Social Work, Mental Health, and Public Policy in Diverse Contexts: Chinese and Cross-Cultural Perspectives (International Perspectives on Social Policy, Administration, and Practice) 3031363116, 9783031363115

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International Perspectives on Social Policy, Administration, and Practice

Sheying Chen   Editor

Social Work, Mental Health, and Public Policy in Diverse Contexts Chinese and Cross-Cultural Perspectives

International Perspectives on Social Policy, Administration, and Practice Series Editors Sheying Chen, Pace University, New York, NY, USA Jason Powell, Office of the Provost, Crescent College Birmingham Birmingham, UK

The Springer series International Perspectives on Social Policy, Administration and Practice puts the spotlight on international and comparative studies of social policy, administration, and practice with an up-to-date assessment of their character and development. In particular, the series seeks to examine the underlying assumptions of the practice of helping professions, nonprofit organization and management, and public policy and how processes of both nation-state and globalization are affecting them. The series also includes specific country case studies, with valuable comparative analysis across Asian, African, Latin American, and Western welfare states. The series International Perspectives on Social Policy, Administration and Practice commissions approximately six books per year, focusing on international perspectives on social policy, administration, and practice, especially an East-West connection. It assembles an impressive set of researchers from diverse countries illuminating a rich, deep, and broad understanding of the implications of comparative accounts on international social policy, administration, and practice.

Sheying Chen Editor

Social Work, Mental Health, and Public Policy in Diverse Contexts Chinese and Cross-Cultural Perspectives

Editor Sheying Chen Public Administration Pace University New York, NY, USA

ISSN 2625-6975     ISSN 2625-6983 (electronic) International Perspectives on Social Policy, Administration, and Practice ISBN 978-3-031-36311-5    ISBN 978-3-031-36312-2 (eBook) https://doi.org/10.1007/978-3-031-36312-2 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

This book is dedicated to The people we serve as educators and helping professionals

Preface

Social work is inherently an international subject. Each nation has a story of professionalization in the evolution of public welfare within its socioeconomic, cultural, and political settings. A study of various (especially non-Western) cases is essential to an adequate understanding of the undertaking. China is undoubtedly an important case with one of the largest populations on earth. It’s unique in view of so-called Chinese characteristics, sometimes fundamentally different from Western societies. It’s intriguing given the country’s history and recent rise to a global superpower with a claim of core values that seem to be rather considerable to social work as a helping profession. Any lessons learned from the Chinese experiences would help with a better understanding of social work, mental health, and public welfare on a global scale. This edited book on the dynamics of social development in China would be aimed at second and third year advanced undergraduates in social policy, social gerontology, sociology, psychology, health studies, nursing, social work, family studies, urban studies, rural community development, China and international studies, and public and business administration. It will also very much appeal to postgraduates in the above areas, including inter-disciplinary Master’s-level courses; to professionals in health and social care and public services, as well as academics in various social and human science fields. The book’s cross-disciplinary appeal is one of its major strengths given the expertise of contributors to the chapters included. Such discussions on social policy and effects on older and young people in China will allow debates around the impact of health and social welfare on contemporary social life into new realms: realms that students and practitioners can utilize to reflect upon their own experiences in challenging assumptions about human needs and relationship to health and social welfare; learning from experiences of other cultures. This edited book is timely given the recent proliferation of degrees looking specifically at the interplay of socioeconomic policies and well-being of the people in China and around the world, but more generally in light of the current high profile of comparative studies of a

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wide range of subjects. It is our hope that the efforts contained in this book will constitute a significant contribution to the research literature as well as teaching resources. New York, NY, USA Manchester, UK Xinxiang, Henan, China

Sheying Chen Jason L. Powell Leidong Wei

Acknowledgments

This book project is supported by the High-Level International Exchange Program hosted by HNU College of Social Affairs.

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Contents

Part I Introduction 1 Social  Work, Mental Health, and Public Policy in China: A Comparative-­Historical and Theoretical-Practical Approach��������    3 Sheying Chen 2 Policy  System, General Public Policy (GPP), and Comparative Social Policy: A Tale of the Economic State vs. Welfare State (and More)������������������������������������������������������������������������������������������������   13 Sheying Chen Part II Professionalization of Social Work as an Eclectic Discipline with Multidisciplinary Collaboration 3 From  Weak Autonomy Embedding to Institutional Embedding in the Development of Social Work Professionalization: A Case Study on a Pilot Project of a Child Welfare Institution����������   23 Wenxiao Ji, Erpeng Li, and Ruirui Zhu 4 Effectiveness  of Social Work Supervision: A Qualitative Case Study and a Framework of Structure–Relationship–Power Analysis ����������������������������������������������������������������������������������������������������   49 Wenxiao Ji, Haibo Lin, and Ruirui Zhu 5 Promoting  the Curriculum System Construction of Public Health Social Work in China: Western Experience and Domestic Exploration����������������������������������������������������������������������   79 Jia Chen, Yifei Zhao, Yaqin Wang, and Xiang Luo 6 Psychosomatic  Medicine, Professional Social Work, and Evidence-Based Clinical Practice����������������������������������������������������  101 Sheying Chen, Elaina Y. Chen, and Yuxia Qin

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7 Biomedical  Education, Health Promotion, and Social Responsibility: International and Chinese Perspectives����������������������  115 Sheying Chen, Yuxia Qin, and Xuejuan Chen Part III Policy and Practice with Diverse/Special Populations 8 Ethnicity  and Diversity: American Experience and Implications for Social Work����������������������������������������������������������������������������������������  125 Sheying Chen, Yanjiao Chen, and Yifan Xu 9 Spirituality  Without Religion: Social Work for Promoting Selfhood Among Chinese Women in a Consumerist Society����������������  133 Margaret Xi Can Yin and Cecilia Lai Wan Chan 10 A  Dialectical Approach to Understanding Family Life: How Parents of LGB Children Experience “Coming Out” and Navigate Parent–Child Ties ������������������������������������������������������������  147 Iris Po Yee Lo 11 Social  Worker Intervention and the Support Mechanism for Mothers Having Lost Their Only Child in China ��������������������������  163 Bo Liu and Yue Fan 12 “Dislocation”  and “Replacement”: Delivery of Welfare Services for Children with Rare Diseases in Young Family from the Perspective of Parens Patriae��������������������������������������������������  191 Wenxiao Ji and Xiaoxiao Cui 13 Ambivalence  in Family Life During the Era of Falling Fertility and Population Aging: Theoretical and Clinical Considerations��������  201 Hong Yao 14 C  hina, Aging, and Panopticism: A Foucauldian Analysis��������������������  219 Jason L. Powell Index������������������������������������������������������������������������������������������������������������������  229

Contributors

Cecilia Lai Wan Chan  Ph.D. (HKU), is Professor Emeritus in the Department of Social Work and Social Administration and Founding Director of the Centre on Behavioral Health at the University of Hong Kong. Elaina Y. Chen  M.D. (IU), is a clinician and Assist. Professor of Medicine at the University of Rochester, New York. Jia Chen  Ph.D. (HKU), is Assoc. Professor of Social Work at Shanghai University. Sheying  Chen  Ph.D. (UCLA), is Professor of Public Administration/Social and Health Policy and former Assoc. Provost for Academic Affairs at Pace University in New York. He is Editor-in-­Chief for the Springer Series on International Perspectives on Social Policy, Administration, and Practice. Xuejuan  Chen  is Assoc. Professor of Physical Science at Hunan University of Arts and Science. Yanjiao Chen  Ph.D. (Shanghai), is Vice Dean of the College of Social Affairs at Henan Normal University. Xiaoxiao Cui  is a Research Assistant at Henan Normal University, Xinxiang. Yue Fan  is a Research Assistant at Guangzhou University. Wenxiao  Ji  Ph.D. (ECNU-NYU), is Assoc. Professor and Chair of the Social Work Department in the College of Social Affairs at Henan Normal University. Erpeng Li  is a Research Assistant at Henan Normal University, Xinxiang. Haibo Lin  is a Research Assistant at Henan Normal University, Xinxiang.

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Bo Liu  Ph.D. (ECNU), is Assoc. Professor in the School of Public Administration at Guangzhou University. Iris Po Yee Lo  Ph.D. (Oxford), is Assist. Professor in the Department of Applied Social Sciences at Hong Kong Polytechnic University. Xiang Luo  is a Research Assistant at Shanghai University. Jason L. Powell  Ph.D. (LJM), is President of Manchester Institute of Learning and Excellence (MILE) and former Professor and Assoc. Dean at the University of Liverpool. He is Co-Editor-in-­Chief for the Springer Book Series International Perspectives on Social Policy, Administration, and Practice. Yuxia Qin  Sc.D. (NENU), is Assoc. Professor of Life Science at Xuzhou Medical University. Yaqin Wang  is a Research Assistant at Shanghai University. Leidong  Wei  Ph.D., is Professor and Dean of the College of Social Affairs at Henan Normal University. Yifan  Xu  MSW, is a Supervising Youth Worker at Hunan Post and Telecommunication College, Changsha. Hong  (Sylvia)  Yao  Ph.D. (HKU), is Assist. Professor in the Department of Ethnology and Sociology at Minzu University of China. Margaret  Xi  Can  Yin  Ph.D. (HKU), is Assoc. Professor in the School of Humanities at Southeast University, Nanjing. Yifei Zhao  is a Research Assistant at Shanghai University. Ruirui Zhu  is a Research Assistant at Henan Normal University, Xinxiang.

Part I

Introduction

Chapter 1

Social Work, Mental Health, and Public Policy in China: A Comparative-Historical and Theoretical-Practical Approach Sheying Chen

 hinese Social Work in Context: Research Needs, Questions, C and Approaches This book will tell a story about a unique system with complex mechanisms in providing for the needs and well-being of a nation with the largest (as of the time of writing) population on the planet (Biswas, 2022). The uniqueness has been proudly acclaimed as “Chinese characteristics” by the people who live in the system (Boer, 2021). To make good sense to both insiders and outsiders, however, more insightful storytelling is needed with both substantive/empirical information and reflective/theoretical thinking. On the other hand, the services of professional social work, mental health, and public welfare, among other ways of provisions, are supposed to have some essential elements shared by all nations to establish any commonality for modern countries based on things like professionalism (NASW, 2017). When the Chinese take both great pride in their uniqueness, that is, so-called “Chinese characteristics” (or more recently, a “Chinese style”) (Bloomberg, 2023), and a keen interest in “a community with a shared future for mankind” (Koh, 2021), how could they reconcile the two different or even opposite orientations/emphases? And how the outside world would both accept their cemented uniqueness and at the same time identify with their claimed commonality for all (what is it anyway, or is there any at all)? By raising questions like these, the author does not suggest any value judgment but simply mean that more comprehensive research is required. And the need has become even more urgent now since the world has greatly changed, seemingly not for the better since more severe confrontations and conflicts are on the rise in many aspects of international (particularly Sino-American) relations and world affairs S. Chen (*) Pace University, New York, NY, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_1

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(Medeiros, 2019). However, the shared interests and needs for human well-being and survival must be stressed and supported with a better mutual understanding to keep the world from falling apart (so to speak). And this will require two things. One is the use of scientific, systematic, and objective comparative-historical approaches to find out how exactly nations converge and differ, and why. This, logically, will require a thorough research understanding of individual country cases, although they should always be studied in comparative-historical contexts rather than isolated from one another as well as their own past. The second is the significance of diversity (which happened to be chosen as the target or focus in the theme for the World Social Work Day this year) as a fundamental framework in support of both differences and commonalities (Lin, 2020; Chen, 2011; NASW, n.d.). Here, the author would like to promote a broader understanding by extending the idea of diversity from an American usual meaning of domestic cross-cultural matters based on ethnic/race relations to international relations and issues, not only politics but also helping professions, including social work, mental health, etc. Such “international diversity” will be used as a fundamental framework under which this book and ensuing volumes on similar subjects will be presented. We must recognize that social work is inherently and inevitably an international subject. Yet, each country has a story of professionalization embedded in the evolution of diverse national arrangements of human services and institutional settings of socioeconomics among other things. A study of various (especially non-Western) cases, therefore, is essential to an adequate understanding of the global undertaking. Undoubtedly, the People’s Republic of China (PRC) is an important case with a population of 1.4 billion. And particularly, some of the Chinese characteristics are fundamentally different from those of Western societies. It is intriguing given the country’s history and recent rise to a global superpower with a claim of core values that seem to be rather considerable to social work as a helping profession (Xinhua, 2017). Any lessons learned from the Chinese experiences would help with a better understanding of social work, mental health, and public welfare on a global scale. As a forerunner in initiating the reconstruction of professional education and research for social work and social policy in mainland China in the mid-1980s (Chen, 2021a), I find the issues of differences vs. commonalities left unresolved or becoming even thornier nowadays than nearly four decades ago. Domestically, history appears to have started repeating itself in today’s China in certain ways. Externally, Western social work professionals may become perplexed when they see that their Chinese counterparts must be led by “Party building,” should have nothing to do with religion, are discouraged (if not banned) from talking about social action, and so on and so forth. Again, no value judgment is implied here in terms of which system of professional practice, approaches, and perspectives being more desirable, but more research is needed to gain a clear understanding with all such comparative-­ historical considerations. When the issues remain unstudied or understudied, including whether Western social work experience or expertise is relevant/acceptable at all in that sociopolitical context, social work professionals may keep getting confused and frustrated to say the least.

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This book does not pretend to provide all the answers needed but will explore some of the issues/topics from both theoretical and practical viewpoints. Such a mixed or integrated theoretical-practical approach should be more effective than going purely theoretical or practical as Chinese professional social work is considered by many as not yet in a very differentiated or mature stage, but still like an infant in some sense (even after more than three decades of development that will be partly explored in this volume). Also, the development of the social work profession in China should not be examined in isolation but in interdisciplinary collaboration or relation with such varied practice fields as health and mental health, and within wide-ranging policy contexts of public welfare and social services. Here are a couple of notes for both the chapter authors and readers to keep in mind: 1. The subject terms in this book may be used in the broadest sense to allow covering/undertaking of all relevant topics, including matters of health and well-being, as well as important policy issues embracing social and economic justice. 2. While social work (the focus), mental health, and public welfare serve as the leading subjects for the volume, authors and readers may approach their shared concerns (i.e., human needs) from any disciplinary or interdisciplinary angle for the writing, reading, and interpretation. Originally the book was proposed to publish the proceedings of a panel on social work with ethnic Chinese in the World Forum on Public Welfare & Charity to be hosted by Tsinghua University in Beijing, which was put on hold due to COVID lockdowns and other matters. This, however, has rendered an opportunity to expand the scope according to the strengths of a scholarly team from greater China and overseas who are experts or rising stars in social work and related fields.

Organization of the Book and Highlights of Chapters The main text of this volume will begin with a systems perspective, which is familiar to social workers and allied helping professionals worldwide. Notwithstanding, instead of staying with a usual and general perception, Sheying Chen, editor of the book and EIC for the Springer Nature Series International Perspectives on Social Policy, Administration, and Practice, has authored several pieces to introduce a unique systematic framework for public/social policy analysis. It was first sketched by the late Professor Robert Morris (1985) and further interpreted and applied to the analysis of Chinese public/social policy by the author (e.g., Chen, 1996, 2002, 2018, 2021b) as a systematic and multifaceted contribution to policy research methodology. A few key concepts/constructs are introduced to provide theoretical guidance and place policy analysis in the comparative-historical context, including a “general public policy” (GPP) vis-à-vis “sectoral policies” in the policy system, an “economic state” (vs. the welfare state) as a special GPP pattern in comparative policy studies, and a “post-economic state” stage of development in historical analysis of policy changes. Furthermore, a “Problem-GPP-ism” Triple Prism is extracted from

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the framework as an essential policy research paradigm to identify and concentrate on the most crucial points, elements, or levels of a policy system. These are the cornerstones for an insightful and useful conceptual framework to derive related constructs as analytical tools necessary to put the development of professional social work in the broad contexts of public welfare, social services, and mental health. These will effectively demonstrate the importance of a cross-cultural perspective at the international level, underlined as “international diversity.” Placed under the systems perspective, the second part of the book elaborates on the professionalization of social work as an eclectic discipline with multidisciplinary collaboration. The relationship between professional social work and the larger social contexts, including social welfare and public affairs, will first be considered, particularly in view of the “Chinese characteristic” that social administration (especially the work of Civil Affairs Administration) was once claimed as identical with social work (Chen, 2021a). A general account of the situation including its historical evolution is provided by Wang Shibin, former Sociology Department Chair and Professor Emeritus at Peking University and longtime president of the China Association for Social Work Education (CASWE) (Wang, 2020). Part II of this volume begins with a case study in this regard by Wenxiao Ji, Haibo Lin, and Ruirui Zhu from the College of Social Affairs at Henan Normal University. Wenxiao Ji and her team’s chapter focuses on the development path of social work professionalization in terms of “from weak autonomy embedding to institutional embedding” by presenting a case study on a pilot project of a child welfare institution in China. In the process of professionalization, how to institutionalize social work into the existing service system is the core issue that needs attention. The findings of the case study show that after the introduction of the professional service model in the child welfare institution, social work has undergone the transformation from “weak autonomy embedded” to “institutional embedded” modes of practice. There are five elements embedded in the institutionalization of social work to achieve professional development, namely, necessity, complexity, exclusivity, autonomy, and organization. The authors argue that these five elements are indispensable in the development of professional social work practice. And the study provides some empirical evidence with theoretical reasoning for such a local professionalization path of Chinese social work development. They underline that the current professionalized path of social work development must deal with the construction and improvement of the welfare system outside the project. Part II includes another chapter by Wenxiao Ji, Haibo Lin, and Ruirui Zhu on the effectiveness of social work supervision as a window to look into one aspect of the professionalization of social work in China. They conducted a qualitative study in an attempt to create a framework called “structure–relationship–power analysis” for practice research. With rapid advancement of social work professionalism as the backdrop, the authors believe that the effectiveness of social work supervision has become one of the key factors restricting the quality of social work service in China. Taking a cross-institutional supervision mode and multilevel supervision mode of Z City as an example, they found that the supervision function of social work in the locality was limited with its effectiveness questionable. By analyzing the empirical

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data using qualitative research methods, the authors identified some important factors that might restrict social work supervision and service. The chapter also attempts to make a methodological contribution by constructing an analytical paradigm called “structure–relationship–power” framework. Human well-being is often denoted by the notion of health in its broadest sense while health and human services are practically intertwined and inseparable. As the first volume of a planned series on Chinese social work in international contexts and comparative perspectives, this part of the book weighs heavily on health-related education, research, and practice. The chapter written by Jia Chen and team is entitled “Promoting the Curriculum System Construction of Public Health Social Work in China: Western Experience and Domestic Exploration.” Reflecting on the huge impact that the COVID-19 epidemic had on the economic and social development of the country, the chapter is concerned with the safety of Chinese people's lives and properties. It asserts that social workers played an important role in this major public health emergency, which further improved the images and prominence of social work professionals in the field of public health in China and accelerated the construction of a relevant educational system. The chapter provides a historical review of the connections between the disciplines of social work and public health to illustrate the development of joint curricula of public health social work in China and worldwide. By exploring the construction of the curriculum system of public health social work in China, the chapter offers suggestions for the strategic development and improvement of professional education and personnel training in the future. Part II also includes the following two chapters shedding light on the health science foundation for clinical social work research and practice: “Psychosomatic Medicine, Medical Social Work, and Evidence-Based Clinical Practice” by Sheying Chen, Elaina Y. Chen, and Yuxia Qin; and “Biomedical Education, Health Promotion, and Social Responsibility: International and Chinese Perspectives” by Sheying Chen, Yuxia Qin, and Xuejuan Chen. Part III deals with policy and practice with diverse/special populations, beginning with an introductory chapter by Sheying Chen, Yanjiao Chen, and Yifan Xue entitled “Ethnicity and Diversity: American Experience and Implications to Social Work.” The following chapters offer further insights into the development of social work, mental health, and public welfare in China with more specific topics and varied approaches. The chapter by Margaret Xi Can Yin and Cecilia Lai Wan Chan is entitled “Spirituality Without Religion: Social Work for Promoting Selfhood Among Chinese Women in a Consumerist Society.” It begins by noting that Chinese consumer market has created a “fertility and beauty” oppression of females for a long time under a joint impact of traditional doctrines. As a country with the majority population having no religion, it is important to establish the spirituality of nonreligious females in China to transcend the social discriminations. The chapter presents a group-based social work intervention for 28 women without religious belief. The participants indicated public scrutiny of their appearance and fertility in pre-group interview and joined a six-session weekly intervention project. Their body surveillance, body shame, appearance anxiety, self-efficacy, and acceptance were

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measured using a questionnaire three times at baseline, the end of the intervention, and 2–3 months after the intervention. The findings show that the participants’ body shame and appearance anxiety reduced while self-efficacy, self-acceptance, and self-love improved after joining the program. The chapter concludes that selfhood promotion is of great significance for Chinese women without religion to transform social judgment on their appearance and fertility in a consumerist society. Iris Po Yee Lo’s chapter takes a dialectical approach to understanding family life from a social work point of view. It aims at understanding how parents of lesbian, gay, and bisexual (LGB) children experience “coming out” and navigate parent– child ties. Many LGB people, particularly those fearing or experiencing parental rejection, are vulnerable to mental health risks, including depression and suicidal thoughts. With limited research attention to parents’ agency and concerns, little is known about how parent–LGB child ties unfold over time. Given the increase in longevity globally and the consequent lengthening of shared lifetimes between generations, it is important to address these gaps and pay more attention to LGB families of origin. This chapter analyzes the complexity of family post-disclosure negotiations, which may vacillate between confrontation and compromise, and between moments of denial and shame and those of acceptance and support. Conceptualizing these negotiations as dialectical, the study moves beyond the focus on LGB vulnerability/agency and centers on both LGB people and their parents as active agents negotiating expectations regarding family, marriage, and (grand)parenthood. The dialectical approach to understanding family life revealed how one can work with family members toward mutual understanding and redefine intergenerational intimacy, and how traditional and new family scripts may collide and be (re-)interpreted. The chapter offers a cross-cultural lens to advance theory and interventions supporting family members with differing sexual orientations to build better relationships. Bo Liu and Yue Fan’s chapter sheds light on social work intervention in support of mothers who have lost their only child in China through a case study in Guangzhou. The remarkable number of families who have lost their only child indicates a dire situation known as shidu family because of a decades-long one-child policy in China. Particularly, the loss of the only child is a fatal blow to the mother, which results in tremendous difficulties and dilemmas in life, mental health, social relations, and personal development. With their unique professional skills, social workers can effectively help shidu mothers get over the pain, resume a normal life, and finally realize their life value. Based on a case study of the “Rose Project,” which is the first social work intervention project to support shidu mothers in Guangzhou, the chapter analyzes the support mechanism of social workers’ intervention in supporting shidu mothers in terms of staffing placement, target orientation, and action strategy. It is found that social work intervention in supporting shidu mothers has achieved significant results in self-empowerment, improvement of the environment, and satisfaction of shidu mothers. Based on the empirical finding with practical reflection, the authors suggest that the support mechanism of social workers’ interventions for shidu mothers needs to be further improved in staffing placement, service content, service mode, and service attitude.

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Wenxiao Ji and Xiaoxiao Cui contributed a chapter on delivery of welfare services for children with rare diseases in China. The country's child welfare system is in transformation from a “compensatory” type to becoming moderately inclusive. Due to insufficient national resources and capabilities, the provision of welfare is still largely divided, which leads to the dislocation and insufficiency of services to children with rare diseases. There is an urgent need to explore a coordinated national system of care services for the children in need. Their study attempts to answer some of the important research questions: In the context of state parental rights, what is the current situation and characteristics of welfare of children with rare diseases in China? How can policymakers and professionals play a coordinated role of all service providers in care for children with rare diseases? They used literature review, interview, and questionnaire survey in trying to understand the situation of children with rare diseases and the interaction among service providers to explore how to improve the mechanism. Their findings reveal that a fourfold dislocation impeded the provision of resources for welfare services to children with rare diseases. The government's basic welfare services for children with rare diseases are financially weak. In the healthcare field, the quality of medical institutions is uneven. Children with rare diseases face the difficulty of having few caregivers. They also need various educational and social services, which are vital to the development of their physical and mental health. The authors hope that by exposing the present situation of welfare supply for children with rare diseases, the causes of “dislocation” and insufficiency of child welfare provision will be addressed with evidence-based practice. Hong Yao’s chapter is interested in the “ambivalence” in family life during an era of falling fertility and population aging in China. Intergenerational dynamics in Chinese families have been as complex and dynamic as the most extensive and profound social changes that have occurred in the Chinese society over the past few decades. A critical feature of neo-familism is an emphasis on affection aspects of family practices, which gradually set it apart from the traditional Asian family cultures based on filial piety. Ambivalence is a ubiquitous complex of love–hate, bitterness–sweetness, harmony–conflict, desire for closeness and fear of loss of autonomy that happens in both vertical and horizontal relationships within a family. Psychological ambivalence focuses on coexistence of both positive and negative emotions or thoughts, while structural ambivalence highlights the underlying dynamics in the social system that generate ambivalent feelings and expressions. Psychological and structural ambivalence of individuals in multigenerational families interact to generate a composite collective ambivalence. Collective ambivalence is a fluid state with positive and negative components among psychological–structural ambivalence of individual family members, all contributing to an ever-­changing, multilayered and rich reality of interactions throughout the life course of the family. Based on studies of intergenerational ambivalence, this chapter highlights the universality of ambivalence embedded in family relations and summarizes the existing literature regarding influential factors, operationalization and measurements, and psychosocial consequences of ambivalence. The chapter concludes from the literature view that future research needs to further study the characteristics, mechanisms, psychosocial consequences, and social context of collective ambivalence.

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Last but not least, the chapter by Jason L. Powell, Co-EIC for the Springer Nature Book Series International Perspectives on Social Policy, Administration, and Practice, makes an important contribution from a Foucauldian perspective. The chapter explores the philosophical contribution of French theorist Michel Foucault to a better understanding of aging in China. This is one of the first book chapters to use the international work of Foucault to assess how the modernization process impinges on the social construction of aging in China. By focusing on aging, the author hopes to get researchers to use theory more to “make sense” of complex relations, such as those between older people and the state and its policymakers through a critical lens. It does so by using his conceptual tools to critically analyze the relationship between the State and older people with thought-provoking concepts such as panopticism and power in how the State monitors and provides nuanced surveillance of its aging population. Health and welfare have emerged as pivotal vehicles used to position the identities that older people adopt in China. Both contain continually shifting technologies that function to intercede relations between older people and Chinese policymakers. However, they also represent an increase in social control that can be exerted on lifestyles in old age, and thus, the wider social meanings associated with that part of the inter-generational life course. The chapter presents a theoretical analysis of Chinese gerontology based on a critical reading of the work of Michel Foucault as applied to China and aging. It highlights the challenges and implications of populational aging and how older people in turn have become an increasing visible issue for the Chinese State.

Main Audience The book aims at the following benefits to its readers as some unique features in the absence of much-needed, highly relevant readings on the contextualized and interconnected subject: –– Systematic, collective contribution of competent, rigorously trained clinical and macro-research scholars in social work, mental health, and public policy offering the most comprehensive understanding unmatched by other publications on the subject. –– Both professional standards and cultural/national relevance are upheld by minimizing the potential influence of various barriers and biases. –– Far-reaching review with up-to-date info/data and a historical-comparative approach to the profession’s future in the Chinese contexts. Striving for a cross-cultural understanding of human and social development, the book’s primary audience includes but is not limited to academics and practitioners in social work/welfare/services, public/social policy/administration, philanthropy and nonprofit organizations, community studies, international/cross-cultural studies, and Chinese/China research. It can be used as a text/reference book or supplemental reading for undergraduate and graduate students in a variety of relevant courses. It should also be a good choice for the public who is interested in the topics.

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References Biswas, S. (2022). India v China: Is becoming the most populous country a boon or curse? BBC News, December 20. https://www.bbc.com/news/world-­asia-­india-­63957562. Retrieved 12 Apr 2023. Bloomberg. (2023). Xi rejects ‘westernization’ and promotes China’s self reliance in new policy speech. Time, February 8. https://time.com/6253825/xi-­china-­rejects-­westernization/. Retrieved 12 Apr 2023. Boer, R. (2021). Socialism with Chinese characteristics: A guide for foreigners. Springer. Chen, S. (1996). Social policy of the economic state and community care in Chinese culture: Aging, family, urban change, and the socialist welfare pluralism. Ashgate. Chen, S. (2002). Economic reform and social change in China: Past, present, and future of the economic state. International Journal of Politics, Culture, and Society, 15(4), 569–589. [Selected by BRILL in the Netherlands: Key Papers on the Chinese Economic History]. Chen, S. (Ed.). (2011). Diversity management: Theoretical perspectives and practical approaches. Nova Science Publishers. Chen, S. (2018). “Bring things Back to order” vs. “reform and open-up”: A theoretical account of general public policy (GPP) and “one man’s 40 years”. Leadership Science Forum: National Governance Review, 11, 5–14. (in Chinese). https://doi.org/10.19299/j.cnki.42-­183 7/C.2018.21.001 Chen, S. (2021a). Oral history – rebuilding of social work profession in China: A review of times and experience. Sino-American Social Work Coop (eJournal), May 9. https://mp.weixin. qq.com/s/H9-­Myt9eXO0LI1WUgSRa2g (in Chinese). Chen, S. (2021b). A review of China’s population and social policy with a “Problems-GPP-isms” Prism. Sino-American Social Work Research eJournal, 1(1), C0001. (inaugural issue). https:// mp.weixin.qq.com/s/hx7-­GPRdDQLhjBPKgrBg_w (in Chinese). Medeiros, E.  S. (2019). The changing fundamentals of US-China relations. The Washington Quarterly, 42(3), 93–119. https://doi.org/10.1080/0163660X.2019.1666355 Koh, K.  K. (2021). A community with shared future  – China’s vision of the new global order. China Focus, January 28 http://www.china.org.cn/opinion/2021-­01/28/content_77165072. htm. Retrieved 12 Apr 2023. Lin, J. C. (2020). Understanding cultural diversity and diverse identities. In W. Leal Filho et al. (Eds.), The Springer encyclopedia of the UN sustainable development goals: Quality education. https://doi.org/10.1007/978-­3-­319-­69902-­8_37-­1 NASW (National Association of Social Workers). (2017). NASW code of ethics. Update 2021. https://www.socialworkers.org/About/Ethics/Code-­o f-­E thics/Code-­o f-­E thics-­E nglish. Retrieved 12 Apr 2023. NASW. (n.d.). Diversity, equity & inclusion. https://www.bing.com/search?q=n.d.&PC=U316&F ORM=CHROMN. Retrieved 12 Apr 2023. Wang, S. (2020). Analysis of China’s social work from embedded development to integrated development[J]. Journal of Beijing University of Technology (Social Sciences Edition), 20(3), 29–38. https://doi.org/10.12120/bjutskxb20200329. (in Chinese). Xinhua. (2017). Core socialist values. China Daily (English edition). http://www.chinadaily.com. cn/china/19thcpcnationalcongress/2017-­10/12/content_33160115.htm. Retrieved 12 Apr 2023.

Citation Chen, S. (2023). Social work, mental health, and public policy in China: A comparative-historical and theoretical-practical approach. In S. Chen (Ed.), Social work, mental health, and public policy in diverse contexts: Chinese and cross-cultural perspectives. Springer Nature.

Chapter 2

Policy System, General Public Policy (GPP), and Comparative Social Policy: A Tale of the Economic State vs. Welfare State (and More) Sheying Chen

 esearch Questions and Origin of the GPP and Economic R State Ideas My learning background, ranging from technology to science and philosophy of science to arts and liberal arts and eventually landing in the behavioral and social sciences, did offer me a unique degree of freedom in terms of personal interests and formal schooling (despite the suffering of a wild time in my childhood and youthful years surrounding the Great Cultural Revolution) (Chen, 2018). The early stage of my academic career, however, was a sociology graduate student turned social work explorer. The field of social work did (and still does) claim social policy as one of its territories (or even a major practice “method”), taking ownership from schools of public affairs, etc. in many countries. And I was one of the first in mainland China to offer a social policy course at Sun Yat-sen University (SYSU, also known as Zhongshan or the “institution of highest learning” in southern China) at Guangzhou (Canton) while pioneering reconstruction of the social work profession in the mid-­1980s (Chen, 2021a). However, I was preoccupied with developing community services (with a hope for social work direct practice) and social welfare/security for the needy including the elderly at the time (Chen, 1996). As a sociology graduate, my imagination could have gone untamed, but further studying professional social work and welfare services required a down-to-earth focus on disadvantaged minority groups (usually not in the racial/ethnic sense but mostly the so-called

S. Chen (*) Pace University, New York, NY, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_2

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“three-no’s”1) in mind. At that time, people tended to talk a lot about policies and politics but the daily discourse was usually conducted in a prescribed way or to get “educated” or “learned” and follow. In other words, students and researchers were not supposed to question or challenge major, basic, or fundamental policies. Engaged in community study and social security/welfare research and exposed to mounting and pressing social needs in the late 1980s, my inquiry logically led to a drive for policy advocacy which, however, ended up being disappointing or almost helpless/hopeless. With a dramatic turn away from “taking class struggle as the central task” (which happened in 1978 after the historic 3rd Plenary Session of the 11th CPC Central Committee) to “concentrating on economic construction as the center” (originated from a talk by Deng Xiaoping in January 1980), no leader at any level of the government, including city district, administrative Street (subdistrict), or even the quasi-official residents' committee, would take my plea for expanding social welfare very seriously since all were preoccupied with “economic construction” or making money/boosting GDP. Frustrated and eager to find out, some fundamental research questions came up and stayed in my mind for a decade-long pursuit across national borders, including (a) How to reconcile a claim for the purpose or mission of serving (or seeking happiness for) the people with such indifference in social welfare services (except for a handful of recipients such as the “three-no's” that constituted only a tiny portion of the population)? (b) Was it due to an ideology or mainly a new capitalism to blame (many outsiders at that time believed China was practicing capitalism without announcing it) (Solinger, 1993; Pieke, 1995)? (c) Could there be a hope for the future of China to become a welfare state?

Finding Out: A Quest Across National Borders I was not very clear about the possible answers, or even the questions themselves, until after I came to the University of Hong Kong (HKU) in April 1989 when it was still under British rule. I was amazed that researchers outside the mainland were not only questioning but seriously disparaging the “reluctance” of the Chinese state in welfare provision. I was not in complete agreement, though, with many of the theories and arguments employed in such analyses and criticisms, particularly those stemming from mere political and ideological stances (Deacon & Hulse, 1997). My own judgment, if yet to be proven in a scientific way, was based on a personal history of life and work in mainland China for more than three decades, even though those experiences were not always pleasant (actually quite miserable before the ending of the Cultural Revolution). As a research student serious about what I was

 Those (often the elderly) with no capacity for work, no means of subsistence, and no reliable source of care (mainly family). 1

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learning as a science, I had to believe in objective observation and logical reasoning based on the information and knowledge I had accumulated over the years about that homeland that has been not only possessing but also pursuing its uniqueness, or so-called “Chinese characteristics” (Boer, 2021). To draw a different conclusion, however, I would have to make a number of assumptions or research hypotheses, which will be elaborated on or translated later (much of my recent publication is in Chinese). Here, the main point is that those years in the 1980s were cherished by many as the most open and reform-oriented in recent Chinese history. To consider such a reformist era as truly worse than before or even “reactionary” from solely a social welfare point of view (Zhan, 1988), it just does not seem to make good sense nor sound right. I believed there had to be something deeper and broader with some kind of theory to account for what had actually happened and was still happening (until the political turmoil that took place in the summer of 1989). To find out the deep-seated theory, if any, so that my research assumptions and hypotheses (whatever they were) could be guided and supported, I studied hard by taking advantage of Hong Kong’s easy access to the classics of social policy as a discipline born in the West (like many other fields in the sciences and social sciences). By the time I departed HKU for UCLA (after declining offers from Columbia in NYC, Queensland in Brisbane, etc.) for continuing advanced studies in social work and public policy, I had achieved a fairly good understanding of the welfare state as a cornerstone of the discipline or profession (Titmuss, 1958, 1968; Wilensky, 1975). However, I had not found the answers to my original research questions, including, for example, whether China was, or would be, a welfare state, and why. And Western classics did not even convince me what in the world a welfare state is which would make truly good sense in comparative studies such as that involving the PRC (Mishra, 1990; Esping-Andersen, 1987; Cavanna, 1998; Freeman et al., 1997; Chatterjee, 1996; Furniss & Tilton, 1977; George & Page, 1995; Gilbert, 1983). Social policy study in the United States looked rather deviant from the type seen in the British Commonwealth, including the colonial times of Hong Kong. And even more intriguing, America was deemed lagging behind its counterparts in Europe and the welfare states in other places (Marmor et al., 1990), with its well-­ known “reluctance” in welfare provisions (somewhat similar to the Chinese case!) but had managed to be the world’s #1 or only superpower (which posts a question as to where the Chinese should turn to if they wanted to learn and desired to achieve). Still, the instruction of those world-class experts at UCLA did not address my China questions, let alone any ready-made answers. Nonetheless, I learned a great deal from those leading scholars, including my social policy professor Dr. Fernando M.  Torres-Gil, who was appointed by President Bill Clinton as the first-ever U.S.  Assistant Secretary on Aging after finishing teaching my doctoral class. He designated a lot of readings for the doctoral students, including a book by Robert Morris (1985). Completing those readings was not fun; however, when I read a policy system framework in Morris’ book, my mind was blown.

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Table 2.1  A policy system framework and the role of general public policy (GPP) Elements/dimensions of policy analysis (Morris, 1985; Chen, 2004) (a) Society’s aspirations or goals (b) Societal policy or social norms (c) General public policy (a guide to the priority aims and preferred means of the policy system) (d) Sectoral public policy (e.g., income security, housing, health, personal social services, the family domain, and the aged) (e) The leadership role of governmental units in moving beyond or in modifying social norms (f) Advocated vs. adopted policy (g) Criteria for assessing policy guidelines (e.g., charity vs. rights or middle-class viewpoints, and distributive-regulative vs. redistributive)

The Policy System and General Public Policy (GPP) Robert Morris, the late Professor of Social Planning at Brandeis University’s Florence Heller Graduate School for Advanced Studies in Social Welfare (from 1959–1979), used the structure of a multilevel policy system to expand the view of social workers and policy researchers (see Table 2.1). Although Morris never followed through with more detailed and deep-going explanation, I found a layer called general public policy in the policy system framework well suited to my dying need for developing a theory to account for the China case, a vital part missing from the foundation of social policy as an academic discipline.

Major Lessons Learned and Implications to Social Work My interpretation of the policy system framework stresses the importance of general public policy (GPP) since I knew from personal experience how crucial something like that could be; in China, it used to be called the “line” or “basic line,” although it is more complex than a GPP and requires an analysis using my "Problem-­ GPP-­ism" Triple Prism (Chen, 2021b). Under the policy system framework and learning the role of GPP in determining the nature of a nation’s public policy, a higher-level or deeper understanding is made possible that the welfare state is only one of many potential GPP patterns. This, logically, calls for identifying possible and existing alternative, diverse development strategies. As a result of my China case study, an “economic state in transition” model was formulated through comparative-historical research, which also led to the identification of a new post-economic state era, as eventually manifested by the CCP’s 19th Congress turning to more balanced development (very hopeful for the nation at the time despite increasing uncertainty afterward, especially since the eruption of the COVID-19 pandemic). My further inquiry had another important conclusion, that is, a “development strategy” cannot be taken for granted. In other words, not all GPP patterns are

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developmental in nature. There are cases in world history with nondevelopment or even antidevelopment GPPs, such as the warfare states in WWII (i.e., Nazi Germany and militaristic Japan), as well as the extremely politicized periods in Chinese history (e.g., the Cultural Revolution). As a unique development strategy, the depoliticized Chinese economic state GPP after ending the Cultural Revolution was extremely and uniquely successful in creating an economic miracle that no existing economic theory could successfully explain (Chen, 2002). On the other hand, the single-minded “concentrating on economic construction as the center” development strategy, despite its huge success, also created mounting social problems increasingly crying for a solution. In preparing to redress such issues, there came complications in domestic politics and international relations (Medeiros, 2019), including a feared rolling back toward the Cultural Revolution and possible wars over the Taiwan Strait and elsewhere. These issues are exceedingly complex and complicated that cannot be fully addressed here due to space and time constraints. However, the implications to social work as a profession are apparent (if only it does not want to be pulled away from professionalization or banned altogether as happened before when the country’s knowledge and understanding about the GPP were not crystal clear and consistently right). The ensuing volumes after this book will form a subseries on Chinese social work, mental health, and public policy placed in the national contexts with diverse cross-cultural perspectives. Particularly, those key concepts/constructs will be thoroughly analyzed to provide theoretical guidance and place policy analysis in the comparative-historical context, including the GPP vis-à-vis “sectoral policies” in the policy system, the “economic state” (vs. the welfare state) as a special GPP pattern in comparative policy studies, and the “post-economic state” stage of development in historical analysis of policy changes. Furthermore, the "Problem-GPP-ism" Triple Prism extracted from the research framework will be treated as an essential policy research paradigm to identify and concentrate on the most crucial points, elements, or levels of a policy system. These are the cornerstones for an insightful and useful conceptual framework to derive related constructs as analytical tools necessary to put the development of professional social work in the broad contexts of public welfare, social services, and mental health.

Conclusion A key to understanding what a welfare state truly is, GPP provides an answer by identifying a different pattern, namely, an “economic state,” by studying the national case of the People’s Republic of China (PRC) as an alternative development strategy and proven competitor to the welfare state. Not only is GPP vital to the study of comparative public/social policy but also it is critical to the detection/determination of a nation’s developmental orientation, or whether it is actually on a dangerous, antidevelopment path. In view of commonly seen but helpless problem-ridden debates and ideological confrontations, this opens a new territory for the analysis of

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domestic policies and international relations (both not purely politics in this view) (Waddan, 1997). It provides an overall rationale about the uniqueness and commonalities of different policy systems. An educated citizenry, particularly helping professionals such as social workers, psychological counselors, and healthcare practitioners, should achieve this basic understanding for the sake of the people they serve through direct practice and policy advocacy, and for their own sanity as well.

References Boer, R. (2021). Socialism with Chinese Characteristics: A Guide for Foreigners. Springer. Cavanna, H. (Ed.). (1998). Challenges to the Welfare State: Internal and External Dynamics for Change. Edward Elgar. Chatterjee, P. (1996). Approaches to the welfare state. NASW Press. Chen, S. (1996). Social policy of the economic state and community care in Chinese culture: Aging, family, urban change, and the socialist welfare pluralism. Ashgate. Chen, S. (2002). Economic reform and social change in China: Past, present, and future of the economic state. International Journal of Politics, Culture, and Society, 15(4), 569–589. [Selected by BRILL in the Netherlands: Key Papers on the Chinese Economic History]. Chen, S. (2004). Public policy and development strategy: Theoretical, comparative, and historical perspectives illustrated with the case of the Chinese state. Kendall/Hunt Publishing. Chen, S. (2018). “Bring things back to order” vs. “reform and open-up”: A theoretical account of general public policy (GPP) and “one man’s 40 years”. Leadership Science Forum: National Governance Review, 11, 5–14. (in Chinese). https://doi.org/10.19299/j.cnki.42-­183 7/C.2018.21.001 Chen, S. (2021a). Oral history  – Rebuilding of social work profession in China: A review of times and experience. Sino-American Social Work Coop (eJournal), May 9. https://mp.weixin. qq.com/s/H9-­Myt9eXO0LI1WUgSRa2g (in Chinese). Chen, S. (2021b). A review of China’s population and social policy with a “Problems-GPP-isms” Prism. Sino-American Social Work Research eJournal, Volume 1, No 1, C0001 (inaugural issue). https://mp.weixin.qq.com/s/hx7-GPRdDQLhjBPKgrBgw Deacon, B., & Hulse, M. (1997). The making of post-communist social policy: The role of international agencies. Journal of Social Policy, 26(1), 43–62. Esping-Andersen, G. (1987). The comparison of policy regimes: an introduction. In M.  Rein, G. Esping-Andersen, & L. Rainwater (Eds.), Stagnation and renewal in social policy: The rise and fall of policy regimes. M.E. Sharpe. Freeman, R.  B., Topel, R., & Swendenborg, B. (Eds.). (1997). Welfare state in transition: Reforming the Swedish model. University of Chicago Press. Furniss, N., & Tilton, T. (1977). The case for the welfare state: From social security to social equality. Indiana University Press. George, V., & Page, R. (Eds.). (1995). Modern thinkers on welfare. Prentice Hall/Harvester Wheatsheaf. Gilbert, N. (1983). Capitalism and the welfare state: Dilemmas of social benevolence. Yale University Press. Marmor, T. R., Mashaw, J. L., & Harvey, P. L. (1990). America’s misunderstood welfare state: Persistent myths, enduring realities. Basic Books. Medeiros, E.  S. (2019). The Changing Fundamentals of US-China Relations. The Washington Quarterly, 42(3), 93–119. https://doi.org/10.1080/0163660X.2019.1666355 Mishra, R. (1990). The welfare state in capitalist society. Harvester Wheatsheaf.

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Morris, R. (1985). Social policy of the American welfare state: An introduction to policy analysis (2nd ed.). Longman. Pieke, F. N. (1995). Bureaucracy, friends, and money: The growth of capital socialism in China. Comparative Studies in Society and History, 37(3), 494–518. Solinger, D.  J. (1993). China’s transition from socialism: Statist legacies and market reforms 1980–1990. Sharpe. Titmuss, R. M. (1958, 1963). Essays on “The Welfare State”. Allen and Unwin. Titmuss, R. M. (1968). Commitment to welfare. Allen and Unwin. Waddan, A. (1997). The politics of social welfare: The collapse of the centre and rise of the right. Edward Elgar. Wilensky, H. L. (1975). The welfare state and equality: Structural and ideological roots of public expenditures. University of California Press. Zhan, H. (Ed.). (1988). Social welfare development: Experiences and theories. Guiguan Book. (in Chinese).

Citation Chen, S. (2023). Policy system, general public policy (GPP), and comparative social policy: A tale of the economic state vs. welfare state (and more). In S. Chen (Ed.), Social work, mental health, and public policy in diverse contexts: Chinese and cross-cultural perspectives. Springer Nature.

Part II

Professionalization of Social Work as an Eclectic Discipline with Multidisciplinary Collaboration

Chapter 3

From Weak Autonomy Embedding to Institutional Embedding in the Development of Social Work Professionalization: A Case Study on a Pilot Project of a Child Welfare Institution Wenxiao Ji, Erpeng Li, and Ruirui Zhu

Introduction The specialization of social work is related to the development direction and construction path of China’s social work. Especially because the new normal of China’s economy is developing from high speed to high quality, social work needs to have new development in specialization, localization, and professionalism. But at the same time, there are also some structural and deep-seated problems in the development of social work in China, including unbalanced development, insufficient professional positions, insufficient recognition, and improper role positioning. It can be said that the path to realizing the professional development of social work has become the key. In this context, this chapter plans to take the pilot project of promoting professional social work services in child welfare institutions as an example to explore the path to promote the professional development of social work through institutionalized embedding.

W. Ji (*) Social Work Department, Henan Normal University, Xinxiang, China E. Li · R. Zhu Youth and Children Research Center, Henan Normal University, Xinxiang, China © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_3

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Literature Review The Professional Development of Social Work As the core topic of social work practice and research in social work, the definition of social work specialization has not been a consensus in the academic circle. As early as 1957, Greenwood pointed out that the professional attributes of social work are different from other professions, specifically manifested in professional authority, social identity, knowledge system, conduct, and other aspects. Later, some scholars believe on this basis that the specialization of social work covers multiple elements, such as professional personnel, professional value, professional knowledge, professional identity, and professional autonomy, showing the following characteristics: (1) based on the values and ethical codes of social work; (2) emphasize the construction of knowledge system and the localization of majors; and (3) advocate professional autonomy, and we should also be alert to excessive specialization and professional hegemony. The process of social work specialization should be a process of striving for realizing social justice, not just for the sake of specialization. In addition, from the perspective of the relationship between right and power, believe that the process of social work specialization is essentially a process of constructing professional power and professional authority through a series of practices, but the construction process in different periods, different social background has different performance, so we should analyze the different situation of social work professional practice from the dynamic and systematic perspective. Combined with the views of the above scholars, the current academic research on the professional connotation of social work can be interpreted as two views: one point of view is that social work specialization is a process of obtaining professional status and professional authority by establishing a professional knowledge system, cultivating professional talents, and engaging in social work occupation; another point of view is that the specialization of social work is different from the previous social work, which is a development process of redefining the practical content and theoretical system of social work. Professionalization has a positive significance in improving the social recognition of social work majors, the effectiveness of front-line practice, and the research of basic theories. In China, due to the long-term influence of the social structure of “big government and small society,” the professional development of social work is also faced with practical difficulties such as insufficient localization, low social recognition, backward social work practice, weak professional autonomy, and conflicts with the government, showing two remarkable characteristics: first, compared with the West, China’s social work developed late and weak; second, most scholars believe that the professionalization process of social work in China is a continuous single-item evolution process, and insufficient attention is paid to the reverse development process of specialization. The reason is that the professional development dilemma of social work is mainly influenced by three factors: endogenous forces (establishment of professional institutions, formulation of professional knowledge

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system and ethical standards), external influence (social recognition, government support), and macrostructure (economic and social environment). No matter what the influence of the factors is, it reflects the localization process of the Western social work value system in China. From this perspective, practicality is an important characteristic and value follow of the social work specialization in China. Based on the above analysis, the scholars have put forward the realistic path of building the social work specialization in China, centering on the three factors affecting the specialization of social work and combined with their own practical content. From the perspective of the construction main body, some scholars believe that the specialization of social work is a prominent dynamic process of institutionalization. Therefore, we should actively give full play to the initiative of government departments, social work organizations, institutions, educators, theoretical researchers, front-line practitioners, and other subjects, constantly stimulate their practical wisdom, and carry out professional reflection to promote the professional process of social work. From the perspective of construction goals, the development goals of promoting “community integration” and “professional skills improvement” is a realistic strategy to achieve the professional integration development of social work. From the point of construction mode, we can promote the process of social work discipline and professional specialization through three forms: on-the-job training (for a line of social workers for professional knowledge and skills training), professional substitution (professional social workers to replace the original social work mode), and professional transformation (according to the current situation of social development design, adjust social jobs and professional training). From the perspective of the construction content, it is a feasible way to get rid of the question of the “unprofessional” of social work to emphasize the social situation and team cooperation and coordinate all resources to carry out preventive services. As one of the important fields of social work professional practice, in recent years, the development of child welfare institutions has been paid more and more attention by scholars. From a theoretical point of view, the social work service of child welfare institutions refers to the final placement service provided by social workers for the disabled children in accordance with the practical principle of child social work and comprehensively using the values, theoretical knowledge, and methods of professional children’s social work. From a practical point of view, it generally includes the whole process from “children entering the institution, resettlement evaluation, resettlement service plan and implementation, child placement (usually family placement), resettlement follow-up, and case closure.” In terms of professional characteristics, social work services for child welfare institutions are a part of professional social work services for children, which is specifically for abandoned babies, orphans, and other disabled children to promote the improvement or disappearance of their disabled status, social work professional services. The main goal is to promote the improvement or disappearance of compliance through resettlement (mainly family placement), and the main method is to use case management methods in social work practice. According to the case management theory, the social work services of child welfare institutions should be composed of six sections: admission handling, resettlement demand evaluation, resettlement service

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plan, resettlement service intervention, resettlement service follow-up, and case closure. Thus, the “professional service model of social workers in child welfare institutions” has been formed—social work-led model of child resettlement services.

Embedded Development of Social Work The concept of “embedding” was first proposed by Polanyi, who believed that the human economy is embedded and entangled in the economic and noneconomic institutions. Granovetter criticized the two tendencies of “low-degree socialization” and “excessive socialization,” proposed the concept of “embeddedness,” and emphasized the restrictive effect of social network structure on people’s behavior to explain the relationship between economic action and social structure. Liu Shicheng compared the embeddedness of Polanyi and Granovetter, arguing that the “embeddability” perspective includes “analytic strategy” and “unanalytic strategy”; however, scholars have also found that both Polanyi’s embedding concept and Granovetter’s embedding theory have some shortcomings (we do not mean to criticize either theorist here). For example, Polanyi’s embedded ideas are deep and not very clear (detailed), and this lack of detail may be what gives it its wide explanatory power. Sharn divides “embedding” into four forms: structure, cognition, politics, and culture; Brian proposes that the “embeddedness” relationship is different from the “keeping the distance type” relationship, and that the exchange logic of the “embeddable” is different. Li Peilin believes that the “embedding theory” is a challenge to the rational choice theory. “Embedded” once became a hot topic of economic sociology research. In China, Wang Sibin, the scholar who introduced the concept of “embedding” into the analysis of the development of professional social work in 2009, believes that compared with the dominant administrative system framework, professional social work in the field of social service is an embedded development process. Since then, scholars have studied the embedded development of social work mainly from the perspectives of theory and practice. In short, the introduction of the concept and theory of “embeddedness” has provided a new development space for the development of sociology, especially economic sociology, and the diffusion ability of this concept has indeed provided a new way to explain relatively complex social phenomena. In this chapter, embeddedness is regarded as an analytical concept and the specific embeddedness problem is studied. From the perspective of the concept of embedded development, some scholars believe that the development of China’s social work in the past few decades is mainly reflected in the transformation from unitary embedded view to composite embedded view, which is the result of the interaction and construction of government policy guidance and practical action at the professional level. Under this logic, the concepts such as “reverse embedding,” “effective embedding,” and “invalid embedding” provide a brand new research paradigm for us to analyze the theory of embedding development. From the practice of embedded development, back in 2011, Wang Sibin pointed out that China’s professional social work will shift from weak professional autonomy led by

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the government to deep embedding under government–professional cooperation, which reflects the unique path of the development of social work in China. Influenced by this view, scholars, through the continuous study of social work practice, believe that “embedded” is a significant feature of local social work that can make up for its developmental deficiencies, and its generation and development have inherent rationality. However, due to the administrative intervention of China’s bureaucratic system, the development of professional social work is slow, and a series of practical difficulties encountered by social workers in the process of service make the professional social work and the administrative system appear “bidirectional to embed the spectrum.” Based on this, the development path oriented by the “state–society” relationship, including both country and society, has become a feasible way to improve the existing embedded development dilemma. To sum up, as one of the important ways to realize the professional development of social work, scholars have conducted different degrees of research on the “embedded development” of social work from the level of theoretical analysis and practical exploration, and hope to find the healthy development of China’s social work in China. These studies, especially the embedded development path of social work oriented by the “state–social” relationship, provide a useful reference for the research ideas of exploring the institutionalized embedding of social work to enhance its specialization. This chapter focuses on a pilot project of social work professional services embedded in child welfare institutions. As an important practical field, social work has entered the vision of child welfare institutions because children in welfare institutions as special social groups, which led to the lack of early family environment, family affection, and education, and result in the imbalance of social development, lack of interpersonal communication skills, poor adaptability, and other characteristics, get care and help from the party and the government and all sectors of society. Children’s welfare institutions focus on raising abandoned babies, orphans, rescued children, and children of prisoners. There are personalized differences in children’s physical, psychological, and cognitive development of children, facing diversified needs such as parenting, medical care, rehabilitation, and education. At the same time, it faces the needs of personalized resettlement, such as centralized parenting, similar family care, foster family care, and domestic and foreign adoption. Compared with the overall needs of children, the original functions of care (care), treatment (treatment), health (rehabilitation), and (special) education in child welfare institutions fail to effectively respond to children’s emotional needs, developmental needs, and protected needs. In other words, even if there is some response to these needs in the original institutional framework, it is scattered, temporary, and noninstitutionalized, and it is urgent to form a systematic, long-term, and stable institutional arrangement at the institutional level. In other words, even if there is some response to these needs in the original institutional framework, it is scattered, temporary, and noninstitutionalized, and it is urgent to form a systematic, long-term, and stable institutional arrangement at the institutional level. Professional service method of case management in social work emphasizes cross-professional cooperation and multilink resources, which can better meet the needs of healthy growth and

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development of welfare institutions, and create a better development environment for disabled children in welfare institutions, so that they can reshape their healthy personality and return to social life as soon as possible. On the whole, China has been lacking a unified understanding of the scope of responsibility and power of social work in child welfare institutions. As a result, local child welfare institutions appear “social work is a brick, where there is a need to move where” situation—social workers carry out all kinds of work in volunteer service management, difficult case solving, group activities, or group work, with different results. Then, as a professional helping profession, what is the service status, content, and effectiveness of social work in the development process of embedding the service system of child welfare institutions to promote the professional level? How can we do a better institutionalized embedding? These are the questions that this chapter tries to respond to.

Case Introduction and Research Methods Case Introduction In 2016–2019, the China Children’s Welfare and Adoption Center, relying on the Ministry of Civil Affairs, and the Children’s Research Institute of China Youth University of Political Affairs carried out the demonstration project of social work professional service model of five child welfare institutions: Z City Children’s Welfare Institute, W City Children’s Welfare Institute, WL City Children’s Welfare Institute, N City Social Welfare Institute, and NX Children’s Welfare Institute. The five child welfare institutions that have the foundation of professional social work development, located in the central, east, west, north, and southwest parts of China, are respectively selected as demonstration institutes. The project is mainly carried out under the background of the uneven development level of social work in China’s child welfare institutions. Due to the different economic and social development levels in different regions, the local children’s social work services are also facing different degrees of difficulties, for example, the lack of professional ability of social workers, serious fragmentation of services, disconnection from the care and healthcare of child welfare institutions, the lack of core business of social workers, the lack of a standardized and complete social work service process, all these directly affect the role of professional social work and restrict the quality and effect of service for disabled children. Therefore, in order to explore the local social work service and supervision mode, the project has set up a supervision team from chief supervision to local supervision. The main purpose of this study is to explore an institutionalized embedded path suitable for local social work from the project on the basis of project practice and scientific evaluation, so as to improve the professional level of social work development.

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Research Method This study adopts the case study method, which mainly takes the practice of the social work resettlement service model pilot project of child welfare institutions in five welfare homes since 2016, and focuses on analyzing the different action logic and internal mechanism of social workers embedded in the existing service system of welfare homes before and after the implementation of the project. In terms of data collection, this study mainly used participatory observation method, in five welfare homes to inspect the life of the service objects, contacted and cooperated with the person in charge of the welfare homes, obtained information, designed the survey outline and observation table, and observed the service objects by using personal senses and auxiliary tools, and interview method to obtain relevant empirical data. Among them, as a supervisor of the project, the author went to various welfare homes many times to understand the development of the project during the observation of the practical actions of social workers. The interviewees mainly involved five welfare homes and conducted in-depth interviews with the general supervision, local supervision, and management staff of local children’s welfare homes and social workers of local children’s welfare homes in the relevant service work of the welfare homes. Among them, the selection of samples takes into consideration the age, identity, position, education level, and other factors of the subjects. The sample size is based on the saturation of data meeting the demand, and those who meet the screening criteria and voluntarily participate in the interview are taken into consideration. We mainly understand the overall project system and promotion of children’s welfare homes, and accordingly, analyze how the pilot project of social work resettlement service model of child welfare institutions promotes the professional level of social work through the institutionalized embedding path. In terms of research reliability, this study adopted a triangular validation method to ensure the reliability of this study. We collect the observations and explanations of the situation from multiple perspectives or positions, such as frontline social workers, supervisors at different levels, and institutional managers, and compare them, so that each party in the triangle mutual certification method can have more sufficient information to test and revise the opinions.

 he Practice Evolution of Social Work in Child Welfare T Institutions and Its Internal Logic  efore the Placement Mode Lands: Weak Autonomy Embedded B in Social Work in Child Welfare Institutions In resettlement mode before the ground, although the welfare homes also set up the social work in our service jobs, due to the lack of corresponding institutional norms, financial security, and school orientation function of the department of social work

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science, social workers in practical work embedded in the existing administrative service system present a state of “weak autonomy,” that is, the practice of social work has a low initiative embodied in the following aspects. Professional Service Boundaries Are Unclear Due to the small number of professional social workers in child welfare institutions, the development of social work services is one-sided, and then leads to the professional service boundary (service scope, service object, serviceability), which is not clear. In the Z hospital, the early functions of the social work department were positioned to manage the volunteer services outside the hospital, carry out social work services in the hospital, and carry out services for children in community difficulties. Among them, the volunteer management work is to manage the volunteer resources outside the hospital into the hospital, match the needs of volunteer service in the hospital, and carry out volunteer service. Specifically, answering volunteer consultation calls, registering volunteer information, and training volunteers, volunteer service process supervision, and volunteer service affect evaluation. The social work service in the hospital is children’s case management service and decompression activities of staff. The service content of community children in distress is a public welfare project for children in distress set up for the transformation and exploration of child welfare institutions. The project is run by full-time social workers. From the above service content, it can be seen that the job responsibility positioning of volunteer management is relatively clear, but at that time, it was not a professional expression and could only be regarded as a relatively standard position or work arrangement. The volunteer management work can be done very well even if it is placed in an administrative department. Outside hospital service for children in distress is an independent project, which is not confused with hospital service and will not be compared here. However, the hospital social work services have no clear boundary in the choice of service objects, that is, which objects need to carry out services, and often determine one or two parenting departments, which will allocate the service objects according to the number of social workers, and conduct regular case management follow-up. When the service objects of other departments only show obvious problems, such as stealing and fighting, can the social workers provide follow-up services. There is also no boundary standard for the serviceability of social workers, what services can be done within the ability scope of social workers, and how to focus on the services of children and workers. As a result, children’s fellowship activities require social workers, workers’ league building, and even guests. None of these can reflect the professionalism of social workers, nor the embodiment of professional results. This also led to the stereotype, or the self-­deprecation, of social workers in the early public, “Social workers do activities, social workers are bricks, where you need to move.”

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Professional Service Activities The activity of professional services occurs not only in child welfare institutions, but also in many government purchases of services in the early project exploration. But for the aforementioned reasons, social work services in early child welfare institutions. There are no established assessment criteria for early social work services in child welfare institutions, which indicates that there is greater freedom in service mode and content, but at the same time, such freedom also conflicts with professionalism. The service objects in the organization include children and employees. In order to highlight the functions of the department and form influence, social workers often choose less professional but more influential activities to carry out services, such as children’s game group activities, employees’ group building activities, volunteer service activities, and theme publicity activities. Most of these activities are one-time and unsystematic and without professional investment. They can be done well by special education teachers, but it can reflect the sense of existence and influence of the social work department. Lack of Cross-Departmental Communication in Professional Services Cross-departmental communication is an effective safeguard measure to improve the effect of social work services, and it is applicable in any field. The social work services of child welfare institutions require the participation of different professional service subjects in many links, such as evaluation, planning, and follow-up, and they require cross-departmental communication. However, before the resettlement service mode, the communication was limited to the communication of administrative affairs. In most cases, the various departments acted independently, and there was no interservice. For example, in the evaluation process of hospital Z, social workers have evaluation, and medical treatment, rehabilitation, special education, and other departments also have evaluation. Each major makes their own evaluation from their own evaluation dimension, and there is no connection between each other; the evaluation goal is from the perspective of the major, inconsistent, children’s real needs that are difficult to be found. The Social Worker Growth Mechanism Has Not Been Established The growth mechanism of social workers in child welfare institutions is mainly manifested in the supervision mechanism, continuing education mechanism, and career promotion mechanism. Take the Z Institute as an example. Before the implementation of the resettlement mode, the supervision system was not established after the establishment of the social work department, and there was no supervision for a long time. The specific service of the social workers depended on the consultation between the department and the social workers, and the problems encountered were often solved by the internal discussion of the department. In terms of

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continuing education, in addition to the need for individual social workers to obtain the qualification certificate, they will participate in the pre-examination training conducted by the Civil Affairs Bureau, and have few opportunities to go out and invite to listen to special social work-related training and field visits. In addition, self-study is determined by the individual consciousness of social workers. Career promotion institutions did not establish the social workers for professional and technical personnel career promotion mechanism. The early social work and administrative management positions are to apply a fixed salary standard. There is no assessment standard and the high grade promotion system of junior high school. The only point that can reflect the value promotion is that the seniority salary will rise year by year.

 fter the Implementation of the Resettlement Mode: A The Structural Optimization of Social Work in Child Welfare Institutions In 2016, the child resettlement model was officially implemented in the welfare home, and the original social work professional services began to integrate with the child welfare business, initially realizing the integrated service of child welfare services. On the one hand, the organizational structure, service concept, standard norms, and role positioning of child welfare social work have been established from the system. On the other hand, we should integrate the social work post structure, integrate the original foster care department and social engineering together, break the original service barriers, and broaden the service content, so as to better provide comprehensive services for children. In this context, the embedding of social workers in welfare homes has changed in the following ways. Department Setting and Post Setting Tend To Be Scientific and Reasonable By verifying the important role of social work in the service of child welfare institutions in the exploration, we believe that in order to meet the service needs of all objects, social workers need to be strengthened, and the quality of social workers needs to be improved, so the department settings and post settings from the organizational structure have been improved. The number of social workers in the social work department has been specifically increased, from 10 people 16 years ago to 30 people after the implementation of the model. The personnel qualification requirements of the post setting must be certified social workers, which ensures the quality of the social work team. The department is divided into different service groups according to the placement mode of the service objects, such as institutional placement social worker group, foster care placement social worker group, adoption and resettlement social worker group, and has set up group leaders. The proportion of

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the team members is also dynamically adjusted according to the needs and number of the service objects. The ratio of social workers and service objects has been adjusted from 1:80 to 1:40, which greatly improves the professionalism and effect of the service. Scientific and reasonable department and post setting have also defined the fifth major in the organization—social work—and clarified the relationship between social work major and other majors. Under a unified “resettlement service,” we established a team with common goals, common work norms, and standards—social worker team! Service Standards and Specifications Are Clear A clear and standardized service standard has been formed in the model exploration, providing specific service guidance for social workers in child welfare institutions. In the standard, the scope of service objects, service content, service principles, service methods, and service tools are all clear, which not only ensures the clear service boundary and standard service activities, but also ensures the professionalism of social workers and the effectiveness of the service. Through the standardized service, the social work of child welfare institutions has also been vigorously developed and has achieved certain results. For example, after the implementation of the model, the child welfare institutions in Z City have produced many excellent cases and excellent projects through standardized services, including foster social workers group case “I want to sing with you-city children welfare home foster children music growth group,” “let love not alone—city children welfare home foster parents support group,” class family social workers “out of the trough, let the heart reproduce sunshine—disabled children service case,” “hear love—hearing children case service,” adopt social workers “room tree people technology application in children case service,” community children social integration project, and so on. These cases were also published in magazines such as Social Welfare and China Social Work, and the project has won the provincial and municipal children’s public welfare project awards.  elevant Service Guarantee Mechanisms Have Been Established R and Improved In order to ensure that every child in the welfare institutions can receive standardized and high-quality social work services, there are corresponding institutional guarantees and standards for each service link. Service mechanism is the guarantee for the smooth and effective development of service. Establish a resettlement service working mechanism, including admission reception system, resettlement evaluation system, working mechanism of resettlement service plan, foster care/adoption family recruitment, evaluation, training mechanism, and follow-up service mechanism after resettlement.

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Establish a supervision mechanism for institutional placement, including institutional placement supervision structure, supervision responsibilities, supervision content, supervision methods, follow-up service guide, and other contents. The establishment of social resource management mechanism and social resources is to respond to the needs of meeting the needs, all can be provided and enough to transform into the specific service connotation of the objects, mainly including human resources, material resources, financial resources, services, site space, etc. The voluntary service management mechanism of welfare homes and the mutual aid service management mechanism of foster care families are both the scope of social resource management mechanism.  he Growth Mechanism of Social Workers Has Been Established T and Improved It is clear above that the growth mechanism of social workers is manifested in three aspects: supervision, continuing education, and career promotion, and the institutional governor director has been established through model exploration—the internal supervision system of department supervision (administration + business) institutions, and the ratio of supervision and social work reached 1:2. In terms of continuing education, an internal professional training curriculum system has been developed. By encouraging social workers to participate in case competitions, project competitions, and seminars, they can participate in various trainings of social work associations, supervise training and academic education at all levels, and use resources outside the organization to carry out continuing education of social workers. Continuing education has made remarkable achievements in China. Taking Z City child welfare institutions as an example, there are 39 social workers, all with certificates, among which intermediate social workers account for more than half, and 9 people are under municipal supervision through continuing education. In terms of career promotion, the assessment standards of social workers have been set up, and the promotion mechanism of primary, middle, and high rank levels directly linked to the salary level, encouraging social workers through clear path design and salary embodiment, and effectively guaranteeing the quality of social workers.

I nstitutional Embedding: The Development Characteristics of Local Social Work Specialization As a demonstration project for the improvement of the professional social work services of the child welfare institutions, its demonstration significance lies not only in the child welfare institutions, but also in the typical significance for the specialization of the current social work in China in a broader sense. Combined with the above analysis, on the basis of summarizing the development process of social

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workers in child welfare institutions, this chapter further proposes that the institutional embedding of social work is the characteristic of the professional development of local social work. That is, the state is guided by the concept of children’s rights, with the goal to meet the basic needs of children’s safe and healthy growth, and based on the institutional system. Professional social work with children will be embedded in the field of local children’s social work practice, clarifying the professional positioning of social work, effectively linking environmental resources, and giving full play to the professional advantages of social workers, so as to provide the best services for disabled children in child welfare institutions throughout the whole process. At the same time, through the in-depth analysis of the child placement mode, the study found that the institutionalized embedding of social work in child welfare institutions is mainly manifested in five characteristics: the institutional organization, the autonomy of professional activities, the necessity at the demand level, the exclusivity of functional characteristics, and the complexity of service technology (Fig. 3.1).

 he Institutionalized Organization Is an Important Guarantee T for the Professional Development of Social Workers Organization is an important support to support the institutionalized embedding of social work to enhance the professional level. In this project, a basic condition for social work in child welfare institutions to change from “weak autonomy embedding” to “institutionalized embedding” is that the project establishes the stable operation of three teams—management team, executive team, and quality assurance team—and the establishment and improvement of relevant systems and norms, including the organizational structure, service concept, standards and norms, role positioning, post

Unconventional tasks that require professional

Complexity

expertise to solve The completion of the

Exclusiveness

Development characteristics

service task is essential Especially important to

Necessity

the service objects Discretionary power

Autonomy

Sense of organization

Institutionalized organizational guarantee

Fig. 3.1  Characteristics of the professional development of local social work

Core features

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division, and other contents of child welfare and social work. Due to the embedding of the organizational system, the necessity of social workers at the demand level, the functional exclusivity, the complexity at the technical level, and the autonomy at the professional level are all demonstrated. Therefore, in the process of institutionalized social work embedded in professional development, it is necessary to play the role of national coordination, provide the corresponding organizational guarantee for social work embedded in other related fields, give full play to the professional level of social workers, and promote the professional development of social workers. After the complete and orderly organizational system is embedded, it is also necessary to pass through the administrative power to promote the implementation of the organizational system from top to down, so as to play a better role. As a foreign major, social work’s coordination and integration with local work needs a certain process. Whether other departments are willing to listen to the advice of social workers, on the one hand, shows the professional ability of social workers, but on the other hand, whether there are institutional constraints on the work coordination between social workers and other departments. The China Child Welfare and Adoption Center in this project plays the role of administrative guidance and professional service supervision and project evaluation throughout the project. The five demonstration institutes are responsible for the implementation of the project and also play the role of project demonstration in the area of the institute. The organizational structure is complete, the position of the project social worker is clear, and the responsibilities are stable. The administrative force and the professional team led by the president and vice president of the demonstration institute reach a consensus for the same goal, creating a good cohesion. Such an organizational structure has a better performance of point to surface, increasing radiation, and increasing the coverage and benefits of the project. Specifically, the demonstration institute has established an administrative organization system in which the “head” president is responsible, and a vice president is in charge of the pilot project management. Under this system guarantee, the model institute has determined the social work professional positioning, service content, special service quality assurance, and other systems; gave full play to the role of professional concepts, knowledge, and methods of social work, moreover, according to the local actual needs of the priority ranking; and selected the best practice field, the localization experiment, so as to play a demonstration effect to ensure the effectiveness of the project implementation.

 he Independent Status of Social Workers and Their T Professional Activities Highlight the Autonomy of Their Professional Development Autonomy, that is, to achieve a unified understanding of what social work is and what role social work should play in child welfare institutions at the level of concept and cognition, and to recognize the autonomy of the unique scope of responsibility

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of social workers, is the basis of the concept of social work. The establishment of autonomy is the core task of embedding social work institutionalization and improving the professional level, and also the core of the demonstration significance of this project. In child welfare institutions, social work needs to be independent of other departments to reduce the nonbusiness work tasks within the work system of child welfare institutions and avoid the superiors from obstructing the normal work process of social work without fully understanding the social work, thus causing unnecessary trouble. As a traditional function of child welfare institutions, raising health education has been widely accepted, but the scope of social work in child welfare institutions has not been unrecognized. For a long time, social workers in local child welfare institutions have carried out various work in volunteer service management, difficult case solving, or group work, with different results. In the face of these problems, one of the important features of this project is the unified understanding of the role that child welfare institutions should play, and the recognition of the autonomy of the unique scope of responsibility of social workers. Under the guidance of the national concept of parental rights, it is confirmed that the resettlement service is one of the core businesses of the child welfare institutions, and the full-­ time social work departments, professional social work positions, and a complete supervision and rank promotion system are established in the child welfare institutions. The social work service mode adopts the resettlement service process from children’s admission reception, resettlement demand evaluation, resettlement service plan formulation, and tracking after resettlement to case closure.

 he Needs of the Comprehensive Development of Disabled T Children Reflect the Necessity of the Professional Development of Social Workers This case is a typical case of social work majors promoting the satisfaction of child developmental needs after being embedded in the work system of child welfare institutions. In child welfare institutions, the professional intervention of social work presents essential characteristics. From the macro level, in the process of rapid social change, how to establish and improve China’s child welfare system, and let children take the lead in enjoying the fruits of reform and opening up, is not only the goal of the Chinese government, but also the desire of every parent. Specifically for child welfare institutions, after the basic survival needs are met, children’s emotional needs and developmental needs begin to receive more attention. The social work placement service model of child welfare institutions not only meets the basic survival needs of children, but also focuses on how to provide better services to children, so as to promote the overall development of children. Professional social work services will combine children’s respective strengths to leverage their potential and link them to the most appropriate resources, so it is very necessary for social workers to function in children’s welfare homes. At present, China’s child welfare

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system is in the process of transformation from filling up type to moderate inclusive type, and the functions of child welfare institutions are also in the process of expansion and transformation. In this transition process, more children in community distress and their families are included in the service scope of child welfare services. Child welfare agencies are an important force among the service providers for these children in troubled situations and their families. The professional development of social work services in child welfare institutions helps us to improve the original service loopholes and deficiencies, improve the quality of welfare services for children in distress, and help the disabled children to meet the needs of all-round development.

 he Characteristics of All Social Workers and the Service T Quality Guarantee Mechanism Show the Exclusivity of Professional Function The concept, role, responsibility, and other professional connotations of social workers determine that the role of social workers is exclusive, and the completion of service tasks belongs to them. This exclusivity is different from other professionals and highlights the important characteristics of social work professional services. First, in child welfare institutions, the goal of social work services is to ensure that every child lives happily with dignity and dignity, realize their maximum potential, promote children to enter the environment suitable for their happy life, and ensure that children receive the best care in this environment. The requirement behind this goal is the need to assess what is the best environment for a child, to find the environment, match the “environment” with the child, and ensure that the child is in the best care in the environment. Thus, the service leader needs to pay attention to children’s whole-person development and provide full service, and other departments within the organization are only children on one aspect, provide one-way service, but professional social workers can ensure that the focus is on children’s whole-­ person development and have the ability to provide full service, for example, in the evaluation process of children, the evaluator has the theoretical and practical knowledge of human behavior and social environment, brain structure and physiology, attachment theory, children’s complex trauma, and their intervention. It is impossible to complete this complex task without professional training, and social workers are the professional role, the only person to dominate the entire placement service. The key to distinguishing social workers from other departments is that social workers not only follow up the whole process, but also comprehensively evaluate and heal children’s physical and mental social development, so as to finally promote the socialization of children and realize the healthy play of social functions. Secondly, in addition to the exclusivity of serviceability, the guarantee mechanism of service quality is also another evidence of the exclusivity of social work service. In this case, the following service quality assurance mechanisms have emerged.

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First, cross-departmental communication mechanism. Child welfare institutions have established a cross-departmental communication mechanism of “taking social work as the leading role, coordinating parenting, medical care, education, rehabilitation and other departments and majors, through cross-professional joint meetings and other communication methods, jointly carry out various services, and jointly solve the multiple needs and problems of children.” The specific forms of expression are the interprofessional child placement joint conference and the cross-­ professional difficult case discussion meeting. Second, the social worker training mechanism. Training mechanism has been clear in the training objectives (promote children have a family), trainees (project advocacy, including head and administrative leaders personally receiving training), training design specialization (invited have a rich practical experience of institutions, supervision, and establish standardized training system), and other specific content to ensure the training results are good. The specific content—training objectives (promoting children to have families), trainees (projects advocating administrative leaders including top leaders to personally receive training), specialized training design inviting institutions with a rich practical experience, supervisors, and establishing a standardized training system—is made clear in the training mechanism to ensure the effectiveness of the training. Taking the training of child welfare institutions in Z City that I participated in as an example, during each training, the director of the institution personally took charge of the whole process of learning, in which the administrative leaders realized the internalization of the values and theories of social work, and improved the efficiency of system implementation. Third, the internal and external supervision mechanism. Supervision mechanism is the core mechanism to ensure the service quality of the project, and it is also an important principle throughout the project. The establishment of the three-level supervision mechanism of governor supervision, local supervision, and welfare home internal supervision not only ensures the service quality of the project, but also promotes the cultivation of social work education teachers in China in the form of projects and ensures that the development of children’s social work is not deformed or out of shape. Fourth, the social work service promotion meeting (case discussion meeting) mechanism. In the pilot project of social work resettlement service model for child welfare institutions, in addition to offline training, various institutions will also hold monthly online social work service promotion meetings (case seminars). The contents of the meeting are not limited to discussing typical cases, exchanging experiences and practices, and so on. By pooling the wisdom of the group, we can provide ideas for the scientific solution of the cases, promote the experience and exchange of various institutes, and comprehensively temper and improve the professional ability and service level of the social workers in the demonstration institute. In general, the exclusivity at the functional level ensures the professionalism and is irreplaceable in the process of social work embedding, which is another essence of the institutionalized embedding of social work.

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 he Establishment of Project Design and Service Process T Highlights the Complexity of Social Work Complexity constitutes another important element of institutionalized social work embedded in child welfare institutions and improving its professional level. In this case, specialized project design and standardized service processes are technical guarantees for the complexity of social work, including the project objectives, project specifications, mode, service mechanism, and other aspects of the professional design and scientific, reasonable, standardized service process and other content. In the daily work of child welfare institutions, social workers need to coordinate various departments to do their work together under the requirements of various systems. First of all, in terms of project design, the project from the very beginning forms the goal, norms, mode, service mechanism, and other aspects of the professional project design. Specifically, set the goal of the project is to help children maximize their potential and enter the environment most conducive to their healthy growth; and provide family resettlement services for children from the standard level of services. The service mode is positioned as the resettlement mode, that is, under the guidance of social workers, through the way of case management, to ensure that all children can achieve the best resettlement work mode. The service mechanism is set up as the resettlement service working mechanism, cross-department communication mechanism, social resource management mechanism, etc. Secondly, in terms of the service process, the process of resettlement service includes six links: admission reception, resettlement demand evaluation, resettlement service plan, resettlement service intervention, resettlement service follow-up, and leaving the hospital and case closure. This process establishes the procedure and content of social work professional service, social work professional service responsibilities and division of labor, social work professional post setting, and layout of social work and social work professional service guarantee mechanism, and puts forward the requirements of social work professional service positions and social work professional service work objectives. Taking this project of Z Children’s Welfare Home as an example, its normative professional project design and standardized service process are shown in Figs. 3.2 and 3.3 respectively. It includes how to connect and cooperate with social work and other professional services, procedures and contents of professional social work professional services, responsibilities and division of labor of social work professional services, and post setting and layout of professional social workers.

Summary Based on the working and living conditions of the interviewees and their attitudes, views, and practices toward the specialization of social work, this study finds that as a professional occupation the realization of the specialization of social work needs

observation

the case

assessment

Educational

assessment

Placement

assessment

Rehabilitation

Source: Z City Children's Welfare Home

evaluation

Medical

Admission to

Medical

service

Medical

Services

ment

Resettle

nce on

Confere

Joint

The

service

Rehabilitation

Intervention

Plan and

Resettlement

service

Medical

placement

Institutional

Quasi family

foster care

Family

adoption

follow-up

service

ment

Resettle

services

Parenting

case

the

Close

services

adoption

Foreign

Education

Domestic

Fig. 3.2  Normative professional project design. (Source: Z City Children’s Welfare Home)

Abandoned children

prisoners

Children of

children

The abduction of

Orphan

Foundling

Death

adulthood

Social placement in

welfare institutions

Transfer to other

of origin

Return to the family

according to law

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report is filed

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Admission to the case

1. Check the admission procedures; 2. Check the children's body and personal belongings; 3. Handle the admission procedures and receive the case for filing; 4. Handle the announcements and carry out the family

Placement services Demand assessment

1. Physical condition assessment (medical rehabilitation assessment); 2. Intellectual development assessment (education assessment); 3. Social development assessment (social worker assessment); 4. Hold a cross-departmental settlement service joint meeting, form the settlement resolution and copy it to the relevant departments

Resettlement service Plan formulation

Placement services Plan implementation

Follow-up tracking

Close the case

Social workers make the resettlement service plan according to the resettlement resolution (determine the resettlement method, steps and working time limit).

1. Adoption and foster care placement: recruiting families, evaluating families, training parents, family matching, integration, handling procedures, and completing placement; 2. Institutional placement: preparing beds and items, training caregivers, receiving children to stay, and promoting the relationship between children and caregivers; 3. Class of family placement. 1. Adoption tracking service; 2. Foster care tracking service; 3. Agency placement tracking service; 4. Class-family placement tracking service.

1. Settlement of institutional resettlement; 2. Settlement of foster care 3. Adoption settlement; 4. Settlement of similar families 5: Reasons for case closure: family search, adoption, transfer to other welfare

Fig. 3.3  Flowchart of resettlement services of child welfare institutions

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five main characteristics: organization, autonomy, necessity, exclusivity, and complexity. Among them, complete and orderly organization is an important basis to ensure the institutionalization and embeddedness of social work, which together with professional autonomy constitutes the core characteristics of social work specialization. The necessity, exclusivity, and complexity of professionalism will, in turn, promote the organization and autonomy of professionalism, which is the inevitable way to improve professionalism. However, it is undeniable that there are still some shortcomings in this study, such as insufficient scale of respondents and insufficient connection between theory and practice. In the future, we will continue to optimize and improve the research program.

 ction Response: The Path Optimization of Social Work A Professional Development This project responds to the deep-seated problems of the development of social work. At present, there are some structural and deep-seated problems in the development of social work in China, including unbalanced development, insufficient professional positions, insufficient recognition, and improper role positioning. Structural problems need top-level design from the structural level, and this project has such characteristics. The project organizer, the China Child Welfare and Adoption Center, conducts integrated design and rhythm control at the national level. Specifically, the China Child Welfare and Adoption Center conducts the development, design, implementation, and evaluation of the professional social work service mode of child welfare institutions, and the whole project is implemented step by step. In the process of promoting the institutional construction of social work embedding, the following six stages can be carried out: in the first stage—understand the development status of social work in children’s social welfare institutions, find problems, analyze problems, and plan projects. In the second stage—the project selection site, carry out the field baseline research, and select the project partners to clarify the responsibilities, rights, and obligations of all parties; In the third stage—form the project framework and project manual, transform social work theory into practice, and develop scientific, feasible, and standardized workflows, tools, and forms. In the fourth stage—the core implementation stage of the project, including the early test of the project, the formation of the system and mechanism, full-staff centralized training, hierarchical supervision, daily business training, etc. The fifth stage—the project is further refined, formulate standardized industry standards, and summarize and evaluate the effect of the project. In the sixth stage—we plan to arrange and sort out the project results and materials, give full play to the leading and demonstration role, and the project points will drive the peer

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institutions to expand the promotion in the province. The center is responsible for the research and development of accurate organized project structure and manual project content, and committed to the nationwide publicity and promotion and the recognition and promotion at the government level. Establish institutional regulations from these six aspects to achieve the goal of standardizing work processes, but also can clarify the post setting of social work, give play to the professional advantages of social work, to provide the whole process of professional services to the children lost in the child welfare institutions, and successfully achieve the best placement. In the process of institutionalized embedding of social work, we should play the role of national coordination and provide corresponding mechanism guarantee for the embedding of social work in other related fields. Its essence is the embodiment of the national care service system for children.

 heoretical Response: The Model Construction of Social Work T Specialization Path On this basis, the author constructs the professional development path of local social work (as shown in Fig. 3.4). The first stage (initial stage): the organization and autonomy at the institutional level determine the professional status embedded in social work specialization, while the necessity, exclusivity, and complexity at the service level establish the professional content embedded in social work. This is the foundation stage to lay the professional development path of social work. The second stage (formation and development stage): under the combined action of professional status and professional content, the professional identification of social work, including successful professional identification and unsuccessful professional identification. This is the key stage to realize the professional development of social work. The third stage (stable stage): Once the embedded subject shows a professional identification of social work, it can be regarded as a successful professional embedding of social work. Specifically, it includes the specialization embedding of the client and the employer. On this basis, the specialization of social work can be further developed.Otherwise, it is regarded as the failure of the professional embedding of social work, and professional embedding should be done on the basis of professional reflection. This stage is the only way for the professional development of social work to move from stability to maturity. At present, the development of social work specialization in mainland China presents a state of diversified coexistence, both in the practical field of the initial stage of specialization but also in the practical field of transition from the stable stage of formation and development stage.

:

Initial stage

Stage

Complexity

Exclusiveness

Necessity

content

Professional

:

Formation and development

Stage

reflection

Professional

identity

identity

Unsuccessful professional

identity

status

Professional

Successful professional

Professional

Fig. 3.4  Professional development path of local social work

social work

embedding of

The professional

Autonomy

Organization

Stable stage

Stage III:

identity

Employer professional embedding

Employers for this

A professional embedding of the client

Client identity

failed

Specialization embedding has

social work

The professional embedding of

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 he Coordinated Development of Welfare System, Social Work T Education, and Social Work Specialization It is found that the professional development of social work cannot be separated from the path of specialization, and the path of specialization depends on the institutionalized environment. The pilot model of social work placement service in children welfare agencies explores the professional development path of social work from a professional perspective, which is an important embodiment of the national service system of caring for children. Practice has proved that this professional path not only follows the principle of service object orientation, but also roots the concept, process, norms, and standards of professional services in the real environment, thus realizing the construction and promotion of local welfare system. It can be seen that the professional development path of social work consists of five mechanisms: necessity of demand, exclusivity of function, complexity, professional autonomy, and organizational embeddedness. From the perspective of epistemology and methodology, the current professional path of social work specialization must cover the construction and promotion of extra-project welfare system, as well as the synchronous development of social work education.

References Bin, L., & Yifei, W. (2014). Organization and specialization: The double evolution of social work in China. Social Work, 255(06), 3–8+151. Brian, U. (1997). Social structure and competition in interfirm networks: The paradox of embeddedness. Administrative Science Quarterly, 35–37. Dinghong, C. (2015). The connotation of social work specialization and the professional-state relations of social work in China. Hubei Social Science, 347(11), 56–59. Fang, Z. (2015). The connotation, subssence and path selection of social work specialization. Social Sciences, 420(08), 73–80. Fei, P. (2018). The professional logic of social work under the relationship between rights and power. Journal of Central South University Social Science Edition, 24(04),144–152. Granovetter, M. (1985). Economic action and social structure: The problem of embeddedness. American Journal of Sociology, 91, 481–510. Greenwood, E. (1957). Attributes of a profession. Social Work, 44–45. Jinmeng, G., & Yangdi, H. (2021). Establishment and specialization: The development experience and enlightenment of social work in Sweden. Social Work, 293(02), 69–82+109. Jun, W., & Jieqiong, L. (2018). Social work specialization: How possible? Why possible? Hebei Academic Journal, 38(04), 156–163+174. Karpetis, G. (2014). Clinical social work professionalization perspectives among mental health social workers. European Journal of Social Work, 17(2). https://doi.org/10.1080/1369145 7.2013.802664 Li, M., & Guolei, Z. (2021). The logic road of social work localization: Based on the perspective of “structure- -mechanism”. Social Science Digest, 72(12), 82–84. Li, T., & Mei, F. (2021). Structural internalization and reflection construction: A local review of the professional logic of social work. Theory Monthly, 469(1), 113–123. Min, T. (2016). The professional logic of project service: The local pathway of social work specialization. Social Work, 264(03), 25–32+124–125.

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Min, T. (2020). The practice turn of space thinking: Why local social work specialization is possible. Social Science Journal, 249(04), 93–99. Peilin, L. (2005). Sociology theory and experience, social sciences (p. 17). Academic Press. Polany, K. (1992). The economy as instituted process (pp. 29–51). West View Press. Sharn Z，Dimaggio P. Structure of capital: The social organization of the economy. : Cambridge University Press, 1990, pp. 29. Shidong, L. (1999). Embedded sex and relationship contract. Sociological Studies, (4), 77–90. Shu, F. (2009). On the professionalization and professionalization of social work. Fujian Forum (Social Science Education Edition), (12), 60–61. Sibin, W., (2011). The embedded development of social work in China. The Social Science Front, 188(02), 206–222. Sibin, W., & Zengyuanqi, R. (2009). The development of China’s social work under the background of harmonious society construction. Chinese Social Sciences, 179(05), 128–140+207. Weiss-Gal, I., & Welbourne, P. (2008). The professionalization of social work: A cross-national exploration. International Journal of Social Welfare, 4, 281. Wu, Y. (2018). “Despecialization” of social work: Theoretical tension and practical rebel in the process of specialization. Hebei Academic Journal, 38(04), 168–174. Xiaohua, C. A. I. (2021). Western experience and local practice: Logic of principal action in the process of social work in alization. Social Work, 297(06), 45–54+103–104. Xuanguo, X., & Jinglian, H. (2020). Political Society is related to the relationship between Party and Society: The Situation Change and Theoretical Change of Social Work Intervention in Community Governance. Social Science, 475(03), 68–85. Xuanguo, X., & Qian, L. (2020). How to develop embed: The change and restructure of embedded view in the process of social work localization. New Horizons, 217(01), 50–58. Xuanguo, X., Xuezhen, T., & Jiekai, S. (2021). Transplantation from external to local consciousness: The theoretical logic of China’s social work development. Learning and Practice, 452(10), 119–129. Yana, F. (2021). Two-way embedded Spectrum series: An analysis framework for government purchase of social work services. Journal of East China University of Science and Technology (social science edition), 36(4), 36–53. Yuxin, L. (2021). An analysis of the connotation, dilemma and path of social work specialization. Society, 389(04), 30–37. Zhifeng, T. (2017). Localization and specialization: The integrated development of social work in Zhejiang province. Social Work and Management, 17(05), 24–29.

Chapter 4

Effectiveness of Social Work Supervision: A Qualitative Case Study and a Framework of Structure– Relationship–Power Analysis Wenxiao Ji, Haibo Lin, and Ruirui Zhu

The report to the 19th National Congress of the Communist Party of China said that we should improve the public service system, ensure people’s basic living standards, build a social governance pattern featuring joint contribution, joint governance and shared benefits, and constantly meet the people’s ever-growing needs for a better life. Government purchase of services has become an important mechanism to promote the transformation of government functions and improve social governance. In recent years, government funding for social work services has gradually increased. Take Z City as an example. By the end of 2016, the amount of social work investment in Z City was five million yuan, and it had increased to 60 million yuan by the end of 2020. With the rapid development of the government purchase of services, the social work supervision service is one of the important mechanisms for the government to ensure the service quality and improve the service level in the purchase of social work services. At present, China’s social work supervision and research are on the rise, but there are still shortcomings: first, small quantity; second, lack of local experience research; and third, lack of qualitative research (Hongying & Wanlin, 2019). Therefore, the author plans to adopt the method of qualitative research to conduct an in-depth analysis of the different supervision modes in Z City and deeply explore the influencing factors of the effectiveness of social work supervision from the perspective of “structure–relationship–power,” which has both theoretical value and practical significance. Based on the shortcomings of the current research and the need for supervision practice, this chapter proposes and explores the following important W. Ji (*) · R. Zhu Henan Normal University, College of Social Affairs, Xinxiang, China H. Lin Henan Institute of Science and Technology, Xinxiang, China © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_4

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issues. How to better achieve the effectiveness of social work supervision? The specific questions are: What is the current situation and effectiveness of the social work supervision service in Z City? What are the factors affecting the effectiveness of social work supervision? What is the contribution of the existing social work supervision mode in Z City to the local social work supervision theory?

Literature Review In the past, the research on social work supervision at home and abroad mainly focused on three aspects: supervision definition, supervision function, and supervision mode. Foreign research on supervision started earlier, took a long time, and had rich results. At present, the number of domestic research on supervision is relatively small, and the main representatives are Zhang Hongying, Tong Min, Li Xiaofeng, Chen Jintang, and so on. In terms of supervision definition, the academic circle mainly has the following views: one view is that supervision is a distinct entity separate from the recognized conceptual framework of professional social work practices. Another view is that supervision should be defined as the social work practice itself (Bertha Capen Reynolds, 1942; Trecker, 1971; Pettes, 1979). A third, different from these, holds that separating supervision and social work practice is a wrong dichotomy. Social work supervision is different from educational supervision and business supervision, and the latter two focus on hierarchical, competitive, power-based relationships, and it seems that some people are considered to be more important than others (Gardiner, 1989). Domestic scholars take the object of supervision as the fourth view, believing that the supervision of social work in the Chinese local context is project-oriented, which integrates the function supervision of project task execution, the growth supervision of project experience learning and the reflexive supervision of project service situation, and promotes the service consciousness and self-determination ability of the supervision object (Min & Tianqi, 2019). Some scholars are institution-oriented, believing that the goal of supervision is to ensure the normal operation of the organization, improve the professional level and service quality of the supervised people, safeguard the interests of the service objects, promote the growth of social workers, and promote the development of social work professional (Hongying, 2011). In terms of supervisory function, the most classical statement is educational, supportive, and administrative. The corresponding roles are teachers, enablers, and managers. From the history of supervision, supervision originated from administrative management, and then embarked on the development path of teachers and promoters. Initially, supervision was provided by paid agents to administratively supervise the work of friendly visitors. As the knowledge system evolved from the first-hand experience of friendly visitors and supervisors, the role of supervisors extends to the role of method teacher (Bertha Capen Reynolds, 1963). Domestic scholars believe that there are four basic roles (Min, 2006): the designer of

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professional services, the translator of professional service needs, the mentor of daily professional services, and the trainer of professional services. In terms of the influencing factors of the supervision effectiveness, the domestic research is mainly divided into two categories: one is based on the study of social work supervision theory, function, mode, etc., and then describes the supervision effect, for example, Tong Min sorted out the research on the functional classification of foreign social work supervision, and proposed that the effectiveness of supervision has gone beyond the dual interaction between the supervisor and the supervised. As a guarantee to improve the quality of professional service, it is necessary to consider how to maximize the effectiveness of supervision from a systematic and multilevel perspective. The other is to study the effectiveness of supervision combined with a special case. Xie Min took the social work practice in Guangdong Province as an example and believed that the effectiveness of social work supervision is deeply influenced by the agreement state between the supervisor and the supervisor (Min, 2015). Foreign scholars mainly analyze the supervision behavior, supervision environment, and supervision relationship. Some scholars believe that the supervision environment and in-depth social, organizational, cultural, professional, and practice are the important factors affecting the effectiveness of supervision (Kadushin, 1992). From another point of view, from the perspective of the supervision relationship, it is very important to establish a constructive, considerate, and caring relationship with the supervision person to achieve a good supervision effect (Storm et al., 2001). In terms of supervision models, different countries have different models. In Sweden, for example, supervision is conducted mainly conducted by groups outside the institution with the assistance of outside consultants, while in England supervision is conducted within the institution (Beckett, 2006), performed one-on-one by managers or project directors. In China, Zhang Hongying proposed the supervision model of Chinese social work (internship) under the context of multiple dynamics (Hongying, 2019). Chen Jintang proposed six supervision practice models, namely, management model, nanny side model, site supervision model, dialogue model, classic model, and care model (Chen, 2012). Yang Hui et al. proposed that the development of China’s social work supervision mode should be guided by institutionalization, integrate the advantages of the current institutionalized and noninstitutionalized mode, and carry out the standardization of construction (Hui & Sen, 2019). Liao qineng et al. proposed collaborative supervision model emphasizing cultural sensitivity and rooted in community social work (Qineng & Heqing, 2019). Lv Xinping (2019) proposed social work supervision mode of empowerment orientation. Different cities have also explored different supervision models, for example, the “practice supervision + practical supervision” mode formed in Shanghai City, the “internal supervision + external supervision” mode formed in Xiamen City, Fujian Province, and the “Hong Kong supervision + mainland supervision apprentice” model explored in the Pearl River Delta (Wong, 2019). Therefore, previous scholars have carried out a more comprehensive study on the supervision of social work. However, the previous studies have certain limitations.

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First, in terms of the influencing factors of the supervision effect, the previous research discusses more from the micro-supervision relationship or the macrosupervision environment, and the combination of the micro- and macro-level analysis research needs to be strengthened. Second, in terms of research objects, the basic paradigm of foreign social work supervision and research is to investigate the definition, mode, and function of supervision in different dimensions, but it focuses more on the mode of supervision theory. The research of foreign social work supervision in China can learn from its analysis ideas, but it still needs to combine the specific situation of the city in China. To sum up, this chapter will expand the previous research, conduct qualitative research on the social work supervision service in Z City, and deeply analyze the phenomenon that the social work supervision effect is not significant enough from the perspective of “structure–relationship–power.”

Study Design and Case Introduction Research Design This study used qualitative research and was conducted in Z City in 2017–2020. The first author participated in the supervision work of Z City S Bureau, J District, Q District, and some social work institutions such as E institutions as external supervisors of universities, and had the opportunity to review the different modes of social work supervision in Z City. At the same time, through the method of “purpose sampling,” each person of the nine supervisors conducts about 30–45 minutes and the supervised experience of Z City. They are mainly responsible for the areas of community service, child welfare, social assistance, and social care, as shown in Table 4.1. The interview questions were all structured and open, mainly including the current situation of supervision, the role of supervision, the advantages and disadvantages of cross-agency supervision, and the supervision of development, etc. After obtaining a large number of interview texts, the author took ATLAS.ti (9) as the analysis software for research materials to organize the materials word for word, and then extracted relevant research topics. ATLAS.ti is an analysis software for multiple forms of data that simultaneously analyzes and processes multiple text documents (such as Word or PDF files), pictures, audio, video, and (Shiyou, 2017) of geographical orientation data based on Google Earth. Its use is helpful to help researchers discover research topics and greatly helps to improve the standardization of qualitative research (Yiping, 2017).

B

Sex Man

Woman Man Man Woman

Woman Woman Man Woman

A

Number Interview 1

Interview 2 Interview 3 Interview 4 Interview 5

Interview 6 Interview 7 Interview 8 Interview 9

35 31 29 31

35 30 35 38

E

Areas of supervision Community and social organization services University supervision Community, station Internal supervision Community (Party and mass) Industry supervisors The elderly and the disabled University supervision Party and mass projects and posts Industry supervisors Medical care, special groups Industry supervisors Community (party-mass) field Internal supervision Enterprise, office positions Industry supervisors Children, justice

D

Age Supervisorship (role) 34 Industry supervisors

C

Table 4.1  Basic information about the interview subjects

2 3 3 2.5

4 0.5 4 2

F Years of supervision 4

Middle Middle Middle Middle

Middle Primary Middle Middle

G Certificate of qualification Middle

Hospital medical social worker Project Supervisor Project minister Field supervisor

Teacher Project Supervisor Deputy Director General Teacher

Intstitutional functions Deputy Director General

H

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Case Introduction The Development of Supervision Service In recent years, the Z municipal government has gradually increased its funds to purchase social work services. In 2017, the city invested 24.45 million yuan, which increased to 40.04 million yuan in 2018, increased to more than 45 million yuan in 2019, and exceeded 50 million yuan in 2020; the number of social work institutions and the number of social work institutions in the initial stage increased. In 2017, the number of Z citizens’ offices reached 70,83 in 2018, 102 in 2019, and over 120 in 2020. The development of social work in Z City has passed the embryonic period and the initial development stage, and has entered a stage of rapid development. Up to now, there are more than 1500 first-line social workers in Z City, including 98 municipal social work supervision talents in Z City, and the ratio of municipal supervision and first-line social workers is about 1:15. Since 2011, after nearly 10 years of exploration, the development of social work in Z City has gone through three stages: embryonic stage, initial development period, and rapid development period, and the local social work supervision is also constantly explored. In 2016, J District of Z City started the first batch of supervisory talent training, and 20 training objects entered the training period. In 2017, this batch of training objects began to try to carry out supervision services as trainee supervisors, bidding farewell to the state of introducing all the supervision objects from advanced regions and universities, and also opening up the exploration of various supervision modes, as shown in Fig. 4.1. In January 2017, Q District, for the first time, publicly purchased three categories of social work service projects: comprehensive social work services, social organization development supervision, and specific group services for social organizations with social work service qualifications nationwide. Among them, the supervision

Fig. 4.1  Development timeline of Z City social work supervision model

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and evaluation project of social work services purchased by the government is undertaken by L Social Work Service Center of Longhua District, Shenzhen. The external supervision for the project are Hong Kong registered social workers, senior supervisors, senior supervision of social workers in Shenzhen, etc. In June of the same year, the Q District Social Organization Service Development Center undertook the social work supervision project of the district, providing it with professional training, regular supervision, professional evaluation of third-party institutions, and other services. Thus, the external supervision of the project are university teachers, local senior local social workers, institutional management personnel, etc. The social work supervision project purchased by Z City S Bureau in 2018 was undertaken by Z City Social Work Association. While employing university teachers as external supervisors, the project hired 18 people from the first batch of 24 municipal supervisors trained by Z City as external supervisors to provide professional service support for various social work projects and posts. Thus, there are multiple levels of supervision service. In June 2018, E institutions in Z City conducted internal supervision selection, and a total of 10 people were selected as internal reserve trainee supervisors. There are three internal supervisors in the organization, one of whom was one of the first supervisors in Z City in 2018. In September 2018, among the first 20 supervisors trained in J District, 5 members of C social work agencies were selected. Until 2020, Z City adhered to the principle of “selecting from the front line” and “combining theory with practice,” and cultivated nearly 100 municipal supervisors. These supervisors can be employed by the internal supervision of institutions and the external supervision of the organization. Therefore, for example, the internal supervision service of Z City C and E institutions has multiple levels of municipal supervision, district-level supervision, institutional internal supervision, and so on. Source of the Supervisors To sum up, the supervisors in Z City have the following categories. The first category is the social work professional teachers in colleges and universities (hereinafter referred to as the university supervision), who are generally funded by the institutions, and a few are funded by the government purchase and supervision projects. The second category is the experienced social workers or supervisors in areas with good social work development (hereinafter referred to as foreign supervisors), who are generally funded by the organization, and a few are funded by the government to buy the supervision projects; the above two categories are from outside the organization, both are external supervisors. The third category is the local senior social workers (hereinafter referred to as industry supervision), who obtain the training and assessment of the municipal or district government. They are internal supervision or external supervision,

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depending on whether the supervision objects are internal social workers or social workers of other institutions. A large part of the external industry supervision is the institutional arrangement made by the government through the purchase of supervision service projects, and they are cross-agency cross-supervision, which is paid for by the supervision service projects; the internal industry supervision refers to the organization employing internal industry supervision to carry out services, and the expenses are borne by the organization itself. The fourth category is the supervision of internal selection and training (hereinafter referred to as internal supervision), and the expenses are paid by the institution. Supervision Mode Classification According to the supervision level and the supervision source, the author divides the supervision mode of Z City into two types, respectively, the cross-organization guidance mode and the multilayer supervision mode within the organization. First, the cross-agency supervision mode mainly refers to the simultaneous existence of both internal and external supervision, and there is at least one level of internal and external supervision. Internal supervision has two levels: internal supervision and internal industry supervision; external supervision includes university or foreign supervision, external industry supervision. In this model, due to the lack of internal supervision experience, skills, and ability, so the external supervision, especially the university supervision or foreign supervision, can play a good complementary and supporting role (Fig. 4.2).

Fig. 4.2  Z City social work supervision mode

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Second, the multilayer supervision mode within the organization generally adopts the combination of “internal industry supervision + institutional internal supervision.” In this mode, the development of supervision services is undertaken by the internal supervision of the organization, and the internal industry supervision focuses more on the cultivation of the internal supervision of the institution. This mode has relatively high requirements for the internal industry supervision, and it is more used in the relatively mature institutions of the industry supervision personnel allocation, supervision system construction, service system construction, and management system construction.

Analytical Framework Liao Huiqing and other scholars in the study of urban community social services found that the community social service factors mainly community governance structure, resource dependence, street administrative forces of social work services, street leadership of the street administrative culture, and the concept of social work institutions and social workers to professional value. Among them, the governance structure of the community is the driving force of the internal organization, and the resource dependence relationship and the quality of the organization itself are the important variables to resist the internal organization of social work services (Huiqing & Ren, 2011). Some scholars mentioned in the theoretical tension in the process of social work specialization that social work specialization is not only subject to the entanglement of internal relations, but also subject to the influence and restriction of many external structural forces (Yuefei, 2018). Based on this, the author constructs the analysis framework of “structure–relationship–power” (as shown in Fig. 4.3) to analyze the effectiveness of the three functions of education, administration, and support. Giddens strives to transcend the dual opposition of relationship between individual and society and action and structure, and proposes the theory of structure duality. He believes that social structure is not only constructed by human action, but also the internal factors and external conditions on which actors depend, that is, rules and resources. Therefore, the “structure” of this chapter refers to the external macrosystem or rules, which affect and restrict the operation of social work supervision services. “Relationship” refers to the relationship between stakeholders generated in the context of “project purchase” as a way of implementing social work services generally adopted by local governments. Power refers to the legal authority proposed by Weber, and the legal authority is the legitimacy basis based on the fair procedure recognized and accepted by the public. Its characteristics include that the activities have fixed rules, clear functions and authority, orderly organization, the members go through full-time training, the officials do not have the means of production, the officials do not enjoy their duties, and their activities are documented (Max, 1978).

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Fig. 4.3  Analysis framework for the effectiveness of social work supervision from the perspective of “structure–relationship–power”. (Source: drawn by the author)

The Current Situation of the Supervision Function in Play Through the analysis of the interview materials, the author found that the educational supervision function has played an obvious role in both the cross-institutional supervision mode and the internal multilevel supervision mode. Social work agencies will provide internal and external supervisors based on personal opinions, individual capabilities, and project needs. The organization or a third party has relevant requirements for the internal and external supervision work, such as making annual supervision plans, carrying out the supervision work regularly, reviewing archival documents, and evaluating the supervision work at the end of the project, so as to ensure the effectiveness of the supervision work. In the supervision work, the supervision topics raised by social workers mainly focus on the development of practical work, such as making demand questionnaires, writing demand reports and annual work plans, writing archival documents, etc. In this process, the educational function of supervision is brought into play to promote the effective promotion of project services. In addition to the educational supervision function, the support function and the administrative function of the supervision play significantly in the cross-­ organization supervision mode and the multilayer supervision mode within the institution respectively, which are as follows.

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Cross-Agency Supervision Model Social work is a job that requires emotional input. Social workers respect and accept their clients. However, they will also encounter twists and turns in their work, and suffer from negative emotions of pressure and anxiety arising from doubts from different aspects. Social work is a job that requires emotional input. Social workers respect and accept their clients. However, they will also encounter twists and turns in their work, and suffer from negative emotions of pressure and anxiety arising from doubts from different aspects. As shown in Fig. 4.4, the “internal supervision support function” and the “external supervision support function” were coded 21 times, so it can be found that the support function of supervision is played well in the inter-institutional supervision mode. This is due to the grant of administrative power the administrative function of internal supervision can be effectively played. With the external supervisors’ lack of power, their existence not only gives social workers the opportunity to internalize different knowledge, but also provides another channel for social workers to express themselves. I think this way can make social workers have more channels to express their feelings. For example, I just said that social workers have added many classes. When encountering similar problems, when he (the social worker) thinks it is more suitable to talk to the external supervisor, he will tell the internal supervisor, and then when it is not easy to talk to the internal supervisor, he will tell the external supervisor about this problem. In this way, social workers have more channels to express their feelings. (Interviewer 6)

Multilevel Supervision Mode Within the Organization In terms of administrative functions, the multilayer internal supervision has different divisions of labor and scope of power, and most of the supervisors also hold positions at the institutional management level, so they play a good role in administrative functions. In addition to being supervisors, I also held other positions. For example, I served as deputy director-general. When we solve administrative problems, we may not act as supervisors, but as deputy director-general. (Interviewer 4)

The Analysis of Supervision Effectiveness Dilemma and Cause  tructural Perspective: The Imperfect Mechanism Leads S to the Dilemma of “Multiple Supervision” On March 13, 2018, Z City issued the “Opinions on Promoting the Construction of the City’s Social Work Supervision Talent Team”. On January 1, 2019, it issued that the Z City government purchase social work service fund management interim

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Lack of endogenous supervision Gr=5 Supervise negative response Gr=13 Supervision requirements Gr=10 Supervise the waste of resources Gr=6 Multiple supervision Gr=30 The practical supervision ability of colleges and universities is long lacking Gr=2 Sense of worth Gr=14 Interest is not coordinated Gr=17 Internal supervision administrativ e function Gr=19 Internal supervision of administrativ e power Gr=10 Internal supervision support function Gr=7 Poor cooperation between internal and external supervision Gr=11 Power Gr=15 Social workers should respond positively Gr=12 The external supervision is not satisfied with the soil Gr=1

W. Ji et al. Interview 1 Gr=56

Interview 2 Gr=26

Interview 3 Gr=18

Interview 4 Gr=27

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4  Effectiveness of Social Work Supervision: A Qualitative Case Study and… External supervision to guide the direction Gr=2 The educational function of the external supervision Gr=12 Supporting function of the external supervision Gr=14 External supervision function Gr=5 External supervision is weak in embedding Gr=17 External supervision have no power Gr=8

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measures, the government purchase service funds, must have 3–4% to hire social work professional supervision ability to the specification of the project implementation of professional supervision, pay project staff to participate in all kinds of training costs, and volunteer training fees, etc. Under the guidance of the above two documents, Z City has seen a municipal or district-level industry supervision, institutional internal supervision, foreign or university supervision, and supervision of a project at the same time. Therefore, social workers have to encounter the dilemma of “multiple supervision,” which is also the highly mentioned status situation of supervision in the supervision interview. As shown in Fig. 4.4, the coding of “multiple supervision” appeared up to 30 times. This current situation of supervision enables social workers to absorb the experience of multiple supervision knowledge and have more channels to express it because there is no corresponding system to regulate the responsibilities of various supervision parties and there are some problems. As shown in Fig. 4.5, the most relevant codes with “multi-head supervision” are “poor supervision coordination,” “negative supervision response,” “waste of supervision resources,” and so on. The Cooperation of All Parties Is Generally Poor Multiple services need all parties to maintain good communication and clear division of labor and cooperation, but the supervision in the division of labor and cooperation is generally not ideal, especially between the internal and external supervision, each supervisor carries out supervision with their own work ideas, and

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Fig. 4.5  Encoding the relationship diagram

even a lot of the supervisory work revolves around the same theme, this not only to the relationship between social workers and supervision, and to a certain extent also caused the waste of supervision resources. Internal supervision is some more administrative work, in addition to the administrative functions, it is not very different from the external supervision, but there is no good division of labor between them. (Interviewer 8) In fact, I would like to say that it is very difficult for us to divide the responsibility relationship between external supervisors and internal supervisors, and it is really very difficult. (Interviewer 2) We all know that the internal supervision and external supervision joint is very lack, including the division of responsibilities, some may through the phone between each other to know each other, there are some simple function division of labor, such as you may be mainly responsible for the professional project team, the other is responsible for ­administrative support, this piece, but this situation is less. Even if the two supervisors come together, there will be a primary and secondary points. In the supervision process, one supervisor gives the main speaker, the other one is affiliated, and the other supervisor does not play the corresponding function. There are internal and external supervision is completely not met or is not any contact. (Interviewer 9)

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 onflicts of Opinions Between Supervisors Have Put Social Workers C at a Loss Due to the different knowledge structure, experience, and supervision style, various parties also give different services and suggestions to social workers, and some of them are even very different, leaving social workers at a loss among the opinions of all parties. For example, interviewer 3 told us about a special case where social workers could not trust the supervisor because of their opposing opinions: The project executive has always stressed the combination of internal and external supervisors, but there will be problems in the joint process. For example, the two supervisors have completely different styles, or if they disagree on one thing, and the social workers will sometimes be confused, the methods and suggestions of the two supervisors are completely different, giving the social workers a less good feeling that it was difficult for the two supervisors to make them trust something. (Interviewer 3)

“ Negative Response” of Individual Supervisors Makes the Quality of Supervision Difficult to Guarantee Because of multiple supervisors, some supervisors were “lazy,” passively responded to the supervision work, and were perfunctory for their own supervision services, which not only failed to give practical help and support to the social workers, but also damaged the image of the supervisors in the social workers, making the social workers lose confidence in some supervisors. When we do external supervisors, we have summed up their own survival rules, indeed, I also have. My principle is strong inside and weak outside, is not internal supervision, external supervision carries up; if internal supervision is strong, I still prefer to internal supervision, I will start. (Interviewer 4) The ability of our supervision talents is now uneven. Some supervisors (one of my teams also met some supervisors before) are not so responsible, and they did not meet several times during the supervision time, and some supervisors did not respond well. (Interviewer 9) In the process of supervision, we often encounter some problems, such as the project team has no supervision needs, then if there is no supervision needs, the supervision may be mixed with this time. (Interviewer 9)

Note: Taking “0.37” as an example, the value indicates that the coding “multiple supervisor” and “poor internal and external supervisor” overlap rate is “0.37,” representing the correlation between the two codes; the red bold connection value is higher than the black bold connection line than the black connection.

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 elationship Perspective: Non-Coordination R Among Stakeholders According to the author’s participation and observation, both the cross-agency supervision mode and the multilayer supervision mode within the organization have formed social workers-centered stakeholders, including supervision, social work agencies, the government, and employers. In Fig.  4.4, the “benefit of non-­ coordination,” as one of the high-frequency codes, is also a phenomenon existing in the social work supervision mode of Z City. Conflicts Between the Stakeholders Social workers are faced with the practical difficulties and pressure brought by the fragmentation of social work supervision and services, the organization of social work organization management, the index of government services and governance, and the administration of the daily management of employers. Social work agencies are faced with the institutional dilemma of government service purchase mechanism, third-party evaluation mechanism, employer evaluation mechanism, and service competition mechanism. Employers are faced with the administrative pressure of service characteristics, highlights, and brands. Employers are faced with the administrative pressure of service characteristics, highlights, and brands. Supervision is facing the responsibility of specialization and professionalization of social work. Stakeholders are forcibly combined under the repressive forces of the government’s purchase of social work services, creating conflict when all forces interact. Inconsistency of the Stakeholders Stakeholders may have discoordinated relationships in their interactions with each other, with different expectations for supervisors. The multilayer supervision mode within the organization is insufficient, and the cross-organization supervision mode that has the embedded supervision force is weak. Under the “instrumental reciprocity” relationship, the government expects social work agencies to leverage their professional advantages, social work agencies expect to establish continuous good partnerships with the government, and employers expect social workers to integrate into the community. However, the reality is that the lack of professionalism of social work agencies is insufficient, the cooperation between the government and social work agencies is uncertain, and the ideas of employers and social work agencies are inconsistent, which leads to the continuous compromise and adjustment of the objectives, content, and forms of social work services among various stakeholders. Supervision, as an important support force of social workers, also accepts the pressure conveyed by these inconsistencies. With the support of the supervision orientation, it is difficult to achieve the ideal state.

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My biggest feeling is the recognition and support of the employer. For example, when I go to give other project supervisor, the employer may not know or even regard it as a burden, and then he does not support this work, and the effect is not particularly good. (Interviewer 3) Supervision gets the attention of employers, I think it is very important. We are discussing the supervision work in full swing. We think the supervision is very important, but many people do not understand the nature of the supervision work, or even know what the supervision is about. (Interviewer 5)

Asymmetry Between Supervision Under Different Supervision Modes It is mainly manifested in the asymmetry of the professional ability of external supervision, service frequency, service content, service concept, and service quality of external supervision and internal supervision. The supervision under the multilayer supervision mode in the organization is more cultivated through the later learning on the post, which can well inherit the mutual aid culture of “the old lead the new,” but lacks systematic supervision training. In the multiagency multilevel supervision mode, although some supervisors have received professional systematic supervision training, which is conducive to the professional growth of social workers, they lack an in-depth understanding of the culture and environment of the social workers’ institutions. However, in the actual supervision service, even the same internal and external supervision will show great differences in role cognition, role positioning, cooperation mode, service attitude, and other aspects according to the actual situation of projects and social workers. I think the role of supervision should be played by different social workers and different projects. (Interviewer 6) In fact, our administrative, educational and supportive functions are fully played and reflected in our supervision process. These three roles may play to different degrees when facing different roles, or different projects. (Interviewer 9) I think my supervision style is actually constantly changing, I will see what kind of person he is or who the other person is, if this person is an internal person for me, then I may have a response, if it is an external person, I may have no request and a response. (Interviewer 7)

To sum up, Z City different social work supervision mode of supervision in pay attention to the growth of the social workers, social work service quality improvement, their supervision ability promotion, at the same time facing the conflict between stakeholders, inconsistency, asymmetric internal tension, with social workers as the center of the system between the coordination, as shown in Fig. 4.6.

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Fig. 4.6  Incoordination among stakeholders with social workers as the core

Power Perspective: The “Pyramid” Type of Power Structure In the analysis of the power operation of the government-purchased social work supervision projects, the author found that there is a “pyramid” power structure in the social work supervision mode of Z City. The power structure believes that the power mainly comes from social institutions. Although not all power is institutionalized, great power exists only in the positions of social institutions. The bureaucratic structure makes the supervisor much more responsible to the immediate superiors than to the social workers (Ostrom et al., 2000). According to the interview with the author, the power of supervision under the cross-agency supervision model and the multilevel supervision model within the organization comes from the employed social work agencies or third-party social organizations. Institutions under the multilayer supervision mode of internal supervision power mainly come from the social work institutions; at the same time, according to the social work institutions and internal administrative structure, internal supervision in different social work institutions may have different power. Supervision generally has the power of service design and service content adjustment, social work service supervision, evaluation of social workers, etc., but only from the supervision role, and it does not fully have recruitment, personnel transfer, and financial power. These adjustments still need to be realized by advice and feedback to the corresponding department. An interesting phenomenon is that if the supervisor also serves as the deputy director general of the social work agency, he will also have the right to participate in the planning of social work agencies and mobilize social workers, which can better realize the play of administrative functions. Under the influence of

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the “pyramid” power structure, due to the motivation of being responsible to the superior leaders, the internal supervisor will combine the work content of the supervision with the social work organization. For example, in the social work project conclusion, the supervisor needs to participate in the writing of the bidding document. In the social work project evaluation, the supervision needs to carry out the pre-evaluation. What is more, some institutions will position more internal supervision at the administrative management level and arrange more administrative functions, which will ignore the supervision of education and support functions. In fact, from the supervision status of internal supervisors, his power is actually very little. Most of the internal management authority of the institutions is still undertaken by each department. Few institutions directly give the supervisor with personnel, financial and other power, his power is more professional, document review, project planning, design, and so on. The fault between the internal supervision and the power is very troublesome. When he exercises some administrative functions within the organization, he also has to use the internal power management structure of the organization. As a supervisor, he himself does not have much power. In addition to being supervisors in the organization, I also held other positions. For example, I served as deputy director-general. When we solve administrative problems, we may not act as supervisors, but as deputy director-general. (Interviewer 4) I have six days in a week, dealing with these errors of all sizes, and you can't do it (do practice).I've been in (internal) projects for just over a year, but at most less than 20% of my energy is focused on service, and 80% or more is focused on administration. (Interviewer 1)

The power of the external supervision under the mode of cross-agency supervision mainly comes from the compulsory arrangement of the government system. The external supervision will face the disapproval of the social work agencies and social workers when implementing the supervision power. On the one hand, the social work agencies do not give any power to the external supervision. On the other hand, the government or third-party organizations do not give social work agencies the authority to appoint and evaluate supervisors. Under such circumstances, external supervision implements more “soft” power such as social work service supervision and advice rights, and the right to adjust service content, to evaluate social workers, and the right to know about personnel transfer and internal planning of social work agencies is missing. The lack of these powers further causes that the external supervision can only rely on the “professional authority” and “personality charm” to promote the implementation of the supervision suggestions, and the effect can be imagined. And the third-party social organization, that is, the undertaker of social work supervision project to exercise supervision over external supervision. Therefore, the right of the supervision, social work agencies, social workers, or employers to participate in the operation of the whole social work supervision project is missing (Fig. 4.7). External supervisors certainly not as aware about the project as internal supervisors. I am now in the east of a project, I am as an external supervisor, I go to supervise the frequency is once a month, sometimes a month to once to ensure, go to once may need four or five hours of time, and then in this time inside want to put this month work have a general understanding, including their psychological condition, burnout, and their internal career road promotion in the organization, etc. These aspects are clearly understood, and that may be

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Fig. 4.7  Z City social work supervision project power operation mechanism more difficult. Understanding of the reality is not as good as the internal supervision. (Interviewer 8) (External supervisors) have no such power. This involves the previous question of the power, and there is no power to force him to do something, but internally, then I can ask him to do something. So at this point I may ask for more, I hope he can follow my idea and rhythm to do. But I think this may also give more pressure to social workers, and sometimes this degree may also have to grasp. (Interviewer 5) When I intervene as an external supervisor in the supervision of other institutions, the disadvantage is that the administrative support is relatively weak, with a relatively weak voice, and it is difficult to solve the problem, and I can only give some suggestions. (Interviewer 7)

System is the product of power structure and power relationship, and the system also affects the formation of power structure and power relationship. Behavior and institutions are deeply constrained by social relations. To sum up, since 2011, the development of local social work supervision in Z City has formed a preliminary development stage, forming the supervision and development path with local characteristics of Z City. In this process, three modes of local social work supervision have been formed, which are influenced by the external macrosystem, the relationship between stakeholders, and the legal authority (Fig. 4.8).

 he Dilemma of Realizing the Effectiveness of Social Work T Supervision Under the Analysis Framework of “Structure–Relationship–Power” From the perspective of supervision function, the multilevel supervision mode within the organization plays a good role in terms of support and administration, and the educational function plays a general role. The cross-agency supervision

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Fig. 4.8  Operation of supervision mode under the framework of “structure–relationship–power” analysis

mode plays a good role in supporting the function, and the educational and administrative functions are general.  ension and Deficiency: The Comparison of Supervision Service T and Supervision Effect Based on Different Modes Through the analysis of the interview results, the author concluded that the supervision results under different supervision modes showed internal tension. Cross-Agency Supervision Model In terms of educational function play, the internal supervision may lack work experience, skills, and ability, which may benefit social workers less, while the external supervision function plays relatively well. However, it is difficult to guarantee the quality and system of external supervision services. Only once a month of supervision services leads to the incomplete situation that the supervisors may understand, and the fragmented and discontinuous supervision content leads to the slow improvement of social workers. At the same time, there may also be a disagreement among the multilevel supervisors, so that the social workers do not know how to choose. Take my own original supervision experience, I supervise this month is a problem, next month I face a new problem, and then every month is a small point, is very fragmented, is I asked you to answer that kind of state, actually you see every year between cohesion is weak, no continuity and logic. (Interviewer 7)

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It should be particularly pointed out that if institutions employ university teachers or experienced social workers or supervisors from areas with better social development as external supervisors, due to financial restrictions, fewer supervisors can be hired, and each supervisor targets more social workers. The time and energy of these external supervisors are limited, and they cannot fully pay close attention to the social workers they supervise, and it is difficult to accompany and follow the whole process. The pertinence and depth of supervision are also lacking. Therefore, some external supervisors are more in the role of consultants. At the same time, if the external supervision comes from universities, compared with the social workers who have been engaged in the front-line practice, there is a lack of practical experience, leading to the relative lack of practical supervision services provided. Now when I think about my later supervisor, I may be a bit like a consultant, I think I am not very good to perform some duties such as the supervisor should accompany, and may be more of just a question and answer. (Interviewer 2) In my opinion, I prefer to refer to cross-agency supervisors as consultants, and he comes here as a consultant. I think the consultant can actually give a lot of help to the social workers from the macro and some external support. (Interviewer 1)

In terms of administrative functions, internal supervision is relatively well. Due to the specific identity of external supervision, many supervisors are not given administrative power, and it is difficult to realize the administrative function. In the case of lack of administrative functions, part of the support and educational functions of external supervision needs to be played by internal supervision or institutions. Its communication and coordination cost is high and delayed, resulting in the overall function of supervision that is difficult to play well. In addition, due to different institutions, there will be some differences in institutional management, system, work process, and other aspects, and many work experience may not be very applicable. Multilevel Supervision Mode Within the Organization In terms of educational functions, because this model has no intervention of external supervision force, it puts forward higher ability requirements for internal supervision. As a result, this model is rarely used by institutions with scarce initial stage or internal supervision resources, while medium and large institutions use it more. At the same time, there are two other concerns about this model: the first is the matching degree of supervision. Whether the organization can only provide social workers with internal supervision with highly matched service field and service experience. The second is the continuing education of internal supervision. Internal supervision needs to constantly improve their ability to meet the various needs in the development of social workers. As for the matching degree, I also had an experience before, including a supervisor of the party and the masses. He did not have any work experience in other fields before, and then the social worker asked a lot of questions, but in fact, he could not give answers and reply.

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In the selection of supervisors, you must have work experience in the relevant field. (Interviewer 7)

In terms of supporting functions, social workers can express more smoothly because they belong to the same organization, without confidentiality restrictions and other reasons. However, at the same time, the channels of expression have been correspondingly reduced, and some problems involving the management of institutions, and even the supervision itself are difficult to find, or difficult to deal with after the discovery.  estricted Supervision Function: The Balances in Structure, Relationship, R and Power Through the analysis of the interview materials, the author concluded that the limited supervision function is mainly due to the external macrosystem, the relationship between stakeholders and the legal authority, which leads to the internal and external supervision service boundary problem. On the one hand, external supervision has become the role of microphone between buyers, employers, social workers, and social work agencies. From the perspective of structure, the government promotes the generation of social work supervision mode from the institutional level, which strengthens the professional support force and limits the development of professional autonomy of social work institutions. In addition, because of the existence of institutional and arranged external supervision, the motivation of institutional selection, training, and use of internal supervision is also discounted, which affects the progress of the establishment and improvement of the internal supervision system to a certain extent. At the same time, due to the trust of the buyer in the social work agency, it adds the role of a supervisor in the government purchase of supervision service projects, which to a certain extent affects the relationship between the organization and supervision, social work, and supervision, resulting in many ethical dilemmas for the supervision. From the perspective of relationship, there is a non-coordinated relationship among various stakeholders, and there are different expectations for the cognitive level, support strength, and service of supervision. This non-coordinated relationship also affects the service objectives and service content of supervision. From the power analysis, the responsibilities and powers of external supervision are unclear. Social work organizations and employers are not clear about the responsibilities of external supervisors, do not authorize them, and even do not pay enough attention to the feedback of external supervisors and the solution of problems. The service boundary between the internal and external supervision of the organization is decided by each organization itself, but at present, the internal supervision and management of each organization are still in the improvement stage, resulting in the external supervision in the supervision process, fearing that the supervising social workers will be embarrassed or made difficult by the organization. External supervisors only need to do a good job of education and support functions, and do not

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Fig. 4.9 Supervision effectiveness under the framework of “structure–relationship–power” analysis

involve administrative functions, which is also an act of self-measurement or selfprotection for individual external supervisors. On the other hand, internal supervision becomes the role of an administrator. The service boundary and service content of internal supervision are mostly stipulated by the management system and work process of institutions, which are more standardized from the perspective of institutional interests. As a result, internal supervision often takes the organization in implementing the management of social workers, thus weakening or losing the function of education and support (see Fig. 4.9).

 he Way to Improve the Effectiveness of Social T Work Supervision This study is based on the in-depth analysis of the different supervision modes of Z City S Bureau, Q district, and E organization, and deeply discusses the limitation of social work supervision function from the perspective of “structure–relationship– power.” Through the research, the author summarizes the factors that the effect of social work supervision is not significant enough and constructs the analysis framework of “structure–relationship–power.” The problem of social work supervision and service not only comes from the restriction of external structure and system, and the relationship entanglement between stakeholders, but also comes from the lack of authorization mechanism. The authors believe that the realization of the better effect of social work supervision and service needs to focus on the following aspects.

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 acro-Social Structure: To Establish the Guarantee System M for the Operation of the Supervision Mode At the institutional level, it is suggested to improve the system of full participation and rational expression of supervision, social work institutions, social workers, and other relevant subjects. On the one hand, to improve the top-down exogenous system led by the government, for example, Social Work Supervision Project Operation System, Social Work Supervision and Evaluation Mechanism, Internal and External Supervision Work Guidelines, establish the policy basis, and divide the responsibility subjects. On the other hand, in the process of interaction, all stakeholders should improve the endogenous system generated from the bottom-up, for example, Stakeholder Communication Mechanism of Social Work Supervision Project, Power and Obligation of Social Work Supervision, and Supervision System of Social Work Supervision promote the internal integration and application of the three parts of structure, relationship, and power. It should be noted that the government, social work agencies, and all stakeholders should fully consider the mutual connection between systems in their respective system design to avoid conflicts between systems, so as to avoid new problems in the implementation. In this process, the role of supervisors at all levels should be scientifically positioned, and the responsibility and obligation system with mutual support and clear division of labor should be formulated to reduce the administrative color and ensure the professional independence between different subjects. At the same time, we should actively build a professional community, respond to professional needs, and realize mutual recognition and knowledge transmission through professional discussions from different subject perspectives, so as to form a collaborative network of mutual support and mutual subject, give full play to the role of the network, and improve the work effectiveness.

 alanced Symbiosis: To Enhance the Coordination and Mutual B Assistance Among Stakeholders At the relationship level, the deficiency of emotional interaction between the subjects and the weak mutual assistance force is an important reason for the difficulty to deal with the relationship between stakeholders. Morrison has proposed the “compromise cycle” model (Morrison, 2005), often called the “red and green cycle,” which is a compromise environment that does not handle anxiety and allow uncertainty, thus causing institutions or individuals to remain in the “fight-escape” mode, and practical work has become a tool for defense and risk avoidance, which can also conflict with cooperative institutions. In the “green cycle” environment, the positive interactions, pressures, and challenges among the stakeholders are known, and any mistake is used as an opportunity to learn, respect each other, work together, and constantly try to find solutions to the problem.

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The authors suggest that, first of all, a joint meeting platform for stakeholders can be built to provide opportunities for both sides of the conflict to express their opinions and feelings, find common interests, and seek common ground while shelving differences. Secondly, a support system is established between internal and external supervisors to promote the balance and consistency of the service quality of internal and external supervisors through peer learning and work visits, field visits, and other visits. Moreover, to enhance the discourse power of social workers, it is necessary to give full play to the subjective initiative of social workers and guide them to get close to the core part of social work institutions. In addition, the integration and redistribution of supervision resources, the internal and external supervision of complementary advantages, to help the growth of social workers. It is suggested that social workers should be good at discovering and integrating internal and external supervision resources while facing the pressure from all parties, maintain continuous and timely communication with internal and external supervision, fully express their opinions through collective supervision or individual supervision, and work together with the supervisors to find solutions. Finally, the supervision should give full play to the demonstration role of “mentoring” and convey the sense of mission and responsibility of social work to the social workers in the supervision process, so as to realize the “social” remodeling.

Participation in Empowerment: A Multicenter Power Structure At the level of power, the power structure of multiple centers is constructed. First of all, fully give the authorization of supervision and administrative power. Without an authorized supervisor, he gradually became a lecturer or a technical instructor. However, supervision is not a one-way role of supervisor as social workers, but also a key role connecting the past and the next, linking inside and outside (e.g., in the linkage of the three societies, supervision may need to lead social workers to linkage). However, in the context of Chinese culture, the supervision without power lacks merit, and it will not receive equal treatment, let alone pay attention to it. Supervisors could have played a crucial role in the professionalization of social workers, but supervisors in real situations are in a marginal position and fail to play their due role. To sum up, the supervision needs to be authorized such as in the institutional decision-making authority or voice, foreign affairs, and only in this way, the supervision can represent institutions to different departments linkage, so as to overcome some of the service in the structural bottlenecks, awarded institutions decision-making and personnel rewards and punishment rights, and make the problems found in the supervision or play an incentive role. At present, these structural authorization mechanisms are too lacking, which leads to the overall function of supervision. Secondly, social work institutions are fully given professional autonomy and the right to choose supervision. On the one hand, social work organizations without professional autonomy will instead form a dependence on the government, relying

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on the evaluation of external third-party organizations and the government’s control of the internal service quality of social work organizations, and gradually lose the space of professional autonomy of social work organizations. Social work organizations with professional and autonomy will cultivate internal supervision talents, set up clear supervision positions and responsibilities, and improve the service quality within the organization, so as to help enhance the credibility of the organization. On the other hand, only by fully giving social work agencies the right to choose the external supervision, and starting from the needs of social work agencies themselves, can the professionalism of social work agencies be better improved. Moreover, employers and social workers are fully given the right to evaluate the supervision and the right to know about the supervision project. On the one hand, employers and social workers fully participate in the monitoring, evaluation, and effectiveness evaluation of supervision, and on the other hand, they have the full right to know about social work supervision projects. Finally, the supervising project undertaker is fully given the right to supervise and evaluate. It can not only guarantee the service quality of supervision, but also improve the service level of supervision, and it can also help to make stakeholders fully participate in the decision-making of social work supervision projects.

Summary At the same time, through the research and analysis of the social work supervision services under the local social work supervision mode of Z City, it is necessary to further reflect on the following. First, the groups who have received the formal social work professional education and training are indispensable in the construction of the social work supervision team. “Without the corresponding theoretical guidance, and without the indirect experience or knowledge created by people before it, social work services are also very difficult to achieve the desired results” (Payne, 2005). Professional service in social work needs to rely on the social service system and social welfare system. Under the realistic situation of backward system construction and service purchase, the functions of the groups who have received formal professional social work education and training in policy suggestions, system construction, system advocacy, and other aspects are irreplaceable. However, it provides new requirements and challenges for the social work education group in the aspects of theoretical guidance, system construction, and theoretical construction reflection. Second, the reflection and critical consciousness and ability of education is one of the missions of the professional development of social work. Supervision that emphasizes the importance of reflection and practice is critical and challenging, and contributes positively to the culture of learning organizations. This practice encourages individuals to reflect on and question recognized ways of doing

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things, and thus to improve and change practice, and supervision needs to be more analytical, critical, and reflective if social workers are to link individual behavior to the wider institutions and their social context. Drawing on the concept of “two-loop learning” mentioned by Argyris and Shaun (citing Davies and Nutley 2000  in 1978), the ideal supervision model also needs this function. Discover problems —learn, reflect, and address—changes in policy and structure. Third, the exploration of the localization of social work in Z City provides the early supervision and talent support for the professional development of social work and provides an opportunity and platform for the independent brand development of social work institutions. Fourth, in order to better play the role of social work supervision talent pool, the government and industry organizations need to formulate industry systems, and promote and standardize the roles of buyers, supervisors, and employers, for example, by signing tripartite agreements to determine the boundaries of supervision rights and responsibilities, institutional rights and interests, and the objectives of employers. Grant Funding  This project was supported by research funding for the Construction and Development Path of the Welfare Service System for Children with Major Diseases (16BSH138), the 2019 Henan Provincial University Science and Technology Innovation Talent Support Plan, and the Research on the Role and Role of Social Work in the Construction of Social Governance Community in 2021.

References Beckett, C. (2006). Essential theory for social work practice. Sage. Bertha Capen Reynolds. (1942). Learning and teaching in the practice of social work. Farrar & Rinehart, Inc. Bertha Capen Reynolds. (1963). An uncharted journey; fifty years of growth in social work. Citadel Press. Chen, J. (2012). Social work supervision – Experience learning guidance [M] (pp. 113–121). Juliu Book Company. Gardiner, D. (1989). The anatomy of supervision: Developing learning and professional competence for social work students. Society for Research into Higher Education. Hongying, Z. (2011). The development of social work practice supervision model in China: Taking Jinan, Shandong Province as an example [D]. PhD dissertation of Hong Kong Polytechnic University. Hongying, Z. (2019). Research on social work supervision in the local situation [J]. Social Work and Management, 19(6), 5–6. Hongying, Z., & Wanlin, Z. (2019). Research on the Chinese social work supervision and evaluation system [J]. Social Work and Management, 19(06), 15–25. Hui, Y., & Sen, Y. (2019). Institutionalization and non-institutionalization: Comparative study of social work supervision mode in China [J]. Journal of Minzu University of China (Philosophy and Social Sciences edition), 46(03), 40–48. Huiqing, L, & Ren, (2011). The trend and mechanism of the internalization of social services in urban communities: A case study from three streets in Guangzhou. 2011 Guangdong Annual

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Conference on Social Sciences: Proceedings on Local Government Functions and Social Public Management. Ed., 2011, 295–307. Kadushin. (1992). Social work supervision: An updated survey. Clinical Supervisor, 10(02), 9–27. Max, W. (1978). Economy and society. University of California Press. Min, T. (2006). The basic situation of local social work professional practice in China and its basic role of supervisor [J]. Society, 3, 194–204. Min, X. (2015). A qualitative research based on social work practice in Guangdong Province [J]. Social Welfare (Theoretical Edition), 03, 47–52. Min, T., & Tianqi, S. (2018). The levels and functions of supervision by local social work agencies: An exploratory framework [J]. Social Work and Management, 18(01), 5–10. Min, T., & Tianqi, S. (2019). Connotation of social work supervision in Chinese local context: Self-­ consciousness and self-determination in project practice [J]. Social Work and Management, 19(6), 7–14. Pettes, D. E. (1979). Staff and student supervision: A task-centred approach. Allen & Unwin. Qineng, L., & Heqing, Z. (2019). The social work supervision paradigm turns to the research: Taking the “double hundred plan” collaborative action as an example [J]. Social Work, 01, 54–63. + 110. Shiyou, W. (2017). How to use ATLAS.Ti to analyze qualitative data and explore research topics [J]. Social Work, 06, 23–40. Storm, C. L., Todd, T. C., Sprenkle, D. H., & Morgan, M. M. (2001). Gaps between MFT supervision assumptions and common practice: Suggested best practices. Journal of Marital and Family Therapy, 27(2), 227–239. Trecker, H. B. (1971). Social work administration: Principles and practices. Association Press. Wong, A. (2019). Integration and transcendence: The development dilemma and localization path of social work supervision [J]. Social Work and Management, 19(6), 26–31. Xinping, L. (2019). Energy-enhancing oriented social work supervision process: Improving self-­ efficacy and promoting professional resilience [J]. Social Work and Management, 19(6), 32–39. Yiping, C. (2017). The dilemma of subjectivity development and its deconstruction of social organizations participating in social governance [J]. Academia, 2, 65–74, 322. Yuefei, W. (2018). “Despecialization” in social work: Theoretical tension and practical rebellion in the process of specialization [J]. Hebei Academic Journal, 38(04), 168–174.

Chapter 5

Promoting the Curriculum System Construction of Public Health Social Work in China: Western Experience and Domestic Exploration Jia Chen, Yifei Zhao, Yaqin Wang, and Xiang Luo

Introduction Social work has played a crucial role in public health systems in countries across the world by seeking to empower and support vulnerable populations during the COVID-19 pandemic (Kodom, 2022). The roles and responsibilities of social work within the field of public health have inspired extensive discussion among professional scholars and educators. The outbreak of COVID-19 triggered severe anxiety among a large number of patients and increased pressure on healthcare workers to cope with a lack of medical resources, deaths of patients, and a great deal of panic in the society. In August 2022, the National Health Commission of China released the 14th Five-Year Plan for the Talent Development of Health Professionals, which set out a number of key objectives for the talent development of health professionals in China. The Plan highlights the importance of strengthening the public health workforce. It proposes that by 2025 the number of personnel in professional public health institutions should be increased to 1.2 million, among whom the number of personnel in disease prevention and control institutions should be increased to 0.25 million. In addition, the Plan mentions developing community health workers and medical social workers, and activating social forces to participate in community health work and provide humanistic care and social support. The potential demand for social workers in the field of public health has thus gradually emerged. To cope with public health emergencies, it is important to consider how to synthesize public Some of the ideas in this chapter were first expressed and published in Chinese (Chen et al., 2021). J. Chen (*) · Y. Zhao · Y. Wang · X. Luo Department of Social Work, School of Sociology and Political Science, Shanghai University, Shanghai, China e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_5

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health and social work so that these two disciplines can complement each other and create greater value for the development of social work. At present, there remains a lack of personnel training in the field of public health social work in China. It is essential for there to be comprehensive exploration of the curriculum system in order to enable social workers to engage in targeted professional services and management in this field. The gap can only be filled if training of the relevant personnel is put into practice in the professional education. This chapter aims to respond to the question of how to promote the development of public health social work curriculum in China. Some of the ideas in this chapter were first expressed in Chinese (see Chen et al., 2021) and are further developed in this chapter. This chapter summarizes and draws on the development of the public health social work curriculum in developed countries. Specifically, the chapter elaborates on the connections between public health and social work, demonstrating the feasibility and necessity of combining the disciplinary knowledge of the two. Finally, by drawing on overseas experiences in the development of a joint curriculum for public health and social work, the chapter explores possible strategies for the construction and development of a public health social work curriculum in China.

The Connections Between Public Health and Social Work The widely cited definition of public health was proposed in the early twentieth century by Charles-Edward Amory Winslow. Winslow maintained that public health is the science and art of preventing disease, extending lifespan, and promoting physical health by improving the community environment through organized community actions, controlling the spread of diseases in the community, developing personal health education, providing early medical and nursing services for the early diagnosis and preventive treatment of disease, and developing social mechanisms to ensure people’s standard of living is enough to keep fit (Schneider, 2006). Social work, by contrast, is a professional activity that helps individuals, families, and communities to restore and develop social functions and create social conditions conducive to achieving their goals. For over a century, social workers have been involved in intervening in social factors both directly and indirectly affecting health. This long history of interdisciplinary collaboration has led to a strong link between social work and public health. A review of the literature reveals that the connections between public health and social work can be viewed from four aspects, namely, origins and development, values, theories and methodology, and the content of work.

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Origins and Development The origins of social work are closely connected to the history of the development of public health in the United States. By exploring the connections between public health and social work at the historical level, some scholars have classified the stages of development of public health social work according to its developmental focus (Li et al., 2020), while others have discussed the development of social work in public health from the perspective of social work specialization and professionalization (Ruth & Marshall, 2017). In this chapter, we have followed Li et  al.’s (2020) approach of classifying the stages of development of public health social work. We have traced the historical trajectory of social work in public health, exploring the connections between public health and social work at different stages, as well as the historical significance of their long-term interdisciplinary collaboration. Li and other scholars have divided the history of public health social work development into the following four stages. The initial stage is the development of prevention and community-based practices. In the early twentieth century, social work, which originated from the social settlement movement and Charity Organization Society, collaborated with public health on issues such as maternal and child health, infectious disease, and venereal disease control. Both practices were dedicated to promoting individual health and social welfare. At this stage, the interdisciplinary collaboration between public health and social work was accidental, but also somehow inevitable, because health officials and social workers were actually working in the same place—that is, the home experiencing both infectious disease and poverty (Folks, 1912). Against a background where medical services were underdeveloped and people had low expectations of them, social workers made great efforts to prevent and intervene in negative social factors affecting health and initiate and reform policies. The second stage is the development of individualized in-hospital services. The specialization of social work increasingly focused on the social and psychological problems of patients during their stay in hospital. By the 1920s, social work had been formally incorporated into the American public health service system. During and after the Second World War, social work played an innovative role in public health, when it evolved into disaster and crisis relief and expanded into areas never covered before, like dentistry. In the mid-twentieth century, although social work in public health continued to focus on the human–environment connection, it became less involved in the community. Along with advances in medical technology, the public had increasing trust in hospitals and medicine, and the rehabilitation of patients was easier to achieve. In this process, in order to secure its role, social work has accepted its auxiliary status in public health by adapting to the biomedical model. The third stage is a stage of calling for and reconstructing public health social work. In the 1960s, social work’s interest in public health shifted from secondary and tertiary prevention and intervention to primary prevention. On the one hand, with the emergence of the welfare state, rising health care costs, and shrinking

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financial support for social welfare, some scholars began to call for turning the social work profession to the field of disease prevention and public health promotion in order to raise the reputation and impact of social work. On the other hand, public health itself was faced with increasing problems such as AIDS, substance abuse, aging, and mental health. At this stage when public health and social work were interdependent, public health and disease prevention were widely integrated into social work education and practice. In the fourth stage, public health social work sought to develop systemic integration. In the twenty-first century, terrorism, chronic diseases, and infectious diseases have posed great threats to people’s health. Social work has also recognized the impact of the integrative development of public health service systems. During this period, public health and social work have achieved mutual success. Social work in the field of public health has been developed to be more scientific. Meanwhile, public health has been able to fulfill its mission of promoting and protecting public health due to the intervention of social work.

Values Public health and social work are linked by a common value system, rooted in history and underpinned by adherence to the principles of social justice (Beauchamp, 1976). The values of social work are divided into two parts: values for the person and values for the social environment (Fan, 2004; Gu, 2004). The values for the person mention that every person has equal value and dignity, while the values for the social environment involve a lot of discussion about social work’s expectations of society and the direction of effort—that is, society should provide fair and equitable opportunities for everyone, respect individual diversity, and meet people’s common needs. Wakefield (1988) also proposed that social justice is the core value of constructing social work. The nature and characteristics of public health determine that equity and fairness are among its core values (Zhang et al., 2019). Effectively mitigating health inequities and injustices is an urgent task that needs to be addressed in public health. Public health aims to minimize preventable death and disability, which is an ideal based on social justice (Powers & Faden, 2006). Ashcroft (2014), however, critiqued that opinion, believing that there is congruence between public health and social work in terms of social justice values. He argued that the paradigm of public health is not concerned with structural inequalities. Nevertheless, he also acknowledged that both social work and public health stay focused on social justice values. In summary, public health and social work are both characterized by a relentless pursuit of social justice in terms of their values. However, the ethics of public health are to some extent utilitarian. Public health uses epidemiology to identify the causes of disease and determine whether a disease should be recognized as of relevance to public health. In other words, in a sense, public health is concerned with life in a statistical sense rather than the individual per se (Cong, 2015). Such utilitarianism

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suggests that the involvement of social work helps public health to practice the values of social justice.

Theories and Methodology The fusion of positivism and constructivism has become an influential epistemology in the paradigm of public health. Positivism assumes that citizens are rational and advocates taking measures for socially constructed categories of risk. Constructivism, on the other hand, focuses on the development of health risks, risk categories, and their identification in relevant areas (Schneider, 2006). Both epistemologies have been influential in guiding assumptions about health from the public health paradigm. When referring to health from the paradigm of public health, it is important to mention social determinants of health such as political, economic, and social structures. The public health paradigm encourages citizens to adopt behaviors and lifestyles that are consistent with the health norms they advocate. The theoretical perspectives of the epistemology and health in the public health paradigm imply the theoretical orientation of the person in the environment in social work. The public health paradigm focuses on the impact of disease on populations. Such impacts are investigated through epidemiology, relying on big data to understand and explain the determinants associated with diseases (Baum, 2008; Bailey & Handu, 2012). Compared with epidemiology, social work research methods have much smaller sample sizes, tending to be descriptive rather than explanatory (Thyer, 2009). Therefore, public health and social work need to be interdependent in order to understand public health phenomena more comprehensively. In addition, social work practice can be tightly focused on the target and risk groups identified by epidemiology.

Content of Work Public health faces threats from bioterrorism, and chronic and infectious diseases. Social work is increasingly seen as playing an important role in public health services (Gorin, 2002). Today, social workers who are not directly involved in health interventions are addressing other social factors affecting health, such as housing, education, child welfare, etc. From this perspective, social work can be seen as a significant but underutilized component of the public health service workforce. Social work involves the prevention of relevant diseases and the promotion and education of relevant hygiene and health knowledge within the community, and these skills are essential to public health (Ruth & Marshall, 2017). There is still a long way to go in the prevention and control of the global COVID-19 pandemic. In China, experts and scholars have also expressed the need for regularization in the prevention of COVID-19 pandemic. In this context, social

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workers in the field of public health should not only make rational use of the three-­ tier prevention mechanism for joint prevention and control, but also establish a response mechanism for public health emergencies. This is particularly important for the specialization and professional development of social work in China. The relationship between public health and social work is reflected in their origins and development, their values, theories, and methodology, and the content of the work, demonstrating the need for interdisciplinary cooperation between public health and social work. At present, the connection between public health and social work in China is not well understood and integrated. An overview of such a connection can provide legitimacy and guidance to explore the curriculum of public health social work. Apart from that, domestic exploration also needs to refer to the advanced relevant experiences and significant lessons in Western countries, which have developed the joint curriculum of public health and social work for decades.

 estern Development of Joint Curriculum of Public Health W and Social Work Having experienced public health events such as SARS in 2003, H1N1 influenza in 2010, and the COVID-19 pandemic in recent years, society has increasingly raised awareness of and emphasized public health emergency and contingency management. The role of social work in the management of a public health emergency is also becoming increasingly prominent. Professional services such as medical and spiritual social work have gradually infiltrated into hospital and community management. Social work’s belief in helping people to help themselves and professional methodology and skills make the governance of public health events more humanistic, showing the uniqueness and special value of its involvement in public events and crisis management. In the face of a public health emergency, (1) what concepts and goals social work services should uphold; (2) how to identify social work’s position and make full use of its professional knowledge, skills, and unique values; and (3) how to help government departments and communities to respond effectively and quickly are major issues for social work to intervene in the governance. This further highlights the importance of developing a joint public health and social work curriculum (Fang & Zhou, 2021). In China, the issues surrounding the curriculum development of public health social work are understudied. However, there have been substantial relevant efforts and attempts abroad. Two themes are mainly covered in the relevant literature: (1) Western experiences in developing the joint curriculum of public health and social work; and (2) dilemmas and suggestions for its domestic development.

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 estern Experiences in Developing the Joint Curriculum W of Public Health and Social Work Public health social work arose in modern Western capitalist society. Public health and social work are two fields naturally complementing one another. As an important component of medical social work, public health social work uses a comprehensive interdisciplinary approach to promote health equity and alleviate health problems. It adheres to the professional concept of social work, applies professional methods to the field of public health, and at the same time integrates a broad public health approach into social work practice (Ruth et al., 2019). Medical professionals were the first to propose integrating the advantages of public health and social work for personnel training and education as they found that relying on efforts to build public health systems alone was a long way from meeting the requirements when responding to some major public health emergencies. Social work emphasized the importance of a public health approach in the early twentieth century and achieved several successes, such as successfully reducing maternal and child mortality and morbidity, and developing the field of maternal and child healthcare. The cooperation of social work and public health is an embryonic form of public health social work—that is, social work in the field of public health tends to investigate the social factors that cause adverse health conditions, combine this with epidemiological knowledge, use case studies and community intervention methods, and achieve structural changes through policy advocacy actions (Zhang, 2021). In 1969, the state of Kentucky in the United States took the lead in proposing to offer community medical courses. The social service department of the university hospital and the community medical department of the medical center jointly established the community medical service education program. Many of the teachers of this program were social workers. They were asked to teach social and community healthcare in imaginative ways. The program’s teaching activities demonstrated the feasibility of integrating public health or community medical principles with social work teaching and practice. Its accomplishment provided new insights into educational arrangements for the curriculum reform of medical schools and offered opportunities for social work participation (Bracht, 1969). By 1989, an early joint degree program of Master of Social Work and Master of Public Health was launched in Florida in the United States. Scholars have found that co-curricular programs can bring great interdisciplinary advantages. In 1985, at the Public Health Social Work Conference held by the American Public Health Association, the concept of public health was officially added to social work education. Since then, knowledge of epidemiology and prevention has also been added to undergraduate and master’s social work and continuing education courses. Social work began in interdisciplinary education and used competence as a standard to measure the degree of effective response in terms of professional knowledge and skills in real-life services (Liu et al., 2020). On the basis of the coordinated development of the two disciplines, the first dual Master of Social Work (MSW) and Master of Public Health (MPH) program (MSW-MPH) was established (Ruth et al., 2017).

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Fundamental methodological tools in public health can help social workers improve the quality of their response to client needs. In particular, the acquisition of relevant skills in epidemiology can improve social workers’ ability to identify at-risk groups and understand and evaluate interventions (Coulter & Hancock, 1989). After that, the University of Michigan implemented a joint curriculum-based public health social work prevention training and development program. Courses in this program mainly included preventive social work intervention, prevention research seminars, preventive internship seminars, health and disease society, epidemiology, etc. Siefert et al. (1992) conducted a 2-year study of students following the new program, evaluating and providing recommendations for the curriculum program from the perspective of the Public Health Social Work Forward Plan. The authors argued for the role of public health services in the reform of the social work education and practice curriculum and suggested the need for and importance of public health expertise for social workers. In 2005, with the participation of social work educators, practitioners, policymakers, and service users, the Practice Standards Development Committee of the USA announced the Public Health Standards and Competences, consisting of 14 service standards and corresponding indicator systems, and five competence requirements. These five competencies specifically included the theoretical base, the methodological and analytical process, leadership and communication, policy and advocacy, and values and ethics (He et al., 2020). Some joint courses in public health and social work are offered for special situations and populations according to the need. In 2019, to meet the unique needs of people living in the US–Mexico border region, New Mexico State University opened a dual-degree program in public health and social work. Students who earned a dual degree in public health and social work in this program were equipped to address human health and related service problems at the micro, meso, and macro levels, and to complete an internship in the community. In addition to practical skills, these students also learned how to deal with sensitivity and humility on cultural issues with people of color and marginalized people. Only jointly trained students had the abovementioned abilities, and because they integrated knowledge from the two disciplines, they could better achieve the service goals of the program (Forster-Cox et al., 2019). The curriculum focus of the School of Social Work should incorporate the contents of healthcare and mental health into the framework of public health teaching, and should include content pertaining to race, ethnicity, cultural diversity, human behaviors, and the impact of each human behavior on health (Siefert et al., 1992). In other words, social work education should include at least three knowledge areas related to public health: epidemiology, prevention, and population assessment and intervention (Wilkinson et al., 2002). In addition to paying attention to the intersection of subject knowledge and teaching content, multidisciplinary professionals’ education should also be concerned with the particularity of interprofessional education. For example, the School of Clinical and Population Health at the University of South Carolina has designed a specialized interprofessional education curriculum for students that contains four important curriculum objectives: ethics in

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interprofessional practice, roles and responsibilities, interprofessional communication, and teamwork (Addy et al., 2015). For decades, foreign experts and scholars have been committed to promoting and reforming the educational integration of social work and public health. For example, Ruth has conducted a number of exploratory studies on public health social work curriculum projects (Ruth et al., 2006; Ruth et al., 2008; Ruth et al., 2015; Cederbaum et  al., 2019). Scholars believe that the development of a joint public health and social work curriculum has important implications for both individuals and society. Joint curriculum training is conducive to promoting improvement in students’ professional ability and career development. Ruth et  al. (2006) compared MSW-­ MPH during 1987–1996 with their counterparts participating in a 3-year (or longer) MSW program. The study showed that the two groups of graduates had no significant differences in wages or job satisfaction, and had similar levels of social work professionalism. However, another study that looked only at MSW-MPH graduates came to a different conclusion, noting that they possessed noticeable advantages (Ruth et al., 2015). The findings showed that MSW-MPH graduates had more professional abilities, higher levels of interdisciplinary skills and abilities, diverse employment opportunities, higher career satisfaction, and stronger perceptions that what was learned in the two majors could be integrated into the workplace (Ruth et  al., 2015). The Social Work-Public Health Joint Program at the University of Minnesota believes that joint training can enable individuals to take leadership and training positions in social health fields such as policy analysis, planning, administration, community organization and education, research, consulting, etc. It enhances individuals’ professional competencies, enables individuals to be competent in more types of work, and is beneficial for ability and career development (Hooyman et al., 1980). Although there are still inconsistencies in the research conclusions, the research in general finds that the MSW-MPH personnel training mode is more likely to bring positive career and professional effects to students in the future. Joint curriculum training is also conducive to promoting community health improvement. The joint educational model of social work and public health majors enables graduates to see and understand individuals in the context of community health. In order to improve the health of the whole person, it is essential to innovate beyond existing professional boundaries. Therefore, public health social work may be one of the best interdisciplinary responsive ways for public health to improve the health and welfare of society (Ruth et al., 2008). Addressing health problems, mobilizing communities, and advocating policy changes are common to social work and public health, and collaboration between the two can reduce health disparities within communities (Watkins & Hartfield, 2012).

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 ilemmas and Suggestions for Developing the Joint Curriculum D of Public Health and Social Work in China Learning from the Western experiences, we can identify some dilemmas and provide some suggestions for developing the joint curriculum of public health and social work in China. At the macro level, the introduction of social work into public health has triggered great development dilemmas. Such dilemmas are mainly reflected in the fact that our institutional framework has not effectively responded to the legitimacy and rationality of social work’s participation in social and local governance. Social work has not been included in the contingency management system of public health emergencies in China. As an important branch of social work, the positioning of health social work is ambiguous, and health social workers have low self-identity (Li et  al., 2021). In addition, in the field of public health where the biomedical model played a dominant role, awareness of social determinants of health still needs to be strengthened (Li et al., 2021). Some educators who do not understand the difference between public health and clinical medicine worry that combining the two fields could lead to the medicalization of social work practice. Others have more pertinent concerns, believing that the synthesis of social work and public health can solve some problems related to funding, organization, and policy in the existing public health system. At the micro level, Holtzman (2017) raises at least two concerns about the future development of public health social work in the United States that we can draw on: Does the major of social work want to move in a direction that focuses more on public health? And can the social work profession be supported by national organizations to gain the conditions for that development? The premise for answering these questions is to realize that public health and social work have conflicting ideas and goals and cannot always compromise with each other. These conflicting moments have formed the main dilemma in the Western development of the joint curriculum over the years. There are four potential barriers to introducing public health content in social work courses: (1) social work departments may lack the ability to teach public health-related content; (2) the MSW curriculum is already too intensive to accommodate new public health course content; (3) some social work educators believe that students who want to gain knowledge of public health can study in public health departments; and (4) some may argue that all social workers who work in the field of public health should have a master’s degree in public health (Wilkinson et al., 2002). These potential obstacles reflect the dilemma encountered in the integration of public health and social work courses, and bring challenges to the development of joint courses. Therefore, in developing the joint public health and social work curriculum, we need to focus on five aspects at least. Firstly, we need to clarify the role of public health social work in the medical and health system, respond to the needs of social work services in the field of public health and even general health, and devote social workers to the practices in multidimensional fields such as community health, disease prevention, health education, chronic disease management, and behavioral

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health (Hu et al., 2022). Secondly, public health social work needs a unified framework that turns the grand challenges of social work from a concept into practice, and we need to articulate coping strategies for these challenges to implement them (Cederbaum et  al., 2019). Thirdly, social work needs close collaboration with a professional discipline that aligns with its goals and emphasizes broader approaches, such as policy practice, advocacy, and social work education. Fourthly, social work should analyze general health problems from a systematic perspective. Social work education must incorporate additional information, provide opportunities to develop competencies relevant to public health for social workers, emphasize the practice of social work within a broad holistic framework, and even provide services in the system led by medical science and care. Finally, in the process of constructing public health social work in China, it is important to reflect on different cultures and social systems, complement the strengths of young and middle-aged scholars returned from overseas with local scholars, and combine international perspectives with localization (Du, 2021).

 xploration of the Curriculum System of Public Health Social E Work in China Since the interdisciplinary cooperation between public health and social work has been demonstrated with promising significance, there has been an increasing amount of well-established Western research on the joint curriculum model of public health social work. Many professionals in public health social work have been trained under different joint curriculum models. These professionals not only perform the function of social workers in the field of public health, but also broaden the field of practice of social work. Moreover, they play key roles in promoting and guiding the development of public health social work. According to the aforementioned relevant Western experience, the localization of a joint curriculum in China not only requires a general grasp of the current situation in domestic social work education but also should be based on an objective analysis of the current needs of the public health field. Compared to the mature experience in the developed countries, China has just started developing and constructing a health or/and public health social work curriculum.

 he Historical Background of Public Health Social Work T Education in China The development of public health social work in China is closely related to the development of medical social work. In 1921, Ida Pruitt, the daughter of an American missionary, founded the Social Service Department at Peking Union Medical

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College Hospital to carry out specialized hospital, medical, and mental health social work, pioneering Chinese hospital, medical, and mental health social work. During the era of the Republic of China, hospitals, medical, and social work services dealing with various epidemic diseases and public health events showed the greatest achievements at the highest level (Pruitt et al., 2008; Song & Zou, 2014). Meanwhile, Yanjing University, Fudan University, Jinling University, Tsinghua University, and other colleges and universities successively set up professional courses in social work: medical affairs and health were one of the focuses of social work education in China at that time. However, after the 1950s, China restructured colleges and departments and social work education entered a period of interruption for more than 30 years. After the resumption of enrollment of social work students in colleges and universities across the country in the 1990s, medical/health social work became an important course in social work education during the reconstruction period. It was a response to many social problems and social needs in the field of health and public health in China during the transition period. Additionally, medical social work education and research were the first to be developed. Social work research and medical sociology began to introduce medical social work. In 1992, relying on the professional training at universities, graduates from 3 years from the Department of Sociology of Peking University started to work in hospitals, applying social work concepts to patient rehabilitation and using case, group, and community social work methods to help patients. After 2000, more and more Chinese universities set up social work majors and offered medical social work courses. An increasing number of social work students entered medical and health service institutions for internships and jobs. Although Chinese universities do not currently offer specialized courses in public health social work, both undergraduates and master’s graduates have received comprehensive training in public health or/and other health social work. This is due to the relatively mature medical social work education and abundant professional internship options. Therefore, when a major public health emergency such as SARS and COVID-19 breaks out, the outstanding social work professionals educated in colleges and universities have been successful in building a solid protective screen for the society. For a long time, the professional development of social work in China has been administration-led and policy-driven. Social work has become a passive object. Academia and practitioners in social work expect the professional status of social work to be enhanced by national policy adjustment, governmental function transformation, and institutional reform (Zhao, 2012; Guo, 2015; Lu, 2015; Wang, 2019). However, the role of social work education is often overlooked in the professionalization of the discipline and in the enhancement of social work subjectivity. The historical experience of social work professionalization at home and abroad shows that the key to professionalization is the subjective and theoretical self-­consciousness of the social work professional community. Social work education is the most important internal driving force for developing its professional subjectivity. The first social work department among public hospitals across the country was established in Shanghai Oriental Hospital in 2000. For public health social work

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education, which focuses on the combination of interdisciplinary experience and theoretical practice, it marked the formal entry of medical/health social work into the practical field. Furthermore, it suggested that the school–hospital cooperation model for personnel training in public health social work was beginning to take shape. In recent years, MSWs have expanded rapidly in China. Since the 1980s, more than 300 colleges and universities in China have successively offered undergraduate programs in social work, nearly 170 of which have enrolled full-time MSW students. Twelve medical schools across the country have established undergraduate majors in social work. Most of them have set up joint training courses for medical science and social work. The interdisciplinary education of public health personnel has begun to receive attention and be emphasized in China.

 trategies for the Curriculum Construction of Public Health S Social Work in China Establish a Curriculum View of Integrating Theory and Practice To better construct the specialized curriculum of public health social work, the general implications for the social work curriculum cannot be emphasized more and need to be summarized with highlights. Specifically, a curriculum view is a general term for various understandings and views of a curriculum. Different views of a curriculum are often reflected in diverse orientations of curricular values, leading to different curricular formats. Firstly, social work education should combine theory and practice. We believe that the public health social work curriculum must be theoretical as well as practical. From the perspective of improving theories, it is essential to take the advantages of the two majors, complement and synthesize them fully with one another, and innovate and develop unique and feasible professional theories for public health social work. From the perspective of practical exploration, students should be equipped with sufficient opportunities to put theory into practice, reflecting the applicability and practicality of public health social work. While students learn theoretical knowledge in the classroom, they should also be provided with places of practice in the course program so that they can apply their knowledge. In addition, students should be equipped with corresponding supervisors in charge, respectively, of practical and theoretical study. Integrating theory and practice is beneficial for the education program in terms of avoiding the disadvantages of dogmatism and formalism, achieving a balance between theoretical and practical study on the basis of their mutual improvement, and forming a dynamic and developmental curriculum view. Secondly, colleges and universities should have multidimensional teaching assessment. Teaching assessment is an important part of the curriculum view. The purposes of assessment are to guarantee the teaching quality of public health social work courses, establish a complete and diverse curriculum view, and improve the

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joint curriculum system. The curriculum system can be evaluated in terms of student development, teaching, and course effectiveness. The assessment of student development involves evaluating whether the curriculum improves students’ professional competence, qualifications, and values, and whether it can have a positive impact on students’ academic and professional career. The evaluation can be implemented by delivering questionnaires to students and organizing interviews with students’ practical supervisors in the internship agencies. The curriculum is evaluated by comparing students’ professional performance before and after the course in terms of mastering the skills of public health social work practice and the ability to apply theory to practice in the learning process. Teaching assessment involves assessing teaching approaches and teaching attitudes. Specifically, teaching approaches are evaluated according to diversity and creativity that inspire students to understand, analyze, and solve problems from an interdisciplinary perspective. A practical teaching approach can bring theoretical knowledge to life and allow students to acquire practical skills. The evaluation can be implemented by collecting students’ feelings and suggestions for the course through questionnaires or interviews. It is aimed at enriching teaching approaches, improving teaching attitudes, and further enhancing the teaching effectiveness. Last but not least, course effectiveness can be assessed in two respects. One is to assess the internship agency’s satisfaction with the student’s practices. Students’ learning outcomes can be observed from the work they accomplish with the internship agency. Schools and departments can invite relevant internship agency staff to comment on the differences and advantages of students following the joint public health and social work curriculum program in comparison with those in the normal social work program. Students following the joint program are evaluated in terms of whether they achieve higher levels of competency in the field of public health. The other assessment targets graduates’ professional recognition and social acceptance. Their feedback can be collected through questionnaires. By doing this, the director of the joint program can understand the program’s effectiveness in increasing students’ employment opportunities, broadening their career choices, and improving their competence and recognition in the relevant fields of work. Explore the Teaching Arrangement On and Off Campus The basic focus of the joint curriculum degree training is on the analysis and resolution of the social factors triggering public health problems. A great number of public health emergencies at home and abroad inspire us to explore and establish a localized education system for public health social work professionals. Specifically, drawing on domestic and Western experiences, the teaching arrangement can be designed and carried out on and off campus. Arrangement of On-Campus Course Content  Learning social work expertise is of the utmost importance. In terms of the on-campus course design, students should cultivate social work professional values in the first place so that they can develop a

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strong sense of professional identity. At the same time, we should pay attention to education in theoretical knowledge, which is the soul of the profession, the basis of the curriculum, the concentration and the essence of professional practice, and plays a leading role in professional training. Teaching is combined with learning. The joint curriculum should incorporate social work’s service concept and professional intervention methods into teaching, as well as diverse activities in the class. Additionally, students should have supplementary knowledge of public health. Since the SARS epidemic in 2003, public health experts and scholars have advocated increasing the number of public health personnel, especially for public health emergencies. However, looking at the prevention and control of the COVID-19 pandemic, we have not paid enough ongoing attention to that. At a time when a healthy China has become a national strategy, on the premise of understanding and mastering social work knowledge, it is necessary to provide students with general public health education. Such general education may include, but is not limited to, studying and understanding major public health events in history, knowledge of hygiene, emergency prevention and control measures, epidemiology, etc. In particular, colleges and universities running medical or health management majors should make full use of their educational resources to set an example. Social work and public health knowledge should be organically combined in professional education of public health social work. The development of any major should follow the rule of first synthesis and then subdivision. In order to carry out public health social work education in China, we should take the professional knowledge of social work as paramount, and then expand its focal issues to the field of public health. After fully mastering the basic knowledge related to both social work and public health, we can realize the transformation from generalist to specialist. Public health social work focuses on social factors that cause public health problems, such as social inequity or injustice related to the economy, culture, gender, class, race, etc. Drawing on the Western experience, the course of public health social work can also be adjusted according to students’ personal interests and social needs, and further divided in line with different target clients and work content. Due to a lack of relevant experience in China, we should learn more from the developed countries and increase international knowledge exchange to promote the design and feasibility of the joint public health and social work curriculum program. Arrangement of Off-Campus Internship Practice  At present, China’s social work education to some extent favors theory over practice, which is not consistent with society’s requirement for social workers’ practical abilities. This inconsistency has led to a contradiction between educational learning and work requirements. Although social work is based on scientific knowledge and theory, it is very practical. Its ultimate goal is to serve society and alleviate social conflicts. This is congruent with the motivation and goal of public health personnel training, which is to serve society, realize social interests, and ensure that people have a healthy living environment. Therefore, if we infer the requirements for the training of public health social work professionals from the goals of the two majors (social work and public health), it is inevitable that theory and practice should be combined.

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Teachers can provide targeted guidance in clinical practices classified according to disease types, target populations, intervention timelines, etc. Relevant clinical services include, but are not limited to, chronic disease health services, maternal and child health services, elder and child abuse interventions, prevention of infectious diseases, mental health services, substance abuse interventions, and health management services. Most importantly, social work professionals should actively explore and develop the practical fields of public health social work in the context of the current social reality and needs. In terms of internship institutions, colleges and universities should actively establish contact and cooperation with off-campus institutions to form effective professional networks, and fully activate their willingness as practice educational bases. In this regard, it is necessary not only to increase the number of practice educational bases, but also to have strict quality control to avoid students being treated as cheap labor in these off-campus internship institutions. In terms of internship time, it must be ensured that students can complete the internship as required, either while learning professional knowledge or after completing the course requirements. Colleges and universities should make proper and flexible arrangements for students’ internship time according to the requirements and needs of the internship agencies and of the students themselves. As a means of testing students’ abilities in applying professional theories and skills, the internship practice evaluation should be based on pluralistic reference indicators, such as quantitative indices, internship outcomes, service records, and so on. At the same time, it is critical to incorporate appraisals from on-campus and off-campus supervisors, internship agencies, and service recipients into the evaluation system as far as possible. Innovate Pluralistic Training Models So far, it is not easy to identify and promote a rule of thumb for the joint curriculum construction yet as more empirical studies are needed to investigate the most feasible training models and pathways in China. However, after reviewing the histories, lessons, and significance of developing public health social work (curriculum) at home and abroad, we can provide at least three potential curriculum training models, although vaguely, for cultivating professionals qualified with both public health and social work knowledge and skills in China. These models can be set as a start for future relevant research with more solid empirical study designs. Joint Curriculum Program Model  The joint curriculum public health social work program model refers to the major of social work and the major of public health jointly training dual-degree master’s students in both social work and public health expertise and practical knowledge. This kind of model is relatively rare in China, but many developed countries have already tried to offer joint public health and social work programs. Compared with the common dual-degree program, the joint curriculum program model increases the coordination and integration of the two knowledge structures. In terms of curriculum design and arrangement, the joint

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public health and social work curriculum program model converges and combines the two master’s degree programs, resulting in an intersection and complementarity between the two disciplines. This model can not only broaden the horizons of social work students in the field of public health, providing students with more possibilities for their future career and improving their professional competitiveness, but can promote the development of public health professionals at the practical level, better practicing the concept and goal of improving public health and disease prevention. Nevertheless, the joint curriculum program model may have several limitations. Firstly, although students following the joint training program can learn more diverse professional knowledge than students following a single major, this joint model may have chaos in student management across two majors. Secondly, during the study and practice process, students are more likely to encounter the challenge of obscuring and distinguishing professional roles. Last but not least, the social work and public health majors may lack linkages in terms of teaching and practice. The joint curriculum program model is more suitable for Chinese colleges and universities where both public health and social work majors are well established and advanced in development because this model has higher requirements for students’ learning ability and teachers’ management abilities in respect of research and teaching. Social Work-Oriented Extension Model  The social work-oriented extension model refers to extending the talent training direction of the social work specialism to target talent training in the direction of public health social work more. From a practical point of view, it is easier and faster for Chinese universities to apply this model than the joint curriculum program model. This extension model places emphasis on the foundation of a faculty with public health education and research backgrounds, as well as the innovation of a public health social work curriculum and internship content. The foothold of the social work-oriented extension model is still within the social work discipline, which can avoid the disconnection in the curriculum of the public health and social work knowledge systems and the confusion of students’ professional roles. This model has several limitations. Firstly, it is difficult for social work departments to attract public health professionals to strengthen the multidisciplinary faculty. Secondly, in terms of the curriculum content, students learn public health expertise in a general way, making it difficult to grasp epidemiology, health, and disease prevention knowledge at comprehensive and multiple levels. This model is more suitable for colleges and universities where there is only a social work major and no public health major, or a weak capacity in public health. Medical-Dominant Supplementary Model  The medical-dominant supplementary model refers to the introduction of social work-related courses in medical majors such as clinical medicine, nursing, and public health. Compared with the former two models, the essence of the supplementary model is to supplement knowledge and understanding of social work among medical professionals and promote the development of public health social work. This model can enhance the recognition

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and professionalism of social work in the medical and health fields. As medical and health services are mainly based on prevention and treatment, supplementing some social work courses can also help to broaden the mindset of medical students and enhance humanistic care in the medical and health fields. There are several limitations to the supplementary model. Firstly, in terms of implementation, this model can only be realized when a consensus is reached between medical and social work majors to recognize and be willing to promote jointly the talent training in social work in the public health or health fields. To some extent, this is closely related to market demand and structural support, which is a challenge to the traditional medical and health professional education in China. Secondly, supplementing social work courses into the intensive medical curriculum may put too much academic pressure on students. It is also difficult to guarantee that this approach will allow students to learn and understand social work expertise fully. This model is more suitable for domestic medical colleges and universities that want to broaden their professional specialties. It is also closely related to leaders’ disciplinary structure, educational philosophy, and policies.

Conclusions The COVID-19 pandemic can be seen as an important turning point for the development of public health social work in China. The close connection between public health and social work in terms of their origins and development, values, theories and methodology, and work content justifies and legitimizes the training of interdisciplinary professionals. Social work plays an important role in the response to public health emergencies. Social work expertise and methods can, to some extent, help to alleviate the negative impact of public health events on individuals, families, and society. This reflects the need to, and feasibility of, training professionals in public health social work. Compared to China, Western countries have a long history of designing and developing joint public health and social work curricula that have positive implications for students’ professional competence and career development, and for community health improvement. However, there are also a number of challenges to the implementation of such joint curricula. These relevant literature reviews provide a reference for the development of a public health social work curriculum and the training of public health social workers in China. The construction of a professional teaching and personnel training system for public health social work in China still faces enormous challenges. Given that the development of public health social work in China is seriously lagging behind that of the developed countries, its exploration not only faces the difficulties of exploring and pioneering, but also challenges the traditional views of health and education in China. However, in the long run, the training of public health social work personnel will have a profoundly positive impact on the emergency management system of healthcare and disease prevention and control in China. We have attempted to

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explore possible strategies for the realization of a public health social work curriculum in China from three perspectives: the curriculum view, the teaching arrangement, and the curriculum training model. We believe that the training model for public health social workers in China will gradually be developed, improved, and localized with distinct Chinese characteristics.

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Chapter 6

Psychosomatic Medicine, Professional Social Work, and Evidence-Based Clinical Practice Sheying Chen, Elaina Y. Chen, and Yuxia Qin

Evidence-based practice is a relatively new concept in social work and other helping professions. This chapter aims at shedding light on the subject by learning from biomedical science that ranges from basic research to clinical operations. The original ideas were first expressed through an open-access online outlet (Chen & Chen, 2021), which will be introduced in the chapter and expanded by emphasizing application in human services and social work as an applied, eclectic discipline.

 vidence-Based Practice: Learning from Psychosomatic E Medical Science The term “psychosomatic” combines psychological and physiological perspectives and approaches, which led to the expansion of the views of biomedical professionals. In the eyes of psychologists and psychiatrists (Lyketsos et al., 2006), the relationship between emotion and disease has long been fascinating (Lyketsos et al., 2006). They see physical illness as a consequence of mental distress (including the role of the nervous system in disease). While psychosomatic medicine is said to have fallen in and out of favor repeatedly over the past centuries, “we are currently witnessing exciting and challenging times for psychosomatic research” (Jindal & S. Chen (*) Pace University, New York, NY, USA e-mail: [email protected] E. Y. Chen University of Rochester, School of Medicine, Rochester, NY, USA Y. Qin School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_6

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Jennings, 2010:131). The key question they dealt with in psychosomatic research has since remained to be: “do psychiatric disorders cause or contribute to physical disease such as heart disease, diabetes and asthma? … a second question is: does timely and optimum treatment of the psychiatric disorders prevent, arrest or roll back the progression of physical disease?” Later, the impact of cognition and emotion (not only psychiatric illness) on general and physical health became an important line of investigation, which even went beyond and helped to expand psychosomatic medicine with a new interest in positive psychology. Subsequently, the impact of such “positive emotional states” as equanimity, level-headedness, and congruence are highlighted (Mcnulty & Fincham, 2012). This chapter attempts to make a case for evidence-based human services and social work practice by learning from the fields of medicine including surgical, clinical, and basic sciences. While psychosomatic research has not yet lived up to its full promise along the line of psychological/psychiatrist thinking, this chapter will approach the topic from professional social work’s eclectic viewpoint. It reflects on the need for psychosomatic medicine research in the domain of surgery by complementing the psychological and psychiatrist perspectives. Then it will further consider what may be helpful to social workers and other helping professionals as well. In this pursuit, all sorts of psychosocial factors and impacts may be considered whether as causes or consequences (equally emphasized here) of medical or other intervention procedures and associated issues (Macleod & Davey, 2003). By drawing on psychosomatic medicine research (broadly defined) and its application in clinical and surgical practices in the United States, the chapter will also highlight their cross-cultural implications. First, we need to clarify a few concepts in the specialty field of surgery. Genest (1990), a retired plastic surgeon, used the term “psychosomatic surgery” to designate esthetic surgery and clearly indicate the psychological problems inherent in every case (Genest, 1990). Though, it is noted that about 80% of that author’s practice was reconstructive surgery. Our discussion here will also focus on esthetic (or cosmetic) surgery while the full range of plastic and general surgery will be considered as needed.1 To further expand and enrich the discussion on the psychosomatic dimensions of clinical practice, we shall also examine a few important perspectives regarding psychosocial factors, or so-called “social determinants of health” (Braveman & Gottlieb, 2014), a focal concern of social medicine and public health (Contrada et al., 2008).

 Cosmetic surgery focuses on enhancing appearance while reconstructive plastic surgery emphasizes on repairing defects to reconstruct a normal function and appearance. The two are closely connected and the terms are sometime used interchangeably although cosmetic surgery and plastic surgery are not exactly the same. 1

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 earning from Evidence-Based Psychosomatic Medicine: L The Case of Plastic Surgery Learning from science can never go too deep. In a sense, plastic surgery (particularly esthetic surgery) would easily make a case for psychosomatic medicine due to its cosmetic nature and intimate psychological grounds. That is probably why Genest (1990) used the term “psychosomatic surgery” first to refer to esthetic surgery and clearly indicate the psychological problems inherent in every case.2 This is quite instructive to clinical social workers, too. In many disciplines and professions, “aesthetic” is considered a more complete approach than “cosmetic” while the latter is sometimes deemed more commercialized (Brown, 2016). In the past, cosmetic surgery recipients were patients, not consumers, but that has changed (Heyes, 2007). According to a review conducted by Harth and Hermes (2007) (Kropotov & Quantitative, 2008), an increasing demand for and use of doctor/medical services by healthy individuals resulted in a drastic change to cosmetic dermatology. While cosmetic surgery was mainly regarded as an eccentric intervention for the rich and famous in the 1980s, nowadays it has become available to lower income people and is aggressively marketed as a necessary and ordinary procedure. In most (if not all) cases, the request for cosmetic surgery by patients is emotionally or psychosocially motivated. This indicates an important need or field for clinical psychology and social work services. Patients with psychological disturbances would even push aside potential risks/complications or disregard side effects (including interactions of the procedures). This, professionally, cannot be dealt with by surgeons alone but requires collaboration from clinical psychologists and social workers to ensure a full range of services needed. Human service professionals should understand that subjective deficiencies of appearance, feelings of inferiority, and social anxieties are some possible factors in somatizing disorders by patients (Barsky et al., 2005). Sometimes major emotional disorders, such as body dysmorphic disorder, personality disorder, or polysurgical addiction, remain undiscovered but should be excluded in any patient receiving cosmetic procedures. This, again, indicates how important clinical psychologist and social work services are even in such a very specialized field of medical science and practice. This is why Harth and

 “Psychosomatic surgery” is totally different from “psychosurgery.” The latter refers to a type of surgical ablation of brain tissue (first introduced as a treatment for severe mental illness by Egas Moniz in 1936, who won the Nobel Prize in Medicine in 1949), in order to alter affective or cognitive states caused by mental illness. In the early times when no satisfactory pharmacological treatment options were available, psychiatric neurosurgery was used to cure schizophrenia, depression, criminal behavior, and some other mental illnesses. After the introduction of antipsychotic drugs in 1954, the role of surgery has declined, though psychosurgery with less invasive techniques is still used nowadays for treatment of brain disorders with known pathophysiology (e.g., Parkinson’s disease, epilepsy, and obsessive-compulsive disorder) (Kropotov & Quantitative, 2008; Harth & Hermes, 2007). 2

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Hermes (2007) made such a suggestion and labeled these issues accordingly as “psychosomatic disturbances” in cosmetic surgery. Honigman et al. (2004) went further with another review of psychosocial outcomes of cosmetic surgery to address whether elective cosmetic procedures affect psychological well-being and psychosocial functioning (Honigman et  al., 2004). The 37 relevant studies of varying cosmetic procedures they identified at the turn of the twenty-first century show that patients appeared generally satisfied with the outcomes of their procedures, though some exhibited transient and some others exhibited longer-lasting psychological disturbances. Factors associated with poor psychosocial outcomes included being young (i.e., the younger, the worse), being male (worse than female), having unrealistic expectations of the procedures, previous unsatisfactory cosmetic surgery, minimal deformity, body dysmorphic disorder, motivation based on relationship issues, and a history of depression, anxiety, or personality disorder. While most people appeared satisfied with the outcomes of cosmetic surgical procedures, some were not, and attempts should be made to screen for such individuals in cosmetic surgery settings (ibid.). Taken beyond the specialty field of cosmetic surgery, this suggests a hidden cause of similar issues medical social workers may face. More recently, Herpertz et  al. (2017) provided an overview of the status with recent developments of the reciprocal effects between plastic surgery and psychosocial functioning by focusing on bariatric surgery (Herpertz et al., 2017). It is noted that (especially in cases of class II and III obesity) bariatric surgery is the only means to reduce bodyweight significantly and permanently, though they carry with them the associated risk factors of metabolic, cardiovascular, and oncological diseases. With regard to psychosocial and psychosomatic aspects of obesity surgery, studies over the past decade provided a huge amount of essential research data to support evidence-based practice. Although the results were partly contradictory and highly dependent on the duration of follow-up, it is evident that bariatric surgery might convey an elevated risk for a minority of patients. Yet, identifying these patients before surgery had been insufficient. Fortunately, psychiatric management of bariatric surgery patients has been available via psychological and psychopharmacological treatments, with certain desired impact on postoperative mental health and weight outcomes (Sockalingam et  al., 2020). Here a lesson for clinical psychologists and social workers is, without addressing the root of psychosocial issues, their intervention might be deemed superficial and thus achieve little without working with the medical professionals. A more detailed literature review of existing research results regarding plastic surgery and its various subfields is not intended for this mainly reflective piece. However, from the viewpoint of psychosomatic surgery, it is safe to say that plastic (particularly esthetic/cosmetic) surgery is no longer a mere set of surgical procedures. Even the psychosocial dimensions are now emphasized and related research interests have continued to increase with regard to Castle and colleagues’ original question (2002): Does cosmetic surgery improve psychosocial well-being (Castle et al., 2002)? Such a question may also become more and more important for reconstructive surgery. Yet the way the question is asked differs from a typical

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psychosomatic research interest. It calls for more research and empirical evidence with a broader scope. In reality, identifying those at-risk patients before surgery is difficult and we may have to continue relying on psychiatric management of surgery patients as well as social work case management. However, a keen awareness raised by such research endeavor should help to promote psychosomatic medicine research as well as evidence-based practice in the fields of clinical social work and allied health professions.

 vidence-Based Psychosomatic Practice: E Theoretical Perspectives The term “psychosomatic surgery” used in a broad sense suggests that any kind of surgery may be viewed in a psychosomatic medicine perspective. In other words, psychological and behavioral (oftentimes also social) issues are inherent in clinical practice, justifying a general need for the services of psychologists and psychiatrists (Clay, 2020), as well as social workers. This, however, not only requires more empirical studies but also a theoretical understanding of important psychosocial factors including, for example, utilization patterns of healthcare services by diverse groups of recipients. In theory, the utilization patterns of healthcare services are a product of social construction, historical accumulation, and interaction among social, cultural, and psychological aspects (Chen et al., 2003). Thus, in order to gain a fuller understanding we have to look at patients’ perceptions of health and examine the stressors and resources that affect their health and utilization of healthcare services. For this purpose, it is necessary to scrutinize health and health-related concepts in a particular culture, as well as the role immigration experience plays and its interaction with the mainstream society (ibid.). Such analysis will help to contextualize our understanding and interpretation of the different patterns of healthcare service utilization based on empirical evidence. And this is where social workers can demonstrate unique professional competence and strength. Drawing on the first author’s previous teamwork (Chen et al., 2003) in psychiatric social work, several theoretical perspectives will be reviewed and introduced below, which are useful for providing a larger context for the study of professional practice. The major viewpoints include a feminist perspective, a cultural perspective, a political and social change perspective, and some other theories and speculations that will contribute to a more comprehensive bio-psycho-social understanding (ibid.). Taken altogether, such perspectives will help to show that utilization of professional services is not only a function of the patient/client/consumer, but also of the healthcare services, gender and racial issues, political context, and social-­ cultural circumstances.

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Feminist Perspective “Psychosomatic surgery” in its narrow sense (i.e., esthetic/cosmetic surgery) is a highly gendered topic. Both women and men are seeking plastic surgery as well as noninvasive cosmetic treatments. Yet the American Society of Plastic Surgeons (2018) revealed from its annual plastic surgery statistics that women constantly accounted for about 92% of all cosmetic procedures, whereas only 8% or so was attributable to men (American Society of Plastic Surgeons, 2018). To translate into actual numbers (in 2014, for instance): 13.6 million total cosmetic procedures were performed for women, while 1.3 million total cosmetic procedures were recorded for men in the United States. Why is there such an extreme gender difference/imbalance? The feminist perspective may provide some unique clues by emphasizing women’s social status, which is often disadvantaged. The various disadvantages can be traced to women’s powerlessness in a male-dominated society. The feminist perspective argues that women suffer from a minority status (i.e., being female) and experience more psychological conflicts and stress in male-dominated cultures. As a coping strategy or unconsciously, some women may choose cosmetic surgery in the hope to increase self-confidence and attractiveness in a sexist society. Also, there is ample evidence in the research literature, based on both feminist and mainstream social science studies, suggesting that women are more vulnerable to mental disorders because of their low-income or poverty status (Belle, 1990), family and social violence against them as women, and high demands stemming from women’s multiple roles (McBride, 1990). In some racial/ethnic communities, women might suffer from triple jeopardy (i.e., being female, being minority, and being in male-dominated ethnic culture), which could have made them experience even more stress and conflicts (Fraser, 2003). The feminist perspective is very insightful in understanding the psychosomatic processes, particularly concerning esthetic/cosmetic surgery. It also calls for the study of a wide range of subjects from the analysis of makeover television shows, cosmetic surgery websites, public health system, cosmetic surgeons, and the ethnic side of cosmetic surgery, to discussion of breast reduction and augmentation surgeries. Social workers can and should play a leadership role in helping to advance theory and practice with evidence-based research. Methodologically, from the social science perspective, both discursive construction and deconstruction (or problematization) of the concept of cosmetic surgery are instrumental. The same is also true for questioning a divide between cosmetic and reconstructive surgery (Heyes & Jones, 2009).

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Cultural Perspective Social work considers cross-cultural competence as a core skill for professional practice, particularly in clinical settings. As a case under our inquiry, cultural factors play a big part in cosmetic surgery (Blum, 2003; Jones, 2006), especially stigmatization as an important consideration. While the numbers of cosmetic procedures continue to climb worldwide, cosmetic surgery continues to be plagued by negative stigmatization (Motakef et al., 2014), similar to the stigmatization issue in mental health that clinical social workers are most familiar with. Recently, Alotaibi (2021) conducted a systematic literature review (among a total of 1515 abstracts reviewed, 94 were identified for full-text review) on demographic and cultural differences in the acceptance and pursuit of cosmetic surgery (Alotaibi, 2021). In addition to reaffirming women comprising roughly 90% of all the recipients, the pursuit of beauty through cosmetic surgery is seen culturally as a universal phenomenon. Though, different countries, races, and cultures differ in how cosmetic surgery is perceived, and in the aesthetic goals of those choosing to have it. In culturally diverse societies like the United States, non-Hispanic Whites continue to dominate among cosmetic surgery recipients, though the proportion of other races is rising rapidly (thanks to the role played by social media). After revealing these trends, Alotaibi’s (2021) literature review concludes that surgeons need to consider demographic and cultural differences of the cosmetic patients in order to understand their aesthetic goals and expectations. Differences between countries and cultures are particularly notable for beautification and transformation. With respect to the former, whereas Western patients generally prioritize their lips and the reshaping of cheeks, Asian patients tend to focus on facial slimming, and nose, cheek, and chin definition. Asian patients also are the most likely to pursue transformation, for instance, as exhibited by certain terms within the South Korean language specific to such changes to enhance marital or occupational success (Yoon & Young, 2020). These findings also provide social workers with clinical and scientific evidence in support of their belief and study on diversity. As for social work and psychological/psychiatric management, the notorious underutilization of mental health services by Asian American populations has been most striking and should first be noted. And the most popular explanation of the issue is from a cultural perspective (Chen et al., 2003). This perspective points out important differences among various cultures in terms of fundamental values, forms of expression, perceptions of mental illness, and patterns of help-seeking (Snowden & Hu, 1997). In a diverse and multicultural society like the United States, such cultural issues may be attributable to people’s immigration statuses, which in turn may have significant effects on their mental health and illness. For instance, voluntary immigrants to the United States may tend to be positively selected from their sending countries in terms of human capital (mental and physical) and socioeconomic status, which may reduce their chances of becoming mentally ill. These may

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serve as some research notes for further exploring the cultural dimension with regard to psychosomatic surgery and associated mental health services.

Political or Social Change Perspective The political or social change perspective on mental health brings about a wide range of logical arguments (e.g., Espiritu, 1996; Wei, 1993). This perspective holds a critical view of traditional mental health practice, public attitudes, research methods, and intervention techniques. Based on a different set of assumptions, it directs the study of psychological problems of individuals to broader issues facing the community and society. The reality of economic disadvantage, social stress, community disorganization, and racism not only causes psychological/psychiatric problems among disadvantaged groups, but also presents a barrier to their getting professional help. In a literature review of psychological studies of oppressed groups (including Chinese Americans), Howard (1980) showed that many people in those groups see their world as hostile, often manifest symptoms of depression, and may suffer from a sense of alienation, self-negation, and ambivalence about personal identity (Howard, 1980). Logically, social workers are better positioned than physicians and surgeons in helping patients/clients to deal with such issues. It is important to note that cultural issues always operate under certain social conditions. Cultural values and the social structure always mutually influence, constantly adopt and adjust, and may also conflict with each other. From the political perspective, social action is viewed as a vehicle for psychological health, and social change is deemed as a necessary precondition for personal change (Jones & Korchin, 1982). There is a less radical but more popular approach under the political or social change perspective, which puts emphasis on policymaking and mental health service delivery in which social workers play an important part on a daily basis. Underutilization of healthcare services does not necessarily mean lack of needs or problems, but rather an indication that healthcare services may not respond very well to the needs of certain populations (e.g., Asian Americans) (Sue & McKinney, 1975). Policy-wise, Sue & Morishima (1982) pointed out that the Center for Minority Mental Health Programs in the National Institute of Mental Health gave primary consideration to Black, Latino, and American Indian groups (Sue & Morishima, 1982). Reflecting a systemic issue in the policy provision, Asian Americans were the only minority group that was not given priority in terms of research funding and mental health service delivery. Later, our previous teamwork provided evidence that the situation has improved since the 1980s (Chen et  al., 2003), thanks to the efforts of Asian American mental health researchers and practitioners. Other research studies also indicated an improvement in mental health service delivery over time in certain areas (e.g., ethnic match and cultural competency training) (Bernal, 1990; O’Sullivan et al., 1989). However, there is still a long

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way to go to achieve racial and social equity in the provision of mental health services. In general, healthcare advocacy is an important tool in the physician/surgeon’s arsenal that stands the potential to improve both patient care and the profession (Mullens et al., 2019). However, many physicians feel that they lack the leverage and knowledge to advocate on behalf of themselves, their practices, their patients, and their profession. Although surgeons are uniquely positioned to advocate based on their clinical acumen, they need help from clinical psychologists and even more from social workers. Working as a team will help to empower surgeons to step into the policy advocacy arena for the betterment of their patients and the professional practice of plastic surgery (Kozusko et al., 2021).

The Bio-Psycho-Social Perspective The feminist, cultural, and political/social change perspectives reviewed and introduced above are instrumental to achieving a deeper understanding of the need for psychosomatic research in the specialty fields of surgery. Yet, more insights can be obtained from available research literature that contributes to a more comprehensive bio-psycho-social perspective regarding evidence-based practice. This is where social workers are most highly trained. As such research interest grows in surgery-­ related healthcare services, social workers can provide tips from the lessons learned in the broad fields of health and mental health services. Taking alcohol abuse issue for instance, social work and allied health professional studies revealed that Asian Americans tended to have lower rates of alcohol abuse than some other racial/ethnic groups. On the other hand, clinical studies also demonstrated that Asian subjects were more sensitive to alcohol than non-Asian subjects, besides the influences of psychological and social factors. Therefore, lower rates of alcohol abuse found in certain Asian cultures might have a physiological base, and thus enriching our understanding with a more comprehensive bio-psycho-social perspective that may also be applicable to the study of reaction patterns to surgical procedures. Also, cross-national comparative studies are needed since different nations have different patterns of alcohol consumption, which may be more complicated than some simple rates can clearly differentiate or evaluate. The same may be true when we introduce a broader context for psychosomatic research in surgery. With regard to the psychosocial aspects of mental illness, theories of stress and coping, along with the role of socioeconomic status (SES), have helped to expand our knowledge in terms of the development of social psychiatry and social medicine (Holzer et al., 1986). On the other hand, unlike the stress theory emphasizing that social conditions may cause mental illness, some other approaches such as selection and drift theories argue that mental illnesses cause low social status through a selecting or drifting process. The first author’s previous teamwork also presented empirical evidence that socioeconomic status would not only affect the onset, development, and prognosis of mental illnesses, but also might have an effect on help-seeking and

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service-receiving (Chen et  al., 2003). In particular, mental patients in the lower socioeconomic classes were less likely to go to private clinics but more likely to receive severe diagnoses when first seen by healthcare professionals, and more likely to be involuntarily hospitalized. Lower class status might also cause mental disorders through environmental and individual factors; conversely, mental disorders could cause lower socioeconomic status (ibid.). At an even higher level of theoretical reasoning, the former is associated with the conflict theory while the latter more associated with the functional theory in sociology. All these ideas and insights would help us achieve a more comprehensive understanding via the bio-psycho-­ social lens when studying a variety of health service issues.

Summary The purpose of this chapter is to demonstrate how social workers can learn from biomedical science and clinical practice by showing an example from psychosomatic medicine. At the same time, it shows that professional social work has a major role in even the most specialized medical/surgical procedures that is essential to achieve desired health outcomes. With the theoretical and research perspectives derived from relevant literature reviews as the guidance, a deeper understanding of the role of human service professionals, including clinical social workers and psychologists in the specialty areas, will make a good case for their own professional advancement. It also provides good arguments for evidence-based practice by drawing on the experience of psychosomatic medicine research in biomedical services. This chapter has used esthetic/cosmetic surgery as well as other examples based on literature reviews as well as the experiences and observations of the authors. In terms of future research directions, this should help to open a door to further and broader inquiry. For instance, in order to maximize the practical impact on the health and human services fields, we should also consider potential administrative issues in the practical settings involving broader psychosocial factors. Utilization of professional services, particularly in mental health and other fields with significant mental health needs, is a complex issue. As Abe-Kim et al. (2002) described, help-seeking decisions are made not only at the individual level; they could be made by patients themselves, their families, or other social agents (in the case of involuntary admissions) (Abe-Kim et al., 2002). Similarly, individual decisions in seeking/accepting professional services are made within a social context and subject to certain limits, or both choices and constraints. Hence, the perceptions, values, and beliefs of the patients/recipients and their socioeconomic status and social support systems, and also their English language proficiency, may all affect their help-seeking and services utilization (Chen et al., 2003). Consequently, the social construct of professional service utilization involves multiple dimensions and levels of facts that require a systematic understanding of potential practical issues.

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A further suggestion for more evidence-based practice via social work research is that more insights are needed under a comprehensive bio-psycho-social perspective. This includes theories on stress, coping, and the role of social support as well as selection and drift theories that provide a causal link between mental illnesses and low socioeconomic status. Issues of gender and race should also be heeded (Corley et  al., 2020). The implications for social work practice are that the best service providers will not only possess good technical skills but also a keen understanding of psychological factors/processes inherent in various kinds of service models. In addition, higher standards are needed regarding clinicians’ cultural competence in providing mental health services, with also a keen awareness of gender, political, and social issues involved that may affect the patients’ help-seeking, stress-coping, as well as other decision-making behavior situated within particular cultures. Such an understanding will help to foster a stronger commitment to empowering the patients in obtaining services and maintaining their physical, mental, and social health before, during, and after various kinds of intervention procedures.

References Abe-Kim, J., Hwang, W. C., & Takeuchi, D. (2002). Predictors of help seeking for emotional distress among Chinese Americans: Family matters. Journal of Consulting & Clinical Psychology, 70(5), 1186–1191. Alotaibi, A. S. (2021; Global open). Demographic and cultural differences in the acceptance and pursuit of cosmetic surgery: A systematic literature review. Plastic and Reconstructive Surgery, 9(3), e3501. https://doi.org/10.1097/GOX.0000000000003501 American Society of Plastic Surgeons. (2018). 2017 plastic surgery statistics. ASPS. Barsky, A. J., Orav, E. J., & Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 62(8), 903–910. https://doi.org/10.1001/archpsyc.62.8.903 Belle, D. (1990). Poverty and women’s mental health. American Psychologist, 45(3), 385–389. Bernal, M. E. (1990). Ethnic minority mental health training: Trends, and issues. In F. Serafica (Ed.), Mental health of ethnic minorities. Praeger. Blum, V. L. (2003). Flesh wounds: The culture of cosmetic surgery. University of California Press. Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl 2), 19–31. https://doi.org/10.117 7/00333549141291S206 Brown, T. (2016). Cosmetic or aesthetic? Aesthetic Surgery Journal, 36(4), 163–164. https://doi. org/10.1093/asj/sjv252 Castle, D.  J., Honigman, R.  J., & Phillips, K.  A. (2002). Does cosmetic surgery improve psychosocial wellbeing? The Medical Journal of Australia, 176(12), 601–604. https://doi. org/10.5694/j.1326-­5377.2002.tb04593.x Chen, S., & Chen, E. Y. (2021). Psychosomatic medicine and evidence-based surgery: Reflections and perspectives. Psychosomatic Medicine Research, 3(3), 1–10. https://doi.org/10.12032/ psmr2021-­0920-­043 Chen, S., Sullivan, N. Y., Lu, Y. E., & Shibusawa, T. (2003). Asian Americans and mental health services: A study of utilization patterns in the 1990s. Journal of Ethnic and Cultural Diversity in Social Work, 12(2), 19–42.

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Clay, R.  A. (2020). How psychologists prepare patients for surgery. CE Corner. (American Psychological Association), 51(6), 40. Contrada, R. J., Boulifard, D. A., Hekler, E. B., Idler, E. L., Spruill, T. M., Labouvie, E. W., & Krause, T. J. (2008). Psychosocial factors in heart surgery: Presurgical vulnerability and postsurgical recovery. Health Psychology, 27(3), 309–319. https://doi.org/10.1037/0278-­6133.27.3.309 Corley, J., Al Shehhi, N., & Kim, E.  E. (2020). Gender equity in global surgery: The feminist mission to achieve the 2030 goals. Journal of Public Health and Emergency, 4, 21. https://doi. org/10.21037/jphe-­20-­86 Espiritu, Y. L. (1996). Asian American women and men: Labor, laws, and love. Sage. Fraser, S. (2003). Cosmetic surgery, gender and culture. Palgrave. Genest, A. (1990). Psychosomatic surgery. Canadian Medical Association Journal, 142(6), 534. Harth, W., & Hermes, B. (2007). Psychosomatic disturbances and cosmetic surgery. Journal der Deutschen Dermatologischen Gesellschaft (JDDG), 5(9), 736–743. Herpertz, S., Kessler, H., & Jongen, S. (2017). Psychosomatic and psychosocial questions regarding bariatric surgery: What do we know, or what do we think we know? Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 63(4), 344–369. https://doi.org/10.13109/ zptm.2017.63.4.344. PMID: 29214946. Heyes, C.  J. (2007). Self-transformations: Foucault, ethics, and normalized bodies. Oxford University Press. Heyes, C. J., & Jones, M. (2009). Cosmetic surgery: A feminist primer. Ashgate. Holzer, C. E., Shea, B. M., Swanson, J. W., Leaf, P. J., Myers, J. K., George, L., Weissman, M. M., & Bednarski, P. (1986). The increased risk for specific psychiatric disorders among persons of low socioeconomic status. The American Journal of Social Psychiatry, 4, 259–271. Honigman, R. J., Phillips, K. A., & Castle, D. J. (2004). A review of psychosocial outcomes for patients seeking cosmetic surgery. Plastic and Reconstructive Surgery, 113(4), 1229–1237. https://doi.org/10.1097/01.prs.0000110214.88868.ca Howard, J.  H. (1980). Toward a social psychology of colonialism. In R.  L. Jones (Ed.), Black psychology. Harper & Row. Jindal, R. D., & Jennings, J. R. (2010). Grand challenges in psychosomatic research. Frontiers in Psychiatry, 1, 131. https://doi.org/10.3389/fpsyt.2010.00131 Jones M. (2006). Makeover culture: Landscapes of cosmetic surgery. Ph.D.  Thesis, Centre for Cultural Research, University of Western Sydney. Jones, E.  E., & Korchin, S.  J. (1982). Minority mental health: Perspectives. In E.  Jones & S. J. Korchin (Eds.), Minority mental health. Praeger. Kozusko, S. D., Lopez, J., Sheck, C. G., & Greco, G. A. (2021; Global Open). Political advocacy from plastic surgery trainees in the United States. Plastic and Reconstructive Surgery, 9(5), e3590. https://doi.org/10.1097/GOX.0000000000003590 Kropotov, J.  D., & Quantitative, E.  E. G. (2008). Event-related potentials and neurotherapy. Academic Press. Lyketsos, C. G., Huyse, F. J., Gitlin, D. F., & Levenson, J. L. (2006). Psychosomatic medicine: A new psychiatric subspecialty in the U.S. focused on the interface between psychiatry and medicine. European Journal of Psychiatry, 20(3), 165–171. Macleod, J., & Davey, S. G. (2003). Psychosocial factors and public health: a suitable case for treatment? Journal of Epidemiology & Community Health, 57, 565–570. McBride, A. B. (1990). Mental health effects of women’s multiple roles. American Psychologist, 45(3), 381–384. Mcnulty, J. K., & Fincham, F. (2012). Beyond positive psychology? Toward a contextual view of psychological processes and well-being. The American Psychologist, 67(2), 101–110. Motakef, S., Motakef, S., Chung, M. T., Ingargiola, M. J., & Rodriguez-Feliz, J. (2014). The cosmetic surgery stigma: An american cultural phenomenon? Plastic and Reconstructive Surgery, 134(5), 854e–855e. https://doi.org/10.1097/PRS.0000000000000604. PMID: 25347670.

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Mullens, C. L., Nathan, S. L., Kozak, G. M., Fischer, J. P., Greco, G. A., & Ueno, C. M. (2019; Global Open). Patient advocacy in plastic surgery: An underutilized tool. Plastic and Reconstructive Surgery, 7(5), e2207. https://doi.org/10.1097/GOX.0000000000002207 O’Sullivan, M., Peterson, P., Cox, G., & Kirkeby, J. (1989). Ethnic populations: Community mental health services ten years later. American Journal of Community Psychology, 17(1), 17–30. Snowden, L. R., & Hu, T. W. (1997). Ethnic differences in mental health services use among the severely mentally ill. Journal of Community Psychology, 25(3), 235–247. Sockalingam, S., Leung, S.  E., Wnuk, S., Cassin, S.  E., Yanofsky, R., & Hawa, R. (2020). Psychiatric management of bariatric surgery patients: A review of psychopharmacological and psychological treatments and their impact on postoperative mental health and weight outcomes. Psychosomatics, 61(5), 498–507. ISSN 0033-3182. https://doi.org/10.1016/j. psym.2020.04.011 Sue, S., & McKinney, H. (1975). Asian Americans in the community mental health care system. American Journal of Orthopsychiatry, 45(1), 111–118. Sue, S., & Morishima, J. K. (1982). The Mental Health of Asian Americans. Jossey-Bass Publishers. Wei, W. (1993). The Asian American movement. Temple University Press. Yoon, S., & Young, A. K. (2020). Cosmetic surgery and self-esteem in South Korea: A systematic review and meta-analysis. Aesthetic Plastic Surgery, 44(1), 229–238. https://doi.org/10.1007/ s00266-­019-­01515-­1

Chapter 7

Biomedical Education, Health Promotion, and Social Responsibility: International and Chinese Perspectives Sheying Chen, Yuxia Qin, and Xuejuan Chen

Research Background The study of population health has drawn huge attention from social scientists and practitioners who are concerned with so-called “social determinants” of population health. A systems (or systems sciences) approach, however, points to the complex interplay of health-related factors at multiple levels, from biological to societal (Fink et  al., 2016). The field of scientific (particularly biomedical) research and education, on the other hand, has seen the rise of SSR (scientific social responsibility), which demands developing linkages between science and society in certain, moral/ethical ways. An old and heated topic for the (philosophical, sociological, etc.) study of science (e.g., Nature, 1935; Butts, 1948), the almighty issue seems to have come back with even more grave concerns since the outbreak of COVID-19, followed by other crises such as deadly nuclear and cyber threats. This chapter will explore the subject from a general/global view while also putting it in perspective by considering the current ideological and political contexts of China that have

The original ideas were first expressed via an open-access online outlet (Chen & Qin, 2022), which are revised and expanded for the needs of advancing professional social work. S. Chen (*) Pace University, New York, NY, USA e-mail: [email protected] Y. Qin Xuzhou Medical University, Jiangsu, China X. Chen Hunan University of Arts and Science, Changde, China © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_7

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resulted in major social changes in the past decade. Implications for the development of professional social work will be highlighted.

From CSR to SSR: A Literature Review Corporate social responsibility (CSR) as a management concept has been used by business organizations (companies) to give back to society while bolstering brand reputation. Its history may be traced back over two centuries, with the birth of “responsible organizations” in the 1800s (Staff Writer, 2019). As a modern practice, it emerged in the twentieth century, with the term “corporate social responsibility” (CSR) coined in 1953 by American economist Howard Bowen who is often referred to as the father of CSR (Bowen, 1953). In 1971, the concept of a “social contract” between businesses and society was introduced under the idea of CSR, acknowledging officially that companies function and exist because of public consent and, therefore, there is an obligation to contribute to the needs of society. As more and more companies began incorporating social interests in their business practices while becoming more responsive to stakeholders, the 1990s marked the beginning of widespread approval or universal acceptance of CSR. By the early 2000s, it had become an essential strategy for many organizations (Staff Writer, 2019). Scientific social responsibility (SSR) may be defined as the confluence of scientific knowledge with visionary leadership and social conscience, concerned with building synergies among all stakeholders in scientific knowledge community. The term SSR is analogous to CSR while the former issue was raised and taken seriously in modern literature even earlier as indicated in the beginning of this article. However, the contribution of SSR compared to CSR is minimal at present and not well documented in the literature. Therefore, Samanth et  al. (2021) conducted a systematic literature review of SSR from 1947 to 2019 from various fields in order to evaluate SSR. Their findings show that there has been a dramatic increase in scholarly interests in SSR since the 1990s, which is similar to the case of CSR, with attention also from political leaders (e.g., Clinton, 1997). In 2011, the Angewandte Chemie International Edition of the German Chemical Society, one of the prime chemistry journals in the world, published an editorial entitled “Scientific Social Responsibility: A Call to Arms” (Krogsgaard-Larsen et al., 2011). In their call for a “preemptive strike,” the authors urge that scientists develop a new mindset and regain the trust of society by reinvigorating scientific social responsibility and actively voicing their commitment to it. While CSR may provide some inspiration, they argue, the scientific world is faced with the urgent challenge to design and develop academic leadership as a separate discipline with an emphasis on responsible use of research funds (ibid.). Broadly speaking, responsible scientific action contains consideration of population health and public welfare at every step, including making choice of what to study, for what purpose, and how to carry it out in a way that is sanctioned by social policy for the sake of social or societal well-being. This has become even more

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apparent since the outbreak of the COVID-19 pandemic, accompanied by other crises such as deadly nuclear and cyber threats. Here, with particular attention to biomedical technology, the development of a keen awareness and ethical standards is seen as a pressing need for social policy to promote scientific social responsibility for research and educational institutions worldwide. In Asia, India is currently leading the movement toward SSR as possibly the first country in the world to implement such a national policy on the lines of CSR. In 2019, a draft of the new Scientific Social Responsibility (SSR) policy was published by the Department of Science and Technology (DST) of the Indian Government, building upon its tradition of earlier policies (e.g., Scientific Policy Resolution 1958, Technology Policy Statement 1983, S&T Policy 2003, Sci-Tech and Innovation Policy 2013). The SSR policy was formally released on India’s National Technology Day 2022 with a set of guidelines in order to “create an ecosystem with a two-way engagement between science and society” (Department of Science & Technology, 2022). This national experiment is of worldwide interest and deserves international attention. With a focus on biomedical education and health promotion, a further look into another giant case of China will also be provided below with some reflection on continuing development of SSR in more specific institutional and cultural contexts. In particular, what social work professionals may learn from the idea of SSR will be brought up for consideration.

SSR Applied: Biomedical Education and Health Promotion Biomedical research plays a pivotal role in the advancement of science in the twenty-first century. Life scientists as educators also share their commitment to SSR by contributing to health promotion, particularly in the biomedical field. From an international perspective, such positive contribution may result from related instructional arrangements by institutions of higher learning. And researchers from various countries have attempted to validate their effectiveness with some empirical evidence. For instance, Muñoz-Rodríguez et al. (2021) conducted a survey to explore the influence of an enrolled degree course on health and eating habits in a population of Spanish university students. Their cross-sectional observational study, by means of a food frequency questionnaire, was carried out with 648 students, and the findings show that the self-reported body mass index (BMI) was higher for the nonbiomedical students group, which also reported less regularity in taking meals, eating fewer colored vegetables and fruits, and a higher alcohol intake. In contrast, the proportion of students that showed more interest in the diet–health duality and a desire to adopt healthier habits was larger in the biomedical students group than in the nonbiomedical group. The dietary habits discovered in the study suggest that biomedical students make healthier food choices; additionally, the group of biomedical students took more walks per week (ibid.). Research like this shows that biomedical

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education, in addition to its scientific purposes, does affect the health behavior of the students with a positive impact on health promotion. Social work, as an eclectic profession, draws on all branches of learning, including biomedical sciences. Therefore, advances in these fields should be headed by social workers while seeking to make a contribution from the angles of social medicine, social determinants of health, health disparities, etc., by observing the SSR standards.

 ealth Ethics versus Ideological/Political Education: A Case H with Chinese Characteristics Aside from the potential benefits demonstrated by the kind of research mentioned above, the term “scientific social responsibility” or SSR carries strong moral implications for scientists and science educators. In the biomedical field as well as allied health professions, it is the subject of scientific and health ethics that both researchers and practitioners are exposed and obliged to (Vevaina, Nora & Bone, 1993). There are certain ethical rules and principles, including non-maleficence, beneficence, respect for individual autonomy, confidentiality, and justice, that appear consistently. Some of the ethical issues may arise in clinical practice anywhere, including informed consent, noninitiation and termination of medical therapy, genetic intervention, and allocation of scarce health resources. However, what can be considered moral and ethical should be further examined within particular, diverse national contexts. In current China, for example, beyond the usual discussion of scientific and health ethics, there is an additional layer that must be considered. That consideration or educational requirement is called Si Zheng in Chinese (in abbreviated form), which means ideological and political education. Aside from courses specifically designed for that purpose, it requires or encourages teaching all other courses from official ideological and political perspectives, or explaining course contents (including science and technology curricula) as much as possible on the ideological and political dimension. Therefore, it is also called “ideological education in the curriculum” or “curriculum ideology and politics” (Liang, 2022). The undertaking, which has seen a dramatic rise over the past few years, possesses strong connections to the established Chinese practice of De Yu (moral education) within its educational systems ever since the People’s Republic was founded. Its evolution to such a dominating status with the current “state of the art” of Si Zheng is worth studying as a renewed case “with Chinese characteristics.” While it may sound like something beyond the subject of this chapter, it is of great relevance to the discussion of SSR in the particular cultural and historical contexts in which we can sense the complexity of the issues involved. The development of professional social work has a lot to do with such issues as well.

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Biopsychosocial Perspectives Bioethics is the discipline of ethics dealing with moral problems arising in the practice of healthcare and the pursuit of biomedical research (Heyes, 2007). Helping professionals, including social workers, may confront ethical dilemmas regularly in their individual relationships with patients and in institutional/societal decisions on healthcare policy. Moral problem solving requires the application of certain ethical rules and principles to specific situations while ethical theories also differ in different contexts. Interpretation of the ethical principles and the application of these principles to each clinical situation demand the thoughtful attention of the practitioner. In biomedical education as well as training in all health-related professions, a biopsychosocial perspective may prove to be very helpful for addressing various ethical issues in research and practice. Available research literature provides plenty of insights that contribute to biological, psychological, and social perspectives regarding biomedical issues on a global scale. Taking alcohol abuse issue for instance, previous clinical studies demonstrated that Asian subjects were more sensitive to alcohol than non-Asian subjects, besides the influences of psychological and social factors. Therefore, lower rates of alcohol abuse found in certain Asian cultures might have a physiological base, thus enriching our understanding with a more comprehensive biopsychosocial view applicable to the study of reaction patterns to biomedical procedures. However, more international comparative studies are needed since different nations may have different patterns of alcohol consumption, which may be more complicated than some simple rates can differentiate and evaluate. Generally speaking, it is the concern of such issues that have given rise to a relatively new field of research in psychosomatic medicine (Lyketsos et  al., 2006). Clinical social workers working in tandem with other health and mental health professionals are blessed with the new knowledge brought by such scientific advancement. With regard to the psychosocial aspects of health and mental health issues (Macleod & Davey, 2003) theories of stress and coping, along with the role of socioeconomic status (SES), have helped to expand our knowledge in terms of the development of psychiatric and social medicine (Holzer et al., 1986). On the other hand, unlike the stress theory emphasizing that social conditions may cause illness, some other approaches such as selection and drift theories argue that health problems cause low social status through a selecting or drifting process. In particular, mental patients in the lower socioeconomic classes were less likely to go to private clinics but more likely to receive severe diagnoses when first seen by healthcare professionals, and more likely to be involuntarily hospitalized. Lower class status might also cause mental health problems through environmental and individual factors; conversely, mental disorders could cause lower socioeconomic status. At an even higher level of theoretical reasoning, the former is associated with the conflict theory while the latter more associated with the functional theory in sociology. All these ideas and insights would help us achieve a more comprehensive understanding via the biopsychosocial lens when studying a variety of health service and bioethics

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issues (Chen & Chen, 2021). And social work as a helping profession particularly is well positioned to take a leadership role. It is important to note that cultural issues always operate under certain social conditions. Cultural values and the social structure always mutually influence, constantly adapt and adjust, and may also conflict with each other. Underutilization of healthcare services, for instance, does not necessarily mean lack of needs or problems, but rather an indication that healthcare services may not respond very well to the needs of certain populations (e.g., Asian Americans) (Sue & McKinney, 1975; Chen et  al., 2003). Furthermore, healthcare advocacy is an important tool in the helping professional’s arsenal that stands the potential to improve both patient care and the profession (Mullens et  al., 2019). However, many professionals feel that they lack the leverage and knowledge to advocate on behalf of themselves, their practices, their patients, and their profession. Yet, as a matter of fact, social work and healthcare professionals are uniquely positioned to advocate based on their clinical acumen, personal experience with patient care, and their position in the healthcare ecosystem value chain. The development of a keen awareness with clear ethical standards, thus, becomes an inherent requirement in our consideration of a potential social dimension in biomedical education.

Conclusion The main issue addressed in this chapter is the role of scientific undertaking, and biomedical education in particular, in promoting individual and societal well-being with useful implications for helping professions, including social work. The major argument is that scientific research and education contains a social dimension in terms of its implications for population health and public welfare. With particular attention to biomedical technology, the development of a keen awareness and ethical standards has become a pressing need for social policy to promote scientific social responsibility (SSR) for scientific research and educational institutions. As Chinese social work professionals endeavor to promote scholarship, practice research, and evidenced-based intervention, this provides useful tips to maintain professional standards. A biopsychosocial view of health-related matters as well as an international perspective on ethical issues in healthcare practice is more important than ever to achieve a higher-level understanding. Cultural sensitivity is equally instrumental to the inquiry (Mcnulty & Fincham, 2012), particularly in relation to China’s current ideological and political contexts in terms of the complexity of the issues involved. By combining an interest in the social determinants of health with a conceptual framework of SSR for understanding how genetics, biology, behavior, psychology, society, and environment interact (Braveman & Gottlieb, 2014), a systems or systems science approach can inform our understanding of the underlying causes of the distribution of health across generations and populations, and can help us identify potential barriers to its achievement. Therefore, it is ultimately important to understand how systems science approaches may make substantive and

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methodological contributions to the study of population health from a combined science–social science/social affairs perspective. That is why allied health professions such as social work may make a substantial contribution.

References Bowen, H.  R. (1953). Social responsibility of the businessman. Harper & Row. https://doi. org/10.2307/j.ctt20q1w8f Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(Suppl 2), 19–31. Butts, C. (1948). Science and social responsibility. Philosophy of Science, 15(2), 100–103. https:// doi.org/10.1086/286978 Chen, S., & Chen, E. Y. (2021). Psychosomatic medicine and evidence-based surgery: Reflections and perspectives. Psychosomatic Medicine Research., 3(3), 53–62. https://doi.org/10.12032/ psmr2021-­0920-­043 Chen, S., & Qin, Y. (2022). On ethics, biomedical education and health promotion: International and Chinese perspectives. International Healthcare Review (Online). Chen, S., Sullivan, N. Y., Lu, Y. E., & Shibusawa, T. (2003). Asian Americans and mental health services: A study of utilization patterns in the 1990s. Journal of Ethnic and Cultural Diversity in Social Work, 12(2), 19–42. https://doi.org/10.1300/J051v12n02_02 Clinton, B. (1997). Editorial (Presidential Speech): Science in the 21st century. Science, 276(5321), 1951. https://doi.org/10.1126/science.276.5321.1951 Department of Science & Technology. (2022). Scientific Social Responsibility (SSR) Guidelines. Government of India. https://dst.gov.in/document/guidelines/ scientific-­social-­responsibility-­ssr-­guidelines-­2022 Editorial. (1935). Science and social responsibility. Nature, 135, 758. https://doi. org/10.1038/135758a0 Fink, D.  S., Keyes, K.  M., & Cerdá, M. (2016). Social determinants of population health: A systems sciences approach. Curr Epidemiol Rep., 3(1), 98–105. https://doi.org/10.1007/ s40471-­016-­0066-­8 Heyes, C.  J. (2007). Self-transformations: Foucault, ethics, and normalized bodies. Oxford University Press. Holzer, C. E., Shea, B. M., Swanson, J. W., Leaf, P. J., Myers, J. K., George, L., Weissman, M. M., & Bednarski, P. (1986). The increased risk for specific psychiatric disorders among persons of low socioeconomic status. The American Journal of Social Psychiatry, 4, 259–271. Krogsgaard-Larsen, P., Thostrup, P., & Besenbacher, F. (2011). Scientific social responsibility: A call to arms. Angewandte Chemie, International Edition, 50, 10738–10740. Liang, W (2022). On the English translation of “Kecheng Si Zheng”. https://www.weibo.com/ ttarticle/p/show?id=2309404784907892425180. Accessed 1 Oct. 2022. Lyketsos, C. G., Huyse, F. J., Gitlin, D. F., & Levenson, J. L. (2006). Psychosomatic medicine: A new psychiatric subspecialty in the U.S. focused on the interface between psychiatry and medicine. European Journal of Psychiatry, 20(3), 165–171. https://doi.org/10.1176/appi.ap.28.1.4 Macleod, J., & Davey, S.  G. (2003). Psychosocial factors and public health: A suitable case for treatment? Journal of Epidemiology & Community Health, 57, 565–570. https://doi. org/10.1136/jech.57.8.565 Mcnulty, J. K., & Fincham, F. (2012). Beyond positive psychology? Toward a contextual view of psychological processes and well-being. The American Psychologist, 67(2), 101–110. https:// doi.org/10.1037/a0024572

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Mullens, C. L., Nathan, S. L., Kozak, G. M., Fischer, J. P., Greco, G. A., & Ueno, C. M. (2019). Patient advocacy in plastic surgery: An underutilized tool, plastic and reconstructive surgery. Global Open, 7(5), e2207. https://doi.org/10.1097/GOX.0000000000002207 Muñoz-Rodríguez, J.  R., Luna-Castro, J., Ballesteros-Yáñez, I., Pérez-Ortiz, J.  M., Gómez-­ Romero, F.  J., Redondo-Calvo, F.  J., Alguacil, L.  F., & Castillo, C.  A. (2021). Influence of biomedical education on health and eating habits of university students in Spain. Nutrition, 86, 111181. https://doi.org/10.1016/j.nut.2021.111181 Samanth, M. V., Hemchand, J., Vrushank, A. K., & Swamy, D. R. (2021). Scientific social responsibility – A systematic literature review. International Journal of Advance Research, Ideas and Innovations in Technology, 7(2), 1335. Staff Writer. (2019, September 25). A brief history of Corporate Social Responsibility (CSR). Thomas Publishing Co. https://www.thomasnet.com/insights/history-­of-­ corporate-social-­ responsibility/. Accessed 25 Sep 2022. Sue, S., & McKinney, H. (1975). Asian Americans in the community mental health care system. American Journal of Orthopsychiatry, 45(1), 111–118. https://doi.org/10.1111/j.1939­0025.1975.tb01172.x Vevaina, J. R., Nora, L. M., & Bone, R. C. (1993). Issues in biomedical ethics. Disease-a-Month, 39(12), 869–925. https://doi.org/10.1016/0011-­5029(93)90019-­Y

Citation Chen, S., Qin, Y., & Chen, X. (2023). Biomedical education, health promotion, and social responsibility: International and Chinese perspectives. In S. Chen (Ed.), Social work, mental health, and public policy in diverse contexts: Chinese and cross-cultural perspectives. Springer Nature.

Part III

Policy and Practice with Diverse/Special Populations

Chapter 8

Ethnicity and Diversity: American Experience and Implications for Social Work Sheying Chen, Yanjiao Chen, and Yifan Xu

Introduction Diversity is an extremely important subject in social work and a central theme chosen in the current year to celebrate the World Social Work Day. Deemed as a core value of the profession, diversity has not been thoroughly discussed and debated in China as has been the case in the United States. This chapter will introduce the topic by examining the American experience with its major issues and achievements in the hope of providing some useful lessons for use by Chinese social work and other helping professionals. If any thing may be called “American characteristics,” race would be one of the defining (and often polarizing) features of American society (Healey, 2009; Donohue III & Levitt, 2001). Racial issues permeate politics, business, education, and other aspects of our social life. Naturally, they are the most important to diversity management. But what is race? And how does it relate to ethnicity? When some sociologists say race is biological (inherited biological traits) and ethnicity is social (shared cultural traits) (like sex vs. gender), not all have remained that certain as to what The topic was originally addressed by the first author (Chen, 2011), which are revised and expanded for the needs of social work practice with diverse populations in China S. Chen (*) Pace University, New York, NY, USA e-mail: [email protected] Y. Chen Henan Normal University, Xinxiang, China Y. Xu Hunan Post and Telecommunication College, Changsha, China © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_8

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biological race exactly means. Chen (2011) explored the meaning of race as a fundamental problem in practice and related debates and discussed various approaches to race and ethnicity from a historical point of view. For the purpose of learning from the American experience, we will review those issues facing racial/ethnic minorities in the United States, as well as its practices in diversity management with implications for social work research and practice.

Issues of Racial Classification and Identification In a layman’s view, especially at first glance, race is about skin color and some other characteristics of people’s appearance. A biological race theory would substantiate that view by classifying racial categories (e.g., Caucasoid, Negroid, and Mongoloid) based primarily upon such externally visible traits as skin color, hair color and texture, eye color and eyefolds, features of the face including nose shape, the shape and size of the head and body, and the underlying skeleton (Lowe, 2010). Recognition of some basic divisions of mankind by the public and the government, while different from early biological classifications (such as the above) by rejecting clear-cut categories, has been informed by and also helped to perpetuate this type of common-­ sense views. Nevertheless, externally visible traits have been found to be unreliable and difficult to give a precise definition of race in social practice, particularly in the practice of law. Historically, in the United States, legally determining one’s racial identity could be a matter of a life of slavery or freedom for the person. That not only involved arguments about one’s skin color and outward appearance (or “characteristic features”) but also required evidence such as findings from genealogy. When some biologists attempted to determine race in terms of internal (e.g., brain mass, frontal lobe mass, brain surface fissures and convolutions, and body lice) and genetic differences, some lawyers, politicians, and other practitioners could hardly wait for their promised or promising results. There had long been a belief that such differences did exist, so Judge St. George Tucker was confident that race could be ascertained by physical appearance because of internal, genetic ingredients of human bodies (Haney-López, 1994). Many social scientists and activists, on the other hand, have been concerned about the implications of alleged genetic difference of race in further perpetuating a historically oppressive racial hierarchy in American society. They point out that scientific data show that intra-group differences tend to exceed inter-group differences, which refute the supposition that racial divisions reflect fundamental genetic differences. Since genetic difference and physical appearance were linked by the popular belief, they have rejected the idea of biological race altogether by claiming that scientific evidence has failed to support such a notion. Instead, they believe that race is socially constructed (Haney-López, 1994). By focusing on the analysis of racial inequity and discrimination, critical race theorists have considered many

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judicial conclusions to be based on inherently racist social assumptions (Delgado & Stefancic, 2000). It should be noted that even the social construction of race may become problematic. Some scholars believe that races are wholly illusory, whether as a biological or social concept (Haney-López, 1994). One of the questions is, should the United States be “color-blind”? The case against race may be based on a noble reason, like the question raised by the early natives “discovered” in the New World as to whether all could be considered in the same “family of man” (Omi & Winant, 1998). By simply ignoring race, however, a popular (if not scientific) dimension of human diversity would be eliminated arbitrarily and important practical issues would remain unaddressed (especially in a racist society). In reality, race and ethnic studies have proven to be important fields of inquiry. As social constructionist Lopez (ibid.) narrates, “Race is neither an essence nor an illusion, but rather an ongoing, contradictory, self-reinforcing process subject to the macro effects of daily decisions” (p. 7). Onwuachi-Willig (2010) notes that, despite a plethora of literature on the social construction of race, a longing for biological race lingers. Aside from those theoretical and political considerations and contentions, there have been a couple of notable practical developments. One is that the most commonly used proxy for race—skin color and outward appearance—has been increasingly complicated by the growth of multiracial or mixed-race population. Through its very existence, such a growing population challenges any rigid notion of race by subverting the color line and steadily destabilizes the assumptions that construct and preserve racial hierarchy (ibid.). The other is the emergence of such technology as DNA testing, which has brought about a new and popular view of genetic race, marking a return to the notion of biological race (particularly in criminal law enforcement) (Lowe, 2010). The two trends being combined, there was a controversial claim that the average African American is 17–18% white according to DNA (http://www.black demographics.com/, retrieved July 1, 2010). Still, biomedical research has led to such new products as race-based packaging of prescription drugs, despite serious concerns expressed by scholars and legal experts (Ikemoto, 2005). Talking about race by eliminating any biological basis (e.g., simply equating with class or something else) seems to go against common sense (if not scientific evidence). After all, the social construction of race refers to people attaching meaning and values, either real or imaginary, to physical differences between groups of people within certain cultural contexts. Simply dismissing skin color or feature of the face or body as superficial, for example, may not help people to deal with the diversity by assuming that they and others will simply ignore the difference and automatically focus on things that are only “social” (not natural). The fact (and designation) “of color” often shows the significance of such a “superficial” matter in political, economic, and social life. Summarizing an important lesson from the decision of the Supreme Court of Appeals of Virginia in the historical case of Hudgins v. Wrights in favor of the non-­ genetic nature of race, Onwuachi-Willig (2010) indicates that race is socially determined by both physical and nonphysical proxies. In dealing with race, particularly

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when physical proxies are involved, however, the society faces a paradoxical need to raise sensitivity to racial diversity, on the one hand, and fight against exaggeration, stereotyping, and stigmatization of racial differences, on the other. This chapter holds the view against any pure biological or social categories of race by recognizing racial ambiguity and the dilemmas of classification. It also considers the purpose of studying and using race as vital since a commitment to racial characteristics may either lead to prejudice and discrimination or serve the cause of promoting diversity and racial/ethnic sensitivity. It should be noted that most data available on race, including surveys and the most important census data, are based on self-reports that may be affected by many factors. In practice, race or ethnicity is oftentimes a matter of self-identification, despite those court cases determined by the judges. As a working definition of race in this chapter, we consider that 1. It is a social construct based on self and community perceptions and choices, shaped by history and influenced by various political, economic, and other interests, which, in this sense, may be used interchangeably with ethnicity that emphasizes behavioral variability (or differences) and cultural contexts (regardless of potential semantic differences between the two terms in certain uses). 2. It has a biological base such as physical appearance, blood relationship, and possibly internal indications, though they must not be interpreted to determine biological race in a particular, simplistic way or exaggerated in support of a racial hierarchy with prejudice and discrimination. In this sense, race is different from ethnicity since the latter does not have such biological meaning.

Approaches to Racial/Ethnic Diversity: A Historical View Race relations are an important subject of sociological study that bears heavily on social work practice in the United States. Sociologists often use “patterns of race and ethnic relations” as the subject heading, sometimes in more general terms such as “patterns of inter-group interaction,” “dominant/minority group interaction,” or “majority/minority relationships.” They identify and trace the evolution and shift of major patterns historically, and sometimes rank them along a continuum that extends from complete intolerance to complete tolerance. At the former extreme is genocide, that is, the intentional extermination (or systematic annihilation) of one population by a more dominant population. The next is expulsion (or population transfer), that is, the forcible removal of one population from a territory claimed by another. In contrast, internal colonialism would keep a population in place but it was controlled (and owned in the case of slavery) by another. Separation of races or ethnic groups in both ecological and institutional senses on the same territory is called segregation, which may be the result of a people’s desire to live separately and maintain their own culture and institutions (voluntary segregation), or created by social norms including laws (involuntary segregation) (Healey, 2009).

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The above-recognized patterns can be arranged toward one end of the continuum as different approaches to exclusion. Toward the other end (inclusion) of the continuum is assimilation, that is, the blending of a minority group into the majority population, with the anticipated outcome that the identities of separate groups merge into a single group (ibid.). The United States has been proud of itself as a “melting pot,” a metaphor to describe the process of assimilation of immigrants in seeking their American dreams. The melting-together metaphor symbolizes a heterogeneous society becoming more homogeneous in the hope of a harmonious whole with a common culture. The assimilation process is sometimes denoted as A + B + C = A, with A standing for the majority or “standard” culture (e.g., see http:// www.adrr.com/adr4/moaad.htm, retrieved July 1, 2023). In other words, assimilation may be seen as the process of being absorbed into the mainstream of the dominant culture. In practice, however, assimilation may also affect the majority, and therefore the result may be different, which is called amalgamation and denoted by A + B + C = D, in a sense closer to the ideal of a “melting pot.” Compared to the earlier, less tolerant patterns of race relations, assimilation and the “melting pot” represented a major step toward better majority–minority relationships. While the assimilation model might expect that other groups conform to, and new immigrants be socialized into, the dominant culture, minority groups may meet with resistance even if they want to assimilate structurally to achieve full citizenship rights in the society. Neither is the assimilation of a minority group leading to its eventual disappearance as a distinct people always desirable. Ethnic stratification in terms of the valuation of different groups according to how closely they conform to Anglo-Saxon standards of appearance, behavior, and values has also caused concern. During the 1970s, the “melting pot” model was challenged by people who asserted that cultural differences within society are valuable and should be preserved. An alternative metaphor of the “salad bowl” was introduced to represent the mix of different cultures that would remain distinct. Such an approach is called pluralism, cultural pluralism, or multiculturalism, denoted by A + B + C = A + B + C. The ideal of pluralism is for different ethnic and racial groups to coexist with equal status and tolerance, maintaining unique cultures and lifestyles without developing positions of subordination. A pluralist society is characterized by recognition and tolerance of cultural and ethnic diversity. Note that “pluralism” and “diversity” are often used together or interchangeably as if they were synonyms. Diversity is extremely important in recognizing human differences. Yet, according to Eck (1997), diversity is just plurality, which does not add up to pluralism. Pluralism is the engagement that creates a common society from all that plurality. After the world experienced a full spectrum of models of race relations, pluralism has emerged as a leading approach to diversity since the late twentieth century, even though assimilation still carries its weight in immigration studies, including an argument about segmented assimilation (Healey, 2009).

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Race/Ethnicity and Minority Issues in American Society The historical development of race in the United States is termed “racialization” by Omi and Winant (1998). Note, with the exception of Native Americans, that the United States is a nation of immigrants in modern history, who arrived in the past few centuries following the “discovery of America” by Christopher Columbus in 1492. A brief review of the immigration history of various racial/ethnic groups, along with the story of Native Americans, will provide a useful perspective. While Native Americans firstly appeared different from the European settlers (Brunner, 2007), the racial category of “black” also evolved with the consolidation of racial slavery. The latter provided a racial logic—the establishment and maintenance of a “color line”—for the ideology of exploitation (Omi & Winant, 1998). That in turn shaped a racial identity for the European settlers themselves in a new term of self-identification as “white.” The influx of Southern Europeans, the Irish and Jews in the nineteenth century, however, challenged that “white” identity based only on the Anglo-Saxon stock of the founding immigrants (ibid.). In addition, the experiences of the Chinese, Japanese, Hispanics/Latinos, and other racial/ethnic groups also contained different but remarkable stories of other immigrants that resulted in more diverse minority groups. A minority means being smaller in number, or being a part of a population differing from others in some characteristics and often subject to differential treatment (see http://www.merriam-­webster.com/dictionary/minority, retried July 1, 2023). In the latter sense, a minority is a category of people who lack power and privilege, subject to prejudice and discrimination (therefore women are often considered a minority in American society). New immigrants, in general, could also be viewed as in a minority status, especially before they are granted citizenship and the rights associated with it. So far, whites, particularly those of WASP (White, Anglo-Saxon, Protestant) origin or those born in the United States, have been deemed the majority of American society, both in number and in status, who are different from new white immigrants or original non-English “White Ethnic Americans.” All first-generation immigrants, however, shared experience with varied degrees and kinds of hardship. The so-called “old” immigration from the Old World to the New World began between Independence and the Civil War, while the “new” immigration wave began in the 1880s, with peak years of immigration from Europe arriving in the 1920s. Of all the immigrant groups, the newcomers joining the category of White Ethnic Americans encountered fewer problems and delays in assimilation and ethnic revival. However, many of them suffered from prejudice and discrimination such as anti-Catholicism and anti-Semitism (Healey, 2009). Note that Hispanic or Latino population is also predominantly white (Grieco & Cassidy, 2001). More recently, “reverse discrimination” (particularly that against white males) became a serious concern and has resulted in outcries and a number of lawsuits. It is predicted that at current fertility and immigration rates, white European (non-Hispanic) Americans will be outnumbered by other racial/ethnic groups by mid-twenty-first century while many of them are unprepared to become future minority (Keen, 1995).

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Asian Americans are sometimes referred to as a “model minority” as their educational attainment and household income on the whole are the highest of all major racial/ethnic groups (U.S. Census Bureau, 2008). However, they are often discriminated against for their “alien-like” look (Andrew, 1998) and are excluded from the benefits of such controversial programs as affirmative actions. Despite their accomplishments, data show that Asian Americans face the lowest “glass ceiling” compared with other racial/ethnic groups, in the sense that they have by far the worst chance to rise to managerial levels in private industries, universities, and the federal government.

Lessons Learned and Implications for Social Work Race is a social construct shaped by history and influenced by various political, economic, and other interests. In that sense, the term may be used interchangeably with ethnicity that emphasizes cultural patterns and contexts. However, race has a biological base such as physical appearance, blood relationship, and possibly internal indications, though they must not be interpreted to determine biological race in a particular, simplistic way or exaggerated in support of a racial hierarchy with prejudice and discrimination. Therefore, race is different from ethnicity since the latter does not have such biological meaning. Issues concerning race and ethnicity are often at the center stage of American affirmative action debate and thus extremely important to diversity management. They also involve technical problems as the society attempts to address them in scientific ways. At this stage, any pure biological or social categories of race would prove futile because of racial ambiguity and the difficulty of classification. The purpose of studying and using race is important since a commitment to racial characteristics may either lead to prejudice and discrimination or serve the cause of promoting diversity and racial/ethnic sensitivity. Most data available on race, including surveys and the most important census data, are based on self-reports that may be affected by many factors. As we indicated at the beginning of this chapter, racial and ethnic are often the core issues in diversity and affirmative action-related debate in American society. A clear understanding of the conceptual issues, historical patterns of race relations, the evolution of various racial and ethnic groups, and the outstanding issues they still face including the special needs of minority groups is crucial to competent diversity management. The tasks for the social worker will include understanding how a racial/ethnic identity is formed, determined, or perceived. What matters to the social worker is the sensitivity to the history and culture of each group, recognition of the special issues they face and how that will play into the particular situations of individuals, and working out solutions under the guiding principles of equal opportunity, equity, and pluralism.

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While racial discrimination is not seen as an issue as common as sexism and agism in China, the fundamental idea of diversity along with the experience, lessons, and achievements shown in the American story is worth studying. It will enable social work and other helping professionals to be culturally more competent and make the society more inclusive and equitable.

References Andrew, G. (1998). Closing the gate: Race, politics, and the Chinese exclusion act. The University of North Carolina Press. Brunner, B. (2007). American Indian versus native American: A once-heated issue has sorted itself out. Information Please® Database, Pearson Education, Inc. Chen, S. (ed.) (2011). Diversity management: Theoretical perspectives and practical approaches. Nova Science Publishers. Delgado, R., & Stefancic, J. (Eds.). (2000). Critical race theory: The cutting edge. Temple University Press. Donohue, I. I. I. J. J., & Levitt, S. D. (2001). The impact of race on policing and arrests. Journal of Law and Economics, XLIV(October), 367–394. Eck, D.  L. (1997). On common ground: World religions in America (CD-ROM). Columbia University Press. Grieco, E. M., & Cassidy, R. C. (2001). Overview of race and Hispanic origin: 2000. United States Census Bureau. Haney-López, I. F. (1994). The social construction of race: Some observations on illusion, fabrication, and choice. Harvard Civil Rights-Civil Liberties Law Review, 29, 1–62. Healey, J. F. (2009). Race, ethnicity, gender, and class: The sociology of group conflict and change (5th ed.). SAGE Publications (Pine Forge Press). Ikemoto, L. (2005). Race to health: Racialized discourses in transhuman world. The DePaul Journal of Health Care Law, 9, 1103. Keen, C. (1995, September 18). Whites unprepared to become future minority. Albion Monitor. http://www.albionmonitor.com/9-­18-­95/minority.html. Lowe, W. Q. (2010). Understanding race: The evolution of the meaning of race in American law and the impact of DNA technology on its meaning in the future. Albany Law Review, 72, 1114–1143. Omi, M., & Winant, H. (1998). Racial formations. In P.  S. Rothenberg (Ed.), Race, class, and gender in the United States: An integrated study (4th ed.). St. Martin’s Press. Onwuachi-Willig, A. (2010). Multiracialism and the social construction of race: The story of Hudgins v. Wrights. In G.  Early & R.  Kennedy (Eds.), Best African American essays 2010 (pp. 311–339). One World Books of Random House. U.S.  Census Bureau. (2008). 2008 American Community Survey 1-Year Estimates. http://factfinder.census.gov/

Chapter 9

Spirituality Without Religion: Social Work for Promoting Selfhood Among Chinese Women in a Consumerist Society Margaret Xi Can Yin and Cecilia Lai Wan Chan

Introduction Chinese youths would spend an average time of 40 min on selfie-editing, and they believed that one should get a photo enhanced before posting it on social media (Fan, 2018). Chinese cosmetic surgery market is reported to grow six times faster than the global average in recent years, and it has become the third largest growth industry in China (Wang et al., 2021). Females were eager to have a slim and small face with big eyes, double eyelid, high nose bridge, a small mouth, and pointy chin as beauty described by the commercial advertisement in China (DeGennaro, 2018). Besides, it is still common that infertile women in China would experience stigma and social withdrawal (Jing et al., 2022). Therefore, fertility and beauty dominate Chinese women’s thinking and behavior in the consumerist society with many traditional doctrines on females. In traditional Chinese culture, “Women should dress up for their beholders,” and “husband guides wife” is one major component of the three cardinal guides in Confucian ethics. These values and rules have bound women for a long time. Under these social norms, women are accustomed to forbearance and sacrifice. They love others, but blame themselves. In China, people believe that harmony in a family makes everything successful, and women are responsible for protecting the family harmony (Lu, 2017). For a long time, the social culture has created a wonderful M. Xi Can Yin (*) School of Humanities, Southeast University, Nanjing, China e-mail: [email protected] C. L. W. Chan Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 S. Chen (ed.), Social Work, Mental Health, and Public Policy in Diverse Contexts, International Perspectives on Social Policy, Administration, and Practice, https://doi.org/10.1007/978-3-031-36312-2_9

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women’s role. That is, in a family, a perfect woman can bring good luck to husband, can educate children well, and is filial to parents-in-law, considerate to parents, and supportive to brothers (usually financially). In a society, a perfect woman is beautiful with a good face, white and smooth skin, and a slim figure, rich, middle-­educated, a little silly but tolerant, from a decent family, and follows father/husband/brother’s arrangement. If someone needs to compromise, women’s feelings are always not important. Chinese women are long-termly being oppressed and get used to sacrificing themselves (Jing et al., 2017). They have, thus, gradually lost their selfhood. China has always been the country with the lowest percentage of religious population in the world. However, almost all of the existing studies on spirituality are related to religion (Paul Victor & Treschuk, 2020). How is the spirituality of Chinese women the majority without religion? Selfhood plays an essential role in spirituality; it refers to the immunity to social influences, the ability to correct distorted moral judgment, and the capability to transcend culture norms and relational requirements (Meyers, 2020). It is important to develop selfhood in order to pursue spiritual growth. What represents the autonomy, independence, and rationality of Chinese women’s selfhood? The consumerist society has set a number of requirements for females, leading to appearance anxiety, fertility anxiety, and mental disturbances. Many young women want to lose weight through fasting; even cleaning staff are spending huge sums of money on expensive skin care products; couples get divorced because of infertility. How can social work help with these situations? Although some young men are falling into this “fertility and beauty” whirlpool, women are more prone to the traditional social norms and values under patriarchy to suffer from appearance and fertility anxieties (Fredrickson & Roberts, 1997; Strelan & Hargreaves, 2005). It is quite common that descriptions of males in Chinese dating market focus mainly on their personal characteristics while descriptions of females are only appearance and figures. Therefore, how to promote selfhood among women without religions in a consumerist society through social work methods is the major question of this chapter. In Eastern philosophy of Buddhism and Daoism, understanding the roots of suffering can empower the spiritual self in containing mishaps while enhancing the capacity of individuals to endure and grow out of sorrows and pain (Yin et al., 2020). Buddhist wisdom teaches that enlightenment occurs only when the practitioner can live with the Four Bodhisattva’s Immeasurables: (1) immeasurable loving-kindness, (2) immeasurable compassion, (3) immeasurable joy, and (4) immeasurable equanimity. Daoism highlights the let-­ it-­be and self-healing process. Self-efficacy is viewed as a Western concept of self, which involves evaluation and self-rating (David et al., 2013). Therefore, accepting suffering, promoting compassion, love, and unconditional acceptance of the self, and self-efficacy may be the crucial components of nonreligious women’s spiritual self-hood. This chapter presents a possible social work intervention highlighting acceptance and self-love for Chinese women to enhance their selfhood against the “fertility and beauty” oppression.

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Methods Participants Participants were recruited at the Department of Gynecological Endocrinology and Reproduction at the University of Hong Kong-Shenzhen Hospital. Patients in this department were common to have infertility worries and appearance changes like obesity, acne, and hair loss because of unbalanced hormone. Patients willing to participate provided written informed consent before entering the study. The study was approved by the Medical Research Ethics Committee of the HKU-Shenzhen Hospital (No. 2019167). Women who (1) were premenopausal women aged above 18 years old, (2) able to understand oral and written Chinese, and were (3) physically capable of simple body movements were included in this study. Those who met the following criteria were excluded: (1) Patients currently suffering from other genetic or endocrine diseases or neuropsychiatric disorders that require psychotropic substances (such as antipsychotics, antidepressants, or anticonvulsants); (2) pregnant women; (3) patients who have taken part in other similar intervention programs in the past 3 months or are currently on other exercise training programs or weight loss programs; and (4) considering the association between nicotine and cortisol levels (Cohen et  al., 2004), which shows the stress level, women who smoke on average five or more cigarettes per day were excluded.

Procedures All eligible participants were approached via doctors’ referrals. A short pre-group interview was conducted to ensure that participants met the screening criteria and to understand their needs. At the beginning of the first intervention session [T0] and the end of the last session [T1], a questionnaire was distributed to assess their psychological status. In 2–3 months after the intervention [T2], the same questionnaire was sent to the participants again to examine the long-term effectiveness of the intervention. Open questions relating to the overall evaluation of the intervention and spiritual transformation after the intervention were also asked at T1 and T2.

Intervention A six-session therapeutic and self-help group was designed. The themes and purposes of the six sessions were to reduce infertility worries, appearance anxiety, and promote selfhood. A detailed protocol is shown in Table 9.1, which was published

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Table 9.1  Outline of the six-session selfhood-oriented intervention Theme Listen to your heart

Purpose Recognize the uncertainty and ambiguity of life; prepare for body mind adjustment

Content Briefing Ice breaking: Self-introduction, union games

Activities Abdominal breathing Sensation of qi Weekly diet Group contract, introduction + original + free self-designed supplement recipes Group introduction Emotional problems, uncertainty and sharing Ups and downs in life sharing One-second Lecture on Focus on Identify objectified acupressure the present experiences; cultivate objectification and massage gender roles healthy aesthetics Lecture and share on Objectified experience sharing family attributes My creative advertisement Meditation: Feel the nature; relax the soul Stressors and their Massage: Hand Take care Understand the effects of yourself dangers of stress; The pressure learn to relieve stress Stress and infertility sources and physically and Talk and share ways calculate my mentally pressure score to reduce stress Experience sharing Weekly soup Meditation: Love introduction and forgiveness Video of you are Daily lifestyle Accept all Learn about beautiful of you self-acceptance; Self-portrait game accept illness Self-acceptance and share uncertainty lecture How to love yourself Confidence auction

Homework Diet and exercise daily record

Diet and exercisedaily record

Diet and exercisevdaily record Self-portrait

Diet and exercise daily record Gratitude journal

game Meditation: Self-acceptance Forgiveness and gratitude (continued)

9  Spirituality Without Religion: Social Work for Promoting Selfhood Among Chinese… 137 Table 9.1 (continued) Theme Cure from the mess

Purpose Develop a positive concept of gain and loss; make changes through selfhood

Continue to build strength

Establish a new way of life; form a long-term support group

Content Briefing The psychosomatic mechanism and coping process of infertility

Important things to choose

Activities Bite stick game and hip breathing

Homework Diet and exercise Daily record Pain point Negative emotions Future plans and suffering Source of pain Gain and loss transformation Meditation: Regain strength Spring of comfort: One word The power of the mind My life and share Keep in contact Future plan sharing and exercise Play and share gifts Meditation: Relaxation and renewal Appreciate each other

in Yin et  al. (2021). Coping with ambiguity and overcoming self-objectification were carried out in the first two sessions. Techniques for self-acceptance and self-­ love were illustrated in the middle two sessions. A discussion on the meaning of life experience and personal transformation were the main focuses of the last two sessions. In each session, targeted tips were given and practiced on-site, and group discussion and sharing were taken. Besides, there was relevant homework after each face-to-face session. Each session was held for 3  h. Each group accommodated 8–10 participants.

Measurements Open questions and a questionnaire were used for program evaluation. Sample questions were: How would you rate this six-session group? What is your major gain after joining this program? Have you experienced any spiritual change? Besides sociodemographic information, the questionnaire contained scales measuring body shame, body surveillance, self-efficacy, illness acceptance, and appearance anxiety. Body surveillance and body shame were measured by the subscales of Objectified Body Consciousness Scale (OBCS-BS) (McKinley & Hyde, 1996), each subscale

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consisting of eight items associated with self-objectification in the form of appearance monitoring and adopting an outsider’s view of oneself. The body shame subscale quantifies feelings of inadequacy and shame of one’s body. It uses a 7-point Likert scale ranging from 1 = strongly disagree to 7 = strongly agree. A high score is corresponding to a high level of body surveillance and body shame. The Chinese version of OBCS has been supported with good reliability and validity, with a Cronbach α of 0.95 (Jackson et al., 2016). Self-efficacy was measured by the General Self-Efficacy Scale (GSES) (Schwarzer & Jerusalem, 1995). GSES contains ten items relating to emotion, optimism, and work satisfaction. A higher score indicates more self-efficacy. The Chinese version of GSES has been clarified with good reliability and validity (Hu et al., 2014). Illness acceptance was measured by the Acceptance of Illness Scale (AIS) (Felton et  al., 1984). AIS contains eight items describing the negative impact of being ill, including the limitations caused by disease, the weakening or loss of self-­ sufficiency, dependence on others, and lowering of self-esteem. The higher the patient’s score, the better they are able to adapt to the limitations and psychological discomfort caused by the condition. The Chinese version of AIS has been clarified with good reliability and validity (Zhao, 2018). Appearance anxiety was measured by a 14-item brief version of the Appearance Anxiety Scale (Dion et al., 1990), which requires participants to report incidents of anxiety about their bodies. Items (e.g., “I wish I am better looking”) are rated along a 5-point scale ranging from 1 (never) to 5 (almost always). A higher total score is interpreted as a higher degree of appearance anxiety. AAS has shown good reliability and validity among Chinese women, with a Cronbach α of 0.94 (Yu & Zhao, 2016).

Analysis Method Tape-recorded pre-group interviews and oral feedback were transcribed verbatim and translated from Mandarin to English. The transcripts were coded and analyzed within NVivo 12 software using both deductive and inductive content analysis approaches (Elo & Kyngas, 2008). This analysis involves six phases: (1) familiarizing with the data, (2) generating initial codes, (3) searching for themes, (4) organizing sub-themes, (5) defining and naming subcategories, and (6) producing the report. All transcripts were analyzed and coded to ensure themes saturation. Categorical data were presented as frequency and percentage of the total. Continuous data were presented as means and standard deviations. The above outcome measures were treated as continuous data. Paired sample t-tests were adopted to test the within-group effect before and after the intervention. Repeated ANOVA analyses were conducted to examine the psychosocial impact of the intervention over time. The effect size (ES) was calculated by Cohen’s d; values of 0.2, 0.5, and 0.8 were taken to suggest small, medium, and large effect sizes, respectively (Cohen, 1988). All the above data analyses were conducted with Statistical Package for the

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Social Sciences (SPSS version 24.0, SPSS Inc., Chicago, IL). Intention-to-treat analysis was taken.

Results and Findings Participants’ Characteristics Three rounds of the six-session intervention were conducted face-to-face in a caring center in the hospital. In total, 28 females joined the intervention while 23 completed and joined in the post-intervention test (four dropped out because of time conflict, one because of a sudden illness), and 21 filled in the follow-up questionnaire (two did not reply without giving reasons). The sociodemographic characteristics of the 28 participants are shown in Table 9.2. They were aged between 21 and 33. Referring to the body mass index (BMI), two were obese (BMI > 28, 7.1%), two were overweight (BMI: 24–28, 7.1%), and three were too thin (BMI