FEBRUARY/MARCH 2004

Focus Group Findings

Professional Social Workers Achieve Effective Outcomes— Systemic Challenges Pose Major Risks

In a focus group conducted in December, 2003 by the NYC-NASW Center for Social Work Policy and Practice, seven social workers from across the spectrum of addictions services discussed the different populations they serve, the challenges they and their clients face, as well as life and death issues at stake in providing services. Also included in the discussion was the unique role that professional social workers play in addictions services.

Most of the social workers carried caseloads, but several did so while in administrative capacities. Four of the five boroughs of New York City were represented. These social workers are employed in programs such as drug de-tox, outpatient treatment, therapeutic community, day treatment, and youth outreach.

One social worker in a municipal hospital discussed her particular role of stabilizing the men and women who enter her program; they are clients that other staff declined to treat. She said that these patients exhibit symptoms, including forms of “strange” behavior, hallucinations, and talking to themselves. Typically, staff would not accept such clients, sending them elsewhere, including to the emergency room or back to the street. However, once the social worker has helped these clients achieve a sense of comfort and trust, the other staff are willing to begin the process of engagement.

Many of the people coming into programs have more problems than they did in the past. It is now typical for staff to see more clients with chronic addictions, as well as many who are homeless, victims of domestic violence, and with a history of crime and recidivism. One social worker described these clients as being “intensely needy”. He said that a key role that he plays is providing coaching and training to the other staff, usually paraprofessionals, monitoring their work and helping them to develop a greater ability to work in a very difficult environment.

One social worker discussed her role in working with mothers referred to her program by the city’s Administration for Children’s Services, and helping them re-unite with their children who have been placed in foster care. The social worker said that she helped the mothers move toward becoming stabilized and learning parenting skills. She said that being able to work with the “whole person”, and not just achieving sobriety, is critical as the women face a broad array of needs, from a history of their own physical and sexual abuse to dealing with the need for housing, income, and learning how to live drug free.

Another social worker discussed working with adolescents in a program that is intended as an alternative to incarceration. The kids exhibit emotional problems, truancy and usually have issues with peers and their home environment. The goal for these teenagers to see their own role in their difficulties is partially achieved through involving parents and utilizing multi-family groups; enabling these families to re-unite with their children is another desired outcome.

Working through Fear and Anger on a Path to Independence

The following is especially illustrative of the challenges of engagement with an addicted client and achieving a positive outcome despite multiple obstacles.

According to a focus group participant, a man entered her program following his release from a correctional facility. He had a history of violence, had been on the streets since he was nine years old, had a 25-year history of addiction, and had been homeless. An overriding symptom was his anger, which was described as “barking” whenever anyone tried to speak to him. The staff were petrified of him.

The social worker sat with this man every week, putting up with his tirades while simultaneously working to get him public assistance, medical coverage, and speaking with his parole officer. The social worker also intervened with this man’s sister to help her obtain services after she had been abused.

Over time this client enrolled in a training program and became skilled in building maintenance. After one year of sobriety, he is giving back to the agency through part-time work; and he is a role model for other clients. She said that others do not find him fright-ening anymore; and he is clean cut.

She pointed out that this individual had no one to trust. She reflected back to him that he was contributing to this by pushing her away while she was the one person who was willing to deal with him. She added that her advocacy on his behalf and that of his sister enabled him to feel that someone cared. That mattered tremendously in helping him to turn his problem-filled life around by 180 degrees.

Challenges with Life and Death Stakes

The participants in the focus group were asked to talk about the challenges they face in providing services. They spoke first about the challenges their clients face, not only the fact of their addictions, but the multiplicity of other problems, as well. This includes the need for income and employment, health care, and housing. In addition, they often have mental illnesses and have experienced traumas, including various forms of violence.

The focus group members indicated that in order to be effective in this work, time is needed to address each of these

needs. This is made especially difficult when managed care and oversight organizations such as the NYC’s Human Resources Administration severely restricts the length of time a client can remain in a program. In addition, excessively large caseloads prevent each worker from being able to invest enough time into any given case to perform essential tasks, from building trust to connecting with other needed services.

Participants also said, that as professional social workers, they work well in conjunction with the many paraprofessionals on staff, and the roles and responsibilities are often complimentary. Nevertheless, the necessity of distinguishing between addictions and mental illness, and how each may be contributing to a client’s behavior, are essential; yet, often goes unrecognized and unappreciated, at times exacerbating the treatment that is needed.

They basically agreed that the very agencies and systems that are responsible for providing addictions services are simultaneously working to limit and frequently undermine the provision of effective care. Under these conditions, the outcome can be that people are left at risk for serious deterioration in their health or exposure to harmful acts, either to themselves or to others.

Policy Implications that Need to be Addressed.

In 2001, the Office of Alcohol and Substance Abuse Services (OASAS) conducted focus groups on the overall workforce around the state. They found that programs are typically understaffed; vacancies are hard to fill; staff are stressed, underpaid, and asked to perform duties for which they are often under-trained; turnover is high; regulations are difficult to comply with; career advancement opportunities are limited; and work environments are typically unappealing. All of these things operate to undermine effective service delivery.

The focus group at NYC-NASW’s Center for Social Work Policy and Practice revealed that professional social workers are confronting the same issues that OASAS has identified for staff more generally. At the same time, these social workers express being committed to taking on these challenges, just as their clients need to face the challenges in their own lives.
NYC-NASW will be looking to build alliances and work with government to understand more fully the benefits of professional social work in addictions, and the need to ameliorate the challenges that the system itself is imposing.r
Professional Social Workers Achieve Effective Outcomes— Systemic Challenges Pose Major Risks

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