Practicing social work from a systems perspective is needed to provide evidenced-based care to an entire system to produce lasting change to complex problems. This paper will first discuss the impact of a systems perspective when choosing theories at all levels of social work practice. The paper will also include the importance of understanding diversity and cultural competence when choosing an intervention. Ethical considerations are also discussed before a choosing a theory for treatment. Finally, a case study is discussed to justify the need for a systems perspective when providing an evidence-based treatment plan for a family in crisis.
A systems perspective is often required to provide a positive solution for a complex problem that cannot be remedied by conventional or linear thinking (Stroh, 2015). This paper will discuss the positive impact of a systems perspective in the social work profession. It will discuss the importance and mandate from the National Association of Social Workers Code of Ethics that require social workers to be culturally competent. It will stress this is not an option, but something that is required in effective social work practice. The paper will further discuss ethical considerations social workers use for applying various theories. A case study is provided to increase the readers understanding of the importance of the systems perspective and justify a systems approach for a family in crisis. The case study describes how the family’s needs were met by using a systems theory approach.
Social workers may be required to work at the micro, mezzo, macro, and/or meta levels in their social work profession. The micro level of social work provides services to individuals and families. The mezzo level includes groups and organizations such as schools, hospitals, groups, businesses, and neighborhoods. Macro level practice works with the population, politics and policy (Netting, Kettner, McMurtry, & Thomas, 2015). Finally, the metal level is practiced at the global level. These four levels of social work practice interact within a system. Social workers use many different theories in practice. These theories are interrelated concepts that provide an understanding of why things work or why they don’t work.
A systems theory states there are multiple components of an entity or body (e.g. group, organization, community) that are better understood when examined through the lens of the whole system. Our community is not just one system, but many systems within the larger community system. Families, hospitals, police departments, and other formal groups are a few examples of systems within the community. It is appropriate to view organizations in the same way. For example, administrators, professional staff, janitors, management, and clerical staff are all smaller systems within the larger organizational system. Of course, the many different systems can impact the larger system to interact at times globally, or from a meta perspective.
When using a systems perspective, we must first understand that systems are often complex, and conflict is not uncommon. We need to use evidenced-based theories that bring homeostasis to the system. Conflicts in the system may arise from different viewpoints in ethics and values, as well as, differences in procedures, goals and desired outcomes. Stroh (2015), notes that conventional or linear thinking is appropriate for uncomplicated issues; however, a complex problem requires systems thinking for a resolution. A student with Autism Spectrum Disorder will require a systems perspective when providing care for the child. Levels of care are provided at the micro level through individual and family therapy, mezzo level through school support and professional services, macro level through the Autism Society of America and ongoing research at the meta level of practice. Care for the child with ASD requires a holistic perspective which evaluates the interdependencies in the system as a whole (Patton, 2016).
Using a systems perspective also requires the social worker to examine the relationships within the system. Biopsychosocial-spiritual assessments are often done when an individual enters the mental health system. Interventions for the patient within the system might be hospitalization, psychopharmacology, case management, outpatient therapy, and/or psychoeducation. Each part of the system has their unique role and responsibility. Systems theory teaches us how people’s lives are influenced by their interactions with others (Nichols, 2017). Attachment theory enables the social worker to discern how the child has attached to care givers throughout their developmental stages and how it impacts their behaviors in other parts of the system (family, school, relationships, etc.)
When systems thinking is used in a complex or chronic problem it motivates the individuals in the system to collaborate and focus on an issue to provide a long-term solution. The social worker may achieve long-term changes through different methodologies and theories. Researchers may use a living systems theory to determine how enzymes impact the human body (Gatenby & B.R.F. 2016). A complexity theory may be used within the healthcare system to many different research concepts to achieve new innovative treatments (Long, McDermott & Meadows, 2018). A human systems model may used to determine the resilience of a community after a natural disaster (Lam, Qiang, Li, Cai, Zou & Mihunov, 2018) and a general systems theory may be used to accomplish international cooperation to improve the world’s environmental system (Rousseau, 2015).
The diversity of each system will allow the system to grow and remain stable or resilient. Each component of the system offers spiritual, mental, emotional, and physical attributes which when implemented produce change and stability (Stroh, 2015). A social worker may use a narrative theory during a family’s initial intake assessment. Their story will provide the background which determines how to proceed in therapy or even family of origin problems. They may than use a Bowen’s Family Systems Theory to achieve a differentiation of self or remedy emotional cutoff. Similarly, Salvador Minuchin used Structural Family Therapy for low income families to examine the family hierarchy and shape the structure within these families (Nichols, 2017). A healthcare provider may use a Social Status Examination to evaluate the biological, psychological, and social factors within a patient’s system to achieve balanced results (Allen & Spitzer, 2016).
Diversity considerations require the social worker to be culturally competent. Schott & Weiss (2016) recommend the social worker complete an initial assessment of the individual or groups’ cultural beliefs and values to provide evidenced-based care to the entire system. They encourage this practice to support and justify the individual/groups experience and align with their belief system. It is only after this assessment is accomplished that the social worker may choose appropriate theories for practice. Social workers must recognize the different sociocultural experiences within different people groups (NASW, 2017). Their cultural and spiritual beliefs must be respected. Death and dying, suffering, and gender roles may differ from culture to culture.
One example a social worker might encounter is with the care of our elderly. It is typical for Hispanic families to distribute the responsibilities of care for their parent among the children. African American families likewise distribute the responsibilities among family members (usually a daughter) whereas the Asian culture usually assigns care to the oldest son and his spouse.
Social workers are responsible to adhere to the National Association of Social Workers (NASW, 2017) code of ethics. The preamble of the code promotes social justice and equal treatment for all, especially vulnerable populations. Ethics are so important in social work that they make up the very core of the NASW code. The code provides a consistent ethical standard for all social work practice. The code is practiced by all social workers at all levels of practice, micro-mezzo-macro-meta. For example, it is not ethical to provide access to some individuals and not others. Our ethical values promote social justice for all participants.
Another example is the NASW code promotes respect for the dignity and worth of those we serve. Sometimes social worker must advocate for those such as the elderly or children who do not “have a voice”. It would be unethical to use theories with these groups that do not provide a complete service to all individuals within the system. When our theories do not impact all parts of the system, we are not advocating for all. Finally, Article 1.05 of the ethical standards of the NASW code of ethics requires the social worker to continue to remain relevant and up-to-date in the area of cultural awareness and social diversity. We are required to have a knowledge base to provide evidence-based practice to diverse cultures NASW, 2017).
The case study for this paper involves an African American mother and her 5 teenage children. Mother (we will call-Lana) is diagnosed with Borderline Personality Disorder and Bipolar I Disorder. Their father is a New York City Police officer and he is angry because Lana moved the children to Pennsylvania. He visits the children once a month. Lana and her family initially presented to my office because Lana was emotionally overwhelmed caring for her five children without additional supports. She reported financial stressors, marital separation, and said her children were disrespectful and refused to help her around the house with chores. Due to the financial stressors mother is unable to keep her psychiatry appointments and she is not taking her medications. The initial treatment plan will begin with structural family therapy which works with the current structure and hierarchy to make changes and restore homeostasis of the family unit.
At the second visit Lana reported they were evicted from their home. This has happened several times in the past and Lana’s husband gets angry because he believes Lana is too impulsive in her spending. The children are all staying in different teachers’ homes from their school. Lana is moving from shelter to shelter until she can find housing and additional supports. Lana reports she is now separated from her husband who refuses to be involved unless they agree to move back to New York. Lana refuses—she does not want to remove the children from their school since they are all in high school and middle school. Her oldest son will graduate this year. She does not believe the Bronx is safe for the children. Lana currently has her family’s belongings in several storage units but admits she will not have the funds to pay for the units for any length of time.
Obviously, the help for this family requires a systems approach. Lana initially called her caseworker to see what she recommended. Lana was fearful because without a residence she would lose her food stamps and she said, “it took so long to get them in the first place.” I initially called our 211-government hotline to see what services would be available to her and her children. They reported all shelters in our area were currently filled to capacity. They asked mother to come to their office to apply for emergency housing; however, they admitted they were currently low on funding since the federal government offices were shut down. Lana reported to their office as scheduled. She was disappointed when she was told there were no funds for emergency housing and they did not know when they would be available to her due to the government shut down. It appeared that the system was failing Lana at both the local and federal levels.
Lana was able to go to her church for some financial aid, but they were not able to provide housing for the entire family. Even if there was housing available Lana had been evicted several times before and she was a significant risk for landlords—many of them refused to rent to her. Lana was finally accepted at a women’s shelter where they are helping her find employment. This shelter does not accept boys over 12 years old, so the children need to remain in their temporary housing situations. The shelter connects with local businesses to provide work for the ladies. Lana currently has a job interview next week.
The case worker met again with Lana and promised to contact her when new funds are released for housing from the federal government. The caseworker made an appointment for Lana to have an appointment with an agency to help with financial planning. The agency would call her creditors and help her make a budget. I made an appointment for Lana with the psychiatrist and used our special needs funds. Lana’s treatment plan involved many different interactions within the system. Today she has a job, intensive case management and stable housing for and her children. The systems approach eventually worked for Lana and her family.
A systems theory was successful in working through the multiple components Lana and her family faced at the time of their eviction from their home. Using the systems perspective allowed the therapist to understand the many issues when they were examined through the lens of the whole system. A biopsychosocial-spiritual assessment was completed to determine the necessary theories and interventions. Interventions for Lana and family included psychopharmacology, case management, outpatient therapy, psychoeducation, financial counseling, and crisis management. Each part of the system performed their unique roles and responsibility. The application of a systems perspective provided resolutions for the significant challenges Lana and her family faced. The effective interaction of the system met the needs of this family in crisis and provided a much-needed balance to their family system.
