To What Extent Do You Specialize?

Social Work is such a diverse profession! Social workers function in every imaginable social services and health care setting, in fields of practice that include:

• Mental health clinics and hospitals
• Medical hospitals, health centers, hospices, and nursing homes
• Child welfare, adoption, and family services
• Social advocacy and policy development
• Housing and benefits 
• Elder Services
• Immigrant and Refugee Services
• Courts and prisons
• Schools and youth programs

And I'm sure the list could go on. There's no way for all of us to master the skills used in all of these settings. Graduate coursework attempts to provide a foundation of generalizable knowledge and skills (basic interviewing, empathy, and psychosocial theories), coupled with field placements that facilitate the development of specific intervention skills in a specialized area of practice. In recent years, programs have also begun offering students the option to specialize in specific areas through electives and placements within their chosen concentration.

The difficulty arises when we're asked to function outside our areas of expertise. I hadn't given the issue much thought until recently, since my work has typically stayed within my specialty of adult mental health and dual diagnosis. However, as one of a small number of clinicians at an urban health center, I have been assigned a new client who is a child. I know there are some similarities between adult therapy and child therapy, but there are also many differences stemming from children's developmentally limited abilities to verbalize their feelings, engage in introspection and metacognition.

The NASW Code of Ethics requires that social workers seek additional training and supervision when they enter an area of practice outside their existing expertise. I'm hoping that my agency will help me in doing so, but I can't help but wonder how often agencies with limited resources ask (or demand) their staff to take on work that doesn't fall within their specialties. Is it reasonable for agencies to do so? Are we too specialized if we prefer to focus on a particular population or modality? Or is the requirement of generalized practice interfering with development (or utilization) of more advanced skills and ostensibly more effective intervention within a narrower scope?