January/February 2009 Issue

Social Work and Public Health — Perfect Partners
By Jennifer Van Pelt, MA
Social Work Today
Vol. 9 No. 1 P. 28

Recent political changes expected to affect healthcare delivery and emphasize prevention and integrated health and wellness services could increase the demand for public health social workers.

Social work shared the public health spotlight following Hurricanes Katrina and Ike, when the important and varied roles of social workers emerged in press coverage. The social worker response to such devastation ranged from medical and environmental actions, such as managing infectious disease threats and access to clean water, to therapy and care assistance, such as grief counseling and assisting with new placements in mental health and long-term care facilities.

Interest in the collaboration of public health and social work has emerged—or reemerged—as evidenced by the growing number of schools offering dual-degree programs, a master’s degree in social work and public health. Enrollment in MSW/MPH programs is increasing as social workers realize the value of public health training and skills.

This combination of public health and social work is not new, says Betty J. Ruth, MSW, MPH, a clinical associate professor and director of the MSW/MPH program and certificate program in clinical social work and behavioral medicine at the Boston University School of Social Work, which has the largest MSW/MPH program in the country. Ruth has written extensively on public health social work and participates in a working group, the Group for Public Health Social Work Initiatives. “Social work has forgotten its roots. Social work originated and grew up alongside public health in the early 20th century, when social workers partnered with doctors to combat sexually transmitted diseases and other infectious diseases and to improve maternal/child health in settlement houses,” she explains.

However, as the field of social work evolved, its early partnership with public health became obscured, perhaps due to an emphasis on therapy and case management for the individual in social work education programs. Of the 500,000 social workers in the United States, the majority work in healthcare settings, but only a small minority are considered public health social workers, Ruth notes. But many healthcare social workers may be practicing public health without full awareness and without recognition (Ruth & Sisco, 2008). For example, social workers often lead prevention and health promotion efforts in field such as HIV/AIDS, child welfare, and gerontology.

Despite the historical link between public health and social work, public health professionals rarely acknowledge the contributions of social workers to their field. “It is a detriment to the social work field that we think of ourselves as visitors to the field of public health,” Ruth notes. “Public health should come to us for assistance in cultural responsiveness and community-based work because social workers are exceptionally good at these,” she says.

More social workers are beginning to realize their potential in the public health arena, according to Michael A. Lindsey, PhD, MSW, MPH, an assistant professor in the School of Social Work and the School of Medicine (psychiatry) and the MSW/MPH joint-degree program coordinator at the University of Maryland. “We’ve had a tendency to work myopically in our own world, even though social work skills lend very well to other disciplines,” he says.

Two Perspectives, One Mission
Public health social workers approach their work from an epidemiological and a social perspective and have the benefit of training in both prevention and intervention. “Public health focuses on prevention at the community level, and social work focuses on intervention at the individual level,” says Bari Cornet, MSW, MPH, a graduate of the MSW/MPH program at the University of California at Berkeley. She has worked as a public health social worker for both governmental and nonprofit agencies and is currently on the faculty at the University of California coordinating the MSW/MPH programs. She also manages the listserv for MSW/MPH program coordinators across the United States.

Because public health social workers function well at different levels, they can effectively use their multidisciplinary skills and training to serve as program directors, community services administrators, policy analysts, and other positions in fields such as maternal/child health, HIV/AIDS, disaster response, trauma intervention (e.g., related to war, terrorism, disaster), disease prevention and surveillance, substance abuse, outreach services, and advocacy.

“A joint degree provides students with the ability to fuse two different perspectives and contextualize social work in the broader public health sphere,” says Lindsey. Social workers are trained to be caseworkers and provide individual intervention, while public health professionals focus on prevention at the population level and look at the larger significance of health issues. For example, one MSW/MPH graduate is developing a program for smoking cessation in Native American groups, and another is coordinating a program for the prevention of child abuse in maternal/child health services, Lindsey notes.

Often, public health social workers will translate community-based work to assist in the development of policies and prevention at a population level. “Public health and social work are naturally complementary fields. Social workers trained in public health possess a broader knowledge and skill set that emphasize community health, safety, and welfare,” says Vikki Vandiver, DrPH, MSW, a professor in the School of Social Work at Portland State University and a clinical associate professor in the psychiatry department at Oregon Health & Science University. For social workers, adding an MPH degree to an MSW boosts research skills by providing training in epidemiology and biostatistics and expanding knowledge in prevention and health promotion techniques across the individuals’ life spans, as well as across public and private spheres such as government, she explains. Training in both fields has enabled Vandiver to advocate for policies and legislation to improve mental health services for individuals with brain injuries.

Vandiver refers to herself as a public health social worker who is “bilingual”—referring to her ability to speak the language of both fields. The MPH degree gives social workers an understanding of public health methods and terminology so they can “talk the talk” in public health circles. “My MSW/MPH training allows me to operate in both worlds and share perspectives. When I am in the public health world, I contribute the social worker’s perspective on the individual, and when I am in the social work world, I question the implications on group or community as a public health professional,” Cornet adds.

Bridging the Gap
Speaking the language of public health allows social workers with a dual MSW/MPH degree to operate in a unique niche, bridging the gap between research and practice, individual and community, and services and policies. Ruth calls the MSW/MPH dual degree a “powerful combination” because graduates have the good cultural response and communication skills of a social worker combined with the rigorous scientific training of a public health professional.

Cornet adds that public health social workers can also bridge gaps from the individual to the community to policy by helping develop policies and legislation that more effectively impact services for individuals and the community. A public health social worker would have the skills to apply the science of diabetes prevention not only in educating individuals about diabetes, but also in setting up community programs to reach, for example, African American populations with a high prevalence of diabetes. “The skills learned in a social work and public health dual program can be applied to bridge the gap between research and practice to improve quality of life,” says Lindsey, who did his postdoctoral community-based participatory research to create better access to mental health services for inner city children.

Public health social workers are often the problem solvers, applying their skills and knowledge to address inefficiencies, deficiencies, and lack of infrastructure in community services. Ruth believes that graduates with the dual MSW/MPH degree can be pioneers, bringing public health methodology to social work programs. At a recent national public health social work conference, presenters described ongoing initiatives that demonstrate the pioneering and problem-solving abilities of dual-trained social workers, including the following:

• a community-based program combining epidemiological indicators with client-based interventions to improve health outcomes of those with HIV/AIDS;

• the Pediatric Mental Health Screening and Intervention Project, which promotes mental health screening for pediatric patients with access to therapy and consultation;

• a public health approach to family violence and sexual assault applying empowerment-based intervention and prevention strategies; and

• an evidence-based intervention for frail older adults to reduce unnecessary hospitalization by integrating social work into primary care settings.

The Future of Public Health Social Work
While the future is bright for MSW/MPH program graduates, there are problems related to increasing awareness of the field, marketing the value of the dual degree, and establishing standards and competencies. The MSW/MPH degree opens the door for twice as many career opportunities, says Ruth, but interviews with graduates indicate that the majority of potential employers do not understand the value of the MSW/MPH combination or view graduates as overqualified (Ruth, Wyatt, Chiasson, Geron, & Bachman, 2006). Including strategies for marketing the dual degree in job searching and establishing networking opportunities for public health social work jobs in graduate programs may help. Lindsey hopes to track graduated MSW/MPH students and devise a feedback loop to help inform current students about career options.

Although published studies on public health social work are increasing in social work journals, awareness of the dedicated field still needs to increase in both public health and social work circles, says Ruth. The Group for Public Health Social Work Initiatives hopes to promote MSW/MPH programs, initiate a national dialogue on public health social work, and conduct and disseminate research on the dual program to further establish public health social work as a dedicated field and enhance collaboration with public health.

The role of social work in public health is also being promoted by a social work section of the American Public Health Association and the Association of State and Territorial Public Health Social Workers. Standards and competencies for public health social work have been developed by the social work section of the American Public Health Association under the leadership of Kathleen Rounds, PhD, MSW, MPH, of the University of North Carolina School of Social Welfare, and evaluation of MSW/MPH programs with the intent of accreditation are underway. A 2006 call for research on social work practice and concepts in health by the National Institutes of Health is also expected to increase the visibility and value of social work in the eyes of public health.

Public health professionals have acknowledged a current crisis in public health: a dwindling workforce (Ruth, Sisco, Wyatt, Bethke, Bachman, & Piper, 2008). There is no doubt that graduates of MSW/MPH programs can rise to the challenges faced by the public health field in the near future. Cornet says, “Training in both public health and social work becomes more important and relevant to solving the ongoing interrelated problems in health and human services.”

At Boston University’s conference, “Public Health Social Work in the 21st Century,” Betsy Clark, PhD, MSW, MPH, executive director of the National Association of Social Workers, suggested that public health social work may be the future of social work. Recent political changes are expected to affect the future delivery of healthcare, possibly leading to more emphasis on preventive healthcare and integrated healthcare and wellness services. The ability of the public health social worker to bridge prevention and intervention, individual and community, and practice and policy will be increasingly valued by our changing society.

— Jennifer Van Pelt, MA, is a Reading, PA-based freelance writer with 15 years of experience as a writer and research analyst in the healthcare field. She has written on depression, attention-deficit/hyperactivity disorder, schizophrenia, mental wellness, and aging.

References
Ruth, B. J., Wyatt, J., Chiasson, E., Geron, S. M., & Bachman, S. (2006). Social work and public health: Comparing graduates from a dual-degree program. Journal of Social Work Education, 42(2), 371-381.

Ruth, B. J., Sisco, S., Wyatt, J., Bethke, C., Bachman, S. S., & Piper T. M. (2008). Public health and social work: Training dual professionals for the contemporary workplace. Public Health Reports. 123(Supp.2), 71-77.

Ruth, B. J., & Sisco, S. Public health social work. In: Mizrahi, T., & Davis, L. (Eds). Encyclopedia of Social Work (20th ed). (2008). New York: National Association of Social Workers, Oxford University Press.

Choosing an MSW/MPH Program
The first dual-degree program was started in the early 1980s, and there are currently about 21 schools offering MSW/MPH programs. Students considering a dual-degree program should examine several factors before making a final decision, including the following:

• the number of current students and alumni;

• the availability of current students and alumni to contact for information on their experience;

• the number of faculty and clear identification of both public health and social work faculty;

• mentoring opportunities;

• choices for specialization;

• the relationship between social work and public health schools;

• whether the program is joint or concurrent (one application or separate applications to each school required);

• options for internships or field placements;

• a predefined curriculum; and

• clear mechanisms for communication and problem solving between the school of social work and school of public health.