Caregivers play a central role across the cancer trajectory, yet their needs often remain insufficiently recognized within routine oncology workflows. This conceptual manuscript proposes a trauma-informed, ecological, and interprofessional model designed to support the systematic integration of caregivers into oncology care from the earliest stages of treatment. Guided by Ecological Systems Theory and trauma-informed care principles, the model conceptualizes caregiver distress as emerging from interacting sources that include medical uncertainty, emotional strain, changing family roles, and practical disruptions. The framework outlines mechanisms through which oncology teams may enhance caregiver visibility, communication, and psychosocial support by embedding structured screening, documentation, and interprofessional coordination into routine clinical practice. A clinical illustration demonstrates how early identification, trauma-informed communication, and collaborative care planning may reduce caregiver invisibility within oncology settings. Integration of caregivers into electronic health records, standardized assessment processes, and shared care planning has the potential to support more coordinated, equitable, and responsive psychosocial care. Overall, the model offers a theory-informed and practice-oriented framework intended to strengthen communication, promote caregiver recognition, and address persistent gaps in oncology caregiver support across the care continuum.
Clinical social work preparation involves more than acquiring professional knowledge. Students must also develop a sense of professional belonging, confidence in emerging clinical capabilities, and a realistic intention to enter practice. This multicenter cross-sectional study examined associations among professional identity, clinical social work self-efficacy, career intention, and commitment among 438 undergraduate and postgraduate social work students across five academic sites in Saudi Arabia. Participants completed adapted measures of professional identity and clinical self-efficacy and study-developed measures of career intention and commitment. Confirmatory factor analysis supported a four-factor measurement model with excellent fit. In the structural model, professional identity was positively associated with clinical self-efficacy and career intention, and clinical self-efficacy was positively associated with career intention. Career intention showed the strongest direct association with commitment and carried the indirect associations of professional identity and clinical self-efficacy with commitment. Because the design was cross-sectional, these findings represent theoretically specified associations rather than causal or developmental sequencing. The results suggest that professional belonging and perceived clinical capability may be most closely connected to commitment when students also form a clear and personally meaningful intention to pursue clinical practice. Implications are considered for education, supervision, and workforce preparation.
Adverse childhood experiences (ACEs) are consistently associated with adverse health and behavioural outcomes, including sexual risk behaviours (SRBs). However, limited research has examined associations between ACEs and sexting, an increasingly prevalent form of technology-mediated sexual interaction. This study investigated relationships between cumulative ACE exposure, SRBs, and sexting behaviours among Canadian adolescents and young adults. Data were drawn from wave two of the Canadian Study of Adolescent Health Behaviors (n = 912). SRBs included age of first sexual intercourse, number of sexual partners, condom use, and alcohol/drug use at last intercourse. Sexting behaviours included sending, receiving (including non-consensual), and requesting sexual images or videos in the past 12 months. Adjusted analyses revealed threshold effects, with five or more ACEs significantly associated with earlier sexual debut (β = -1.14, p < .001) and a greater number of lifetime sexual partners (β = 2.04, p < .05). Four ACEs were also associated with higher odds of alcohol/drug use at last intercourse (AOR = 2.22, p < .05). ACE exposure demonstrated stronger and more consistent associations with sexting behaviours – participants reporting five or more ACEs had significantly elevated odds of engaging in all sexting outcomes, especially non-consensual experiences. Findings underscore the cumulative impact of ACEs on both offline and digitally mediated sexual behaviours, highlighting the importance of social work interventions that are sensitive to early adversity, stress responses, and developmental and psychosocial contexts.
Racism has well-documented impacts on mental health, yet people of color have long been underserved by mental health services. Researchers have increasingly examined how therapeutic practices can better address the realities of racial trauma and systemic oppression. This qualitative study explored how therapists engaged clients around issues of race and racism in the years following the COVID-19 pandemic and the surge in public and professional attention to the Black Lives Matter movement and systemic racism. Based on ten focus groups and follow-up affinity groups with 46 psychotherapists conducted between 2022 and 2024 in the United States, this analysis examines how therapists navigate conversations about race and racism in clinical practice. Thematic analysis revealed differences in how Black and White therapists described addressing race and racism in clinical practice. Black therapists more often raised race early, integrated it throughout treatment, and drew on lived experience to validate clients’ realities, whereas White therapists more often waited for clients to broach race and reported greater uncertainty. Across racial groups, therapists viewed racism as a potential source of trauma but reported limited awareness and use of racism-related assessment tools. Black therapists more often questioned the clinical utility of these measures, whereas White therapists more often viewed them as conversation starters. Racialized dynamics also shaped therapists’ experiences, with Black therapists describing disproportionate burdens related to discussing and teaching about racism. Findings suggest growing recognition of racial trauma alongside persistent gaps in the training, implementation, and organizational supports needed to address racism in clinical practice.
The Substance Abuse and Mental Health Services Administration1 funds a federal grant entitled,“Healthy Transitions: Improving Life Trajectories for Youth and young adultswith serious mental disorders program” with the goal to improve and expandingaccess to developmentally, culturally, and linguistically appropriate servicesand supports for transition-aged youth and young adults ages 16-25 who eitherhave or are at risk for developing serious mental health conditions. The Transitionto Independence Process (TIP) Model®used broadly and supported by SAMHSA has not been widely used among AmericanIndian/Alaskan (AIAN) tribes. Prior to our work, there has been no success inadapting the TIP Model® for AIAN communities. The tribal behavioral healthagency partnered with a local university to employ a rigorous process todevelop cultural modifications of the TIP Model® Core Practices in accordancewith community strengths and needs. Adaptations occurred in consultation withmodel developers, with consideration of the conceptual rationale for theprogram, while grounding new content in indigenous cultures and worldviews.Additional research is needed to test the efficacy of this culturally groundedlife skill intervention with AI/AN adolescents and young adults to determineits effectiveness in achieving health and well-being outcomes.
The profession of social work has a long history of being involved with efforts to colonize Indigenous Peoples. This qualitative phenomenological case study explores the question, “What do Indigenous people want social work students to know?”. Seven Indigenous people between the ages of 36 and 79 who received social work services participated in interviews to share their experiences. Participants came from diverse geographical and cultural backgrounds including tribally and non-tribally enrolled. Four themes which emerged: knowing history, walking with trauma, knowing your prejudices, and it’s all about healing. These themes highlight the participants’ recommendations for social work education to include the history of colonization and the profession’s role in oppression both past and current, to acknowledge and address intergenerational trauma, to foster self-awareness of bias and systemic racism, and to honor Indigenous healing practices. Participants emphasized the need for revising the social work curriculum and teaching methods to include the use of Elders, service learning and cultural immersion, and a mindset shift from a “saving” to a “serving”. The findings call for a transformation in how social workers are trained and how services are delivered. Healing for Indigenous Peoples who carry trauma and mistrust toward social workers can only begin when meaningful changes are implemented which start with honoring Indigenous worldviews.
IndigenousMIND-crafts is a culturally grounded, intergenerational mindfulness intervention designed for group therapy settings in Native American communities. Piloted with a Northeastern tribal nation, the program paired Elders and youth in weekend workshops that integrated mindfulness practices with traditional crafts such as corn husk dolls and finger weaving. Rooted in the IndigenousMIND framework, IndigenousMIND-crafts emphasized psychological openness, cultural identity, and intergenerational healing. Twenty-four tribal citizens were recruited through community networks and consented via a culturally attuned virtual process. Using Rapid Qualitative Analysis, we identified three key themes: (1) cultural crafts fostered openness and affirmed identity; (2) intergenerational engagement enhanced emotional well-being and community connection; and (3) cultural transmission was viewed as a vital responsibility linked to survival and ancestral ties. Participants described both immediate emotional benefits and a desire for sustained, culturally rooted programming. Findings highlight the potential for IndigenousMIND-crafts to be adapted across tribal contexts, demonstrating how traditional knowledge and mindfulness can be woven together to support therapeutic, culturally affirming care.
This study presents a comprehensive bibliometric and thematic evolution analysis of scholarship at the intersection of clinical social work and healthcare from 2006 to late 2025. Based on 15,885 publications indexed in the Web of Science and Scopus databases, the analysis employs Bibliometrix and VOSviewer to examine publication trends, keyword co-occurrence patterns, collaboration networks, and thematic trajectories using bibliographic metadata (titles, keywords, and abstracts). The results indicate sustained growth in research output over two decades, reflecting the increasing integration of clinical social work into healthcare research and practice. Core thematic clusters—including social work, healthcare, mental health, palliative care, and patient care—underscore the profession’s combined focus on psychosocial intervention and systemic service delivery. Thematic evolution analysis indicates a shift from earlier emphases on allied health and occupational therapy toward more recent priorities, including mental health crises, interprofessional education, health equity, and digital health. COVID-19 emerges as a major thematic inflection point, highlighting its substantial impact on healthcare systems and social work practice, while the appearance of artificial intelligence and ChatGPT signals growing scholarly engagement with technological, ethical, and policy challenges. Conceptual structure mapping further identifies education, communication, and social support as cross-cutting dimensions linking micro-level practice to macro-level healthcare reform. The findings provide an integrated overview of the field’s intellectual development and offer analytically grounded insights relevant to research, education, and policy discussions on integrated and equitable healthcare systems.
With historical increases in depression among college students being enhanced by the COVID-19 pandemic, the need for addressing depression with this population was critical. The association between depression and rumination further indicates the importance of attending to rumination when treating depression. Consequently, psychotherapeutic interventions treating depression and rumination with celerity are needed. The aim of this pilot study was to investigate if protocols used in Acceptance and Integration Training (AAIT) - an ahistoric, non-narrative, iterative model of psychotherapeutic intervention could decrease college students’ depression and rumination. Using a one group, pre-test post-test quasi-experimental design, thirteen (n = 13) eligible graduate and undergraduate volunteers completed a pre-test State Depression Scale (S-Dep), and Brief State Rumination Inventory (BSRI). They then participated in a three-hour group training in which they were taught two specific protocols (End of Words and Deep PEAT 2) utilized in AAIT, followed by self-practice using the skills. Afterwards, participants completed post-test S-Dep and BRSI measures. Results indicated a statistically significant median decrease in S-Dep scores (Mdn = 9.00) post-intervention (Mdn = 37.00) compared to pre-intervention (Mdn = 46.00) (p =.022). There was also a statistically significant mean decrease in BRSI scores post-intervention (M = 316.54, SD = 190.34) as compared to pre-intervention (M = 493.70, SD = 173.74) (t(12) = 3.537, p = .004). These results support AAIT as an intervention to effectively address depression and rumination in college students.
Psychedelic substances continue to garner interest for their potential therapeutic application in various mental health disorders. Current enthusiasm brought about by a departure from a more stigmatized and prohibitive era has led to an explosion of “second wave” psychedelic research within the fields of medicine, neuroscience, and psychology. This review was conducted to address the following research question: “To what extent and in what ways has the social work profession contributed to the academic literature on psychedelic substances and psychedelic-assisted psychotherapy through authorship, inquiry, and profession-specific conceptual, ethical, or practice-oriented analysis?” A scoping review methodology was selected and led to the identification of 12 resources meeting the inclusion criteria. A thematic analysis was conducted, resulting in identification of four interconnected themes to which social workers have distinctively contributed: (1) stigma, public perception, and society; (2) professional development and training; (3) ethical, safety, and legal concerns; and (4) social justice and cultural sensitivity. Thematic content was then reconstructed to provide recommendations across the macro, mezzo, and micro levels of social work practice. Professional social workers, as leading providers of mental health services, must recognize how their values and ethical perspectives contribute to ensuring that psychedelic treatments and research efforts are accessible and delivered equitably and safely.
Countertransference, an essential yet often misunderstood concept in clinical work, is defined as the clinician’s emotional, cognitive, and somatic responses—both conscious and unconscious—that emerge in relation to the client and shaped by the clinician’s history, identities, and internal world (Gelso Hayes, 2007). Countertransference can become more pronounced in moments of clinical uncertainty, a concept that refers to instances in clinical practice where client contexts, needs, or therapeutic direction remain unclear, evolving, or difficult to interpret. Drawing on a larger simulation-based study of social work clinicians’ and trainees’ encounters with uncertainty, this paper explores participants’ experiences (n = 8) as they engage with two simulated clients who presented with uncertain contexts, trajectories, and needs. Findings illustrate three interrelated themes: (1) client-based uncertainty can activate negative countertransference reactions, such as frustration or judgement, particularly when clients’ ambiguity or contexts differed from those of the clinician; (2) countertransference itself can become a source of clinician uncertainty, often disrupting clinical focus, therapeutic presence, and decision-making; and, (3) clinicians’ ability to identify, reflect on, and regulate negative countertransference responses serve as a critical mediator in managing the impact of both uncertainty and emotional activation. Study findings contribute to a growing body of literature calling for a deeper understanding of countertransferential and emotional processes in clinical social work practice. Findings also suggest the importance of reflective supervision and training that supports clinicians in navigating the mutual entanglements of uncertainty and countertransference, especially in an era where both are increasingly characteristic of clinical practice.
The COVID-19 global pandemic impacted clinical social workers both directly and indirectly through their work with clients. This phenomenon, referred to as shared trauma, speaks to the dual impact of collective trauma on the clinician. Using structural equation modeling (SEM), this study examined a national sample of 3,184 social workers several years after the peak of the pandemic with respect to its personal and professional impact. As hypothesized, insecure attachment, greater exposure to potentially traumatic life events, and distress related to COVID-19 were predictive of higher levels of shared trauma (operationalized as shared traumatic stress, or “ST”). As a mediator, resilience had an inverse relationship with avoidant attachment and enduring pandemic distress and a positive relationship with the experience of a traumatic life event, as well as predicted negative relationship with ST. These results are compared to similar studies on shared trauma. Implications for practice and the need for self-care are also discussed.
Traditional Chinese Medicine (TCM) offers a complementary framework for understanding and treating Post-Traumatic Stress Disorder (PTSD), supporting the social work practitioners’ trauma-informed lens. Conventional psychotherapeutic treatments, while evidence-based, frequently fail to adequately address the persistent somatic and neurovegetative symptoms associated with PTSD. The purpose of this exploration is to establish a theoretical and clinical bridge, synthesizing TCM’s pattern-based diagnosis with the DSM-5’s criteria-based approach. The article then proposes best practices for the integration of clinical assessment, referral to and care integration with acupuncture. It is hoped that this discussion enhances social work practitioners’ understanding of holistic and integrative approaches and strengthens collaboration within trauma care.
There is broad consensus that attainable goals are essential for guiding effective, client-tailored interventions. However, unrealistic goals—grandiose, vague, or idealized—pose a familiar challenge in social work practice, particularly in mandated or high-risk contexts. These goals are often met with social workers’ efforts to reframe or redirect them toward more realistic aims. While these efforts are often well-intentioned, they may provoke resistance and inadvertently bypass the internal emotional meaning embedded in the client’s original formulation. This Practice Report introduces a clinical minimalist method based on a single bridging question: “And then what would you feel?” designed for collaborative goal formulation. By accepting the client’s stated goal and gently exploring its emotional resonance, social workers can access subjective, emotionally grounded goals that matter to the client and support therapeutic progress. The bridging question lays the groundwork for integrating emotional exploration and action-oriented work across clinical orientations. Through two clinical illustrations drawn from different areas of social work practice, the article demonstrates how the question facilitates emotional clarification, strengthens the therapeutic alliance, and supports goal setting that reflects both the client’s internal world and real-life possibilities.
Clinical social workers represent the largest group of mental health professionals in the United States, playing a central role in delivering care across diverse populations. As frontline providers, clinical social workers must stay informed about emerging diagnostic trends and treatment innovations. Recently, the American Psychological Association (APA) introduced treatment guidelines for Complex Posttraumatic Stress Disorder (CPTSD), reflecting an urgent need to recognize and understand this condition and formulate practical clinical approaches. CPTSD is a distinctly different condition from PTSD and has catastrophic, long-term, far-reaching impacts on individuals, families, and societies. Despite its profound effects, CPTSD is rarely assessed and poorly understood. According to the new APA guidelines, as well as earlier expert guidelines, treatment for CPTSD requires tailored approaches that go beyond the standard unimodal therapies for PTSD. The literature unquestioningly supports phase-based treatments while stating that no phase-based treatment framework has yet been offered that addresses the complete symptom set of CPTSD. A five-phase framework is proposed as a new guideline for social workers navigating the lengthy treatment process. This conceptual framework integrates evidence-based practices and can be utilized by a solo practitioner or adapted for massed, concurrent treatment by a multi-disciplinary team.
The post-COVID-19 surge in screen time, averaging 7.5 h daily among Iranian adolescents (Rideout et al. in Common Sense census: Media use by tweens and teens, 2023. Common Sense Media. https://www.commonsensemedia.org/research/common-sense-census-media-use-by-tweens-and-teens-2023 , 2023), has been linked to disrupted family dynamics and strained cohesion in urban households amid rapid digitalization (McDaniel and Radesky in Child Dev. 89:100–109, 2018; Ebadi and Azadarmaki in Iran Stud 51:751–768. https://doi.org/10.1080/00210862.2018.1467266 , 2018). This study explores the systemic impact of excessive screen use and evaluates Digital Balance Family Therapy (DBFT), a novel intervention. Data from 75 urban families (N = 225) in Tehran and Isfahan, collected from July 2024 to February 2025, included the Family Assessment Device (FAD), Kessler Psychological Distress Scale (K10), screen time logs, and interviews. Baseline data for the DBFT group (n = 20) revealed moderate dysfunction (FAD: M = 2.40, SD = 0.60), distress (K10: M = 18.50, SD = 4.30), and screen time averaging 7.80 h/day (SD = 1.20). A 12-week DBFT pilot reduced FAD to M = 1.90 (SD = 0.50, p < .01, η² = 0.17), K10 to M = 14.20 (SD = 3.70, p < .05, η² = 0.10), and screen time to M = 5.60 (SD = 1.00, p < .01). Qualitative insights highlighted digital overload, mitigated by DBFT’s culturally sensitive tools like boundary-setting and offline rituals. DBFT offers therapists practical strategies to enhance family resilience in Iran’s digital landscape, addressing post-pandemic challenges effectively.
Poor social worker well-being can have serious negative effects on the individual social worker and the organisations they work for. The Mindfulness-based Social Work and Self-Care programme has been found to be effective at improving social worker well-being and social work practice. We are still unclear on how the Mindfulness-based Social Work and Self-Care programme improved these outcomes. Using an explanatory sequential mixed method study design, this study aimed to examine the effects of the MBSWSC programme on key mindfulness-based mechanisms of action: attention regulation skills, mindfulness, non-aversion, non-attachment, acceptance and self-compassion, and then explore if and how changes in these mechanisms led to improved participant well-being and social work practice. Replicating previous findings, MBSWSC programme participation was found to increase attention regulation skills, mindfulness, non-aversion, non-attachment, acceptance and self-compassion. The qualitative findings highlighted how improvements in each of these mechanisms led to multi-faceted and cascading positive effects. These include increased self-awareness of thoughts, emotions, physical sensations, needs and behaviours which supported more adaptive stress coping and deeper, more consistent reflections both in and on practice, which facilitated the utilisation of more productive person-centred practice approaches. This study adds further evidence that if social work service providers, service commissioners, and funding bodies deliver the MBSWSC programme to wider cohorts of social workers that the benefits derived from this programme will extend beyond the individual social worker to the organisation and most importantly to the service users they work with.
Access to affirming healthcare improves health outcomes for transgender and gender diverse (TGD) children (Tordoff et al. in JAMA Network Open, 2022). Yet, there is often a dearth of competent providers in rural areas. This study investigated the healthcare access experiences and needs of parents of transgender children in a rural setting. For this study, healthcare was broadly defined to include not only gender affirming care, but also other physical and mental healthcare experiences. A qualitative methodological approach, using a semi-structured interview protocol, was used as this approach enabled a richer description of the experiences of the parents of transgender children. Six parents participated in group or one-to-one interviews upon receiving written consent. Thematic analysis identified four major themes, each with two or three subthemes: specific needs of children, lack of local care, provider attitudes, and existing supports. Results displayed the overwhelming gap in current healthcare for TGD children in a rural setting. Continued education and efforts within the healthcare community to assist TGD children are desperately needed. Further research, with the expansion of a broader range of participants and increased inclusion of children of color, is needed.
This study aims to review national guidelines and best practice standards for how state boards should regulate clinical supervision in social work. It also aims to examine variations in state rules regarding clinical supervision regulations and categorize states by the strength of their regulation of clinical supervision. The analysis of the Model Practice Act and Best Supervision Standards provides the following four domains for regulating clinical supervision: (1) supervisor qualifications, (2) supervision plans, (3) documentation and reporting, and (4) supervision timeframe and hours. The analysis of state regulatory rules, combined with data from clinical license applicants, indicates that seven states -representing approximately 21% of clinical license applicants nationwide -had weaker regulation, lacking rules in all or most regulatory domains in their social work statutes. In contrast, 23 states-representing approximately 24% of license applicants nationwide-had stronger regulation of clinical supervision, having rules in all four regulatory domains. The findings suggest that further research is necessary to investigate how the absence of regulatory rules affects the quality of clinical supervision, the clinical workforce, and public safety measures.
A gap exists both in culturally grounded, evidence-informed Native American and Alaska Native (NA/AN) programs and in dissemination and implementation (D&I) approaches to replicate, translate, and adapt such clinical programs. D&I approaches grounded in Indigenous knowledge are needed to translate evidence-informed programs effectively into real-world settings. The purpose of this article is to (a) outline the Weaving Healthy Communities (WHC) D&I approach, with a focus on talking/sharing circles, and (b) provide results of talking/sharing circle feedback from the culturally adapted and efficacious Chukka Auchaffi' Natana (in Choctaw) or Weaving Healthy Families program (WHF). WHF promotes resilience, wellness, and health equity, while preventing problem alcohol and other drug use, violence, and mental health conditions among NA/ANs. Using a community-based, critical ethnography with a southeastern tribe in the United States, we conducted quarterly talking circles after each cohort of WHF participants (i.e., families and facilitators) completed their active intervention. Team-based thematic qualitative data analyses were completed by the principal investigator and research team engaged in prior work with the tribe. Thematic data analysis revealed important themes of core WHF components, along with participants' desires for extended and deepening programs that could benefit NA communities. The most frequently reported theme was talking circle benefits, coded 228 times. Within this theme, prominent subthemes included: building trust; providing stress relief and offsetting personal burdens; learning from listening; fostering positive communication; sharing within the same peer groups; and help with problem and solution identification .
