, 'There is nothing really built into our system that helps us debrief and helps us to take care of ourselves... I get up early in the morning...! pray; I do some stretching; I have my coffee." Respondent three also talked about being able to debrief with a colleague and how important that has been for both of them. The fourth interview question asked was "how do you measure the effectiveness of your work?" Respondent one measures goals and objectives

42 40 every three months but stated, 11 1 don't necessarily measure my effectiveness that way because other circumstances could have changed in their life and that's why they got better; it has nothing to do with me. I look at, did they build a relationship with me? Did they connect with me? The agency measures productivity. If you have a lot of cancellations, if you have a lot of no-shows, if your schedule is not full, then that can be a problem because your productivity is low... but I think that has nothing to do with effectiveness." Respondent two stated, "The county and the state measures effectiveness by whether the client is working and self sufficient." Respondent three stated the hospital measures effectiveness by length of stay, the expense of the tests that were performed, and reimbursement issues. "I measure it more by a person saying I have this disease but I guess I'm just going to have to deal with it and deal with it the best I can and take one day at a time or by their spouse saying I don't know how I would have handled this without your help, or by the cards that I get." It was interesting to note that despite very different practice settings, all three social workers were similar in their answers in defining their major approach to practice, how they assess cases and make practice decisions, and their views of major problems in their field of practice. All three emphasized working from a strengths perspective and meeting the client where they are at. All three used an eclectic approach when working with clients. The practitioners were unanimous in stressing the importance of conducting an accurate and thorough assessment. It was interesting to note that while all three were able to

43 41 define what formal models, theories, and/or conceptual frameworks they use to guide their practice, it was the question that seemed to be most difficult to answer. When working on my PPM, I found this to be true for myself as well. Learning from Interviews Having the opportunity to meet with and interview three MSW practitioners was undoubtedly the highlight of creating my PPM. Each practitioner had a unique personality and practice setting. I chose these participants because they are working in fields that I am most interested in. I appreciated the opportunity to develop my qualitative research skills and look forward to conducting more qualitative research in the future. It was interesting to note how I felt when interviewing these professionals. Due to my excellent undergrad and graduate education, and the extensive learning from conducting my literature reviews for my PPM, I felt confident and able to carry on intelligent discussions with seasoned professionals. After conducting this qualitative research, I have a deeper understanding for the need to have an eclectic knowledge base and to be flexible in my practice. I was in agreement with the practitioners when they stressed the importance of conducting an accurate assessment of the client situation, for it is the foundation for effective service. I also have a deeper understanding and appreciation for the many roles of an advanced generalist practitioner. I could strongly identify with respondent one when stressing the importance of self-awareness and the need for humility and integrity.

44 42 I was surprised to hear of respondent one's opinion of the problem of incompetent colleagues. I was also disappointed to hear of the frustrations with agency policy, paperwork, and other frustrations. While I was aware that these problems exist, it was never the less disheartening to hear. It certainly serves as a catalyst for me to strive for professional excellence and to hopefully be a part of the solution to these problems. After completing my interviews, I have discovered that I would have liked to have asked my respondents more questions. My questions would have focused more specifically on the role spirituality plays in their practice. It was interesting to note that without prompting two of the three respondents mentioned the role spirituality plays in their personal and professional lives. Both of these respondents work in settings where the subject of spirituality comes up regularly and they address these issues on a daily basis. I would have liked to discuss cultural and diversity issues more in depth. I also would liked to have discussed any ethical dilemmas they have encountered and how they handled the situations. It would have been interesting to compare their views with my literature reviews on these topics. I finish this component of my PPM with a grateful heart. I am thankful for the willingness of these three respondents to share from their hearts and the example they have set before me. I am thankful for their many words of encouragement and look forward to working with them in the future.

45 43 Summary of Personal Practice Model This document, which constitutes a statement of my own unique approach to social work practice, contains my self-assessed views of seven components of social work practice: 1) natural helping skills that I use in practice, 2) the learned skills and roles that I use, 3) my preferred conceptual frameworks, 4) my views of human diversity and cultural competence, 5) how I make practice decisions, 6) the value base underlying my practice and my professional ethics, 7) how I determine my practice effectiveness. I have also described a social work practice area of special interest and have accomplished literature reviews of six of the seven components focused on my special interest area. A literature review was not undertaken on the first PPM component - natural helping skills - since it had been determined from the experience of students in previous years that little published material is available relating specifically to this topic. To further help me identify and evaluate my Personal Practice Model I interviewed three MSW social workers and related their views on certain aspects of social work practice to my own. The natural helping skills I identified are developing rapport, listening, empathy, encouragement, and problem solving. The skills and roles that I have learned in various educational/training experiences are conducting accurate assessments and working in the role of case manager. The conceptual frameworks that I use to guide my practice are the Strengths, Feminist, and Ecosystem's Perspectives, Cognitive/Behavioral and Ecological Systems Theory.

46 44 My basic approach to considerations of human diversity and cultural competency is characterized by the belief that diversity in cultural perspectives is critical to societal functioning. Social workers must possess an awareness and acceptance of cultural differences and an awareness of their own and dominant society's cultural values. The journey to cultural competence is ongoing and evolving. I do not believe anyone can truly arrive. This is a process that involves much self reflection, respect, and humility. I make practice decisions by the use of critical thinking, evidence-based practice, and practice wisdom. The value base, which is the foundation of my social work practice is characterized by adherence to the NASW Code of Ethics, my personal values, and the values of the agency I work for. To help determine my effectiveness in practice I will use program and practice evaluations, participate in peer reviews and performance evaluations, and always give my clients the opportunity to express their views of the professional relationship. My area of special social work interest is the role spirituality plays in social work practice. My literature reviews pertaining to the six PPM components were to gain new understanding about my area of special interest. For example, I learned that there has been a return of attention to religion and spirituality and an increase in related research and publication. Spiritually sensitive social work is in many ways analogous with culturally sensitive social work practice. I can miss opportunities for meaningful and helpful relationships with my clients if I avoid the religious aspects of my client's lives. Conducting an accurate assessment from a

47 45 strengths perspective in the light of the client's cultural and spiritual context can reveal key strengths I might otherwise miss. It is important for me to remember that the subject of spirituality in social work practice can present ethical concerns. Self-awareness is vital and the awareness of professional boundaries is of the utmost importance. In adherence to the NASW Code of Ethics, my mission is to promote social justice and the bio-psycho-social-spiritual well being of my clients. I will adopt a holistic practice approach that includes spirituality but does not emphasize it over other resources and aspects of a client's life. Four questions were posed to each MSW social worker that I interviewed 1) What format models, theories, and/or conceptual frameworks do you use to guide your practice? 2) How do you set goals and objectives for your cases (or projects for those in indirect practice? 3) Other than funding and personnel shortages, what major issues and challenges do you see in your field of practice, and how do you think these should be addressed? 4) How do you measure the effectiveness of your work? The theme of their answers to the first question on conceptual frameworks used in practice was the importance of an eclectic knowledge base, and utilizing a Systems and Strengths Based approach. I found myself in essential agreement on this question. The theme of their answers to the second question on setting goals and objectives was a strong emphasis on the importance of conducting an accurate assessment and from that assessment developing measurable goals and objectives. I definitely agreed with this. The theme of their answers to the third question on identifying issues and challenges

48 46 and how these challenges should be addressed was frustrations with agency policy, insurance and government regulations, and dealing with burnout. Again, I found myself in essential agreement to their answers on this question. The theme of their answers to the final question on practice efficacy was a little more vague. There was a stark difference with the way the agency measured effectiveness and the way the respondents measured it. The agencies measured effectiveness more with the completion of client goals and objectives and the respondents measured it with a combined interest in goals and objectives but also included the positive relationship with the client. Respondent one summed it up nicely when she stated productivity does not necessarily equal effectiveness. I agreed with this as well. My Understanding of the Advanced Generalist Perspective When I first decided to attend graduate school, I did not fully understand the importance of being trained as an advanced generalist practitioner. I thought it would be more beneficial to specialize in one particular area. My desire was to specialize in clinical social work and become a counselor/therapist. My view of an advanced generalist practitioner was erroneously one that could be likened to the common cliche, "A jack of all trades but a master of none." Thankfully, I no longer feel this way. Advanced generalist social work practice builds upon the knowledge, values, and skills of the generalist perspective. Practitioners should be capable of working independently on an individual, family, community, state, national and

49 47 international level with a variety of problems and populations. Advanced generalist practitioners possess increased knowledge and skills in complex direct practice in which goals are met through personal contact and immediate influence with those seeking social services. Practitioners are also called upon to utilize their advanced skills in indirect practice such as administration, community organizing, research, policy development, and education. Selfreflection of personal and professional needs, motives, and actions and a commitment to lifelong learning are other examples of the advanced generalist perspective. Advanced generalist practitioners must be ever aware of the cultural aspects and human diversity of the client system. The advanced generalist model of social work practice is based on a strengths perspective that encourages client empowerment. Together the client and practitioner identify strengths and resources that can create positive change, build self-confidence, and instill hope. Central to the strengths perspective is the belief that every individual, group, family, community, and environment has strengths and even the most difficult situations, while injurious at the time, can be sources of challenge and opportunity. Practitioners best serve clients by working with them and should take individual, group, and community aspirations seriously (Kirst-Ashman & Hull, Jr. 2002). Direct practice, indirect practice and self-awareness are three areas where the advanced skills, knowledge, and professional values of advanced generalist social work practitioners can be utilized. Direct Practice refers to those activities

50 48 that involve frequent face-to-face interaction with the client system and requires a wide array of practice skills. The advanced practitioner has the ability to put social work knowledge into effective intervention activities with individuals, families, and groups. Intake and engagement techniques such as engaging involuntary, hard-to reach clients and responding to manipulative and or dangerous clients are skills the advanced practitioner will possess. The advanced generalist practitioner will have a deeper understanding of working with groups and using special techniques such as thought stopping, reframing, cognitive imagery, and progressive muscle relaxation to aid in interpersonal intervention. The advanced generalist social worker will also possess the skills necessary to move into the role of counselor, educator, broker, case manager, mediator, facilitator and advocate. The advanced practitioner has extensive knowledge of direct practice models such as the Addiction, Crisis Intervention, Family Preservation, and Problem-solving models (Sheafor & Horejsi, 2003). Another area of advanced generalist social work practice that calls upon a deeper level of skill is the area of indirect practice. Indirect practice does not involve extensive contact with clients or consumers of services, but indirectly serves or benefits those who need various types of services or assistance. Examples of indirect practice include agency administration, staff supervision, program planning and evaluation, fund-raising, education, advocacy on behalf of a large group of persons in need, and efforts to enact legislation and change public policy that would benefit clients and consumers of human services

51 49 (Sheafor & Horejsi, 2003). The advanced generalist practitioner may be required to do oral presentations, educational seminars, grant writing, agency policy proposals, program evaluation, and community organizing. A third area of advanced practice expertise is the area of self- awareness. Advanced generalist practitioners continue to develop in the areas of cultural competence, self-exploration, and a commitment to lifelong learning. The advanced generalist practitioner continues on the journey towards cultural competence, moving through the fluctuating stages to advanced cultural competence. The advanced generalist practitioner is ever cognizant of the impact of human diversity and the effects of discrimination. Advanced generalists diligently work to promote social justice and see to it that all persons have access to services regardless of race, class, gender, or sexual orientation. Practitioners are forever mindful of personal values and biases and believe that to be an effective practitioner one must first understand oneself. Advanced generalist practitioners make a commitment to become lifelong learners, listeners, and participant observers. They must courageously work through their own discomfort in cross-cultural situations and examine their value base, biases, prejudices, and racism as part of their own self-assessment (Mattaini, Lowery, Meyer, 2002). Personal values, agency values, and upholding the values of the NASW Code of Ethics are carefully intertwined in all aspects of the advanced generalist's life. Not only is the practitioner a professional within the walls of the agency, but is also an example at home and in the community.

52 50 Advanced generalists are educated to be able to practice independently within a wide variety of settings. Unlike advanced practitioners who have chosen to focus on a particular area of expertise such as clinical, school, or community organizing, thus limiting their areas of expertise, advanced generalist practitioners are better equipped to handle complex client systems and problems. Advanced generalist social workers approach practice issues from a global, holistic perspective with the ability to utilize a wide variety of skills, interventions, and practice theories. They are not limited as to where they may practice or are they focused on one particular area of expertise. There is a word picture that illustrates the difference between an advance practitioner that focuses on one area of expertise and the advanced generalist whose knowledge, skills, and value base is deeper and broader. It states: If you reach into your toolbox and all you have is a hammer, then everything starts looking like a nail. The toolbox of the advanced generalist practitioner is filled with a wide variety of tools to better serve a diverse client system in our ever changing social environment. I am proud to be an advanced generalist practitioner who has been educated from such a well-rounded perspective. Future Growth I love learning. Already, I find myself missing the classroom setting. I am the type of person who is energized after mastering a new skill or completing a difficult task. I have found that the more I learn, the more I realize how little I know. Learning comes through many forms. Academics, listening with the heart,

53 51 and courageous self-reflection are some of the ways I remain engaged in learning. I need to be clear about my feelings, opinions, beliefs, and moral commitments that shape my approach to practice. My own limitations, biases, prejudices, and negative attitudes need to be identified so I can grow beyond them. I also need to continue with the attitude of lifelong learning, not only from the academic arena, but from the clients, colleagues, and mentors I am privileged to meet along the way. I also need to operate from an attitude of humility and willingness to learn from my mistakes and to move forward to greater effectiveness. I have received very little formal education regarding how to assess or operationalize a client's spiritual strengths and look forward to developing my skills and knowledge in this area. There is a need for ongoing self reflection and dialog among people of many spiritual perspectives in an effort to increase understanding. I look forward to entering into respectful dialogue with other professionals in an effort to better understand the other person's perspective. I must remember that spiritually sensitive practice is more than mere tolerance of spiritual diversity among clients. It moves us to appreciation and advocacy for clients' religious freedoms, spiritual self determination, and the many variations of spiritual expression. We must value inclusion and connection We need to have a broad enough sense of respect and compassion that we can

54 genuinely engage with clients and their spiritual communities even when aspects of them are contrary with our own beliefs and values (Canda & Furman, 1999). In the best interest of our clients, social workers and religious or spiritual helpers need to become more familiar with each other, earn each other's trust, and develop an ongoing collaboration. Collaboration between social workers and clergy can avoid duplication of services and integrate psychological and theological perspectives to allow for a deeper healing process. Some ways I can further develop spiritually sensitive social work practice are: Becoming more comfortable with my own beliefs Respectful dialog about moral frameworks and ways of finding meaning in life Appreciation of spiritual diversity Familiarization of various religious beliefs Knowledge of spiritual resources for personal and community support Respect of religious beliefs different from my own Continued self awareness and personal growth I have appreciated the valuable teaching I have received thus far, and I am excited to continue to increase my learning in these and other areas. 52

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