The Changing Environment of Social Work Practice in Schools

Calvin L. Streeter

and

Cynthia Franklin

University of Texas at Austin

School of Social Work

School social work is one of the oldest and most revered fields of social work practice. Traditionally, most of the practice of school social work was thought of as being separate from clinical social work practice. School social workers practiced in public school systems and clinical social workers practiced in psychiatric and other mental health facilities. Changes in how children and family services are delivered and broader political and economic changes, however, are re-shaping the delivery of school social work and other student services (e.g. psychologists, nurses). In recent years, there has been a substantial increase in school-linked and school-based health and mental health services and national resources to support the development of school-based health and mental health clinics (Franklin and Streeter, 1995; Franklin and Allen-Meares, 1997; Taylor, 1999; Weist, 1999). For example, there are two national training and technical assistance centers for school-based mental health services. Both centers are housed in universities and have been in operation since 1995. The UCLA School Mental Health Project, Center for Mental Health in the Schools is operated by the UCLA Department of Psychology (http://smhp.psych.ucla.edu/) and the Center for School Mental Health Assistance is operated by The University of Maryland Department of Psychiatry (http://www.nasbhc.org/).

The emphasis in the 1990s on funding collaborative-based services in the human services, and school-linked services programs in particular, has added to a plethora of clinical professionals working in schools including clinical social workers. Franklin (1999, 2000ab) has previously discussed the fact that these changes in mental health delivery are also redefining the roles and practices of school social workers. This current chapter summarizes the trends in service delivery and major political and economic changes that are having an impact on the organization of schools. The chapter further discusses the types of collaborative skills that clinical social work practitioners need to effectively work in school organizations. The chapter further highlights the increases in school mental health and health clinics and the influence these types of programs have on school-based practice. Finally, this chapter offers guidelines for helping clinical and school social workers effectively work together in school programs.

Trends in Service Delivery Affecting School-Based Practice

Clinical social workers, clinical psychologists, and other mental health professionals are working in school-linked programs offering services to children and families on or near school campuses. David Austin (this volume) suggests that, in the future, children and family services are going to continue to be offered through the schools. Presently, in schools, we can already see this trend in service delivery. Trends toward offering services in schools were fueled by several developments. Major examples include: (a) managed behavioral health care; (b) the increasing competition of private practice which led practitioners to seek other practice domains; (c) the Individual with Disabilities Education Act (IDEA), which required more comprehensive health and mental health services be offered in schools for special education students; (d) changes in funding in Medicaid and the Child Health Insurance Program (Chip), which more readily allowed schools to receive funding for primary health care and mental health services for adolescents; and (e) PL 105-17- Individual with Disabilities Education Act improvement grants (1997), which spoke to prevention and early intervention and promoted interagency agreements between schools and community agencies.

Major Political and Economic Changes

Worldwide economic restructuring in the last decade has produced a global economy in which organizations have been forced to become decentralized and flexible as they strive to provide high quality services and products, respond to individualized demands from consumers, and remain competitive in a rapidly changing social, political, and economic environment.

Gareth Morgan (http://www.imaginiz.com/provocative/concept/find.html) points out an apparent paradox in public education, generated in part by the changing demands placed on all organizations and institutions in the new global economy. Many school systems are being overwhelmed by the demands of a constantly changing and highly unpredictable environment. School staffs are feeling stressed and overwhelmed and academic performance in some schools continues to decline. At the same time, educational organizations at all levels have never faced greater opportunities. As we moved into the new information economy, knowledge became a critical resource and schools are uniquely positioned to take advantage of this fact.

According to Morgan, the problems facing the education sector are largely self-imposed. They are created by traditional management philosophies, planning models, and control mechanisms that produce high levels of stress and contradiction for those working in the system. As educational institutions, and other institutions in the community, struggle to cope with the demands of a rapidly changing environment, they are faced with the limitations of their traditional beliefs about how large complex systems function.

The Ineffectiveness of Bureaucratic Schools

Bureaucratic organizational structures that have dominated human service organizations in general, and schools in particular, are being increasingly challenged by the dynamic forces generated by the global economy and are being compelled to adapt to the demands of an uncertain and constantly changing environment. Traditionally, these systems operate as rigid and inflexible systems with a great deal of top down control. Centralized decision making requires that information flows to the top of the system where decisions are made and policies are written. These policies are then communicated down to line staff who are responsible for implementation. Feedback systems are rare and, when they do exist, are usually indirect, with several levels of management mediating the feedback between front line staff and top management.

It is assumed that the system is directed by a singular mission and goals that are officially sanctioned and consistent with that mission. For example, the main mission of schools is to educate and not to provide human services. Personnel are usually hired because they bring discipline specific knowledge and job skills that are needed by the system as it pursues its singular mission and goals. Job titles reflect professional affiliation. When necessary for goal attainment, multiple disciplines may be brought together, with each discipline making a unique contribution toward meeting the needs of the client. Teamwork may be an effective way to respond to complex problems in the system, but teamwork itself often requires an element of conflict, tension, and constructive competition.

The Need for School Reform and Change

During the 1990s, rigid, bureaucratic thinking and the idea of the singular mission of education was discovered to fall short of what was needed to respond to the needs of students and families. Interprofessional models were thrust into the limelight by those who wanted to revamp school organizations in order to be more responsive to children, families, and communities (Corrigan and Udas, 1996). Educators were challenged to come up with better resources and services that could address the demands of an ever changing, diverse society. Even though some schools have been slow to change, others moved forward with reforms aimed at transforming school systems into organizations that could adequately respond to the vast human needs presented by their diverse student populations. In particular, several reformers sought to remove schools from their isolated world of education and to link schools with other human services agencies that could help them address issues that kept children from learning.

Education Reforms Aimed at Addressing Human Resource Limitations of Schools

School-linked services models have grown in the past 10-15 years and are proposed as solutions to broadening organizational and resource restraints impeding the progress of schools, as well as providing better service systems for children’s services that encompass health care, mental heath, and social services. Each individual system of care has struggled with fragmentation and ineffectiveness as far as children’s education and mental health are concerned. Reformers hoped to develop better access to health and mental health care and to form better networks of care through collaboration, and integration of existing service systems. For example, school reformers hoped to remove the barriers of learning which students with mental health problems experience. They were looking for better grades, attendance, and overall academic achievement. Health and mental health systems hoped to gain access to youth and families and to be able of offer the services necessary to change behavioral, social, and learning problems (Franklin and Streeter, 1995).

School-Based Health Centers

Joy Dryfoos (1998) summarizes the significance of the School-based health center (SBHC) in school reform. SBHCs were developed with the mission of providing adolescents with immediate access to primary health care and helping them prevent adolescent pregnancy. These centers have grown rapidly over the past 20 years. In 1984, for example, only 10 SBHCs were in existence. Advocacy groups such as the Center for Population Options (now Advocates For Youth) and foundations such as the Ford Foundation, were instrumental in advancing SBHCs.

According to the National Assembly on School-Based Health Care (http://www.nasbhc.org/), a recent national survey identified 1,135 school-based health centers operating across 45 states in urban (56% of responding health centers), rural (30%), and suburban (14%) communities. Much of the growth in school health centers is recent: nearly 60% of centers are no more than four years old. These centers serve more than 1 million students at every grade level. About half (51%) are located in schools that include high school grades, more than one-third (35%) serve elementary grades, and 29% are in schools that include middle grades.

Expanded School Mental Health Services

As school-based health centers gained advocates and grew, there was also a push to expand school mental health services. This effort is known as expanded mental health services (Taylor, 2000; Weist, 1999; Flaherty, et al. 1998). Importantly, about 50% of the referrals to school clinics involve a shift of primary mental health services for youth from community mental health centers and private practices to schools (Flaherty, et al., 1998). In spite a long history of disagreements over funding mental health services in the schools, expanded mental health services have continued to grow. There is also evidence to show that services within the school-based clinics have greater utilization by youth and are just as effective as community-based mental health clinics (Weist, et al., 1999).

New Inter-professional Practice Context of School Social Work

At the same time clinical social workers are taking up their practices in the schools through various health and mental health services programs, traditional school social workers continue to fight for money and legislation to be funded through education monies and to safeguard their current practices in public schools. Franklin (2000ab) argues that, due to the increase of clinical professionals on school campuses and the way that managed behavioral health care is funding community-based programs, school social workers may wish to consider identifying themselves more strongly with clinical practice, giving consideration to the evolving nature of their roles and practices. This is based on the possibility that, in the future, school-based social work services may be increasingly funded under the auspices of managed care systems and that funding streams for school-based practice may become complex with a good amount of the revenues being generated from sources outside of education (Armbruster, Andrews, Couenhoven, and Blau, 1999; Franklin, 1999, 2000a; Friedrich, 1999).

Recent trends indicate that both clinical social workers and school social workers may be working to provide services to students and families in the same school setting. At the same time, social workers who provide services in schools are competing with a number of other mental health professionals who desire to provide similar types of services (Franklin, 1998). The result is a highly complex, “politically charged”, inter-professional work environment. Differing professionals, including clinical social workers, must learn to compete fairly, share expertise, and work cooperatively toward the common good of schools and their students.

Moving Beyond Host Settings to Transdisciplinary Teamwork

Social workers have long worked in host settings where other professional groups dominate. Schools, where educators are the dominant professional group, are a good example of this arrangement. The recent trends of clinical and health professionals linking their services to schools has added to the complexity of this host setting arrangements in schools. In such a context, the ability to work effectively as part of an interdisciplinary team is critical. Professionals can no longer view themselves as independent unidisciplinary practitioners. They must be willing and able to work with other disciplines, as part of an interdisciplinary team, to meet the needs of students and their families. Most clinical and school social workers are knowledgeable about the need for interdisciplinary teamwork, but may be unprepared for the types of team work required to effectively work in the newer highly complex, interprofessional work environments of schools.

Myron Weiner (1990), for example, argued that as organizations are forced to move to a more service based and information economy, the context of professional practice increasingly requires what he calls a transdisciplinary teams approach. This approach goes beyond a willingness to work with other disciplines for the common good of the client. He defines transdisciplinary as "of or relating to a transfer of information, knowledge, and skills across disciplinary boundaries." (p. 434). He argues that there are five levels of professional practice:

1. Unidisciplinary, where each professional possesses sound preparation and competency in his/her own discipline.

2. Intradisciplinary, where professionals work with others in their discipline believing each can contribute to the client group.

3. Multidisciplinary, where professionals recognize that other disciplines can also make important contributions to the client group.

4. Interdisciplinary, where professionals are willing and able to work with other disciplines in joint services to the client group.

5. Transdisciplinary, where professionals commit to teaching-learning-working with other service providers across traditional disciplinary boundaries.

Transdisciplinary teams systematically seek to expand the common core of knowledge and competency of each team member. Transdisciplinary practice is a deliberate attempt to pool and exchange information, knowledge, and skills, with team members crossing and re-crossing traditional disciplinary boundaries. This type of boundary spanning will require a number of strategies including planned individual study, one-to-one instruction among team members, and a planned and systematic team teaching-learning process.

The notion that other professional specialists can practice in one's discipline is as difficult to accept as the reverse, that one can practice in other disciplines. From the traditional unidisciplinary perspectives, this idea is generally rejected as unworkable. Weiner (1990) argues that this attitude can be traced to the fact that all organizations in the United States, private and public, business and non-business, have fashioned their personnel systems around narrowly defined specializations. Such systems place us at a great disadvantage when flexibility and a quick response to the unique needs of individuals and situations are required.

The transdisciplinary team approach does not suggest that clinical social workers could perform highly specialized services for which they have not been trained. But it does anticipate that a team comprised of different professional disciplines can expand the common core of knowledge and competency of each team member as it moves from an unidisciplinary to a transdisciplinary approach.

Embracing Transdisciplinary Teamwork

Embracing a transdisciplinary team approach will require a shift in basic values. It will require that one accept the notion that transdisciplinary practice can produce more effective, individualized client services, as well as a more productive, responsive, and competitive service delivery system. It will require a level of mutual respect and trust that will make it possible to move beyond deeply entrenched unidisciplinary practice models. Further, it will require a fundamental belief in mutual and shared responsibility for the effective functioning of the entire system. If the total system is not functioning effectively, everyone is responsible.

Schools may be one setting where this approach to teamwork is viable. Given the educational mission of the system, and the number of different disciplines that practice in this setting today (teachers, counselors, nurses, social workers, etc.), the transdisciplinary team approach may be a viable model for professional practice.

An issue for social workers practitioners will be how to participate in this type of team and still maintain commitment to the social work profession and its values. One approach would be to make social work values and ethics part of the cross-disciplinary core knowledge. While the notion of transdisciplinary teams may be counter-intuitive, it does offer an opportunity for social workers to respond to the new realities and at the same time work to share their professional values and practice perspective with other disciplines. This will require professionals who are strong enough to do this in a setting where many other professionals want to dominate.

It seems clear that the new realities demand a systems perspective more than ever before. Professionals need to understand the entire system, how it works, and where they fit into that dynamic and changing system. This may be another area where social workers can make a unique contribution to a transdisciplinary team.

Working Successfully in Schools as Members of Transdisciplinary Teams

Knowledge is just beginning to emerge for how to best work in schools as members of transdisciplinary teams (Taylor and Adleman, 2000; Waxman, 1999; Weist, et al., 1998). Even though, more than ever, school social workers and clinical social workers are working in school settings on the same client cases. There has been a dearth of models for how to successfully work with one another when housed on the same school campus or when working with the same student case load, as is in the case with some school mental health and health clinics. One of the important issues to emerge in expanded school mental health services is how outside professionals can effectively work with other mental health professionals, like school social workers who already work on the school campus. Interestingly, many of the same issues that confront fragmentation and lack of cooperation of services within a community setting also make it difficulty to achieve unified service delivery on a school campus. Lack of communication and political turf battles have been major issues detracting from the effectiveness of school-linked services, for example.

Flaherty et al. (1998) offer an interprofessional, educational review of the credentials and roles of differing professionals. Waxman (1999) offers important guidelines and a thoughtful review of issues for how clinicians can effectively work in schools. Taylor and Adelman (2000) also offer practice models and guidelines for using asset mapping and teamwork models to transcend fragmentation of school-based services. Osterloh and Koorland (1997) surveyed school administrators in Florida and provide some data and recommendations that should prove helpful for both clinical social workers and school social workers.

Guidelines for Enhancing Clinical Practice in Schools

Clinical social workers can work better in the transdisciplinary environment of schools if they prepare themselves by:

1. Learning about laws (e.g. idea), policies, and procedures for special education.

2. Making a concerted effort to understand the school culture.

3. Developing working relationships and friendships with teachers, administrators, and other professionals such as school social workers and guidance counselors.

4. Scheduling regular times to meet with educators and those who work on the inside of schools.

5. Sharing treatment plans and offering feedback to teachers and others after working with youth.

6. Being receptive to teacher concerns about students.

7. Assisting in school development and teacher training

8. Spending more time in schools and be reliable about attendance

9. Maintaining a consistent schedule but be flexible in service delivery.

10. Trying to focus on prevention and early intervention

Additionally, according to Waxman et al. (1999) school social workers who are already working on school campuses can enhance the clinical services of those coming from the outside by:

1. Being positive, affirming and receptive to collaborations.

2. Setting up school teams and assuming leadership and coordination of roles on inter-agency teams.

3. Working with agencies and collaborators to overcome barriers that prevent them from getting along.

4. Serving as mediators in resource conflicts and disputes.

5. Taking the initiative in leading efforts at mapping and coordinating resources.

6. Working with the school and agency to develop formal agreements and formal mechanism for maintaining programs and relationships.

7. Working to help other mental health professionals achieve outcomes that are academic as well as behavioral in nature.

8. Adelman and Taylor provide other papers on effective practices, and practice guidelines for working with diverse professionals in school settings at the website of The Center for Mental Health in the Schools (http://smhp.psych.ucla.edu/)

Summary

Clinical services to children and families are increasingly being offered on school campuses through various types of school-linked services programs. There is a strong indication that this trend may continue for the immediate future. The current context of schools is subject to larger political and economic changes being created by the global economy. Radically restructuring and ever changing reforms are aimed at garnering resources and improving school services and effectiveness. Diverse mental health professionals are working in schools and this has created a complex transdisciplinary work situation. This chapter provides a review of these complex issues and some guidelines to help clinical social workers and school social workers effectively work together in schools.

References

Armbruster P., Andrews, E., Couenhoven J., & Blau G. (1999). Collision or collaboration? School-based health services meet managed care. Clinical Psychology Review, 19, 221-238.

Center for Mental Health Assistance, http://www.nasbhc.org/.

Center for Mental Health in the Schools, http://smhp.psych.ucla.edu/.

Corrigan, D. & Udas, K. (1996). Creating collaborative, child-and family centered education, health, and human service systems. In J. Sikula (Ed.), Handbook of research on teacher education (2^nd ed.). New York: MacMillan.

Dryfoos, J. G. (1998). School-based health centers in the context of education reform. Journal of School Health, 68 (10), 404-408.

Flaherty, L. T., Garrison, E. G., Waxman, R., Uris, P. T., Keys, S. G., Glass-Siegel, M., & Weist, M. D. (1998). Optimizing the roles of school mental health professionals. Journal of School Health, 68 (10), 420.

Franklin, C., & Allen-Meares, P. (1997). School social workers are a critical part of the link. Social Work in Education, 19 (3), 131-135.

Franklin, C., & Streeter, C. L. (1995). School reform: Linking public schools with human services. Social Work, 40 (6), 773-782.

Franklin, C. (1998). One hundred years of innovative ideas about practice. Social Work in Education, 20 (4), 211-218.

Franklin, C. (1999). Preparing for managed behavioral health care in children’s services. Social Work in Education, 21 (2), 67-70.

Franklin, C. (2000a). Predicting the future of school social work practice in the new millennium. Social Work in Education, 22 (1), 3-7.

Franklin, C. (2000b). What’s in a name. Children & Schools (formerly Social Work in Education), 22.

Friedrich, M. J. (1999). Twenty-five years of school-based health centers. Journal of the American Medical Association, 28, 781–881.

Morgan, G. "Finding Your 15%: The Art of Mobilizing Small Changes to Produce Large Effects." Imaginization Website (http://www.imaginiz.com/provocative/concept/find.html).

National Assembly on School-Based Health Care, http://www.nasbhc.org/

Taylor, L. (2000). Achieving coordinated mental health programs in schools. Journal of School Health, 70 (5), 169.

Taylor, L., & Adelman, H. (2000). Toward the end of marginalization and fragmentation of mental health in schools. Journal of School Health, 70 (5), 210.

Weiner, M. E. (1990). Human services management: Analysis and application. Belmont, CA: Wadsworth Publishing Co.

Waxman, R. P., Weist, M., & Benson, D. M. ( 1999). Toward collaboration in the growing education-mental health interface. Clinical Psychology Review, 19, 239-253.

Weist, M. D. (1999). Challenges and opportunities in expanded school mental health. Clinical Psychology Review, 19, 131-136.

Weist, M. D., Myers, C. P., Hastings, E., Ghuman, H., & Han, Y. (1999). Psychosocial functioning of youth receiving mental health services in the school vs. community mental health centers. Community Mental Health Journal, 35 (1), 69-81.