Clinical social workers often sit down one on one with patients and offer mental health therapy to help them improve the quality of their lives. That may sound like providing direct services -- it could hardly be called indirect – yet it's not what people generally mean when they talk about direct service social work. That’s because there are three types of social work: macro (or indirect), direct, and clinical. Macro social workers work at the level of programs, institutions, and government policy -- their services help individuals, but in an indirect way.
Both direct service and clinical social workers are at the front lines, working with needy individuals and families. However, clinical social workers have some expertise that direct service workers do not. They have a broader scope of duty.
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Direct service social workers connect people and services. They often do intake and initial screening. They may determine program eligibility and refer individuals and families for other services that they need. They can have a variety of duties, depending on the setting and population served. They sometimes do mediation. They frequently do case management, at least with children and families. Some types of case management, though, are generally reserved for professionals with higher levels of education and licensing. (This can include individuals who need health services long term but at different levels, and tend to transition back and forth between hospitalization and community-based care.)
A direct care social worker may be allowed to do some counseling, but will not be allowed to do psychotherapy. Again, the words sound the same, but aren’t. One difference is that counseling isn't necessarily related to a diagnosable mental condition. Nonclinical social workers generally counsel individuals who are basically healthy mentally. The counseling is limited in scope; it may be designed to educate the client and help them examine options and make decisions. While direct service workers may have contact with people who have serious illnesses, they will not actually be treatment providers.
Clinical social workers often work with people who have psychiatric conditions or emotional disturbances. They may perform psychotherapy and even make diagnoses. They are often part of a large team, with colleagues in various disciplines: psychiatrists, advanced practice psychiatric nurses. Others are in private practice, providing services similar to those of mental health counselors.
What about working with patients who have illnesses that are not primarily psychological? This typically falls to the clinical social worker as well – or, at the least, to the social worker with master’s level education. Social workers in hospital settings wear a number of hats. They are typically in discharge planning; in some instances, this involves locating many community resources. Hospital-based social workers may assess patients’ psychological health and even diagnose secondary mental conditions. They may offer counseling related to loss.
Clinical social work is a master's level profession. In fact, professionals must complete a period of supervised practice before they are allowed to go into private practice or otherwise exercise independent judgment with regard to treating and diagnosing mental illness.
People often get their start in direct services social work, though, at the baccalaureate level. Sometimes they continue on for more education and a higher credential. If someone chooses to go on for a master's, it's not always to get a clinical social work license, however. There are many specialties, and many possible goals, including working one on one with children and families in a public school setting.
Social workers at the highest level(s) are always licensed – this includes anyone who uses the title clinical social worker. Direct service social workers are often licensed, but it depends on the individual state.