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A Working Model
Elizabeth D. Hutchison,
Virginia Commonwealth University
Every day, social workers meet up with complex challenges faced by individuals, families, communities, and organizations. In this book, we are presenting and demonstrating a working model to help social workers understand the many and varied challenges they will encounter in their work.
Why a Challenges of Living Approach?
Social work scholars have long attempted to find frameworks for organizing social and behavioral science knowledge about human behavior in a way that is useful for the varied roles that social workers play. Two popular approaches are a social systems approach and a life course approach. Each of those approaches makes important contributions to the understanding of the complexities of human behavior encountered by social workers (see Hutchison, 2003a, 2003b). Each has been evaluated, however, to be more helpful for the social work assessment process than for guiding intervention. In this book, we are proposing another organizational framework that we think will assist social workers to move from scientific understanding to intervention. We call this approach a challenges of living approach, because it is organized around specific challenges of living that social workers confront and it proposes a way of thinking about the wide range of challenges of living that move social workers to action. Because this approach is quite specific about how it draws on general knowledge from the social and behavioral sciences, it can serve as a working model for searching for and integrating the best possible evidence about any challenge of living social workers encounter in their work.
The idea of challenges of living as an organizing framework is not a new idea. From the early days of the social work profession, social work scholars have focused on knowledge of client problems as the basis for intervention (e.g., Meyer, 1993; Perlman, 1957; Richmond, 1917). Although we write in this same tradition in this book, we have chosen to use the language of “challenge” rather than “problem.” By dictionary definition, problem means a situation that presents perplexity or difficulty, and challenge means a call to engage in a contest or struggle (Mish, 1998). We are using challenge here to mean a difficult situation that calls for engagement and action.
We think a challenges of living approach makes sense for organizing knowledge for social workers because all social work methodologies are used to address troubling situations that are to be prevented, altered, improved, or managed. Social work intervention begins with assessment of “what the trouble seems to be” (Kirk & Reid, 2002, p. 54) as a basis for a plan of action. A challenges of living approach also makes sense because social and behavioral scientists often engage in systematic study of specific problematic conditions. Consequently, social workers can and should efficiently draw on existing empirical research about general classes of people and/or situations. Stuart Kirk and William Reid suggest that social work practitioners and social and behavioral scientists share an interest in difficult situations, although the nature of their interests is somewhat different. Social workers want to know how to help clients cope with challenging situations, and social researchers want to understand the causes of human problems.
Social workers encounter many challenges of living in their work. Indeed, any client situation may involve multiple challenges. The knowledge base for social work is very broad because of the extensive range of problems addressed by social workers and the diverse roles in the professional social work repertoire. Writing of this breadth of focus, Carol Meyer (1993) suggested that “theoretically, there is almost no end to what a social worker might have to know” (p. 15). It is not the purpose of this book to present a comprehensive encyclopedia of knowledge about the full range of challenges of living that become the focus of social work intervention. Rather, we want to present a working model that can be used to develop understanding of any challenge of living encountered and provide examples of application of the model. The working model gives a structure to facilitate the transfer of general knowledge about human behavior to discrete practice challenges (i.e., problems, populations, and settings). It includes a set of questions that guides the social worker in acquiring a base of knowledge that goes beyond, and serves as a screen for, data about the unique situation faced by the social worker.
The social and behavioral science knowledge base is ever growing and always changing. What we know about a specific challenge of living can be outdated quickly. However, if we have an organizational framework for thinking about relevant sources of knowledge, the work of developing understanding of the challenges faced by client situations will be far less daunting. We will be able to update our knowledge when necessary, and perhaps more important, we will be able to mine the available scientific knowledge about novel challenges that we encounter. In this way, we can modify existing intervention methods and/or develop new methods to align the plan of action with what “the trouble seems to be.”
In this chapter, we describe the working model, and in Chapters 3–10, we demonstrate the use of the model to develop understanding of eight challenges of living: financial impoverishment, community violence, child maltreatment, traumatic stress disorders, substance abuse, obesity, HIV/AIDS, and major depression. We have not followed any classification system to select the exemplar challenges of living, nor are we suggesting one. We have attempted to choose exemplars that are considered to be major contemporary social work as well as public health problems that present across the life course, that are faced by communities as well as individuals and families, that represent a range of challenges to physical and mental health, and that cut across race, culture, ethnicity, social class, gender, and sexual orientation. The final chapter, Chapter 11, overviews the themes of Chapters 3–10, noting both commonalities and differences across the challenges of living.
The Working Model
Kirk and Reid (2002) suggest that frameworks for organizing knowledge for social work practice must present “a multidimensional matrix framed by client problems, intervention targets, and client characteristics” (p. 72). The working model presented in this book focuses primarily on client problems (challenges of living), but it also provides tools for thinking about intervention targets and client characteristics. The intent is to present a model of knowledge acquisition that assists social workers to “notice” the complexity of the multidimensional situations they encounter. Several social work scholars have written about the tendency of social workers to shrink from the complexity of the situations they encounter, to simplify and narrow the focus in the face of challenging situations (see, e.g., Begun, 1993; Gambrill, 2003a; Gibbs & Gambrill, 1999; Meyer, 1993). Our working model raises seven questions that, taken together, help social workers attend to the complexity of the challenges they face in their work:
- Who is affected (pattern of occurrence)?
- What are the current theories of causation, or association, related to the challenge of living?
- What are the multidimensional (biological, psychological, social, and spiritual) developmental risk and protective factors?
- What are the consequences of the challenge of living? Are different people affected in different ways?
- How have people attempted to cope with the challenge of living?
- What social justice issues are involved?
- What do the answers to the above questions suggest about action strategies (practice implications)?
Patterns of Occurrence
One way of understanding a challenge of living is to ask “who is affected,” what are the patterns of occurrence? The answer to this question has particular relevance for the development of preventive interventions. Social workers can draw on the field of public health, where epidemiological research has addressed this question. Epidemiology is the study of the distribution of disease and health in a population (Kaplan & Sadock, 2002). Epidemiological research can identify causal factors of diseases, social problems, and troubling situations as well as the different patterns of occurrence across age, gender, socioeconomic status, cultural groups, geographic regions, and so on (Nash & Randolph, 2004). For example, epidemiological research tells us that, in the United States, women are 2 times more likely than men to be diagnosed with major depression during their lifetime (Gorman, 2006) and that males are 3 times as likely as females to be both victims and perpetrators of homicide (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Epidemiological research has also been used for international comparisons, for example, in 2000, for one definition of relative poverty (40% of median income), 14.1% of children in the United States, 1.3% of children in Finland, and 17.1% of children in Mexico lived in poverty (Luxembourg Income Study, 2004). With this attention to patterns of distribution, an epidemiological approach is crucial for social work’s attention to human diversity and social justice.
We want to interject a word here about terminology and human diversity. As we attempted to uncover what is known about human diversity in relation to specific challenges of living, we struggled with terminology to define identity groups. We searched for consistent language to describe different groups, and we were dedicated to using language that identity groups would use to describe themselves. However, we ran into challenges endemic to our time related to the language of diversity. First, it is not the case that all members of a given identity group at any given time embrace the same terminology for their group. Second, as we reviewed literature from different historical moments, we recognized the shifting nature of terminology. In addition, even within a given historical era, we found that different researchers used different terms and had different decision rules about who comprises the membership of identity groups. So, in the end, you will find that we have not settled on fixed terminology that is used consistently to describe identity groups. Rather, we use the language of individual researchers when reporting their work, because we want to avoid distorting their work. We hope you will not find this too distracting. We also hope that you will recognize that the ever-changing language of diversity has both constructive potential to find creative ways to affirm diversity and destructive potential to dichotomize diversity into the norm and the other.
To interpret epidemiological research, it is important to understand two types of statistics used in that research, prevalence and incidence. Prevalence is a rate of the number of existing cases (of a troubling situation) at a particular point in time divided by the total population studied. For example, in 2003, 929,985 people in the United States were estimated to be HIV infected, for a prevalence rate of 0.0033. Incidence is the rate of new occurrences of a troubling situation within a given time period. For example, in 2003, the estimated number of new diagnoses of HIV in the United States was 43,171, for an incidence rate of 0.00015 (Centers for Disease Control and Prevention [CDC], 2004b). Oftentimes, prevalence rates are reported in terms of the number per 100,000 of the population.
Theories of Causation
Much of what we “know” about challenges of living is organized into theories, or “systems of concepts and hypotheses designed to explain and predict phenomena” (Kirk & Reid, 2002, p. 18). Theories help us bring order to the vast, and exploding, information about human behavior, calling attention to patterns and relationships. As Anne Fortune and William Reid (1999) suggest, the theories that social work practitioners find most useful are those that produce explanatory or causal hypotheses, those that provide the “whys” of challenges of living. However, unlike medicine, where researchers seek “cause” by isolating specific biological mechanisms of causation, social scientists must live with the reality that, for the social world, “it may never be possible to identify causes and their effects fully” (Fraser, 2004, p. 6). Social science theorists rely on research that indicates that one variable is likely to influence another, and they attempt to build theory that explains these associations.
In the process of building knowledge about a specific challenge of living, we think it is important to begin by surveying the range of current explanatory theories. Because human behavior is subject to many influences, no one theory is likely to account for the complexity of a particular challenge of living. Attending to the range of explanatory theories brings more variables into view and prepares us to recognize the multiple factors influencing difficult situations. As Berlin and Marsh (1993) assert, this theoretical pluralism obligates social workers to engage in critical analysis of the strengths and limitations of a variety of theoretical frameworks. In the final chapter of the book, we analyze the empirical research evidence, the information produced by careful, purposeful, and systematic observation, for the various theoretical perspectives discussed throughout the book.
Multidimensional Risk and Protection
For the past several decades, researchers across several disciplines have been studying challenges of living through the lens of multidimensional developmental risk and protection. They have attempted, with much success, to identify antecedent factors of troubling situations, those factors that came before the troublesome situation, in several personal and environmental dimensions. A number of large-scale longitudinal studies have been a real boon to this line of inquiry (see, e.g., Masten & Garmezy, 1985; Rutter, 2000; Werner & Smith, 2001). The researchers have identified risk factors, or factors that increase the probability of developing and maintaining problem conditions. Some researchers call these vulnerability factors. More recently, researchers have also been interested in individuals who have adapted successfully in the face of risk factors (see, e.g., Luthar, 2003). They have identified protective factors, or factors (resources) that decrease the probability of developing and maintaining problem conditions. They have begun to recognize the power of humans to use protective factors to assist in a self-righting process over the life course, to be resilient in the face of adversity, a process known as resilience (Vaillant, 2002; Werner & Smith, 2001). Sometimes protective factors are just the other end of a continuum from risk factors; intelligence is a factor for which this is the case. This is not always the case, however. For example, having a teenage mother is a risk factor, but having a mother at the ...
