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Macro Matters — The Need for Specialization Beyond the Micro-Clinical Level
By Harry A. Russell, PhD, LMSW

The early years of the social work profession were marked by the search for identity, which continues to the present day as an ongoing challenge. Jane Addams and others promoted the generalist perspective looking at the environment, policies, housing, health care, and justice issues, in addition to individual conditions. Mary Richmond and others like her promoted clinical work, looking primarily at individuals as the source of their conditions. There is a significant initiative occurring that seeks “to infuse the foundational macro component of our profession into the classroom and field to achieve a more equal footing with its clinical counterpart.” The idea of promoting macro practice gained momentum when President Obama declared himself the “community organizer-in-chief,” (Rothman & Mizrahi, 2014).

The emergence of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, which used the International Classification of Diseases (ICD), sixth revision, as a model to develop the first DSM, provided the means for diagnostic billing as with the ICD, giving the profession occupational recognition in the marketplace. This ability to enter the marketplace by billing for clinical services accelerated the dominant interest in clinical practice, while deterring social work interest in pursuit of practice with larger macro social matters. According to NASW, “Over the decades, professional social work practice have become relegated, in large part, to the delivery of clinical services in government health units, private and public social service units, school settings, case management, and other micro level direct service along with management administration of community-based mental and behavioral health and similar service organizations.”

Issues
Michael Reisch’s 2016 essay “Why Macro Practice Matters,” commissioned by the Special Commission to Advance Macro Practice in Social Work, sets the tone for further discussion. Reisch cites a survey conducted by Rothman in 2013, which found that many social work faculty, in schools primarily emphasizing clinical education, were resistant to the idea of integrating macro practice into BSW and MSW curricula. The survey findings note that “a devaluing of macro content by some program administrators, and a general lack of interest in or understanding of macro practice among many students” exists. “Although generalist practice has been established as the core of social work education for several decades, many programs pay scant attention to macro content either in their coursework or field placements” (Reisch, 2016).

Practice Observations
Areas most commonly reported by licensed social work practitioners are mental health (37%), child welfare/family services (13%), and health care services (13%). Nine percent of social workers reported aging as primary practice, and only 8% reported working as school social workers. Only 6% of licensed social workers reported working with adolescents as their primary practice. Less than 5% of social workers reported primarily working with developmental disabilities, higher education, addiction services, persons experiencing homelessness/displacement, criminal justice, occupational social work, community development, and income assistance (National Association of Social Workers Center for Workforce Studies, 2006). The need for social workers in areas such as economics, justice and policy areas, occupational social work, community development, and other related macro areas is as important to the profession as the micro-clinical services.

The Bureau of Labor Statistics (BLS) has categorized social workers into the following four groups: child, family, and school; health care; mental health and substance abuse; and all other social workers. BLS 2016 data indicate there were more than 680,000 social workers employed in the United States. The largest number of social workers specialized in practice with children and families or worked in schools. The smallest number worked in the “all other” occupations (BLS, 2019).

Social Worker Employment, by Type, 2016 and Projected 2016–2026

Source: U.S. Bureau of Labor Statistics, Employment Projections

The 2018 BLS macro practice identified related occupations are cited in the “community and social services” area. The list contains the following major group occupations: educational, guidance, school, and vocational counselors; marriage and family therapists; rehabilitation counselors; substance abuse, behavioral disorder, and mental health counselors; counselors, all other; child, family, and school social workers; health care social workers; mental health and substance abuse social workers; social workers, all other; health educators; probation officers and correctional treatment specialists; social and human service assistants; community health workers; community and social service specialists, all other; clergy; directors, religious activities and education; and religious workers, all other (BLS, 2019).

The category of “all other” identifies industries hiring workers of the major group identified. It becomes evident from the occupations list that all of what social workers identify as macro practice is not associated with the profession in the labor market.

In the global context, macro practice is needed, perhaps, more than micro practice activities. In emerging economies, there exists tremendous need for social workers to work with broad sectors of the populations and communities across multiple social domains and problems. There exist needs for conflict resolution in war-torn countries, to address climate change impacts, to promote human rights, to combat poverty, and for working to reduce social vulnerability of health conditions, among other matters. In the United States there are similar macro issues but also those involving immigration, social and criminal justice, equal rights, homelessness, health, and income and education disparities, among others. Assessing community needs and environmental concerns; developing strategies for social programming and policy development; addressing health, education, and poverty concerns; and engaging in conflict resolution and justice work are just some of the activities in which macro practitioners are trained to address. However, many macro areas do not appear in the BLS occupation listings. For those that do appear, social workers are not associated with those related occupations.

According to the BLS, “Social workers help people solve and cope with problems in their everyday lives. Clinical social workers also diagnose and treat mental, behavioral, and emotional issues” (BLS, 2019). The BLS does not single out any other social work specialization area. The duties identified are the following:

• identify people who need help;

• assess clients’ needs, situations, strengths, and support networks to determine goals;

• develop plans to improve clients’ well-being;

• help clients adjust to changes and challenges in their lives, such as illness, divorce, or unemployment;

• research and refer clients to community resources, such as food stamps, child care, and health care;

• help clients work with government agencies to apply for and receive benefits such as Medicare;

• respond to crisis situations such as child abuse;

• advocate for and help clients get resources that would improve their well-being;

• follow up with clients to ensure that their situations improved; and

• evaluate services provided to ensure that they are effective (BLS 2019).

According to the BLS, the typical working environments of social workers include the following:

• hospitals, primary care settings, and clinics, including veterans’ clinics;
• nursing homes;
• community mental health clinics;
• private practices;
• state and local governments;
• schools;
• colleges and universities;
• substance abuse clinics;
• military bases and hospitals;
• correctional facilities; and
• child welfare agencies (BLS 2018).

While these occupations and duties have become the stereotyped hallmark of U.S. social workers, they are extremely limiting in the scope and diversity of environments and client systems with which social workers are trained to practice. Macro advocacy, empowerment, and transformative work are equally important to the profession as micro and mezzo level work popularized by related job visibility in the BLS occupations listing with identified salary ranges.

Why BLS Data?
One may ask, why the focus on BLS information? Well, the answer is simple: The BLS is the gatekeeper of income-based professions and records the trends and future job outlooks. When job types aren’t directly associated with a profession and/or its specialized disciplines, there is no place for identification in the free marketplace. It is clear that U.S. society does not consider or fully understand the history and breadth of social work as a profession. Thus, social workers are called upon to practice their advocacy and empowerment skills on behalf of the profession—to have macro social work and its associated occupation types identified in the BLS and mandate advertising related professional job positions using the label of “licensed macro social worker.”

Per LaTosch and Jones (2012), “We are concerned that few social workers are formally trained in macro-level work; this includes the vast majority of existing practitioners—both social work faculty and the social workers supervising students at field placements. It’s been noted that some schools of social work find it difficult to integrate the core competencies with respect to macro-level practice with communities and organizations.” The view of these authors illustrates how our own educational standards, common practice/placement environments, and professional practice may hinder and limit the professional development and recognition of social workers in macro practice arenas. A review of multiple social work licensing test preparation websites found that none of the practice test items addressed worker knowledge and skills of macro practice activities: There was no reference to addressing poverty, health disparities, income inequalities, and other such macro issues.

The Council on Social Work Education has, over the past several years, strongly promoted the need to increase macro-focused education, even to the point of providing grants to develop program education and field placements in policy arenas. The report, “Assuring the Sufficiency of a Frontline Workforce: A National Study of Licensed Social Workers,” concludes that “the lack of a standard definition leaves the profession without reliable data required to base future projections about the supply and demand of social work professionals’ needs in the marketplace” (National Association of Social Workers Center for Workforce Studies, 2006).

Impacts
Americans enjoy many social privileges, often taken for granted, resulting from the work of early macro social workers who addressed systemic problems and injustices by confronting matters such as abuse and neglect, housing discrimination, lack of employment opportunities, poor living and working environments, health and education inequalities, and poverty. Major policy changes due to early macro workers, such as Jane Addams and Whitney Young, include civil rights of all people; workers’ unemployment insurance, disability pay, workers’ compensation, and Social Security; legislation promoting humane treatment for people with mental illness and developmental disabilities; Medicaid and Medicare for the poor and access to health care for minorities, people with disabilities, and older adults; and legislative requirements to prevent child abuse and neglect. Current advocacy actions have led to declining mental illness and substance use disorder treatment stigma.

Globally, there must be a strong interdependent relationship between the two groups of practitioners: Micro practitioners informing macro workers of problem trends among their client population with roots in a larger systemic condition; and macro workers informing micro-practitioners of policy and social program changes that impact micro level client systems. Both would work to improve conditions of underserved, oppressed, and marginalized populations and communities.

Terry Mizrahi, PhD, MSSW, (2014) acknowledges community organizers are everywhere: “They are active in civic organizations, tenant and block associations, neighborhood improvement committees, parent associations, church outreach to the poor, citizen mobilization, school-based projects, and countless other local action groups.” Mizrahi suggests organizing is not a well-known career choice, in part because the term “community organizer” is not a listed occupation by the Department of Labor and BLS. The result is that “many young people who may want to get involved in community life don’t necessarily know that they can do this for a living.”

Social work education, practitioners, accreditation, and licensing bodies must advocate on behalf of the profession to make known the varied specialization practice arenas of social work beyond clinical practice. Educating potential employers and federal agencies such as BLS would go far in promoting the breadth of social work occupational diversity. Finally, transformation of the way the profession views itself professionally and the way in which external entities view the profession could change the employability of social workers and may become more attractive to new student recruits of social work.

Final Thoughts
The social work profession must rally around itself and to provide clear definitions of the multiple practice specialization areas identified by the profession. Further, it must bring attention to the broader population—particularly among policy makers and industries where macro social workers practice—that the need exists to advertise for macro social workers in related positions in political arenas, administration, community organizing and planning, policy development/implementation/evaluation, justice, conflict resolution, and other related macro work. Advocate for changes to licensing exams to reflect generalist practice in its entirety and address multiple specializations within the profession. Finally, to broaden the scope of social work education to have more inclusive curricula, promote the need and importance of social workers in macro practice to students in hopes of encouraging movement into this critical area.

— Harry Russell, PhD, LMSW, is a native New Orleanian with 30 years of professional social work experience. He is an associate professor and director of the MSW program at Southern University at New Orleans. Russell is experienced in areas of direct services, agency/organization administration, and city government administration. He has a background in grants management/evaluation, mental/behavioral health services, developmental disabilities, foster care, program administration and evaluation, and public policy analysis/evaluation.

References
Bureau of Labor Statistics. (2018). Occupation outlook handbook: Social workers: What social workers do. http://www.bls.gov/ooh/Community-and-Social-Service/Social-workers.htm#tab-2.

Bureau of Labor Statistics. (2019). Occupation outlook handbook: Social workers: Summary. http://www.bls.gov/ooh/Community-and-Social-Service/Social-workers.htm.

LaTosch, K., Jones, K. (2012, Spring). Conducting macro-level work in a micro-focused profession. Field Educator, Volume 2.1, Practice Digest. http://www2.simmons.edu/ssw/fe/i/LaTosch.pdf

Mizrahi, T. (2014). Community organizers: For a change. https://greenthinkboxsocialnetworking.blogspot.com/2013/09/community-organizers-for-change.html.

National Association of Social Workers Center for Workforce Studies. (2006). Assuring the sufficiency of a frontline workforce: A national study of licensed social workers. https://www.socialworkers.org/LinkClick.aspx?fileticket=QKU6bvt6Rwc%3d&portalid=0

Reisch, M. (2016). Why macro practice matters. Journal of Social Work Education, 52(3), 258-268.

Rothman, J., & Mizrahi, T. (2014). Balancing micro and macro practice: A challenge for social work. Social Work, 59(1), 91-93. doi: 10.1093/sw/swt067.