Massachusetts collaboration will enhance social work training in addictions

Massachusetts has an all-hands-on-deck approach to the opioid epidemic, and the most recent group to be involved is social workers. In October, the state unveiled a collaboration with the Massachusetts chapter of the National Association of Social Workers (NASW-MA) and nine schools of social work to upgrade the curriculum so that social work students are better prepared to prevent and treat substance misuse.

A working group, in a meeting with Gov. Charlie Baker, presented recommendations, which will expand a social work student’s competence when working with individuals with substance use disorders.

“Almost every front-line social worker will engage with a client struggling with substance use disorder or a family with a loved one struggling over the course of their career,” said Mary Lou Sudders, Health and Human Services Secretary (and a social worker), in announcing the plan Oct. 10. “They must be equipped with the best clinical tools to help clients navigate a path to treatment and recover.”

The Department of Health reported that the populations social workers often work with—the homeless, people with an incarceration history, and people with mental health diagnoses—are more likely to die from an opioid overdose than the rest of the population.

The core principles of social work training in addictions are broken into three categories (a more detailed description is included at the end of this article):

• Primary prevention: preventing substance misuse;

• Secondary prevention: caring for individuals at risk for substance use disorders; and

• Tertiary prevention: managing substance use disorders as a chronic disease.

The nine participating schools of social work are Boston College, Boston University, Bridgewater State University, Salem State University, Simmons College, Smith College, Springfield College, Westfield State University and Wheelock College. Each school will fit the principles into their classes. In addition, continuing education programs will be available for current social workers.

Already working in the field

This is not to say that Massachusetts social workers aren’t already working with clients with addictions. There are 7,000 members of NASW-MA, says Jamie Klufts, association spokeswoman. “They have clients they see one-on-one, and the majority of them are working on behavioral health issues, with much of that related to addiction,” Klufts tells Addiction Professional.

The social work field is split into two main types of practice, Klufts explains. Micro-practice is clinical work involving counseling. Macro-practice is connecting people to resources, such as helping them navigate bureaucracy to get Social Security benefits. Social workers may be in private practice, or work in hospital settings or agencies such as foster care. In Massachusetts, the Department of Children and Families employs many social workers. “They work with youth who are homeless,” Klufts says.

Before the new social work principles, “There wasn’t a standardized way to talk about an approach for the field” in addressing the opioid epidemic, says Klufts. “Social workers are on the front lines—they are in the communities, they’re in agencies focusing on the opioid crisis.”

Training needed

Currently, social workers do not have to have specialized training in order to treat clients with addiction, says Klufts. In fact, in many jurisdictions, neither do physicians. “That’s why the governor of Massachusetts has done a lot of work around training medical doctors,” says Klufts. “So now, it’s time to train social workers who are on the ground.” She adds, “Every social worker should be trained in addiction.”

Social workers have traits that make them well-suited to helping people with addiction, such as their mission to work with the underserved, and their focus on human relationships. Sometimes, people with addiction really need someone to talk to, not just a medication to take. Social workers don’t prescribe, or make recommendations or referrals for medications, says Klufts.

Underpaid profession

Social workers who are in private practice accept all types of insurance, and they get reimbursed for their services just like a psychiatrist or any other professional, says Klufts. Social workers on the prevention side do not get direct reimbursement, because they don’t see clients one-on-one, she says.

But social workers aren’t in the business for the money. “The social work population is traditionally underpaid for their services, with the average $35,000 [a year],” says Klufts. “This is abysmal for a master's-level clinician, but these are people who are in it for all the right reasons—they're social justice minded. They often serve the most vulnerable populations—people on Medicaid or Mass Health, which other providers might not accept.” And in Massachusetts, social workers are pleased that the governor values their work.

Alison Knopf is a freelance writer based in New York.

Core principles of social work training in addiction in Massachusetts

Primary Prevention Domain—Preventing Substance Misuse: Screening, Evaluation, and Prevention

1. Demonstrate an understanding of evidence-based prevention techniques and strategies, including community assessment, the use of data to inform prevention efforts, a focus on risk and protective factors for substance misuse, and other approaches consistent with the Strategic Prevention Framework and other evidence-based strategies.

2. Assess a person’s risk for substance use disorders by utilizing age-, gender-, and culturally and linguistically appropriate communication, screening, and assessment methodologies, supplemented with relevant available information, including (but not limited to) family history, co-occurring mental health disorders (especially depression, anxiety disorders, and PTSD), and environmental indicators.

3. Demonstrate an awareness of how to inform individuals about the risks associated with substance misuse and the neurobiology of addiction, and to coach them about available resources, such as pharmacologic and non-pharmacologic treatment options, including opioid and non-opioid pharmacologic treatments for acute and chronic pain management.

Secondary Prevention Domain—Caring for Individuals At-Risk for Substance Use Disorders: Engaging Individuals in Safe, Informed, and Person-Centered Care

4. Demonstrate an understanding of the substance use disorder treatment and recovery supports system, and how to appropriately refer individuals to their primary care physician, substance use intervention and treatment services, mental health specialists, community-based supports, and/or pain specialists for consultation and collaboration.

5. Demonstrate the ability to complete a multi-dimensional contextual assessment inclusive of substance use and its interaction with symptoms of mental illness, which informs treatment and recovery support recommendations across the continuum of care.

6. Articulate the foundational skills in person-centered counseling and behavior change, consistent with evidence-based techniques, including motivational interviewing, harm reduction, relapse prevention, and brief intervention skills.

Tertiary Prevention Domain—Managing Substance Use Disorders as a Chronic Disease: Eliminate Stigma and Build Awareness of Social Determinants

7. Recognize the risk factors for, and signs of, opioid overdose and demonstrate the correct use of naloxone (Narcan) rescue.

8. Recognize substance use disorders as a chronic disease that affects individuals and families physically, mentally, spiritually, and socially. Importantly, substance use affects pregnancies and parent-child relationships. Addiction can be treated and recovered from with effective assessment, referral, community supports, and inter-professional collaboration.

9. Recognize and assess their own and societal stigmas and biases against individuals suffering from substance use disorders and associated evidence-based medication-assisted treatment to work toward eliminating stigma.

10. Identify and incorporate relevant information regarding health inequities, current and historical drug policies, criminal justice practices, and related forms of systemic oppression into planning how to support individuals in the management of their substance use disorder, and recognize that in order to have a better chance at recovery, an individual’s basic needs must be met, including safe and stable housing, primary health care, mental health care, and access to ongoing support services as needed.

Source: NASW-MA