10 Things You Will Learn About Private Practice

-Private Practice Group (Allie Dashow, Eliza Adler, Julie Sessler, David Montes, Mariah Stein)

1.Social workers in private practice work outside of an agency or government facility. This means that they are self-employed. Unlike social workers within an agency, a private practitioner must understand how to manage their practice in terms of business requirements in addition to the actual practicing of clinical social work. To some, including Mario Nunez a recent guest speaker for the SW250 class, starting a private practice can be a slow process because it takes time to build up a solid reputation with clientele (Mario Nunez, personal communication, April 21, 2016)

 giphy

2. Most all of private practice work is conducted mainly on the micro/mezzo level. Clinical social workers can provide individual counseling, marriage or relationship counseling, family counseling, and also group counseling. Some themes that private practitioners may work with include trauma, gender identity and relationship counseling, substance abuse counseling, and counseling for other various types of mental illness. Practitioners with ‘R’ designation may also serve on committees or policy and insurance board’s as well as provide expert witness testimony or advocate for policies with legislators in support of their clients, therefore doing some work also at the macro level.

talking-people-about-things

3. Social workers must acquire numerous degrees and licenses in order to practice. More specifically, private practitioners need an MSW and state license to practice. Further, they may have to work their way up between levels of clinical social work in addition to the minimum requirements, ultimately leading to the ability to receive ‘R’ designation, and therefore bill insurance and also work more at the macro level on behalf of clients. The three levels include the: Postgraduate practice, autonomous practice, and advanced practice. Advanced practitioner have their degree and licensing as well as over five years of experience in private practice.

 

4. Private practitioners can make more money than they would working for an agency. Some debate exists regarding this difference in wage for social workers, however, most all provide services on a sliding scale thus accommodating for those who are unable to pay higher rates.

635940953634641242255481255_cash

5. The difference between social workers and many other fields that may provide clinical services include the ideology of a systems perspective or holistic approach which considers all of the environmental factors contributing to a client’s overall well-being. They can use many different types of interventions and evidenced based practices when working with clients.   A popular method used in private practice may be cognitive behavioral therapy. This method is a short-term, goal-oriented form of psychotherapy which utilizes problem-solving to consider patterns of thought and behavior and ultimately works to change them.

Chris 3

6. Private practice allows for more flexibility than other fields of social work. This is often a commended characteristic favorited by many practitioners. Clinical social workers get to make their own schedules. While consistent scheduling and hours are necessary to receive a common salary each week, this flexibility is beneficial to social workers in that they can accommodate both the clients’ needs and their own personal scheduling needs. Private practitioners may have other part-time jobs, or raising family, and therefore often appreciate the ability to set their own hours.

jammin-on-my-planner

7. Unlike agencies, social workers in private practice often work alone. Some may even do their own receptionist and accounting work as well. This means that they do not always have the support of fellow co-workers to consider ideas or decompress with after a challenging day. Some may feel isolated or lonely without peer or supervisor support. It is, therefore, important for social workers to take care of their own emotional and physical needs. Often, many clinical social workers also take part in other activities including group sessions. For example, John Davidson a private licensed practitioner in Binghamton, NY, also spends time with the healing house as the clinical director (John Davidson, personal communication, March 25, 2016).  

tumblr_mr9oxffgvx1saudxwo1_500.gif

8. One aspect of private practice that makes it different from other fields of social work is that Clinical social workers can provide services to people of all ages and backgrounds. Practitioners often work with people of all ages, backgrounds, and needs. Still, some practitioners advertise special focus areas within their practice that they are interested in for specific clients also.

tumblr_mip12hsOwZ1qiu15uo4_250.gif

9. It is important for private practitioners to be very aware of themselves in order to provide health services for their clients and also to maintain their own well-being. Self-awareness is important in avoiding conflicts of vicarious trauma while counseling. Vicarious trauma can result when the professional providing services feels deep engagement and empathy for the client. Specifically, it happens in a way in which the professional is disrupted and unable to provide adequate services for the client in need due to the distress and overwhelming feelings felt by the practitioner. Therefore, as John Davidson said in his interview, new social workers “need to know themselves”. One of the best ways to do that, according to John, is to participate in therapy before practicing to better understand yourself and to ensure that you do not have any unopened histories that could limit your ability to provide services to people.

giphyff.gif

10. Private practitioners provide valuable services to clients seeking wellness, especially in the field of mental health care.  It may take a significant amount of work to become a successful social worker in private practice, but many report that they love their job overall. Some of the greatest accomplishments and conversations can happen in the office of a private practice social worker.

tumblr_nkbeydGVEl1qj9cp6o1_5001.gif

 

Sources:

Mario Nunez, Guest Speaker (4/21)

John Davidson, Guest Speaker (3/25)

Advertisements

Gerontological Social Work

 

There is a major shortage of qualified gerontological social workers in the US (PowerPoint 4/26)

People are starting to live longer and are consuming more resources because of the advances in health care and technology. Due to this there aren’t enough social workers working with this population.

Death is not talked about in our society. (Lecture 4/26)

Death is something that no one wants to talk about. Although everyone is going to die eventually, in our society that topic is just pushed to the side. It is very important to talk about the process because there are many things that need to be discussed (will, DNR) to make sure that everything is going the way it should be. It is also harder for the caregiver to deal with what is going on if nothing is discussed.

There are four definitions of aging. (PowerPoint 4/26)

Chronological Age: the number of years the person has been alive

Biological Age: how changes in bodily systems affect the physical, psychological, and social functioning of elders

Psychological Age: person’s ability to adopt and to modify to familiar and unfamiliar environments

Social Age: A person’s position or role in a social structure, as well as the person’s ability to relate to others

There are four assessment principles for evaluating older adults. (PowerPoint 4/26)

  1. Compare a person’s age measured in years and functioning and see how they compare
  2. Use brief assessment instruments (depression scales mental status exams)
  3. Assessment must result in delineation of strengths and weaknesses
  4. Clinicians should use many different assessment methods to improve the quality of the information

There are 5 stages of grief according to the Kuebler-Ross scale. (PowerPoint 4/26)

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptancestages-of-grief

Our society does not take the time to grieve. (Sarah Hopkins, 4/28)

As we continually move forward with life we are always saying goodbye to things, but we don’t take the time to do that. Just like when we lose someone we don’t take the time  to mourn them, we just quickly move on with life because that’s what society expects us to do. Based on the relationship, a person only gets 3 bereavement days from work. People need to talk about their feelings and take the time to grieve the loss of their loved ones.

time

 

Sources:

Vassello, J. (2016). Social Work With Older Adults [Power Point Presentation]

 

Hopkins, S. (2016). Guest Speaker

Consumer Groups in Mental Health

  • 46% of all Americans experience some form of mental illness in their lifetime (DiNitto & McNeece, 2008, pg. 145).
  • Social workers in the mental health field work in many areas including: emergency, psychiatric services, hospitals, residential programs, partial hospital programs, and outpatient services. (DiNitto & McNeece, 2008, pg. 145)
  • Social workers in this field also work with some different types of consumer groups. (DiNitto & McNeece, 2008, pg. 152)mh

1.Children and Adolescents (DiNitto & McNeece, 2008, pg. 153-154)

  • Half of mental orders manifest by age 14, and 3/4 by age 21
  • Mental health services are not presently available in the same quantity/quality as those for adults
  • Some factors that can increase a child’s risk for mental disorders include: physical/sexual abuse, substance abuse, running away from home, sexually abusing others, history of family violence, caregivers who have felony convictions, substance abuse problems, histories of psychiatric hospitalization, or a sibling in foster care or any institutional setting
  • Federal laws now require school districts to serve disabled children, so many social workers work in early childhood intervention programs. These last from age 3-22.

2. Consumers with Co-ocurring Disorders (DiNitto & McNeece, 2008, pg. 154)

  • Many people have multiple disorders at the same time; including a mental illness  and another medical problem such as substance abuse, heart disease, HIV/AIDS and many others
  • Treatment agencies attempt to provide integrated treatments, but many times consumers must go from agency to agency because these programs are still new
  • The team of clinicians used for integrated programs consist of a physician, nurse, social worker, and some others who provide services tailored to the consumer
  • Home visits are a mainstay of social work services because they provide practitioners with a better understanding of clients’ biopsychosocial functioning
  • The techniques that are most effective with this category of people are: education, cognitive-behavioral interventions, and peer support

3. Consumers who are Homeless (DiNitto & McNeece, 2008, pg. 154-155)

  • 20-25% of individuals who are homeless have serious mental illnesses (SMI)
  • Half of those individuals also have drug or alcohol abuse disorders, while also having substantial health problems
  • Homelessness is more likely to follow the onset of mental illness (schizophrenia and bipolar disorder are the most common)
  • The assertive community treatment (ACT) team model is commonly used to seek out individuals living on the streets and deliver services to them
  • 76% of homeless children have a mother who has major depression, schizophrenia, a substance use disorder, or high distress
  • Almost 50% of the children in homeless shelters show symptoms of depression and anxiety (1/3 meet the criteria for clinical depression)
  • Homeless shelters employ social workers to provide mental health services to adults and children, or social workers from mental health agencies may come to shelters to assist them

4. Military Personnel and Their Families (DiNitto & McNeece, 2008, pg. 155)

  • Military personnel and their family face many stressors that puts them at risk for dysfunction including: moving often, adapting to living in other countries, episodic or long separations, and fear of death or disability during wartime
  • Many military personnel (even in combat) experience post-traumatic stress disorder
  • Social workers provide services such as child abuse, spousal abuse, alcohol and drug problems, and post-traumatic stress disorder
  • The Department of Veteran affairs provides mental health services that employs a substantial number of social workers

     

 

Sources:

DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.

Practice Models within Disabilities

Social workers practicing within the disability, developmental disabilities, and mental retardation fields can be involved on the micro, mezzo, or macro level. There is not just one social work practice model used in the disability field though and social workers choose from many based on the situation. (Dinitto & McNeece, 2008, p. 224)

  1. Behavioral Model – focuses on conditioning and changing undesirable behavior. This model uses positive and negative reinforcement to obtain the desired behavior, and it focuses on the actual change in behavior instead of why. (Dinitto & McNeece, 2008, p. 224-225)page-11
  2. Crisis Intervention – this is generally used for short term, most often when an individual (or family) first learns hat he/she has acquired a disability that is permanent. Immediate fears and feelings are addressed before they can begin to plan for the long term. (Dinitto & McNeece, 2008, p. 225)handbook-crisis-intervention-developmental-disabilities
  3. Case Management – this is most often used when the client has multiple needs and the resources addressing those needs are scattered over the community. The case workers coordinate everything for the client. (Dinitto & McNeece, 2008, p. 225-226)6bae0242-bf36-4a32-826b-99672b10cab9
  4. Advocacy- the social worker performs tasks that the client cannot do themselves, or needs assistance with. It entails working with the client to find out what he/she needs as well as working with the community agencies to determine how the services can be obtained for the client. (Dinitto & McNeece, 2008, p. 226)
  5. Strengths Model – this takes the focus off the deficits associated with disability and can be expanded at the community level. It focuses on identifying strengths of clients and the environment, viewing client motivation as developing from a focus on strengths, and developing a cooperative relationship between the client and worker. (Dinitto & McNeece, 2008, p. 226)disability-573x382
  6. Empowerment – this centers on the principle of client self- determination. It assists clients to achieve their potential and to promote changes in their environment and in social policy that will promote social justice.This helps clients to achieve their full potential as well as improving society. (Dinitto & McNeece, 2008, p. 226-227)
  7. Independent Living – this is a different type of model because clients are responsible for running their own lives. Customers may use professionals as consultants, but they make their own decisions.This is mainly for people with physical disabilities. It is more geared to focusing on physical and attitudinal barriers rather than tasks that individuals have difficulties performing. Dinitto & McNeece, 2008, p. 227-8)

 

Sources:

DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books

School Social Work

  • Because of complex social, emotional, and developmental issues, children in today’s schools are not as ready to learn and have a harder time adjusting to school. Educators are faced with the struggle of teaching these children. (Diehl & Andy, 2008 p. 1-2)noyouddiint
  • There is increased pressure with the No Child Left Behind Act to also meet the needs of disadvantaged  as well as improve overall academic achievement. (Diehl & Andy, 2008 p. 2)10278-round-nclb-logo
  • Community schools now involve partnerships between school systems and community organizations, which offers programs and social services to help meet the needs of children, youth, and family. (Diehl & Andy, 2008 p. 2)sfcp_universalmanual_33009_img_0
  • It is very important to keep an open relationship with the parents of troubled children. Calling the parents and reinforcing  good things that their child has done helps keep a positive relationship with the parents. (Lecture 4/5)tumblr_n5vzl8y4nj1tv4k5po1_400
  • There is a large effect of school social workers in reducing behaviors that interfere with normal school adjustment and validates the role of social workers in the school reform movement. School social workers play an important role in the community school movement. (Diehl & Andy, 2008 p. 17)schoolsw

Sources:

Diehl, D., & Frey, A. (2008). Evaluating a Community-School Model of Social Work Practice. School Social Work Journal32(2), 2.

Class Lecture 4/5

The Child Welfare System

By: Mariah Stein

Social workers labor to address the many life circumstances and events, such as violence, neglect, and poverty, that prevent children’s needs for health, security, belonging, and self-fulfillment from being met. (DiNitto& McNeece, 2008, p.239)cw15.jpeg

Family Preservation: (DiNitto& McNeece, 2008, p.249-250)

  • It is preferable for a child to live with his or her original family; states use federal funds to keep the child safe at home while providing support services to the family
  • Social workers teach parents how to effectively parent their children and how to safely oversee their home
  • “Wraparound Services” wraps services around the family to prevent the child’s removal
  • Family group decision making is a model that brings together family members, friends, and other significant adults to create a permanency plan for a child
  • There are also other programs such as the shared family model, and the Child and Family Program, that help to preserve families

Foster Care Family: (DiNitto& McNeece, 2008, p.250-252)

  • On any given day approximately 500,000 children are in foster care in the US. Children stay an average of 33 months, though 17% have been in care for 5 years or more
  • Most enter due to abuse or neglect, but could also be there because their parents are incarcerated, disabled, or deceased
  • Most children are usually traumatized and confused when they are taken out of their homes and put in a foster home, and usually exhibit serious behavior problems
  • 20,000-25,000 kids age out of foster care each year with no ongoing family support and need help transitioning into the real world
  • Social workers help recruit, train, and oversee foster parents

 

Adoption: (DiNitto& McNeece, 2008, p.252-254)

  • About 2% of all American children live in adoptive families
  • It is very challenging to find suitable adoptive placements for the 126,00 special- needs children (children who are older or have physical, emotional, or mental difficulties)
  • International adoption has become a growing segment of adoption
  • Adoption social workers recruit potential parents, thoroughly study potential parents’ homes, and help determine the adoptive placements that best meed the child’s needs

 

Kinship Care:  (DiNitto& McNeece, 2008, p.255)

  • About 6 million children live in houses headed by grandparents or other relatives
  • Many times neither of the parents are in the house so the relative is responsible for rearing the child
  • Depending on circumstances, the relative caregiver and/or the child may be eligible for financial assistance or other public assistance payments
  • Social workers play an important role in helping kinship care families find the resources they need

 

Group and Residential Care: (DiNitto& McNeece, 2008, pg. 255-256)

  • Group facilities accept children who suddenly must be removed from their homes for protection
  • Other group facilities serve particular groups of children, such as those who have run afoul of the law or children who are developmentally disabled
  • Residential institutions may serve dozens of children who can benefit from a group environment that provides a variety of professional services as well as a structured environment with established routines and supervision

 

Sources:

DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.

How Social Workers Treat Substance Abuse

By: Mariah Stein

There is no single treatment approach in the US to helping people with AOD (alcohol or other drug dependence or abuse) problems, but there are over 13,000 specialized substance abuse treatment facilities in the US that provide a variety of treatments. These are some of the treatments that are used with substance Abuse. (Straussner, 2012, pg. 128)drugs 1.jpg

Pharmacotherapy: (Straussner, 2012, pg. 128-129)

  • There are medications that can help diminish the cravings for drugs and assist clients in re-establishing normal brain functioning for opiate addictions, as well as other medications to treat alcohol addiction.drugs 4.gif

Drugs:

  • Methadone is highly controversial because it is a drug replacement and not abstinence, but it is currently the most widely applied and researched medication for opiate dependence

– Methadone significantly decreases opiate use, reduces drug related crimes, illnesses and death, and enhances social productivity

  • Buprenorphine is the newest medication for opiate addiction. In 2000, Congress passed the Drug Addiction Treatment Act (DATA) allowing qualified physicians in private practice to prescribe this to a limited number of patients.
  • These medications are not enough for the majority of patients, but need to go along additional psychosocial and medical services

Alcohol:

  • Disulfiram has been used to treat alcohol dependence for over 40 years. It produces extremely unpleasant side effects (nausea, flushing headaches, and heart palpitations) if the patient drinks alcohol.
  • Naltrexone (typically used with counseling) blocks opioid receptors that are involved in the rewarding effects drinking and the craving for alcohol.
  • Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness and dysphoria.

Behavioral Therapies: (Straussner, 2012, pg. 129-130)

  • There are a few different behavioral therapies that help people engage in the treatment and recovery process, provide incentives to remain abstinent, modify their attitudes and behaviors related to substance abuse, and increase skills to handle stress and environmental cues that may trigger craving for AODdrugs 8
  • Contingency Management (CM):this involves giving patients incentives (food vouchers, travel/movie tickets) for meeting previously agreed upon behavioral goals. This is highly effective (because of operant conditioning) for people diagnosed as being dependent or abusing alcohol, stimulants, narcotics, and marijuana.
  • Cognitive Behavioral Therapy (CBT): attempts to reduce self-defeating behavior by modifying cognitive distortions and maladaptive beliefs, as well as teaching techniques of thought control. CBT is based on trying to enhance self- control by teaching the patient to explore the costs and benefits of continued substance use, to pay attention to their thinking, to cravings and substance-seeking behaviors, to identify high risk situations that con compromise one’s recovery, and to develop effective relapse prevention strategies.drugs 11.jpg
  • Motivational Enhancement Therapy (MET): this draws upon combining (precontemplation, contemplation, preparation, action, and maintenance) with the clinical techniques of Motivational Interviewing. This emphasizes expressing empathy, developing discrepancies, avoiding argumentation, and rolling with the resistance. This approach is very successful, especially with engaging substance abusers to enter treatment.

-the MET led to  the development of the SBIRT (Screening Brief Intervention, and Referral to Treatment) which is becoming a widely adopted model for early identification of alcohol problems in primary health facilities.drugs 12.jpg

  • Twelve Step Facilitation Therapy (TSF): a brief structured approach to facilitating early recovery from alcohol and drug abuse. It is implemented in 12-15 individual client sessions, and is grounded in the behavioral, spiritual, and cognitive principles of the fellowships of AA and NA. Central principles include: accepting that AOD addiction is a chronic, progressive disease that one is powerless over and that life has become unmanageable, surrendering to a higher power, and active involvement in 12 step fellowships.
  • Harm Reduction: designed to reduce the harmful consequences associated with drug use. This includes needle exchange programs and opioid substitution therapy. This is also used by engaging clients in a therapeutic relationship without getting into  a power struggle over preordained set goals by the therapist.drugs 17.jpg

 

Sources:

Straussner, S. (2012). Clinical Treatment of Substance Abusers: Past, Present and Future. Clinical Social Work Journal Clin Soc Work J, 40, 127-133.