Social Workers' Attitudes about Psychotropic Drug Treatment with Youths

Given the precipitous rise in psychotropic drug use with youths in recent years (for example, Rushton & Whitmire, 2001; Zito et al., 2003), nearly every social worker practicing with youths has worked with a medicated child or adolescent. Despite the controversies and concerns this trend has generated (see, for example, Ingersoll, Bauer, & Burns, 2004; Moses & Kirk, 2005), we know very little about social workers' attitudes toward this trend. This is unfortunate because social workers provide the largest proportion of mental health services in the United States (Gibelman & Schervish, 1997; Knowlton, 1995), and their attitudes are likely to affect how they broker clients' access to drug treatment and the quality of supportive services that accompany drug treatment (for example, education; monitoring of side effects, adherence, and effectiveness; and collaboration with physicians). Moreover, parents often turn to social workers to ask about medication because social workers often serve as intermediaries among families, schools, and physicians in regard to referrals for medication evaluation and follow-up (Bentley & Walsh, 2001; Taylor, 2003). Social workers' attitudes about drug treatment likely affect their behavior and communication style with clients (Bentley, Farmer, & Phillips, 1991; Taylor, 2003). Johnson and colleagues (1998) found that social workers expressing stronger beliefs that medication is helpful in treating emotionally disturbed youths were also more likely to have favorable attitudes toward collaborative work with other professionals (for example, to refer youths to other specialists) and to work more closely with families (for example, to share information with parents and to avoid attributing blame). Social workers' attitudes toward medication treatment are likely to affect medication referrals. Bradley (2003) noted that social workers' "beliefs and theoretical framework impact why, when, and how this decision [to refer for medication consultation] is made" (p. 36). Moreover, social workers' attitudes are likely to affect clients' receptivity, satisfaction, and response to this form of treatment. A recent survey of social workers' roles in clients' psychiatric medication reported that when asked about their most important personal contribution to a successful outcome with psychiatrically medicated clients, 16 percent of respondents indicated that it was holding positive attitudes and beliefs that support medication (Bentley, Walsh, & Farmer, 2004).These social workers thought that communicating hope and sharing professional experiences of other clients' positive outcomes contributed to positive outcomes. There have been no empirical studies, however, of whether there is a direct relationship between social workers' attitudes toward drug treatment and treatment outcomes. Social Workers" Views of Drug Treatment Much of the earlier social work literature from the 1970s and 1980s depicts the profession's view of psychotropic medication treatment as suspicious and negative (for example, Berg & Wallace, 1987; Davidson & Jamison, 1983; Matorin & De Chillo, 1984).This literature, focused on adult clients, suggests that social workers are resistant to the medical model, a perspective that defines clients' problems using medical-psychopathological terms that are apolitical, decontextualized, and deficit oriented and that steers treatment toward "fixing" the individual. This literature tends to focus on the negative physical or psychosocial consequences of biological interventions and about possible drug misuse involved in inadequate screening, overmedication, and infringement on patients' rights. More recent literature, however, has suggested that many social workers subscribe, at least to some extent, to the medical model and support as well as facilitate the use of drug treatment for adults with mental illness. Several studies of social workers' attitudes toward psychopharmacologic treatment suggest that they are more positive about drug treatment than other mental health professionals (Bentley et al. …