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Social Work and Digital Transformation in Real Time
By Sean Erreger, LCSW, MSW
Social Work Today
Vol. 20 No. 5 P. 26

With no time to spare, social work educators have leapt on technology’s back to navigate their way during the pandemic.

This past spring, the world changed forever. The outbreak of the coronavirus sent numerous sectors, from travel to banking, into disarray. The need for social distancing meant that technology would need to step up to help complete essential tasks. Although this evolution was already happening in social work circles, the profession was nevertheless impacted. As social work began social distancing polices, it had to transform from what is a high-touch field to digital formats.

It was a stressful time to be both a seasoned direct care manager and an adjunct professor in my second semester. A few months prior to the COVID-19 outbreak, I began reading Teaching Social Work With Digital Technology, written by Laurel Iverson Hitchcock, Melanie Sage, and Nancy J. Smyth, to enhance my teaching skills. This confluence of events illustrates how technology is changing social work practice and education.

The need to pivot to technology was complex, but understanding the frameworks of digital transformation assisted with the transition. It’s not that social workers wanted to do their work via technology—they had to. During this time, concepts of teaching social work helped me better understand what the profession was going through and how it can improve during the coronavirus crisis.

SAMR Model for Technology Integration
Teaching Social Work With Digital Technology examines the SAMR (Substitution, Augmentation, Modification, and Redefinition) theory, founded by educational designer Ruben Puentedura, PhD, in 2010. In the Substitution component, technology acts as a direct tool substitution with no functional change in the learning activity. An example in a social work setting would be recording a role play rather than it being performed in class.

In Augmentation, the technology acts as direct tool substitution with a functional change. For example, recording a role play but then using editing software to cut it down to five minutes. In Modification, technology allows for a significant redesign such as recording the role play but using an editing tool to annotate the skills being used.

Finally, Redefinition features technology creating a completely new task. In this case, recording the role play, editing, annotating, and then downloading it to a website for public view.

This highlights the need for the scaffolding skills that it takes to learn technology in both teaching and social work practice. Learning one technology skill and building on the next is an effective way to learn. During the pandemic, social workers have had to substitute, augment, modify, and redefine the nature of their work quickly.

Challenges of Digital Transformation
How is practicing social work digitally different from doing so face to face? How do clients express their pain via a telehealth platform? How does it differ from expressing these feelings face to face? How is community organizing via project management software different from having face-to-face meetings? Can macro social work tasks such as social coalition building be accomplished through Zoom?

As COVID-19 has progressed, the profession has had to reevaluate and transform experiences that were once routine.

Initially, it was a question of, where do we begin? Moving away from face-to-face meetings to a digital world required an understanding of the technology itself and the basics of implementation.

Back in February, the MidWest Center for Personal and Family Development in Minnesota was already considering telehealth as an option. Nevertheless, Brit Barkholtz, MSW, LICSW, notes that things changed quickly once COVID-19 emerged.

“Personally, I went from, ‘Hmm, maybe telehealth is an option I should consider’ to my agency telling me, ‘We are fully transitioning to telehealth by the end of next week’ in the span of about a week,” she says. “It was a very quick transition but thankfully a smooth transition thanks to a lot of organization and legwork done by our admin staff.”

Karen Carlucci, LCSW, a licensed psychotherapist and certified professional coach based in New York City, says making the digital transformation requires training to better understand best practices. Another consideration is the need to modify work areas to accommodate the technology, she says.

Gerald Joseph, MSW, ACM, a case manager at Inova Health System, says the move to telehealth is worthwhile, especially under today’s circumstances. "Learning a new workflow that included telehealth was challenging, but we were able to increase coverage and provide safety for our clients,” he says.

Once telehealth visits take the place of face-to-face contact, changes in the therapeutic process are necessary. Therapists must learn to work with the medium with slight reframes about how tasks should be accomplished. For example, how can confidentiality, privacy, and safety be maintained via video or telephone?

That concern is one of a long list, according to Keri Mohr, LCSW, owner of A Good Place Therapy and Consulting. “We were worried about confidentiality, reliable internet, our virtual platform’s inconsistency, clients who left the city and state—and even country—to quarantine and, therefore, outside of our areas of license jurisdictions, and the difficulties these factors would pose for continuity of care,” she says.

Putting Technology Into Practice
Mohr recognizes that implementing telehealth was a parallel process that signaled a shift for both clinicians and clients.

Clinicians often talk about connectivity challenges. To mitigate connectivity issues, Dorlee Michaeli, LCSW, EMDR, a clinical social worker/therapist, used “two HIPAA platforms, a regular telehealth platform (such as SimplePractice) for the video component and a phone app (such as Spruce Health) for the voice. In this manner, [the client and I] remain connected and talking even if/when the video transmission cuts out for a few seconds a few times during our sessions.”

As treatment has moved into clients’ homes, it’s marked a shift in the therapeutic process. For example, social workers are helping teenage clients by organizing their virtual learning space via telehealth, illustrating how direct skills can be taught via and augmented by technology.

This makeover comes with potential risks and requires the ability to adapt to the technology. Barkholtz says a lot of young people are concerned with privacy issues—that family members may be listening. As a result, some have gone to great lengths to ensure privacy. “I've had sessions with clients camped out in their car, clients out for a walk, clients sitting out in their yard,” she says.

Clinicians find themselves in similar circumstances. The use of technology has revamped how work is being done. Joseph points to electronic communication to share information and handouts. This sort of technology also can be used to track progress in between encounters by supplementing verbal telehealth visits with brief e-mails or texts. This helps maintain communication, and I found I did this more with telehealth visits than I did with face-to-face visits.

From a group practice management perspective, Mohr had to consider multiple ways tech tools could assist with supervision. She uses a combination of video and project management software to bring her team closer together. Other teams have built tools such as video and group text on top of each other.

Technology has redefined how clinicians treat and interact with clients. Michaeli, who is trained in EMDR (eye movement desensitization and reprocessing), typically conducted this specialized treatment face to face. Now, not only does she use the technology but she also has adapted tasks and instructions to meet therapeutic needs.

Michaeli says learning new technology skills redefined how she manages her practice, including introducing new payment tools that have improved revenue.

Barkholtz, who spends 35 hours per week on various video platforms, admits that the transition to virtual services was mentally draining. For social work professionals, whose work is difficult enough without having to consistently redefine it, this is an important consideration.

Bright Spots
Despite these challenges, many clinicians describe the move to telehealth as a rewarding process. Sometimes it goes without fanfare that digital learning is leading to positive outcomes such as creating more efficient and convenient processes. This can occur despite the lack of face-to-face contact.

Barkholtz notes that clients were happy with the switch overall and that the transition did not significantly affect the therapeutic relationship. “A majority of my clients have made the switch without too much difficulty, and some of them even prefer it,” she says.

Other clinicians note how the technology offers flexibility for both themselves and their clients.

Nevertheless, the social work profession will have to continue to grapple with challenges moving forward. How it continues to pivot and learn is critical. To deal with these significant technology changes in education, it’s advisable to lean on learning theory such as SAMR, which can provide a helpful road map to success. It’s not that the work can’t be done during COIVD-19, it’s that there needs to be a framework for the profession to get there.

Those in care management have similar challenges but remain optimistic. “Throughout this difficult time, technology is allowing relationships to develop in a deeper way, as it's especially important to maintain meaningful connections,” Carlucci says.

— Sean Erreger, LCSW, MSW, is a care manager for youth at a New York state psychiatric facility. He also blogs about social work and technology at www.stuckonsocialwork.com.