The Generalist Approach in Social Work

The ecological perspective encourages social workers to view clients in terms of their relationships with their environments, including factors like family systems, culture, institutions, and hierarchies. As part of the psychosocial orientation, the ecological approach generally considers three different levels of individual experience: the macro, the mezzo, and the micro. The macro level includes broader societal factors including those related to public policy but also to culture, norms, worldview, and value systems. Mezzo structures include intermediate social institutions such as schools or neighborhood level organizations. The micro level issues are those most immediate to the client’s life including relationships with kin and psychological issues. The ecological model provides a balanced view of the client because it takes into account the interplay between micro, mezzo, and macro levels rather than limiting the focus on just one problem. Similarly, a generalist approach to social work can interface with the ecological model. The generalist approach allows social workers to target any of the three levels to promote change (Watson, 2014). This report will focus on one macro level issue to illustrate how that macro level issue might impact an individual client in the community. Moreover, this report will show how changing the macro level issues might not necessarily lead to micro level improvements in the client’s wellbeing. Only by taking into account micro, mezzo, and macro levels together is it possible to illustrate a healthy, desirable, and goal-driven developmental transition for the client.
In this hypothetical case, an individual is transitioning from adolescence to adulthood. The individual has a history of both eating disorders and substance use. As Shanske, Arnold, Carvalho & Rein (2012) point out, social workers frequently serve as the de facto case managers during developmental transitions. The “significant psychosocial considerations impacting this developmental process are a primary focus in health care,” and social workers possess the specialized training to help clients successfully navigate developmental transitions. Social workers are uniquely equipped to handle developmental transitions precisely because of their application of the ecological approach and the emphasis on the generalist approach to working with clients from diverse backgrounds and who may have differential goals and needs. Developmental transition is a term used in social work and healthcare to describe the critical period when a client shifts from one stage to another, such as from adolescence to adulthood, or from adulthood into old age. The developmental transition can be difficult in situations where the social institutions at both the mezzo and macro level do not offer sufficient supports.
When working with individuals, the social worker avoids focusing solely on the individual. Buchbinder, Eiskovitz & Karnieli-Miller (2014) advocate a critical-reflective approach for social workers, encouraging an honest assessment of how all three elements of the ecological model are being addressed. Often when dealing with individuals experiencing developmental transitions, it can be too easy to get caught up either in overemphasizing the political issues at stake with the macro level issues such as healthcare policy, the mezzo level issues such as ineffective outreach or mental health services available in the area, or the micro level issues such as the client’s substance use issues. A generalist approach requires open mindedness and critical thought to tackle all three levels because of the assumption that they are inextricably entwined. If the macro level issue in question is related to healthcare policy, then the social worker would advocate on behalf of the client to initiate healthcare policy reform. At the same time, the social worker would mobilize federal, state, and local resources to direct client to services available in the immediate vicinity. Any problems the client encountered when accessing services would also be addressed at the mezzo level.
Some biological characteristics that individuals bring with them that may help or hinder their progress include health-related issues that could complicate their developmental transition. This is why social workers perform biopsychosocial assessments during critical transitions, as well as initial assessments (Shanske, Arnold, Carvalho & Rein, 2012). Evaluations of their biological characeristics might also reveal weaknesses in the mezzo and macro levels such as problems accessing cancer screening locally or inadequate insurance coverage. Likewise, psychological characteristics that individuals bring with them may help or hinder their progress. The psychosocial characteristics that might have a bearing on client progress include attitudes and beliefs, diagnosed or undiagnosed mental health issues, relationships with family members or presence of abuse, and identity. Race, culture, religion, and experiences with discrimination are also critical concerns that comprise a client’s psychosocial health. Moreover, issues related to race, culture, and discrimination highlight the importance of the ecological approach. Experiences with discrimination reflect macro level policies that either mitigate or enable discrimination, as well as mezzo level issues that ameliorate the effects of discrimination or alternatively, bring those issues to the surface. The client’s self-image, self-concept, and struggles with identity are the micro level outcomes of discrimination.
The processes involved in case management begin with initial assessments and proceed toward a thorough analysis of the micro, mezzo, and macro levels. Ignoring macro issues can do a disservice to the profession as a whole, but especially to clients who expect that social institutions, laws, and public policy should change to prevent problems from occurring, ensure social justice, or directly minimize harm. The profession of social work is elevated when practitioners capitalize on the “unique ability to practice with both depth and breadth,” (Watson, 2014). Therefore, social workers also cannot ignore the importance of mezzo level issues, even when their focus remains on public policy, legislation, or even on public relations campaigns designed to change social attitudes and norms. For example, if a client has been experiencing discrimination due to sexual orientation, the social worker may become involved in public relations campaigns that target homophobia. The social worker can simultaneously work with local schools and employers in the private sector to address their institutional shortcomings, or to find partners in the community who can provide funding or human resources to help individuals struggling with discrimination. On the micro level, the social worker devises interventions that strengthen the individual with strong psychological coping mechanisms.
Some additional interventions that can help strengthen a person include family systems therapy, which can enhance pre-existing social networks. Important buffers that increase resiliency, social networks can involve the person’s family, or might entail extricating the person from an abusive family and showing how a social group can become a surrogate family that offers nurturing, love, and support. Membership in professional organizations can also strengthen a person’s self concept and provide them with the confidence needed to succeed in a chosen career path. Interventions that strengthen the environment include both mezzo and macro level responses to a presenting problem. Specific examples include presenting papers or lectures to industry stakeholders, to healthcare workers, or to the private sector at conferences and seminars. Similarly, social workers can collaborate with educators and policymakers to promote social justice and tackle the root causes of the problems impacting the daily lives of people such as poverty, racism, and gender-based discrimination. Case management in social work does address the immediate needs of an individual and his or her family, while also acknowledging the root causes in the community and the society at large.


References

Buchbinder, E., Eiskovitz, Z. & Karnieli-Miller, O. (2014). Social workers’ perceptions of the balance between the psychological and the social. Social Service Review 2004. Retrieved online: http://www.mosa.gov.il/CommunityInfo/PersonnelForums/Documents/Social%20Workers%20Perceptions%20of%20the%20Balance%20between%20the%20Psychological%20and%20the%20Social%20%E2%80%93%20Buchbinder,%20EisikovitsKarnieli-miller.pdf
Shanske, S., Arnold, J., Carvalho, M. & Rein, J. (2012). Social workers as transition brokers: facilitating the transition from pediatric to adult medical care. Social Work Health Care 51(4): 279-295.
Watson, C. (2014). Generalist social work. Lipscomb University. Retrieved online: https://www.lipscomb.edu/socialwork/filter/item/0/28229