u05a1_Andrea Steht

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1 Policy and Professionalism Analysis Andrea Steht Department of Public Service, Capella University SWK5026: Foundation Practicum 2 Dr. Sandi Barberis February 18, 2024

2 Policy and Professionalism Analysis Analysis and Application of a Human Behavior Theory There are many different theories used in social work. Social learning theory states that learning occurs in a social context, and we learn from one another. It also states that we learn by observing others (Chavis, 2012). Social learning theory has its roots in behavior theory. It focuses on principles developed by Ivan Pavlov and principles of operant conditioning developed by B.F. Skinner. Client Issues and Theory Assistance As stated above, Bandura’s social learning theory suggests that learning may occur via observing others’ behaviors (Fryling et al., 2017). Bandura defined intrinsic reinforcement as internal benefits like pride, contentment, and a feeling of success (Bouchrika, 2024). Tee- Melegrito (2023) lists several therapy modalities for treating oppositional defiant disorder, one of which is social skills training, which falls under social learning theory. Client and Theory Application LaTasha was diagnosed with oppositional defiant disorder (ODD) in 2019 due to her displays of aggression toward teachers, peers, and family members. According to Tee-Melegrito (2023), there is no single treatment for ODD. Children with ODD show a persistent pattern of disobedient, uncooperative, and hostile behavior toward authority figures. Early intervention is crucial for clients to learn how to cope with their symptoms. The intervention provided at Erskine Elementary is social skills training. When in sessions, LaTasha is given the skills necessary for her to have more positive interactions with her peers. During skills sessions, LaTasha is taught a specific skill, which is then modeled for her, and finally, she can practice the

3 skill. An example of this is when staff shows LaTasha different ways to appropriately express anger and then asks her to model these. Research and Bias The article by Chavis (2012) specifically addresses the cultural context of social learning theory. She cited McCullough-Chavis and Waites (2004), stating, “The cultural context refers to the environment and cultural influences but recognizes that society, community, and cultural heritage, values, beliefs, thinking, and traditions affect individuals and families.” Kilpatrick and Holland (2009) state that in some cultural groups, social learning theory approaches appear as being white, middle class, or incompatible in other ways with many cultural groups. Cheek (1976) was one of the first behaviorists to generalize behavior theory specifically to counseling with African Americans. Here are two different arguments on whether behavior theory and social learning theory specifically are culturally informed. Chavis (2012) used two case illustrations that showed that social learning theory can be used in a culturally competent way. Social Policy and Client Impact The definition of social policy is government policy created to enhance the welfare of its citizens. Social policies influence everything a social worker does. There are policies that dictate the services provided by social workers; there are policies that dictate how social workers provide services, and there is a lack of some policies that social workers must advocate for. No matter what a social worker does in their career, they are guided by policy. These policies then impact the services clients receive or services clients do not receive.

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4 Policy Description The policy that most impacts LaTasha and her care is the Medicaid Rehabilitation Option (MRO). MRO refers to medical or remedial services recommended by a physician or other licensed professional within the scope of his or her practice for the maximum reduction of a mental disability and the restoration of a member’s best possible functional level ( 405 Ind. Admin. Code 5-21.5-1 , n.d.). According to 405 Ind. Admin. Code 5-21.5-7, a client’s behavioral health service package, or the services Medicaid has determined a client needs, is based on the results of a Division of Mental Health and Addiction (DMHA) approved assessment tool. This assessment tool is used to determine a client’s level of need (LON). The assessment tool used for LaTasha is the Child and Adolescent. Needs and Strengths Assessment (CANS), which was created by the Praed Foundation. In order to be able to do the assessment, the clinician must be certified through the Praed Foundation. Policy Influence and Impact Policies like MRO that are related to healthcare, mental health services, and public health initiatives directly impact the health and well-being of individuals and communities. Access to affordable healthcare and social support systems can improve health outcomes and reduce healthcare disparities. People in Indiana with private insurance have started to see the impact of MRO on the care they receive. When a person with private insurance seeks behavioral health care, the services offered are now based on their LON, which is determined by the CANS or ANSA (Adult Needs and Strengths Assessment).

5 Policy System and Levels There are many levels to policies. There are international level policies, national level policies, state-level policies, community level policies, household/family level policies, and for kids, school-level policies. A policy system refers to the interconnected elements and processes involved in the creation, implementation, evaluation, and revision of policies aimed at addressing specific issues or achieving particular objectives. At the micro level, social workers may provide individuals counseling, therapy, and support services. As stated before, these services are determined by the client’s LON, which is determined by their CANS or ANSA score. There are many other ways Medicaid intersects with micro social work practice. Some of these are client eligibility and enrollment, case management, advocacy and empowerment, crisis intervention, and care coordination. Because LaTasha mainly receives community-based services, Medicaid intersects with micro social work practice and the services she receives with behavioral health services. Medicaid intersects with mezzo social work practice through community outreach and education, advocacy and policy development, program development and management, quality improvement and evaluation, and interagency collaboration. Medicaid also intersects with mezzo social work practice through groups. For LaTasha, when she is seen by Centerstone staff, she is typically joined by 2-4 of her peers. This gives the clients opportunities to practice the skills being taught with each other within a safe place to do so. Finally, Medicaid intersects with macro social work practice in several ways. These include policy analysis and advocacy, program development and administration, budget and resource allocation, health policy research and evaluation, and interagency collaboration and coordination. For LaTasha, Medicaid’s budget and resource allocation for her services are

6 determined by her CANS LON. As her mental health improves, her LON will lessen, as will the amount of services she qualifies for. MRO was created so that clinicians would be able to measure clients’ LONs and the impact their services are having on their client’s mental health. Though MRO can be frustrating, it can also be a helpful tool that aids behavioral health care workers in having a measurable tool to see if the people they serve are improving. Advocacy and Social Policy Social workers impact policy choices, challenge discriminatory practices, and advocate for permanent change via policy analysis, research, and engagement with different stakeholders (Pawar, 2019). Social workers focus on social justice, support vulnerable people, and study to recognize social problems, understand their origins, and provide evidence-based solutions. Evidence is essential for informing choices on policy, financing, and programs aimed at addressing social issues that hinder the well-being of families and children. Policy advocacy is crucial in social work since it enables practitioners to tackle systemic challenges and bring about significant change, such as promoting fair access to opportunities, services, and resources (Saxena & Chandrapal, 2022). Policy advocacy acts as a connection between social work research and practice (Day et al., 2023). Cultural Humility Cultural humility is along the same lines as cultural competence. According to the NASW (2015), cultural humility refers to the attitude and practice of working with clients at the micro, mezzo, and macro levels with a presence of humility while learning, communicating, offering help, and making decisions in professional practice and settings. LaTasha is an 11-year- old African American girl, while the three adults who work with her are white females. The

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7 Centerstone staff must be aware of their biases, learn from them, and practice social work with cultural humility in mind. Code of Ethics Application It is important to follow the NASW Code of Ethics. Sometimes one of the hardest things to do is to keep client information confidential. This is especially true when we want to tell our family about our workday. A client may have had a rough day, causing your day to be hard, or maybe a client had an amazing breakthrough you just want to share. As social workers, this is not allowed. It is also important to keep passwords hidden so that only those who have been granted access to electronic records can access them. Code of Ethics and Decision Making Thankfully, Centerstone has a social media policy. They have a special department that typically handles posting anything client-related to social media. The Code of Ethics has a “guide” to posting to social media, but it is fairly vague. One of the biggest ethical decisions social workers can make is whether or not something should be posted. If there is ever a question, it probably shouldn’t be. Also, it is important to remember that what is posted, whether personal or professional, can impact the poster’s career. It may be helpful for social workers to have a professional profile for social media accounts. There are times when sharing something may be helpful, or when providing services to kids, if organizations allow it, it may actually be helpful to friend them on social media, especially if it is someone that has a lot of social anxiety. As social workers, it is always important to weigh the pros and cons. Code of Ethics and Field Experience The Code of Ethics and HIPPA are clear about keeping client information confidential. During my practicum experience, there have been several times throughout the 15 weeks or so

8 that I have been there where my site supervisor and coworker have discussed client information with other clients. Also, during my virtual site visit, a client entered our office and was seen by my instructor. This also violated HIPPA and the Code of Ethics, even though no identifying information was given about the client. I often walk into the office and find release forms lying on the table or the counter. I have not addressed these concerns because I am unsure how to do so. Typically, our clients know which kids in the school see us, but just because they know doesn’t mean we can say yes if someone asks if their friend is one of our clients because they couldn’t remember. I still see this as a Code of Ethics violation.

9 References 405 Ind. Admin. Code 5-21.5-1 . (n.d.). CaseText.com. Retrieved February 18, 2024, from https://casetext.com/regulation/indiana-administrative-code/title-405-office-of-the- secretary-of-family-and-social-services/article-5-medicaid-services/rule-405-iac-5-215- medicaid-rehabilitation-option-services Code of Ethics . (n.d.). https://www.socialworkers.org/About/Ethics/Code-of-Ethics Bouchrika. (2024, February 8). Social Learning Theory & Its Modern Application in Education in 2024 . https://research.com/education/social-learning-theory. Retrieved February 18, 2024, from https://research.com/education/social-learning-theory Chavis, A. M. (2012, January 20). Social Learning Theory and Behavioral Therapy: Considering Human Behaviors within the Social and Cultural Context of Individuals and Families. Journal of Human Behavior in the Social Environment , 22 (1), 54–64. https://doi.org/10.1080/10911359.2011.598828 Cheek, D. K. (1976, January 1). Assertive Black, Puzzled White . Impact. Day, A., McLeod, B., Hawkins, R. L., & Mogro-Wilson, C. (2023, August 3). The Importance of Policy Advocacy in Social Work. Families in Society: The Journal of Contemporary Social Services , 104 (3), 243–244. https://doi.org/10.1177/10443894231187908 Kilpatrick, A. C., & Holland, T. P. (2009, January 1). Working with Families (6th ed.). Pearson. Pawar, M. (2019, March). Social Work and Social Policy Practice: Imperatives for Political Engagement. The International Journal of Community and Social Development , 1 (1), 15– 27. https://doi.org/10.1177/2516602619833219 S. (2022, January 19). Social Work and Theories | Syracuse University . SYR-UMT. https://onlinegrad.syracuse.edu/blog/social-work-theories/

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10 Saxena, A., & Chandrapal, S. (2021, June 12). Social Work and Policy Practice: Understanding the Role of Social Workers. The British Journal of Social Work , 52 (3), 1632–1642. https://doi.org/10.1093/bjsw/bcab073 Standards and Indicators for Cultural Competence in Social Work Practice . (n.d.). https://www.socialworkers.org/Practice/NASW-Practice-Standards-Guidelines/ Standards-and-Indicators-for-Cultural-Competence-in-Social-Work-Practice Tee-Melegrito, R. A. (2023, January 9). Treatment for oppositional defiant disorder . https://www.medicalnewstoday.com/articles/treatment-for-oppositional-defiance-disorder

u05a1_Andrea Steht

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