C NNECTIONS Fall 2019 | Volume 2, Issue 3
C NNECTIONS CELEBRATING 40 YEARS Association of Black Social Workers still fighting for justice (page 17)
RECLAIMING OUR PLACE Bringing a social work lens to the medical model (page 20)
REFLECTION A new RSW considers challenges, resistance and balance (page 30)
SAVE THE DATE Mental Health, Today and Tomorrow FRIDAY MAY 22 & SATURDAY MAY 23, 2020 Mark your calendar for two days of learning, connection and growth at the College’s 2020 conference and annual general meeting. Mental health is a social justice and human rights issue. Social work as practice is embedded in psychosocial models that acknowledge the profound impact of lived experience and social
We’re gathering Nova Scotia’s social work community to explore the current landscape of mental health in our province, share local and global knowledge, and envision our future.
environment in shaping mental health.
Questions? Contact Annemieke Vink at
Poverty, racism and violence put people
at higher risk of developing mental health problems.
Submissions are open until November 22 at nscsw.org/call-for-submissions-2020
C NNECTION C NNECTION
Fall 2019 | Volume 2, Issue 3
Published three times a year by the Nova Scotia College of Social Workers 1888 Brunswick Street, Suite 700 Halifax, NS B3J 3J8
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the Nova Scotia College of Social Workers, and also reserves copyright for all articles. Reproduction without written permission from the publisher is not allowed.
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Fall 2019 | Connection 3
TABLE OF CONTENTS Volume 2, Issue 3
WELCOME NEW NSCSW MEMBERS
The Scope of Practice
May 2019 â€“ September 2019
Working with Perpetrators
ETHICS IN ACTION
40 Years: Still fighting for Justice
Child Welfare in Crisis
Reclaiming our Place
Inspire, Aspire, Conspire
Challenges of Social Work
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The scope of practice During my term as Acting Executive Director/Registrar, I’m delighted to have the chance to introduce an issue of Connection magazine to our members, and to our broader community. In this issue, we’re taking a look at the social work scope of practice, and the unique perspectives social workers bring to their work.
In this fall issue of Connection, we celebrate stories of excellence and leadership in our community. Turn to page 17 to read about the 40th anniversary conference of the Association of Black Social Workers, “40 Years: Still Fighting for Justice,” which was held in Halifax last month. We also shine a spotlight on the award recipients from our own annual conference in May (page 25).
Lynn Brogan, MSW, RSW Acting Registrar/Executive Director
Some of the articles in this issue are about different types of clinical practice. On page 10 you’ll hear from a social worker who strives to prevent future harm by working directly with perpetrators of violence. We’re also sharing an article about the ethical challenges posed by Community Treatment Orders (page 14) and a proposal from experienced private practitioners to use Bowen Family Systems Theory to apply a social work lens in medical settings (page 20). Our research article on page 18 is an executive summary of a longer paper about child welfare challenges in Nova Scotia, many of which are echoed on a national scale, and pathways to possible solutions. The authors’ full-length article can be found on our website. On page 30, we close this issue with a reflection from a relatively new social worker who completed candidacy this year. She writes about the differences in how social work can be perceived by the public, and the actual challenges she faces in her role. The broad scope of the social work profession offers diverse opportunities to co-create meaningful change at micro, mezzo and macro levels. I’m grateful to our contributors who’ve generously agreed to share some of these with our College, and with you. We are fortunate to be part of a vibrant and vocal community of social workers.
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Canadian Domestic Violence Conference 6 Marriott Harbourfront & A Hotel . Halifax, Nova Scotia March 3-6, 2020 EMBROIDERY AND TAILORING SERVICES
ST SH CO
Networking the grassroots domestic violence movement from across Canada. https://canadiandomesticviolenceconference.org
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Fall 2019 | Connection 7
WELCOME NEW NSCSW MEMBERS
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New Private Practitioners, Registered Social Workers, and Social Worker Candidates Approved by Board of Examiners May 2019 – September 2019 PRIVATE PRACTITIONERS Kara Andrews Kathryn Bourgeois Robin Cann Nicole Hattie Valerie Hewitt Elaine Howell Angela McCready Patricia Mugridge Norma Profitt Victoria Sanford Andrea Shaheen Tammy Stone Shaunalee Van Niekerk Denise Webe
REGISTERED SOCIAL WORKERS Laura Andrea Grace Atkinson Ashley Avery Troy Bell Roberta Bernard Carla Boss Jennifer Brain Tracey Brovold Courtney Brown Emily Brushett Melanie Bunnett Shelley Cameron Marianne Colbourne Emily Courney Lee Covin Andy Cox Brittany Currie Cathryn D’Arcy Victoria Dixon Rhea Farris Amanda Gogan
Stephanie Griver Nicole Hankinson Nikolas Harris Carissa Hatfield Erin Hickey Ashley Hill Christine Himmelman Corinne Hooper Lindsay Jones Mercy Kasheke Cynthia Kincaid Andrew Landon Sarah Laroque Jasmine Lavhey Sylvie Legere Jesse Lightstone Kelsey Maber Reilly MacDonald Katelyn MacLeod Alexa MacLeod Julia McCluskey Lawrence McKnight Maria Medioli Karen Overholt Ruby Peterson Breagh Potter David Rider Mario Rolle Richard Rubin Andrea Shaheen Shabnam Sobhani Heather Soucy Katelyn Walsh Susanne Williams Jeffrey Wilson
SOCIAL WORK CANDIDATES Erin Abbott Tope Abiagom
Breah Ali Allan Anderson Corey Arsenault Julie Balasalle Chelsey Belliveau Courtenay Black Jennifer Burgess Michael Butler Sara Carabin Rheanna Chisholm Madison Cole Sarah Coleman Alicia Compton Meghan Corvec Laura Couturier Jillian Dahlgren Andrew Daniels Amanda Davis Melissa Deluca Cindy Dollemont Kimberley Dunphy Gabriel Enxuga Rebekah Estabrooks Jenny Gage Sophie Gallant Rachael Gardiner Alexandra Geston Jenna Gordon Brenna Gould Yoland Grant Emma Hachey Kirsten Hall Natasha Harrison Katrina Jarvis Sarita Johnson Phoebe Johnston Victoria Judd Emma Kearney Alice Kitz Hannah Long Kaitlyn MacFarlane
Quinn MacIsaac Breanne MacKenzie Katelyn MacPhail Melissa Matheson Krista McNeil Alexa Morash Megan Moulaison Kathleen Murphy Heidi Naegele Jessica Naegele Deanne Neufeld Sarah O’Halloran Evan Parker Mallory Perry Sarah Pino Alissa Quinn Rebecca Reichmann Aliya Rubin Tracey Shay Lauren Simmons Jessica Slawter Kaleigh Smith Rachel Smith Alyson Smith Angela Smith Danica Snow Joseph Sylliboy Melinda Taylor Melissa Thomas Jacqueline Thomson Caitlyn Tobin Christine Van Kooten Pamela Viddal Natalie Westhaver Kathryn Williston Kathleen Wright Emily Yarn Kelly Yorke Denise Young Alanna Young
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Fall 2019 | Connection 9
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WHY WORK WITH PEOPLE WHO PERPETRATE? BY JAMES OWEN DUBÉ, BSC, BSW, RSW
Since 2015, I have worked with people who use drugs, violence, and various other means to cope with adverse experiences. People often stigmatize work with perpetrators of sexual and other violence as much—or more—than they do some of our other social problems (like drugs, mental illness). They wonder why anyone would work directly with people who abuse their partners, perpetrate sexual violence, or engage in other deviant behaviours. The short answer is that working with them can break the cycle of harm. The longer answer is that I have some compassion for people who deviate. This compassion may not be aesthetically pleasing, or even palatable, for many. I hope to tread carefully as I outline where it comes from. This writing describes how I have come to value work with people who have problems: largely through helping them heal from their own victimization. Throughout this text, I will refer to a man named Duncan. He is not an actual client, but a composite of men whom I have worked with in various settings. Duncan came to me before engaging in any of the higher-end violent offenses, but may very well have been on his way there. His history was light on the criminal side of things, but he certainly developed some anti-social behaviours and had become marginalized due to them. Duncan’s family history was littered with mental illness and problematic substance use. He had also experienced some family conflict and the issues that often come with it. Duncan had been sexually assaulted as an adult, bullied heavily as a child, physically abused by an intimate partner, used substances dependently and chronically, and had no discernible symptoms of mental disorder even though he had been treated for some over the years. Accessing services was difficult for Duncan, as most were focused on his personal defects. While he had some, he certainly also had much pain to heal from. We are in an era when the full scope of sexual and other violence against women is being brought into full view. Discussions about these issues are usually focused on victim or survivor experiences, and they are always binarily gendered. Rightfully so—stories of female victims have been silenced historically. It makes sense for them to be at the centre of any new
movement. We hear much about the harms done and the flaws in our systems in relation to working with people who have been harmed (but not much when these people are male-identified). There are also major flaws in our systems meant to work with people who cause these harms. Take Duncan, who had not yet been charged with any of the higher-end violent offenses. He was on his way there.
In Nova Scotia, there are very few services to help people like Duncan change their behaviour until such time that they cause our communities major problems.
Most services that are available nationally follow models that focus on acknowledging responsibility and correcting defective ways of thinking. But having lived marginalized for half of his life and having experienced this kind of pathologizing approach for years, Duncan was not ready for this space. Many people like Duncan need to heal from other things before they can contemplate their own problems. This is not to excuse bad behaviour, but it is to create space for the changes needed. Most of our responses are punitive, focused on deterrence. We certainly should denounce sexual violence, and intimate partner violence, and anti-social behaviour in general. We should be clear that it is unacceptable. Our systems should protect victims—all victims—above all else. And we should give credit to women’s services and the champions who built them. But a strictly binary, gendered analysis of these crimes offers only structural and systemic fixes, rather than clinical ones. Working with individuals who use violence—whether it be sexual or in other forms—requires a clinical solution.
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Duncan had undoubtedly developed some problematic views on sex and gender and participated in some forms of violence that could have become worse. But he did so in a street-affected, drug-fueled, survival-oriented context that could not be ignored should pro-social change be a desired outcome of treatment. What were Duncan’s clinical needs? I have found that psychosocial assessment offers the most appropriate lens to facilitate clinical work with complex histories. Duncan had a family history where conflict, mental illness and problematic substance use were prevalent. He had experienced several traumatic events. He at one point began using drugs problematically to cope with all of this. Duncan himself had been sexually assaulted. Although these issues were not the concerns of the systems built around him, ignoring them had made helping Duncan change his behaviour a useless exercise; he had been accessing services and approaching more dangerous behaviour. Duncan did not need to hear one more time that he was the problem; he needed to hear that he could find a solution.
We are unlikely to prevent use of violence through deterrence. Deterrence prevents people from speeding, parking illegally, and breaking other simple societal rules. It does not prevent them from murdering.
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Reasons for avoiding such behaviour are far more complex and have developed over lifespans as results of socialization and psychological development. There was far more to Duncan’s story than him simply not respecting others or having toxic views on sex and gender. He could grasp on an intellectual level what boundaries and consent were. He could even discuss his values at length. His life had rendered him incapable of living by them. Helping him get well would take hearing his whole story and helping him find a comfortable place within it. Perhaps we should start treating the clinical needs of people like Duncan so that we can create the space necessary for more simplistic behaviour change to happen. When Duncan was finally heard and allowed to heal from the harms done to him—harms that were not his responsibility— he was able to carve out the pieces of his story that were his job to fix. What I have found during my work at The Peoples’ Counselling Clinic and in other settings is that violence is more complex than many discussions allow. We simply will not change people by teaching them. In working with perpetrators of all genders who have used violence—sexual or other forms—I have found that the answer to changing future behaviour is most often in working through their victimization. This victimization may not be directly related to people in their current relationships. Victim blaming is, of course, not an option. This kind of work is not sympathizing with people who use violence; it is naming and addressing what is necessary to prevent further harm. It is always done in keeping with the
messages of denunciation and deterrence, and respecting history and discourse.
harm to victims reduces human suffering and saves our
What else did Duncan need? Full participation, as allowed by the social determinants of health, was necessary for him to become pro-social. Duncan had an education but had been marginalized largely due to substance use and stigma. He needed the opportunity to live well in every respect. Adequate housing, employment, food, and income were necessary pieces of his healing.
And anyone working within these systems can tell you we do
communities and systems a great deal of trouble.
not need more trouble, as can anyone who has been harmed by sexual or intimate partner violence. In providing clinical services to perpetrators, we do not wish to replace services for victims that offer more structural solutions. We never know how people like Duncan can contribute if
Criminality is, by definition, anti-social behaviour. It makes sense that to foster a return to compliance with societal norms we need to provide pro-social opportunities. This flies against the idea that perpetrators need only denunciation, deterrence, and punishment, but I would argue that it is necessary. Remember this is clinical, not systemic or ideological work. On critical reflection, preventing escalation of violence through making healthier community members jives well with most ideologies. I think we avoid such models simply because they offend our sensibilities and need for punishment and justice. This is understandable, if not effective.
we work with them to make it possible to break the cycle of violence. Work with people who use violence occupies a much different, clinical space than previous services have envisioned. A space that is focused on the individual’s relationships to others. One that helps us treat the root causes of violence while facilitating change in behaviour. If we continue to neglect this important piece of preventing violence—whether this neglect be based on ideology or values or anything else—we will continue to hear too many stories of victimization. I work with people who hurt others in part because they
People like Duncan develop violent responses to
have stories. These stories are heartbreaking, and someone
the world around them during their psychosocial
stories heard. In opening the space to identify the ways
development. This is not a strictly cognitive process,
needs to hear them. Many perpetrators have never had their people have been victimized, I help them heal, and healed people stop hurting others. Historically, we have moved from
and treating their intellect through teaching alone
ignoring these problems to dealing with them strictly through
does not seem to work.
Now we need to find more comprehensive ways to change the
punishment. Then we tried to simply teach people to be better. ways people cope. I have seen that these changes can often
I often see people who have had tragic stories of growing up without care (or in institutional care), without food, without adequate housing. We also see people who were abused sexually or physically (an obvious connection to deviant adult behaviour). We see others marginalized by race, gender, Indigeneity, or sexuality. They have much to be angry about. Not that there are ever excuses for violence, but creating safe spaces for people to receive care for these issues also provides them the opportunity to consider their own problems. Through providing safe spaces for people to work through these issues, and through fostering full participation in community life, I have seen people become more comfortable in their relationships. This has allowed them to stop acting out violently. So why work with people who perpetrate? It is the most powerful way to prevent further harm to victims and people who perpetrate are often victims themselves. Preventing
be made by people who have let go of the ways they have been harmed. This is the space I try to provide when working with perpetrators.
JAMES OWEN DUBÉ (BSC, BSW, RSW) helped form The Peoples’ Counselling Clinic in 2017. He has bachelor’s degrees in both neuroscience (Dalhousie University) and social work (University of Victoria), and recently completed a health-focused master’s program in social work (University of Waterloo). James’ time at The Peoples’ Counselling Clinic has focused on group and individual counselling and case management for people who have used or been victimized by sexual or intimate partner violence. James has also been the clinic’s point person for a partnership with the Halifax Domestic Violence Court Program.
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BALANCING ACT Ethics of involuntary treatment in Nova Scotia BY JODI BUTLER, MSW, RSW
In the last year, the NSCSW has begun to critically examine ways social work can expand practice mental health beyond the medical model. Indeed, this framework is not new for social work. Our profession has embraced the medical model since its development to gain credibility, demarcate a scope of practice and secure positions of employment. This relationship can obscure where our commonplace practices fit within each framework. One way of identifying ethical dilemmas is to hold the practice or situation up to our ethical standards.
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Scholars, psychiatric survivors, critical psychiatrists and allies have demanded that professionals reconsider the medical model. They argue the framework leads to unjust treatment and control. Certainly unjust treatment and control fit with our definition of oppression. One of the most controlling interventions in mental health is Section 47 of the Involuntary Treatment Act otherwise known as a Community Treatments Order [CTO]. Social workers in Nova Scotia, especially those who work with individuals labelled with a psychiatric diagnosis are required to use CTOs in their work.
A dilemma emerges for social workers about the legal implications of CTOs. Sections of the act mandate the use of least restrictive measures; whether CTOs are the least restrictive measures as possible has been debated in legal circles. Moreover, they present potential violations of the Canadian Charter of Rights and Freedoms. There is legal ambiguity surrounding whether using CTOs creates undue hardship counter to section 7 of the Charter. These issues undoubtedly contribute to the United Nations recognition of any form of coercive treatment as torture. They suggest forced treatment violates individual rights of freedom from torture and poor treatment in addition to breaching autonomy in decision making for people with disabilities. In some instances the UN and their special rapporteurs have made appeals using the Convention on the Rights of Persons with Disabilities to stop their use. It seems that the UN would argue CTOs contradict our ethical obligation to uphold the integrity and dignity of all persons.
Ethical examination of our profession is particularly relevant in the current context of Truth and Reconciliation and the ongoing mistreatment of Indigenous and historically The frequency that social workers must work with CTOs warrants examination of the practice against our professional values and ethics. Our profession has supported the use of evidencebased practice at least since Mary Richmondâ€™s early campaigns encouraging use of methods supported by scientificÂ methodology. However, there is a significant lack of evidence proving CTOs effectiveness. No research to date demonstrates that forced treatment reduces readmission to hospital or length of stay, nor does it result in symptom reduction. There is also no evidence to suggest that service users or the public are safer as a result of CTOs. Instead, there are findings showing the benefit of non-coercive approaches, including but not limited to: peer support, family support, community-based alternatives, supported decision making and advanced planning. Examples of these programs exist around the world. For instance, Soteria in the U.S, and Europe and the Open Dialogue approach developed in Finland. The ambiguity found in the research around CTOs must be considered in light of the ethical imperative to demonstrate competence in our professional practice.
significant Black communities in the province. This means practising in ways that address power imbalances and marginalized communities. Minority groups including racialized people are overwhelmingly subject to coercive treatment like CTOs. Any practice that targets disenfranchised populations contradicts our commitment to the value of social justice that underlies our ethics. While the use of CTOs is questionable, ultimately this ethical dilemma challenges us to balance the demands of our work with our professional commitments. Hopefully, as the College pursues research to expand how social workers view and work with mental health, answers will emerge. Until then, we must broaden how and where we see contradictions with our professional values. When we move towards these contradictions and the discomfort they bring, we are also prompted to think about what we can do differently. It is this critical examination of our work, and the possibilities for change that emerge, that may ultimately be one of the effective ways to engage in ethical practice.
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SOURCES Burstow, B., LeFrancois, B., & Diamond, S. (Eds.). (2014). Psychiatry Disrupted: Theorizing Resistance and Crafting the (R)evolution. Retrieved from http://ebookcentral. proquest.com.qe2a-proxy.mun.ca/lib/mun/detail. action?docID=3332799 Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. Anchor Books. Gooding, P., McSherry, B., Roper, C., & Grey, F. (2018). Alternatives to Coercion in Mental Health Settings: A Literature Review. United Nations Special Rapporteur on the Rights of Persons with Disabilities. LeFrançois, B. A., Menzies, R., & Reaume, G. (Eds.). (2013). Mad matters: A critical reader in Canadian mad studies (1st edition). Toronto: Canadian Scholars’ Press Inc. LeFrancois, B. A. (2016). Why New Brunswick Should Not Legislate Community Treatment Orders (p. 3).
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Nova Scotia Legislature—Involuntary Psychiatric Treatment Act. (n.d.). Retrieved 16 September 2019, from https:// nslegislature.ca/legc/bills/59th_1st/3rd_read/b203.htm Nowak, M. (2009). Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development [Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment]. https://doi.org/10.1163/22107975_HRD-9970-2016149 Russo, J., & Sweeney, A. (Eds.). (2016). Searching for a rose garden: Challenging psychiatry, forstering mad studies. Wales, U.K: PCCS Books Ltd. Szasz, T. (2011). The myth of mental illness:fifty years later. Psychiatric Bulletin, 35(5), 174–182. Retrieved from https:// stress.org/wp-content/uploads/2011/11/July-12-mentalillness-myth-after-50-years.pdf Trueman’, S. (n.d.). Community Treatment Orders and Nova Scotia—The Least Restrictive Alternative? 35.
40 YEARS: STILL FIGHTING FOR JUSTICE! Nova Scotia Association of Black Social Workers On September 26 and 27, 2019, the Association of Black Social Workers honoured their history and hopes for the future during their 40th anniversary conference in Halifax. The conference featured an array of exciting keynote speakers: Robyn Maynard, author of Policing Black Lives: State Violence in Canada From Slavery to the Present; Kimberly Papillon, judicial professor and lecturer on neuroscience and fair decision-making in law, medicine, education and business; Dr. Tanya Sharpe, a social work educator who currently holds an endowed chair in Social Work in the Global Community at the University of Toronto; Dr. Wanda Thomas Bernard, founding member of ABSW and Senator for Nova Scotia; and Dalhousie professor Michelle Williams, director of the Indigenous Blacks & Mi’kmaq Initiative at the Schulich School of Law. Robyn Maynard
Dr. Tanya Sharpe
ABSW is a volunteer charitable organization that consists of Black social workers, human service workers and other helping professionals throughout the province. The organization was founded in 1979 by four women, in response to concerns they had about the state of social services being provided to African Nova Scotians, especially the placement of Black and mixed-race children in foster care.
These four women who founded the organization in our province – Althea Tolliver, Maxene Prevost Shepard, Frances Mills-Clements and Dr. Wanda Thomas Bernard – were all community minded, socially conscious, Senator Wanda Thomas Bernard
political advocates who realized that their collective effort and voice were needed to address the concerns
The sessions and events at this year’s conference were wideranging in topic and scope. Themes explored by presenters and participants included social change and social justice, culturally responsive approaches, mental health and addictions, education, child welfare, family preservation, anti-Black racism, reparations, spirituality, and the needs and concerns of African Nova Scotian youth.
they witnessed in their community. Although there have been many positive changes in policy and practice in Nova Scotia during the last 40 years, there is still work to be done. To learn more about the ongoing work of the Nova Scotia Association of Black Social Workers, visit nsabsw.ca. Photos contributed by NSABSW.
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NOVA SCOTIA CHILD WELFARE IN CRISIS: A Shared Perspective BY JACQUELINE BARKLEY, MSW, RSW & ROBERT S. WRIGHT, MSW, RSW EXECUTIVE SUMMARY The child welfare system in Nova Scotia is currently in crisis. Our experience in Nova Scotia is consistent with a Canadian Association of Social Workers report published in the summer of 2018 that outlined similar concerns regarding child welfare practices across Canada. As clinicians who have long worked with families in the child welfare system, we have seen things get worse for families, not better, even as recent changes to the Children and Family Services Act were pushed forward despite heavy criticism from practitioners and others. We are aware of the necessity and complexity of delivering child welfare programs and services, and do not wish to criticize the many front-line workers who do what they can in a broken system. What are the ideas that are preventing effective child welfare interventions? Families experience issues of substandard housing, lack of access to culturally competent mental health services, horribly inadequate minimum wage and income assistance rates, barriers to accessing subsidized day care. These challenges relate to larger issues about how we have designed the society we live in, and dealing with these issues in depth is not the purpose of this paper. Instead we have outlined possible changes to our current child welfare system, with full awareness that a siloed solution would be insufficient. The CASW report on child welfare mentioned above outlined five core recommendations made by social workers to address child welfare services. We would agree generally with these national recommendations, and offer our own as they apply to the delivery of child welfare in Nova Scotia. We have moved from caring for the welfare of children and families to diminishing child protection work, policing parents and fetishizing risk. We need to develop local models of practice, and cultivate and empower local champions. We need to focus more on measuring child welfare outcomes and effects, and plan our interventions accordingly. We must evaluate how child welfare works in cooperation with early childhood
education and public school settings; family resource centres; income supports; afterschool programming; and health and mental health services. We also need to foster the wellness of social workers. We have long legal battles, royal commissions, state apologies, and huge compensation packages result from failing to address the needs of Canadian children and families. The current crisis in child welfare in Nova Scotia is ripe for such an outcome. We suggest intervening systemically now rather than engaging in disingenuous hand-wringing later. Protestations of “we did not know” can no longer be an excuse for inaction. To read the full text of this paper online, visit http://bit.ly/SharedPerspective.
JACQUELINE BARKLEY (MSW, RSW) has over 35 years as a social worker. She is a private practitioner and community organizer with significant experience in mental health and child welfare, and a strong professional interest in cultural competence and anti-racism work. ROBERT S. WRIGHT (MSW, RSW) is a social worker and sociologist. His 29 year career has spanned the fields of education, child welfare, forensic mental health, trauma, sexual violence, and cultural competence. To contact the authors about this paper, email email@example.com. The authors would like to thank James Dubé for his editorial and research assistance in the preparation of this paper.
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RECLAIMING OUR PLACE Successful Social Work Practice in Medical Model Settings BY ANNE PIRIE, MSW & JIM MORTON, MSW
Abstract: Social workers know that people can only be understood in relation to their social and physical environments, yet they often practice in settings where the focus is on individuals and cause-and-effect thinking. The authors, who are seasoned social workers, propose Bowen Family Systems Theory as a way to operationalize contextual practice. During the last several decades the contexts within which social workers practise have become laden with contradictions: restrained funding while faced with burgeoning demand; prepackaged interventions intended to target problems as unique as the clients who register for service; increased reliance on cause-and-effect, medical-model approaches to complex human problems; and time-limited service for conditions that unfold over a lifetime. These contradictions have led the Nova Scotia College of Social Workers to commission
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research to investigate mental health experience in the province, to advocate for child welfare reforms, and to make mental health the theme of the Collegeâ€™s conference in May 2020. This context inspired our article. We have decades of diverse experience in psychiatric and acute care hospitals, addictions services, mental health clinics, private practice, child welfare, and family service settings where they have worked in clinical, supervisory, leadership and consulting roles. We are hopeful that this article will stimulate both reflection and discussion within the social work and larger professional community, and are encouraged by the Collegeâ€™s proactive responses to the issues that social workers face every day.
In a clinical world where interventions focus on individuals, social workers know that people are best understood within the context of their lives. “Social work’s legitimacy and mandate lie in its intervention at the points where people interact with their environment, which includes the various social systems that people are embedded in and the natural, geographic environment…which has a profound influence on the lives of people.” 1 What are the implications for social workers in practice settings where the medical model predominates, where complex social problems are reduced to a diagnosis, and where treatment tends to concentrate on individuals? 2
Our experience tells us that social workers are often unsure about how best to assert their knowledge of intersectionality when under team pressure to adopt the dominant model. Social work education may contribute to this discomfort. Our online review of MSW courses in schools of social work in Canada shows that many emphasize larger systems over direct practice models. Few offer in-depth study of the family, despite the International Federation of Social Work’s (IFSW) assertion that “human health and symptoms are closely connected with the environment and the intersections of significant relationships.” 3 The following scenario illustrates the tensions many social workers experience in clinical settings.
Ashley soon realized that a commitment to contextual understanding and client empowerment was going to be challenging in this work setting. After an initial assessment, a psychiatrist was assigned to evaluate diagnosis and medications. Ashley agreed to conduct a psychosocial assessment and began to think about how the client and family may already have tried to address the problem, but a team member suggested that Ashley consider this client for Dialectical Behaviour Therapy. Addressing the relational axis of person-problem-environment poses a challenge for social workers like Ashley, because differing perspectives between social work and the medical, cause-and-effect model are profound. What theoretical framework can give clinical social workers the clarity and confidence required to assert their professional responsibility to focus on context? 4
BOWEN SYSTEMS THEORY One way out of this dilemma is Bowen Family Systems Theory. This framework describes the relationship between individuals and their social and physical environments. Bowen Theory suggests “that human behaviour…is not only self-regulated by individuals, but co-regulated in the highly interdependent systems in which individuals are embedded.”5 Since the 1950s Bowen Theory 6,7,8 has been influenced by broad exposure to “…sociobiology, genetics, cell-biology, cancer research, physiology, biofeedback…”, 9 and more recently, neurological research. It offers a set of concepts derived from direct observation of human systems. Social workers have played leading roles in this endeavour in fields as diverse as clinical practice,10,11 substance abuse,12 family business,13 and child protection.14
Ashley, a social worker, recalls the initial weeks of work in a mental health clinic. The office had two chairs—not sufficient to accommodate a family. A psychologist wondered aloud how social workers could do therapy and Ashley needed to explain that social workers are skilled in counselling individuals, families, and groups. Then, at the weekly intake meeting with nurses, psychiatrists, social workers, psychologists and an occupational therapist, Ashley tried to sketch a family diagram, but there were big information gaps regarding who lived in the household, the nature of family functioning and their socioeconomic status. Referral information described problems in biomedical terms such as depression, anxiety, and sleep/appetite challenges, with scant information on drug and alcohol use. Team discussion revolved around diagnoses and medications.
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To learn more about Bowen Family Systems Theory and its eight concepts visit: thebowencenter.org/theory Like social work, Bowen Theory replaces cause-and-effect thinking with an emphasis on intersections or systems. “A system is an organized whole made up of interdependent elements that can be defined only with reference to each other and in terms of their position in the whole” (de Saussure).15 Examples of human systems include health care teams, government departments, communities, and the diverse, multigenerational family, which appears “…to have an emotional centre or nucleus to which family members (and other non-related individuals) are responsively attached.”16 This responsiveness has evolved to make the family an emotional unit,17 with members both highly reactive to each other, yet also capable of exercising profoundly valuable leadership which Bowen Theory refers to as differentiation of self.18
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Why is systems thinking significant? It is significant because it fits within social work’s mandate to focus assessment and intervention on the intersection connecting person and environment.
Bowen Theory describes, in observable detail, how human systems actually work, offering insights that can empower social work practice. Social workers who own a solid understanding of system processes add value to interdisciplinary teams, especially when other professionals are concentrating on symptoms such as diabetes, child abuse, or psychosis. And importantly, a systems lens offers choices for targeting interventions, rather than focusing solely on the symptomatic person.
The following example illustrates how systems thinking influences clinical practice.
MEDICAL MODEL APPROACH: In desperation, Mariam telephones the Family Services Centre, seeking help for her son Brent, age twenty. The duty worker learns that Brent dropped out of community college six months ago, is unemployed, living at home, sleeping late and always out at night. Mariam suspects he’s drinking, maybe using other drugs. Last night when his father ordered Brent to get a job, things nearly came to blows. The duty worker concurs that Brent needs help, but clarifies that he will need to call himself to arrange an appointment. Mariam sounds discouraged but agrees to try. Brent ignores his mother’s pleas to call Family Services and tensions between Brent and his father intensify. Three weeks later, after another argument, Brent storms out and hasn’t returned. The Family Service Centre, not hearing from Brent, moves its intake document to the inactive file.
SYSTEM-FOCUSED APPROACH: In desperation, Mariam telephones Family Services. The duty worker reflects that the situation must be distressing. She offers an appointment for Brent, Mariam, her husband and Brent’s older sister. “I don’t know if Brent will come,” worries Mariam. “Hopefully he will,” says the intake worker, “But if not, come yourself. Bring whomever you can. These troubles are affecting everyone.” A week later the social worker finds Mariam and her partner Redge in the waiting room. “Brent refused to come and Meghan had an exam today,” reports Mariam. “To be honest, Redge wonders how this can help when it’s Brent who has the problem.” “Let’s talk about it,” says the social worker. “From what I’ve understood, life hasn’t been much fun for anyone this past while. Don’t be discouraged that Brent is not here. Let’s explore what’s going on with Brent and with your family to see what we can learn. That’s the first step toward making a plan and to seeing how you can make a difference.” Why does it matter to recognize families as emotional units? It matters because a change in any one member influences everyone else in the system. If one member takes charge of their own emotional functioning, the whole family, including
those with symptoms, will adjust in response. In the above example, helping the parents deal with the situation may ultimately help Brent. From a practice perspective, this is what IFSW is getting at when it argues our mandate is to intervene “at the points where people interact with their environment.” 19
CONCLUSION: As social workers, we need to focus our attention on the space between and among individuals and their contexts. Bowen Family Systems Theory, backed by decades of research, offers a way to conceptualize that emotional space. Bowen Family Systems Theory offers a framework that can guide both practice and interactions with clinical teams. In the systems-focused example just described, the social worker accepts the family as an emotional unit, shows empathy for the parents’ experience, and sets the stage to explore opportunities for creative leadership in this troubled relationship system. Working this way reduces stress for the social worker because it provides a clinical approach that is compatible with professional values. Imagine a future where a social worker is describing how the identified patient is caught in a family pattern, where family diagrams are commonplace and colleagues from other disciplines lean forward to listen and ask questions about the social work perspective. Bowen Family Systems Theory provides a useful framework from which we can explore that future with confidence and clarity.
ANNE PIRIE is a social worker living in Sackville, NB. Anne worked in various clinical settings: mental health, hospitals, family services, child protection. Bowen Family Systems Theory enhanced her understanding of her own family, parenting, practising family therapy and designing intergenerational gatherings. JIM MORTON is a social worker living in Kentville Nova Scotia with interests in mental health, family systems theory, politics, and social change. After a decade of practicing and teaching family therapy, he explored Bowen Family Systems and discovered a new way of thinking.
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REFERENCES: 1. International Federation of Social Work: https://www.ifsw.org 2. Ambrose-Miller, Wayne and Ashcroft Rachelle. (2016). Challenges Faced by Social Workers as Members of Interprofessional Collaborative Health Care Teams Health Soc Work. p.6
11. Donley, Margaret G. (2015). Mating and Parental Care: The Influence of Gender on the Primary Triangle (pps. 219-235) in Noone, Robert J. & Daniel V. Papero (Editors). The Emotional Family System: An Integrative Concept for Theory, Science and Practice (pp. 185-198). New York: Lexington Books. 12. White, Charles M. (2011). Learners Without Teachers: The Simultaneous Learning About Self-Functioning and
3. International Federation of Social Work: http://www.ifsw.org
Bowen Theory by Supervising Staff, Interns, and Clients in an Outpatient Treatment Program (pp. 117-136). In Ona Cohen Bregman and Charles M. White, (Editors) Bringing
4. Morley, Christine and Dr. Selma Macfarlane. (2008) Repositioning Social Work in Mental Health: Challenges and Opportunities for Critical Practice. Paper presented at Australian Association of Social Workers, Strength in Unity Conference, Sydney 5. Noone, Robert J. & Daniel V. Papero. (2015). The Emotional Family System: An Integrative Concept for Theory, Science and Practice. New York: Lexington Books, p. 10 6. Bowen, Murray. (1978). Family Therapy in Clinical Practice. Northvale, Jersey: Jason Aronson. 7. Kerr, Michael E. and Murray Bowen. (1988) Family Evaluation: An Approach Based on Bowen Theory. New York: W.W. Norton & Company. 8. Butler, J. (Editor) (2013). The Origins of Family Psychotherapy: The NIMH Family Study Project. Toronto: Jason Aronson 9. Kerr, Michael E. (1991). Family Systems Theory and Therapy (pps. 226-264) in Gurman, Alan S. & Davis S. Kniskern (Editors) Handbook of Family Therapy Volume I. New York: Brunner/Mazel, p. 264 10. Brown, Jenny. (2012). Growing Yourself Up: How To Bring Your Best To All Of Lifeâ€™s Relationships. Wollombi, Australia: Exisle Press.
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Systems Thinking To Life: Expanding The Horizons For Bowen Family Systems Theory. New York: Routledge. 13. Baker, Katharine Gratwick and Leslie Ann Fox (2009). Leading a Business in Anxious Times: A Systems Approach to Becoming More Effective in the Workplace. Chicago: Care Communications Press. 14. Smith, Walter Howard, Jr. (2001) Child Abuse in Family Emotional Process in Family Systems: A Journal of Natural Systems Thinking in Psychiatry and the Sciences. Volume 5, Number 2. 15. Selvini Palazzoli et al. (1986). The Hidden Games of Organizations. New York: Panthion Books, p.175 16. Papero, Daniel V. (1990). Bowen Family Systems Theory. Toronto: Allyn and Bacon, p.26 17. Kerr, Michael E. (2019) Bowen Theoryâ€™s Secrets: Revealing the Hidden Life of Families. New York: Norton 18. Titelman, Peter (Editor). (2014). Differentiation of Self: Bowen Family Systems Theory Perspectives. New York: Routledge. 19. International Federation of Social Work: https://www.ifsw.org/
CELEBRATING EXCEPTIONAL NOVA SCOTIA SOCIAL WORKERS At the Collegeâ€™s 2019 conference we recognized the contributions of social workers in our province. Congratulations to all of our award recipients! Photos contributed by Michelle Doucette.
ABOVE: Geraldine Browning
Honourary NSCSW membership GERALDINE BROWNING Geraldine Browning grew up in Nova Scotia, in Gibson Woods and East Preston. As a teenager in the 1950s, she set her ambitions on becoming a social worker or nurse. The principal of her school told her that she would never be able to become either in Nova Scotia, because she was Black.
Many groups that exist to this day have benefited from her
Although Mrs. Browning was denied access to the profession of social work, her work and life continued to exemplify core social work values of respect for the inherent dignity and worth of persons, pursuit of social justice, and service to humanity. She was a teacher, a nurse, a parent, and a community organizer and advocate. She has worked tirelessly in her communities to counter racism and discrimination; promote literacy and education; and protect women, children, and elders from violence and abuse.
with students at schools and universities. Mrs. Browning has
efforts as a founder or board member, including the Black Business Initiative, the Black Cultural Society, and the Valley African Nova Scotia Development Association. She has continued to volunteer in her community, and shares her story received an honourary Doctor of Humanities degree from Acadia University, and the Order of Nova Scotia. This year, the College was pleased to be able to honour Mrs. Browning with an honorary lifetime membership. We are grateful that so many in our province have been affected by her lifeâ€™s work.
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ABOVE: Deanne Matheson-Fuller
David William Connors Memorial Award
Diane Kays Memorial Award DEANNE MATHESON-FULLER
HEIDI STEVENS Heidi was nominated by a former mentee, now a colleague, because of her commitment to supporting young people in Cape Breton.
Deanne grew up in Cape Breton. She returned here in 2015 after years in Ontario and the US, and soon started a private practice based in Sydney.
Heidi continues to provide frontline social work in her case management position where she often leaves the confines of her office and offers services to clients where they are at, literally – in their homes and communities. She has developed impeccable knowledge of ongoing and ever-changing community resources, and develops relationships with these providers. Their respect and belief in her work is evidenced by the way they remain in contact with her and keep her updated on provision changes and how clients are doing. They know she cares.
Deanne’s private practice provides trauma-specific treatment to individuals and families in Cape Breton. She has extensive skills providing clinical therapy services to youth in particular, and she has been increasingly been working with First Nations families affected by trauma.
Heidi is skilled at working with youth who are living with or have experienced psychosis, as well as their families. She helps youth to establish and embrace a meaningful and full life, even in the face of hardship. Her approach to practice demonstrates her belief in each human being’s personal worth and ability. She has led by example, conveying respect, care, empathy and dignity towards others in the delivery of social work.
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Many social workers have been influenced by Deanne’s presence in her short time practicing in Cape Breton. She came to Nova Scotia with experience teaching university students, and since then she has supervised several Social Worker Candidates, including the person who nominated her for this year’s awards. She empowers others in the field of social work to learn, and to develop competencies to support the clients they serve and to address social needs. Her knowledge around supporting individuals affected by trauma is impressive, and her motivation to make a difference in their lives is contagious. Deanne models a dedication to professional development that reflects her commitment to our profession.
Freda Vickery Award TONYA GRANT Like Freda Vickery, Tonya was the chief of social work at the IWK Health Centre. And like Freda Vickery, Tonya volunteers and is very involved in our College.Â Tonya also embodies the ethical values of social work practice at the micro, mezzo and macro levels.
private practice committee. She has been involved in many
During her time as the Chief of Social Work at the IWK, Tonyaâ€™s creativity and imagination in her work was forefront. She developed and launched a mentoring program to ensure new social workers had support in navigating the healthcare system. She continued to promote and advocate for the profession within this system, and organized events to create opportunities to offer and receive support from one another.
Currently Tonya is working at the provincial level as the
Tonya gives freely of her time. At NSCSW, she is the current chair of the Board of Examiners and the former chair of the
generosity and empathy, and her demonstrable commitment
important initiatives to assist in moving our profession forward, while adhering to the ethical standards and values of our profession to protect the public.
coordinator for trauma informed care, working with the mental health clinic in Amherst, and maintains a private practice. She has spent countless hours researching the history of the social work profession, and teaches a course about this subject for social work students at Dalhousie University. In her award nomination, colleagues speak of her knowledge and integrity, her sense of humour, her to professional, ethical social work practice.
FROM LEFT TO RIGHT: Pam Roberts, (nominator), and Tonya Grant
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ABOVE: Marion Brown
Canadian Association of Social Workers Distinguished Service Award MARION BROWN Marion knew when she was a teenager that she wanted to be a social worker. She now holds bachelor, master, and doctorate degrees in social work, and has dedicated her life to this profession and practice. For nearly three decades, she has worked as a practitioner, an advocate, an educator, and a researcher. The colleagues who nominated her for this award tell us Marion is animated by optimism and compassion, and driven by an analysis of social justice tempered with compassion and humility. Her research and community work focuses on health equity, sexualized violence, migration of social workers, experiences and trajectories of youth both in and out of child welfare care, and professional identity. She expertly connects individual experiences with systemic and structural social issues, and she sees possibility for change in each encounter.
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Marion currently teaches at the Dalhousie School of Social Work, and has a small private practice. She also facilitates program and leadership development. She has offered her effort and expertise to many organizations, including our College, but with particular focus on those that help children and youth. She is a founding member and Board Chair of the North End Opportunities Fund, a grassroots non-profit that facilitates equity and inclusion for young people to pursue their interests and talents.Â We are fortunate to have Marion as part of our social work community. Her award acceptance speech came was a spoken word poem, which was a delightful surprise.
Inspire, Aspire & Conspire BY MARION BROWN, PHD, RSW
In social work, I am INSPIRED: to pay attention, dig deep and reach higher; spend time, listen closely and connect with the people, with the land, and then reflect on the values and the ethics we espouse; it’s to equity and justice that we rouse. ‘It’s not right’ is indeed our fervent cry; then we work to articulate the reasons why and what the impact is, for whom and how. Intention is not the focus in the now. I’m INSPIRED by acts of courage that I see: those who take a stand when they do not agree; those for whom human rights are a daily fight; the woman who called out racism just last night. Those who carry risk upon their bodies I’ll never know; whose emotional labour is what sows the trauma of generations with its pain, worn yet deeper when it’s met with disdain. So many children whose young lives are fraught; people of colour criminalized for not adhering to the version of humanity upheld by white supremacy. Cindy Blackstock, Wanda Thomas Bernard, Hannah Cameron inspire me. In social work, I ASPIRE to keep at it and do what is required. Skills in deconstruction I must hone through introspection and self-awareness on my own yet also provocation, agitation, and dissent with folks who press me – this re-orients my understandings of this time and space. It’s accountability for what I do not face.
Yes, my privilege is my inoculation. The world doesn’t greet me with distrust and denigration. Systems and structures don’t silence my words. Eurocentrism ensures that I am heard. A daughter of the Empire am I; my likeness to Lady Bountiful I can’t deny. My positionality I must reconcile else I’ll replicate my ancestor’s guile.
Let’s ASPIRE to… be curious, be congruent, and be kind; to historicize, politicize and remind that justice is the vision and the call; a collective cause and purpose for us all. In social work, I CONSPIRE. I want to scheme and plot to see what can transpire when we educate to agitate for change; when we communicate to activate exchange. The little things are the big things, this I know: can’t spout principles without behaviours to show. Details aren’t in the grand but the mundane. Gardens of social change need the worms and the rain. Revolutions are few and far between; into the day to day is where and when we lean. Opportunities are prolific and complex, where we can analyse, act, and reflect on what inspires us to aspire and conspire, and keep alight this social justice fire.
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THE CHALLENGES OF SOCIAL WORK BY EMILY MACARTHUR, RSW
When I tell people I’m a social worker I am sometimes met with strange reactions. When I told people that I was going to school for social work, I was met with criticism and sometimes negativity. Although the career of social work has its challenges, I feel like there is a lot of misconception in the public about what those challenges are. I preface this with sharing that I am a new social worker. As well, the profession of social work has a diverse and broad range of fields to work within and each come with their unique set of challenges. I am speaking solely from my own experience. Often, people assume that clients are the most challenging aspect of the work. While sometimes clients may be challenging, in my experience the real challenge is working with limited resources, and within oppressive systems rooted in colonization, heteronormativity, and patriarchal values. It is also important to note that when there are challenges with the people with which we work, it is usually much more complicated than we can ever understand at face value. They may have a distrust of systems because of past experiences, they may be struggling with their mental health, or we may fail to recognize how our approach is playing a role. The most difficult parts of my career have been related to the feelings of helplessness that tends to accompany the lack of services. When people are crying out for help and there is no one to hear their cries. When they are stigmatized because of the judgement of their identity or lived experiences. When they are retraumatized by systems that were intended to help the most vulnerable, but instead patronize or punish them for reaching out for support.
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These experiences as a social worker have been challenging, humbling, and enlightening. I am constantly reminded of the importance of navigating privilege and power dynamics. My practice has become rooted in the concept that people are the experts of their own lives, and it is a privilege for me to walk alongside them if they so choose.
The people with whom we work do not owe us anything, and our role as social workers is not to “save” or “fix” someone. Rather, it is more about “fixing” oppressive systems. While I deeply value front line work and supporting individuals and families, a big component of social work is done at the macro-level. If there is no engagement in societal change, we as social workers overlook a crucial aspect of the profession. A commitment to social justice is one of the overarching values as described in the Code of Ethics which guides our practice. While the notion of societal change can be daunting or overwhelming, I feel that it also sustains us and promotes resiliency. Scrolling through social feeds or consuming news media can be significantly disheartening. Community engagement has taken on many forms for me such as joining boards and committees, attending rallies and protests, attending professional development opportunities, and volunteering for causes about which I’m passionate. These activities have allowed me the opportunity to align myself
with people holding similar values, learn more about causes I care about, and devote energy to important issues in my community. In many ways, social action has become a crucial aspect to my self-care practice and an important strategy in approaching some of the challenges I faced within the field. One of my BSW professors once described the practice of social work as walking a tight rope. The more I immerse myself in the profession, the more this analogy rings true. Everything is about balance. As a social worker, I am constantly unraveling my privilege without taking the focus away from the person or group Iâ€™m working with. I am challenging systemic systems, advocating for community change, and engaging in social action without burning bridges. I am constantly working to establish and maintain personal and professional boundaries, and ensuring that I take care of myself while still practicing a commitment to the profession. As a social worker, I can feel myself constantly inching across a thin, suspended tightrope. Sometimes I am wobbly and shaky, sometimes I may even fall down, but with each step, however small, I feel so fulfilled and accomplished.
It is an amazing thing to have the privilege and opportunity to practice in a profession in which you can find such meaning and purpose. I welcome the challenges because they force me to take initiative, step out of my comfort zone, and encourage me to seek creative and innovative solutions. Although navigating a tightrope can be tricky sometimes, I couldnâ€™t imagine working in any other career field. I am so grateful for the opportunities this profession has afforded me, and I look forward to continuing to venture, step by step, across the tightrope that is social work.
EMILY MACARTHUR is a social worker and writer who lives in Cape Breton. An earlier version of this article was previously published as a post on her blog, where she writes about happiness, feminism, body positivity, social issues, and mental health. You can read more of her words at emilymacarthur.wordpress.com.
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