Journal of Primary Prevention 6(3), Spring, 1986
Competence-Centered Social Work: Prevention in Action MARY FRANCES LIBASSI and ANTHONY N. MALUCCIO ABSTRACT: Competence-centered social work is presented as a useful approach for practice in prevention. Its major features are outlined and illustrated through examples from diverse settings. Of particular importance to prevention is the systematic focus on the person's assets and potentialities rather than weaknesses or pathology. It is stressed that the promotion of competence in clients should be a prominent aspect of social work intervention.
A major framework for conceptualizing approaches to primary prevention is that of promoting positive mental health. Practice strategies useful in this framework include the promotion of social competence, coping capacities, ego strengths and thus "positive mental health" (Goldston, 1977). Although various programs utilize this framework for prevention and emphasize the promotion of competence,1there is a dearth of specific methods or techniques for explicitly incorporating competence promotion into ongoing practice activities (Cowen, 1982). This paper presents competence-centered social work as a useful approach for practice in prevention. Its major features are outlined and illustrated through examples from diverse settings. It will be evident from these examples that the authors of this paper believe that competence promotion, i.e., the promotion of mental health, can be done with individuals as well as groups and communities. This view is in contrast to much prevention literature, which underscores that primary prevention must be oriented to groups of people, to populations. Competence-centered social work practice expands the possibilities for prevention and can lead to making prevention a natural and integral part of every social worker's approach to practice. Integrating preventive/promotive strategies into every aspect of practice fosters the attitudes and framework that make prevention more understandable and achievable! (Libassi, 1983).
Address reprint requests to Mary Frances Libassi, The University of Connecticut, School of Social Work, Greater Hartford Campus, West Hartford, CT 06117 168
©1986 H u m a n Sciences Press
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Definition of Competence To utilize fully techniques of competence promotion in prevention, one must first define competence. While theorists and researchers from various disciplines have contributed much to its study, competence remains a vague concept with multiple meanings. Most writers agree with Robert White (1963), who defines competence as the repertoire of skills, knowledge, and qualities that enable a person to interact effectively with the environment. Following this definition, various prevention approaches focus on the development of skills and knowledge in individuals as a way to increase competence for dealing with life's problems (Bond and Joffe, 1982; Bond and Rosen, 1980; Seligman, 1975; Spivack and Shure, 1974). This definition and the resulting programs, however, place the burden on the h u m a n organism. Competence is simplistically regarded as an inherent property or trait of the person. It would be more accurate to regard competence as a transactional concept, or as an attribute of the interplay between the person and the environment. Such a view is emphasized in particular by Sundberg, Snowden, and Reynolds (1978), who propose the notion of ecological competence. These authors point out that an adequate consideration of competence should take into account not only all relevant personal dimensions, but also the environmental context in which the individual lives. In other words, competence is not a fixed attribute of the person; it is the outcome of the transaction between (1) the person's capacities, skills, and motivation and (2) environmental qualities such as social networks, social supports, and demands or obstacles in one's ecological context (Maluccio, 1981). This approach to competence expands dramatically the possibilities and potential for preventive programming and is congruent with George Albee's view that a focus on individual competence must always be accompanied by a broader effort toward social change, as needed (Albee, 1980; 1983).
Competence-Centered Social Work In conjunction with related formulations such as the life model of social work practice (Germain and Gitterman, 1980), the concept of ecological competence leads to a perspective that has been termed competence-centered social work practice (Maluccio, 1981). This perspective is quite old, since it reflects what m a n y practitioners in diverse settings
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have long been doing and builds on time-honored social work traditions, such as emphasis on provision of concrete services and environmental supports. But it is also new, in that it draws from newer bodies of knowledge from disciplines such as psychology, ecology, biology, and General Systems Theory. Above all, it helps give theoretical support and perhaps prestige to the kind of practice that has long constituted the essence of social work as a profession, that is, social work practice that supports and enhances adaptive capacities and promotes positive mental health. Competence-centered social work reflects themes that are common to other perspectives on practice, but is distinguished by its integrated emphasis on a number of features, as outlined below. Of particular importance in regard to prevention is the systematic focus on the person's assets and potentialities rather than weaknesses or pathology.
Humanistic Perspective H u m a n beings are regarded as striving, active organisms capable of organizing their lives and developing their potentialities as long as they have appropriate environmental supports. This humanistic perspective leads to de-emphasis of pathology and recognition of each person's multipotentialities, that is, actual as well as latent resources, strengths, and creativity. This orientation is congruent with the emphasis in prevention literature on promotion of mental health through identification of individual stengths, rather than deficits or weaknesses (Klein, 1969).
Human Problems H u m a n difficulties are defined as "problems in living," or as manifestations of the poor fit or lack of mutuality between people and their environments (Germain and Gitterman, 1980). Problems are conceptualized in terms of the outcomes of transactional processes that create stress and place demands on the person's coping capacities. Problems or needs thus are not seen as specific weaknesses or properties of the person. "Behavior is not viewed as sick or well but is defined as transa c t i o n a l - a n outcome of recriprocal interactions between specific social situations and the individual" (Kelly, 1973). Similarly, prevention literature calls attention to stressful life events or life transitions as times when "problems in living" are likely to become apparent and programs for preventive intervention can be
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especially useful. At these times, stress may result from the lack of mutuality between people's present skills and coping capacities and the environmental demands of new life situations (Bloom, 1979; Dohrenwend, 1978).
Competence Clarification In line with the preceding definition of h u m a n problems, assessment is reformulated as competence clarification, that is, as the process of identifying and understanding the person's competence in dealing with the environment at any particular time, present and future (Maluccio and Libassi, 1984). The overall aim of competence clarification is to understand as clearly as possible the "goodness of fit" between people and their impinging environment, so as to see how and where to intervene in order to enhance the person-environment transaction. In assessment, the worker is, therefore, guided by these specific purposes: (1) clarifying the unique capacities, skills, motivations, and potentialities of the person; (2) clarifying the characteristics of the impinging environment that influence his or her coping and adaptive patterns; and (3) clarifying what needs to be changed in the person and/or the environment, so as to make their transaction more mutually satisfying and growth-producing. Assessment skills can be buttressed with theory and research findings from the field of social epidemiology. Practitioners can be trained to be alert to the social factors and/or environmental conditions associated with health and disease in the general population (Siefert, 1983). Such knowledge can add significant information to individual and group assessment obtained through the process of competence clarification and can alert practitioners quickly to populations at risk, high risk situations, and in general areas where a lack of fit between person and environment exists or may emerge in the future.
Client and Practitioner Roles Clients are explicitly viewed as partners in the helping process, as persons with assets and potentialities, as resources rather than carriers and/or sources of pathology. Social workers are defined primarily as enabling or change agents who play diverse roles and use varying approaches in order to provide the conditions and the information necessary for clients to achieve their purposes, engage in their developmental processes, and carry out their adaptive tasks (Studt, 1968). The
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role of teacher is of paramount importance; providing information and guidance, such as anticipatory guidance, is in some cases a central role for social workers. As workers provide resources and promote a sense of hope, clients are encouraged and empowered to take action in their own behalf and thus enhance their coping skills and adaptive strivings. In this practice approach, clients are also viewed as resources to each other and encouraged to redefine themselves in terms of their competence, their areas of special experience, and their particular knowledge. The helper therapy principle is evident, as people learn by teaching, sharing, and helping one another (Sarason, 1979).
Client-worker Relationship The client-worker relationship is one in which openness, authenticity, and h u m a n caring are nurtured (Germain and Gitterman, 1980). To be effective in promoting competence, the relationship should be characterized by encouragement of client autonomy, reduction of social distance and the authority and power invested in the worker, and elimination of hidden agendas (Hartman, 1970). Even though promotion of positive mental health is a noble goal, we must keep in mind the basic tenet that good practice always starts where the person is, with his or her concerns and agendas. Furthermore, competence can be promoted in the helping process itself through the use of client feedback; workers can obtain, on a regular basis, the views of clients concerning their helping efforts. In addition to encouraging participation of consumers in evaluation of services, obtaining such feedback can have other positive consequences, such as providing opportunities for decision making and increasing the person's sense of control over his or her life (Maluccio, 1979a).
Life Processes and Experiences In intervention there is explicit use of the person's own life processes and experiences, such as life transitions, developmental crises, and other events that unfold in the course of living. Life itself is approached as the arena of change; life experiences, events, and processes are used as means of teaching coping skills (Maluccio, 1979b). Many programs that promote positive mental health are "embedded in the fabric of a setting's (e.g., a school's) normal activities" (Cowen,
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1982). These settings afford excellent opportunities to intervene in the midst of life's ongoing struggles and to provide resources and skills so t h a t responses to stress fall within the adaptive range. 2 Success in these situations promotes competence and has a triggering effect on the person's ability to meet future life challenges. Restructuring the Environment
Competence flourishes through a nutritive environment t h a t is suited to the person's needs and qualities and supports his or her life processes. Consequently, there is emphasis on understanding the environment with all of its complexities, as well as enriching or restructuring it in a purposive and systematic fashion. For instance, much can be accomplished by identifying and using "environmental instruments" (Cumming and Cumming, 1962), t h a t is, people, resources, social networks or supports, and facilities t h a t exist in the person's life space or t h a t can be added to it. These instruments, already acknowledged as major methods of primary prevention, 3 are used in competence-centered practice as integral components of intervention, rather t h a n as simply desirable additions to the helping process (Germain and Gitterman, 1980).
Practice Illustrations
As the preceding summary suggests, competence-centered social work involves an orientation that helps the practitioner focus on people's strengths, potentialities, and natural growth processes. It stresses a set of attitudes, principles, and strategies designed to change the person-environment transaction, in order to support and/or enhance the competence of individuals, families, and groups in dealing effectively with their environment, present and future. Such attitudes, principles, and strategies are congruent with and, indeed, essential for, engaging in programs and interventions that promote positive mental health. The value of this perspective in practice is illustrated through the following examples, which draw from the work of graduate social work students placed in a community mental health training unit (Libassi and Maluccio, 1982). This field unit of students from all social work methods was located in an urban neighborhood that is diverse and includes a number of "populations-at-risk," such as the elderly, the poor, single parents, teenage mothers--in short, human beings who are typically perceived in terms of problems and weaknesses rather than strengths. Although placed in diverse agencies, students in this
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unit entered the life space of their clients and attempted to carry out social work intervention in the midst of real life situations and settings.
Clarifying and Promoting Competence in an Elderly Woman The concept of competence clarification underlines the importance of assessing the "goodness of fit" between the person and the environment, in order to identify ways of supporting human beings in their adaptive strivings (Maluccio and Libassi, 1984). The location of social workers within the client's life situation provides excellent opportunities for competence clarification and competence development, as shown by the following example of a student's work with an elderly person. Mrs. Taylor, a woman in her mid-seventies, came to a primary health care facility with health problems but also commented to the physician that she was lonely and "very blue." The doctor, aware of the multiple stresses on the elderly, referred her to a student social worker. The worker made a home visit and found a rather barren apartment and neighbors who were cut off from each other, leaving Mrs. Taylor with no one to talk to or confide in. Time hung heavy on her hands, and there was much opportunity for ruminating about loss. Numerous studies suggest that a lack of social support is associated with increased vulnerability to disease, both physical and psychiatric (Tolsdorf, 1976; Lowenthal et al., 1967); other studies verify the health-protective quality of such social support (Gottlieb, 1981; Stephens et al., 1978). Futhermore, gerontologists highlight the impact that progressive loss of meaningful roles, an experience common to many elderly, has on life satisfaction and morale (Tobin and Neugarten, 1961). In light of such information, Mrs. Taylor was a 'person-at-risk,' one whose environment provided neither social support nor opportunity for a meaningful role into which her energy could be channeled. Utilizing the orientation of competence-centered practice and prevention, the worker, focusing on strengths and assets, found that Mrs. Taylor was an energetic woman who enjoyed people, was motivated toward an active life, was well organized, and had good cognitive skills. She and the worker discussed interests and potential volunteer jobs that would provide an opportunity for socialization, productive activity, and, in essence, a meaningful new role. A job was selected in a local library as part of the "Retired Seniors" Volunteer Program," and opportunities for successful action to promote competence emerged. The first days on the job were difficult for Mrs. Taylor; she was apprehensive and sensitive to what she perceived as criticisms on the part of the library'Staff and considered resigning. Rather than perceiving these difficulties as a failure on Mrs. Taylor's part, the worker, continuing the use of techniques of competence clarification, located the problem in the transaction between an overly sensitive elderly person and the librarian, a busy younger person who was not sufficiently aware of the needs and skills of her new volunteer. A visit to the library helped to clarify the nature of the environment into which Mrs. Taylor
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was entering, and a talk with the librarian about her feelings and needs was successful in changing the person/environment transaction so that it became mutually satisfying. The worker, as enabler, supported Mrs. Taylor's coping and intervened in restructuring the environment with and for her, until a good match was found. As the worker terminated with Mrs. Taylor, the latter had increased her autonomy, enjoyed her new role as a volunteer, and found friends in her apartment and in her work environment. Effective performance in her life situation contributed not only to a sense of present competence but also to enhanced coping strategies for future life situations (Maluccio, 1979b). Mrs. Taylor had grown in her ability to deal with the problems in living of an elderly individual through learning and practicing new coping skills. In addition, her environment had changed and now contained support and nourishment. The competence-centered approach resulted in increased self-confidence and self-est e e m - i n sum, positive mental health.
Empowering Clients in a Housing Project The task of mobilizing the potentialities and motivation of clients in activities toward competence requires practitioners to take sufficient time to identify issues of primary concern around which motivation can be awakened. As already mentioned, it means choosing interventive activities that take into consideration the person's strengths and potentialities as well as environmental resources and deficits and, finally, interventions that serve to empower human beings to take action in their own behalf. Practice in the field unit illustrated this dramatically. Both casework students and community organization students were deployed to work in a lowincome housing project where the majority of residents were minority single mothers receiving various entitlements. As students clarified the characteristics of the environment, they found it to be overly stressful: the buildings were in deplorable condition; social interaction and supports were minimal; and people lived without basic necessities of life. From the perspective of prevention, both the mothers and their children constituted a population-at-risk. The casework students, utilizing a more traditional therapeutic orientation, found the residents to be depressed, dependent, and in need of counseling and supportive services. However, the work went slowly, and only a limited number of people accepted services that were offered. The response to the work of a community organization student in the same training project was quite different. The environment and the residents were the same. The difference was that this student, following the guidelines of competence clarification, identified people's strengths and skills, in addition to specific personal problems and needs. The student's first task was to combat the sense of alienation and discouragement and provide a measure of hope. Utilizing the approach of competence-centered practice, she redefined client
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and worker roles and regarded the residents as resources and herself as enabler and catalyst. As she indicated to them, she was not there to solve their problems but to provide some direction, to give information in order for them to solve their own problems, and to work as a collaborator. And so it happened; following careful, painstaking work, the residents responded. Meetings that had been sparsely attended were now well attended. The chairperson of the group, with some coaching from the student, played a forceful leadership role. Meetings had focus and direction. Residents identified their agenda and changes they desired and soon had enough clout to be heard. For example, the manager of the housing project, city council members, and other officials came to talk personally with the group. Changes came slowly, but they did come. Not only were the environmental conditions that influenced the susceptibility of residents to psychological stress improved, but also the residents themselves were empowered as they participated in influencing their own environment. The concept of empowerment is receiving increasing attention in work with minority clients. As suggested by Solomon (1976), empowerment in Black communities involves a process where the worker engages in practice activities that aim to reduce the powerlessness often caused by the negative evaluation associated with membership in a stigmatized group. For persons such as the minority residents in the housing project, working together to obtain needed resources for a better life for themselves and their children was one way to counteract the feelings of powerlessness and to promote competence and selfesteem. The use of community organization in the project demonstrated that, as people are perceived as having strengths and skills, they can respond in amazing and varied ways when provided with appropriate resources. Mental health can be promoted through having residents participate in community action around common concerns and needs (Cardoza et al., 1975; Naparstek et al., 1982).
Promoting Competence in a Health Care Setting Health care settings in the training project provided excellent opportunities for identifying "people-at-risk." Health problems are often indicative of stressful life situations, and primary health care facilities offer a much more acceptable entry point for mental health services for the general population. As reported in a study of services (Borus, et al., 1980) at the Bunker Hill Health Center of the Massachusetts General Hospital, neighborhood-based settings provide an excellent context for the provision of a range of mental health services. In contrast to community mental health centers that tend to be used primarily by a relatively narrow spectrum of patients who are acutely or chronically ill, primary health care facilities providing mental health services offer unusual opportunities for case finding as well as prevention/education outreach programs concerning mental health issues.
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In the primary health care facilities where these practice examples occurred, physicians, nurses, and other health care providers, knowledgeable about the impact of crisis events, changes in role or status, and environmental stress on health and mental health, made referrals to the social work students when stresses seemed about to overwhelm resources or when information and skills were lacking. The students, utilizing a competence-centered perspective, were often able to turn a stressful experience into a growth-producing one where self-esteem and competence were enhanced and mental health was promoted. Both casework and group work were useful methodologies for responding to the needs of persons referred. Examples of referrals for casework service included the following: a mother struggling with the new status of single parent; a middle-aged man with elevated blood pressure overwhelmed by the transition to unemployment; and a teenage mother striving to care for her infant but not knowing how. All of these individuals may have functioned at a minimal level with no help at all. However, they flourished with the additional resources, skills, and information provided by the project participants; they learned new coping skills and experienced a sense of success, triggering their sense of competence and ability to meet ongoing challenges in life. In essence, these interventions served to promote and enhance positive mental health. Group work approaches in the health care facility were equally productive in promoting competence in persons dealing with transitions of role and status. For example, a student formed an education and support group for firsttime mothers and mothers-to-be who received obstetric and pediatric care at the facility. The purpose of the group was to share information and give support around this major life experience. Subjects discussed in the group included care of oneself during pregnancy, the birth process, nursing, and care of a young infant. These topics promoted the capacities and skills of the participants for negotiating the anticipated life task of parenting. The mix of pregnant women and young mothers was a positive experience, enabling the latter to be "helpers" to the mothers-to-be. For both groups, competence and selfesteem were enhanced and the possibility for successfully negotiating the task of parenting increased. Conclusion
P r e v e n t i o n is a n idea w h o s e t i m e h a s come (Klein a n d Goldston, 1977)! We w h o a r e p a r t of t h i s f o u r t h m e n t a l h e a l t h r e v o l u t i o n ( P r e s i d e n t ' s C o m m i s s i o n on M e n t a l H e a l t h , 1978) m u s t s e e k w a y s to t a k e t h e w e a l t h of a v a i l a b l e k n o w l e d g e a n d r e s e a r c h a n d t r a n s l a t e it into s t r a t egies a n d t e c h n i q u e s t h a t can b e c o m e a p a r t of t h e r e p e r t o i r e of all h u m a n service personnel. T h e c o m p e t e n c e p e r s p e c t i v e offers one app r o a c h for i n t e g r a t i n g p r o m o t i o n into ongoing p r a c t i c e a c t i v i t i e s w i t h a wide r a n g e of persons. P r a c t i t i o n e r s utilizing t h i s a p p r o a c h , w i t h its
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ecological orientation, will find ways to enhance and strengthen the coping strategies which human beings use to deal with life's demands, while at the same time working with and for clients to restructure environments. The field of primary prevention is compelling, even addictive (Kessler and Albee, 1975). For the authors of this paper, competence-centered practice is a viable and valuable approach that makes prevention and promotion attractive, addictive, understandable, and achievable!
Notes 1. A special issue of the American Journal of Community Psychology, (Vol. 10, No. 3 - - J u n e 1982) describes a number of programs whose major outcome is the promotion of competence. 2. See Perlmutter (1983) for a comprehensive discussion of promotion programs in human service agencies. 3. A recent issue of the Journal ofPrimaryPrevention, (Vol. 3, No. 2--Winter 1982) focuses on programs of prevention that involve the mobilization and strengthening of various forms of social support and reduction of risk.
References Albee, G.W. (1980). A competency model must replace the defect model. In L. Bond & J. Rosen (Eds.), Competence and coping during adulthood (pp. 75-104). Hanover, NH: University Press of New England. Albee, G.W. (1983). Psychopathology, prevention, and the just society. Journal of Primary Prevention, 4, 5 - 40. Bloom, B.L. (1979). Prevention of mental disorders: Recent advances in theory and practice. Community Mental Health Journal, 15, 179-191. Bond, L.A. & Joffe, J.M. (Eds.) (1982). Fostering infant and early childhood development. Hanover, NH: University Press of New England. Bond, L.A. and Rosen, J. (Eds.) (1980). Competence and coping during adulthood. Hanover, NH: University Press of New England. Borus, J., et al. (1980). Coordinated mental health care in neighborhood Health Centers.
Mental Health Service System Reports--Series DN: 3, Health~Mental Health Research. Washington, DC: U.S. Department of Health and Human Services. Cardoza, V.G., Ackerly, W.C. & Leighton, A.H. (1975). Improving mental health through community action. Community Mental Health Journal, 11,215-227. Cowen, E.L. (1982). The special number: A complete roadmap. American Journal of Community Psychology, 10, 239-250. Cumming, J. & Cumming, E. (1962). Ego and milieu. Chicago: Aldine-Atherton. Dohrenwend, B.S. (1978). Social stress and community psychology. American Journal of Community Psychology, 6, 1-15. Germain, C.B. & Gitterman, A. (1980). The life model of social work practice. New York: Columbia University Press. Goldston, S.E. (1977). An overview of primary prevention programming. In D.C. Klein & S. Goldston (Eds.), Primary prevention: An idea whose time has come. DHEW Publication No. (ADM) 77-447. Washington, DC: U.S. Government Printing Office.
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Gottlieb, B.H. (1981). Preventive interventions involving social networks and social support. In B.H. Gottlieb (Ed.), Social networks and social support (pp. 201-231). Beverly Hills, CA: Sage Publications. Hartman, A. (1979). The extended family as a resource for change: An ecological approach to family-centered practice. In C.B. Germain (Ed.), Social Work Practice: People and Environments, (pp. 239-266). New York: Columbia University Press. Kelly, J.G. (1973). Ecological constraints on mental health service. American Psychologist, 28, 535-539. Kessler, M. & Albee, G.W. (1975). Primary prevention. Annual Review of Psychology, 26, 557-591. Klein, D. (1969). The meaning of community in a preventive mental health program. American Journal of Public Health, 59, 2005-2012. Klein, D.C. & Goldston, S.E. (Eds.) (1977). Primary prevention: An idea whose time has come. DHEW Publication No. (ADM) 77-447. Washington, DC: U.S. Government Printing Office. Libassi, M.F. (1983). An integrative approach to primary prevention in the field. In J.P. Bowker (Ed.), Education for primary prevention in social work, (pp. 75-92). New York: Council on Social Work Education. Libassi, M.F. & Maluccio, A.N. (1982). Teaching the use of the ecological perspective in community mental health. Journal of Education for Social Work, 18, 94-99. Lowenthal, M.F. & Berkman, P.L. (1967). Aging and mental disorders in san francisco. San Francisco: Jossey-Bass. Maluccio, A.N. (1979a). Learning from clients--Interpersonal helping as viewed by clients and social workers. New York: The Free Press. Maluccio, A.N. (1979b). Promoting competence through life experiences. In C.B. Germain (Ed.), Social work practice: People and environments (pp. 282-302). New York: Columbia University Press. Maluccio, A.N. (1981). Competence-oriented social work practice: An ecological approach. In A.N. Maluccio (Ed.), Promoting competence in clients--A new~old approach to social work practice. (pp. 1-24). New York: The Free Press. Maluccio, A.N. and Libassi, M.F. (1984). Competence clarification and social work practice. Social Thought, 10, 51-58. Naparstek, A.J.; Biegel, D.E. & Spiro, H.R. (1982). Neighborhood networks for humane mental health care. New York: Plenum Press. Perlmutter, F.D. (1983). Partnership for mental health promotion. Journal of Primary Prevention, 4, 96-106. President's Commission on Mental Health (1978). Report of the task panel on prevention. Washington, DC: U.S. Government Printing Office. Sarason, S.B. & Lorentz, E. (1979). The challenge of the resource exchange network. San Francisco: Jossey-Bass. Seligman, M. (1975). Helplessness: On depression, development and death. San Francisco: Freeman. Siefert, K. (1983). Using concepts from epidemiology to teach prevention. In J.P. Bowker (Ed.), Education for Primary Prevention in Social Work (pp. 54-74). New York: Council on Social Work Education. Solomon, B. (1976). Black empowerment: Social work in oppressed communities. New York: Columbia University Press. Spivack, G. & Shure, M.D. (1974). Social adjustment of young children: A cognitive approach to solving real life problems. San Francisco: Jossey-Bass. Stephens, R.; Blau, Z.; Oser, G.I.; & Millar, M.D. (1978). Aging, social support systems and social policy. Journal of Gerontological Social Work, 1, 33-45. Studt, E. (1968). Social work theory and implications for the practice of methods. Social Work Education Reporter, 16, 22-24 and 42-46. Sundberg, N.D.; Snowden, L.R. & Reynolds, W.M. (1978). Toward assessment of personal competence and incompetence in life situations. Annual Review of Psychology, 29, 179-211.
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Tobin, S. & Neugarten, B. (1961). Life satisfaction and social interaction in the aging. Journal of Gerontology, 16, 344-346. Tolsdorf, C. (1976). Social networks, support and coping: An exploratory study. Family
Process, 15,407-418. White, R.W. (1963). Ego and reality in psychoanalytic theory. New York: International Universities Press.
Competence-Centered Social Work: Prevention in Action MARY FRANCES LIBASSI and ANTHONY N. MALUCCIO ABSTRACT: Competence-centered social work is presented as a useful approach for practice in prevention. Its major features are outlined and illustrated through examples from diverse settings. Of particular importance to prevention is the systematic focus on the person's assets and potentialities rather than weaknesses or pathology. It is stressed that the promotion of competence in clients should be a prominent aspect of social work intervention.
A major framework for conceptualizing approaches to primary prevention is that of promoting positive mental health. Practice strategies useful in this framework include the promotion of social competence, coping capacities, ego strengths and thus "positive mental health" (Goldston, 1977). Although various programs utilize this framework for prevention and emphasize the promotion of competence,1there is a dearth of specific methods or techniques for explicitly incorporating competence promotion into ongoing practice activities (Cowen, 1982). This paper presents competence-centered social work as a useful approach for practice in prevention. Its major features are outlined and illustrated through examples from diverse settings. It will be evident from these examples that the authors of this paper believe that competence promotion, i.e., the promotion of mental health, can be done with individuals as well as groups and communities. This view is in contrast to much prevention literature, which underscores that primary prevention must be oriented to groups of people, to populations. Competence-centered social work practice expands the possibilities for prevention and can lead to making prevention a natural and integral part of every social worker's approach to practice. Integrating preventive/promotive strategies into every aspect of practice fosters the attitudes and framework that make prevention more understandable and achievable! (Libassi, 1983).
Address reprint requests to Mary Frances Libassi, The University of Connecticut, School of Social Work, Greater Hartford Campus, West Hartford, CT 06117 168
©1986 H u m a n Sciences Press
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Definition of Competence To utilize fully techniques of competence promotion in prevention, one must first define competence. While theorists and researchers from various disciplines have contributed much to its study, competence remains a vague concept with multiple meanings. Most writers agree with Robert White (1963), who defines competence as the repertoire of skills, knowledge, and qualities that enable a person to interact effectively with the environment. Following this definition, various prevention approaches focus on the development of skills and knowledge in individuals as a way to increase competence for dealing with life's problems (Bond and Joffe, 1982; Bond and Rosen, 1980; Seligman, 1975; Spivack and Shure, 1974). This definition and the resulting programs, however, place the burden on the h u m a n organism. Competence is simplistically regarded as an inherent property or trait of the person. It would be more accurate to regard competence as a transactional concept, or as an attribute of the interplay between the person and the environment. Such a view is emphasized in particular by Sundberg, Snowden, and Reynolds (1978), who propose the notion of ecological competence. These authors point out that an adequate consideration of competence should take into account not only all relevant personal dimensions, but also the environmental context in which the individual lives. In other words, competence is not a fixed attribute of the person; it is the outcome of the transaction between (1) the person's capacities, skills, and motivation and (2) environmental qualities such as social networks, social supports, and demands or obstacles in one's ecological context (Maluccio, 1981). This approach to competence expands dramatically the possibilities and potential for preventive programming and is congruent with George Albee's view that a focus on individual competence must always be accompanied by a broader effort toward social change, as needed (Albee, 1980; 1983).
Competence-Centered Social Work In conjunction with related formulations such as the life model of social work practice (Germain and Gitterman, 1980), the concept of ecological competence leads to a perspective that has been termed competence-centered social work practice (Maluccio, 1981). This perspective is quite old, since it reflects what m a n y practitioners in diverse settings
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have long been doing and builds on time-honored social work traditions, such as emphasis on provision of concrete services and environmental supports. But it is also new, in that it draws from newer bodies of knowledge from disciplines such as psychology, ecology, biology, and General Systems Theory. Above all, it helps give theoretical support and perhaps prestige to the kind of practice that has long constituted the essence of social work as a profession, that is, social work practice that supports and enhances adaptive capacities and promotes positive mental health. Competence-centered social work reflects themes that are common to other perspectives on practice, but is distinguished by its integrated emphasis on a number of features, as outlined below. Of particular importance in regard to prevention is the systematic focus on the person's assets and potentialities rather than weaknesses or pathology.
Humanistic Perspective H u m a n beings are regarded as striving, active organisms capable of organizing their lives and developing their potentialities as long as they have appropriate environmental supports. This humanistic perspective leads to de-emphasis of pathology and recognition of each person's multipotentialities, that is, actual as well as latent resources, strengths, and creativity. This orientation is congruent with the emphasis in prevention literature on promotion of mental health through identification of individual stengths, rather than deficits or weaknesses (Klein, 1969).
Human Problems H u m a n difficulties are defined as "problems in living," or as manifestations of the poor fit or lack of mutuality between people and their environments (Germain and Gitterman, 1980). Problems are conceptualized in terms of the outcomes of transactional processes that create stress and place demands on the person's coping capacities. Problems or needs thus are not seen as specific weaknesses or properties of the person. "Behavior is not viewed as sick or well but is defined as transa c t i o n a l - a n outcome of recriprocal interactions between specific social situations and the individual" (Kelly, 1973). Similarly, prevention literature calls attention to stressful life events or life transitions as times when "problems in living" are likely to become apparent and programs for preventive intervention can be
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especially useful. At these times, stress may result from the lack of mutuality between people's present skills and coping capacities and the environmental demands of new life situations (Bloom, 1979; Dohrenwend, 1978).
Competence Clarification In line with the preceding definition of h u m a n problems, assessment is reformulated as competence clarification, that is, as the process of identifying and understanding the person's competence in dealing with the environment at any particular time, present and future (Maluccio and Libassi, 1984). The overall aim of competence clarification is to understand as clearly as possible the "goodness of fit" between people and their impinging environment, so as to see how and where to intervene in order to enhance the person-environment transaction. In assessment, the worker is, therefore, guided by these specific purposes: (1) clarifying the unique capacities, skills, motivations, and potentialities of the person; (2) clarifying the characteristics of the impinging environment that influence his or her coping and adaptive patterns; and (3) clarifying what needs to be changed in the person and/or the environment, so as to make their transaction more mutually satisfying and growth-producing. Assessment skills can be buttressed with theory and research findings from the field of social epidemiology. Practitioners can be trained to be alert to the social factors and/or environmental conditions associated with health and disease in the general population (Siefert, 1983). Such knowledge can add significant information to individual and group assessment obtained through the process of competence clarification and can alert practitioners quickly to populations at risk, high risk situations, and in general areas where a lack of fit between person and environment exists or may emerge in the future.
Client and Practitioner Roles Clients are explicitly viewed as partners in the helping process, as persons with assets and potentialities, as resources rather than carriers and/or sources of pathology. Social workers are defined primarily as enabling or change agents who play diverse roles and use varying approaches in order to provide the conditions and the information necessary for clients to achieve their purposes, engage in their developmental processes, and carry out their adaptive tasks (Studt, 1968). The
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role of teacher is of paramount importance; providing information and guidance, such as anticipatory guidance, is in some cases a central role for social workers. As workers provide resources and promote a sense of hope, clients are encouraged and empowered to take action in their own behalf and thus enhance their coping skills and adaptive strivings. In this practice approach, clients are also viewed as resources to each other and encouraged to redefine themselves in terms of their competence, their areas of special experience, and their particular knowledge. The helper therapy principle is evident, as people learn by teaching, sharing, and helping one another (Sarason, 1979).
Client-worker Relationship The client-worker relationship is one in which openness, authenticity, and h u m a n caring are nurtured (Germain and Gitterman, 1980). To be effective in promoting competence, the relationship should be characterized by encouragement of client autonomy, reduction of social distance and the authority and power invested in the worker, and elimination of hidden agendas (Hartman, 1970). Even though promotion of positive mental health is a noble goal, we must keep in mind the basic tenet that good practice always starts where the person is, with his or her concerns and agendas. Furthermore, competence can be promoted in the helping process itself through the use of client feedback; workers can obtain, on a regular basis, the views of clients concerning their helping efforts. In addition to encouraging participation of consumers in evaluation of services, obtaining such feedback can have other positive consequences, such as providing opportunities for decision making and increasing the person's sense of control over his or her life (Maluccio, 1979a).
Life Processes and Experiences In intervention there is explicit use of the person's own life processes and experiences, such as life transitions, developmental crises, and other events that unfold in the course of living. Life itself is approached as the arena of change; life experiences, events, and processes are used as means of teaching coping skills (Maluccio, 1979b). Many programs that promote positive mental health are "embedded in the fabric of a setting's (e.g., a school's) normal activities" (Cowen,
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1982). These settings afford excellent opportunities to intervene in the midst of life's ongoing struggles and to provide resources and skills so t h a t responses to stress fall within the adaptive range. 2 Success in these situations promotes competence and has a triggering effect on the person's ability to meet future life challenges. Restructuring the Environment
Competence flourishes through a nutritive environment t h a t is suited to the person's needs and qualities and supports his or her life processes. Consequently, there is emphasis on understanding the environment with all of its complexities, as well as enriching or restructuring it in a purposive and systematic fashion. For instance, much can be accomplished by identifying and using "environmental instruments" (Cumming and Cumming, 1962), t h a t is, people, resources, social networks or supports, and facilities t h a t exist in the person's life space or t h a t can be added to it. These instruments, already acknowledged as major methods of primary prevention, 3 are used in competence-centered practice as integral components of intervention, rather t h a n as simply desirable additions to the helping process (Germain and Gitterman, 1980).
Practice Illustrations
As the preceding summary suggests, competence-centered social work involves an orientation that helps the practitioner focus on people's strengths, potentialities, and natural growth processes. It stresses a set of attitudes, principles, and strategies designed to change the person-environment transaction, in order to support and/or enhance the competence of individuals, families, and groups in dealing effectively with their environment, present and future. Such attitudes, principles, and strategies are congruent with and, indeed, essential for, engaging in programs and interventions that promote positive mental health. The value of this perspective in practice is illustrated through the following examples, which draw from the work of graduate social work students placed in a community mental health training unit (Libassi and Maluccio, 1982). This field unit of students from all social work methods was located in an urban neighborhood that is diverse and includes a number of "populations-at-risk," such as the elderly, the poor, single parents, teenage mothers--in short, human beings who are typically perceived in terms of problems and weaknesses rather than strengths. Although placed in diverse agencies, students in this
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unit entered the life space of their clients and attempted to carry out social work intervention in the midst of real life situations and settings.
Clarifying and Promoting Competence in an Elderly Woman The concept of competence clarification underlines the importance of assessing the "goodness of fit" between the person and the environment, in order to identify ways of supporting human beings in their adaptive strivings (Maluccio and Libassi, 1984). The location of social workers within the client's life situation provides excellent opportunities for competence clarification and competence development, as shown by the following example of a student's work with an elderly person. Mrs. Taylor, a woman in her mid-seventies, came to a primary health care facility with health problems but also commented to the physician that she was lonely and "very blue." The doctor, aware of the multiple stresses on the elderly, referred her to a student social worker. The worker made a home visit and found a rather barren apartment and neighbors who were cut off from each other, leaving Mrs. Taylor with no one to talk to or confide in. Time hung heavy on her hands, and there was much opportunity for ruminating about loss. Numerous studies suggest that a lack of social support is associated with increased vulnerability to disease, both physical and psychiatric (Tolsdorf, 1976; Lowenthal et al., 1967); other studies verify the health-protective quality of such social support (Gottlieb, 1981; Stephens et al., 1978). Futhermore, gerontologists highlight the impact that progressive loss of meaningful roles, an experience common to many elderly, has on life satisfaction and morale (Tobin and Neugarten, 1961). In light of such information, Mrs. Taylor was a 'person-at-risk,' one whose environment provided neither social support nor opportunity for a meaningful role into which her energy could be channeled. Utilizing the orientation of competence-centered practice and prevention, the worker, focusing on strengths and assets, found that Mrs. Taylor was an energetic woman who enjoyed people, was motivated toward an active life, was well organized, and had good cognitive skills. She and the worker discussed interests and potential volunteer jobs that would provide an opportunity for socialization, productive activity, and, in essence, a meaningful new role. A job was selected in a local library as part of the "Retired Seniors" Volunteer Program," and opportunities for successful action to promote competence emerged. The first days on the job were difficult for Mrs. Taylor; she was apprehensive and sensitive to what she perceived as criticisms on the part of the library'Staff and considered resigning. Rather than perceiving these difficulties as a failure on Mrs. Taylor's part, the worker, continuing the use of techniques of competence clarification, located the problem in the transaction between an overly sensitive elderly person and the librarian, a busy younger person who was not sufficiently aware of the needs and skills of her new volunteer. A visit to the library helped to clarify the nature of the environment into which Mrs. Taylor
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was entering, and a talk with the librarian about her feelings and needs was successful in changing the person/environment transaction so that it became mutually satisfying. The worker, as enabler, supported Mrs. Taylor's coping and intervened in restructuring the environment with and for her, until a good match was found. As the worker terminated with Mrs. Taylor, the latter had increased her autonomy, enjoyed her new role as a volunteer, and found friends in her apartment and in her work environment. Effective performance in her life situation contributed not only to a sense of present competence but also to enhanced coping strategies for future life situations (Maluccio, 1979b). Mrs. Taylor had grown in her ability to deal with the problems in living of an elderly individual through learning and practicing new coping skills. In addition, her environment had changed and now contained support and nourishment. The competence-centered approach resulted in increased self-confidence and self-est e e m - i n sum, positive mental health.
Empowering Clients in a Housing Project The task of mobilizing the potentialities and motivation of clients in activities toward competence requires practitioners to take sufficient time to identify issues of primary concern around which motivation can be awakened. As already mentioned, it means choosing interventive activities that take into consideration the person's strengths and potentialities as well as environmental resources and deficits and, finally, interventions that serve to empower human beings to take action in their own behalf. Practice in the field unit illustrated this dramatically. Both casework students and community organization students were deployed to work in a lowincome housing project where the majority of residents were minority single mothers receiving various entitlements. As students clarified the characteristics of the environment, they found it to be overly stressful: the buildings were in deplorable condition; social interaction and supports were minimal; and people lived without basic necessities of life. From the perspective of prevention, both the mothers and their children constituted a population-at-risk. The casework students, utilizing a more traditional therapeutic orientation, found the residents to be depressed, dependent, and in need of counseling and supportive services. However, the work went slowly, and only a limited number of people accepted services that were offered. The response to the work of a community organization student in the same training project was quite different. The environment and the residents were the same. The difference was that this student, following the guidelines of competence clarification, identified people's strengths and skills, in addition to specific personal problems and needs. The student's first task was to combat the sense of alienation and discouragement and provide a measure of hope. Utilizing the approach of competence-centered practice, she redefined client
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and worker roles and regarded the residents as resources and herself as enabler and catalyst. As she indicated to them, she was not there to solve their problems but to provide some direction, to give information in order for them to solve their own problems, and to work as a collaborator. And so it happened; following careful, painstaking work, the residents responded. Meetings that had been sparsely attended were now well attended. The chairperson of the group, with some coaching from the student, played a forceful leadership role. Meetings had focus and direction. Residents identified their agenda and changes they desired and soon had enough clout to be heard. For example, the manager of the housing project, city council members, and other officials came to talk personally with the group. Changes came slowly, but they did come. Not only were the environmental conditions that influenced the susceptibility of residents to psychological stress improved, but also the residents themselves were empowered as they participated in influencing their own environment. The concept of empowerment is receiving increasing attention in work with minority clients. As suggested by Solomon (1976), empowerment in Black communities involves a process where the worker engages in practice activities that aim to reduce the powerlessness often caused by the negative evaluation associated with membership in a stigmatized group. For persons such as the minority residents in the housing project, working together to obtain needed resources for a better life for themselves and their children was one way to counteract the feelings of powerlessness and to promote competence and selfesteem. The use of community organization in the project demonstrated that, as people are perceived as having strengths and skills, they can respond in amazing and varied ways when provided with appropriate resources. Mental health can be promoted through having residents participate in community action around common concerns and needs (Cardoza et al., 1975; Naparstek et al., 1982).
Promoting Competence in a Health Care Setting Health care settings in the training project provided excellent opportunities for identifying "people-at-risk." Health problems are often indicative of stressful life situations, and primary health care facilities offer a much more acceptable entry point for mental health services for the general population. As reported in a study of services (Borus, et al., 1980) at the Bunker Hill Health Center of the Massachusetts General Hospital, neighborhood-based settings provide an excellent context for the provision of a range of mental health services. In contrast to community mental health centers that tend to be used primarily by a relatively narrow spectrum of patients who are acutely or chronically ill, primary health care facilities providing mental health services offer unusual opportunities for case finding as well as prevention/education outreach programs concerning mental health issues.
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In the primary health care facilities where these practice examples occurred, physicians, nurses, and other health care providers, knowledgeable about the impact of crisis events, changes in role or status, and environmental stress on health and mental health, made referrals to the social work students when stresses seemed about to overwhelm resources or when information and skills were lacking. The students, utilizing a competence-centered perspective, were often able to turn a stressful experience into a growth-producing one where self-esteem and competence were enhanced and mental health was promoted. Both casework and group work were useful methodologies for responding to the needs of persons referred. Examples of referrals for casework service included the following: a mother struggling with the new status of single parent; a middle-aged man with elevated blood pressure overwhelmed by the transition to unemployment; and a teenage mother striving to care for her infant but not knowing how. All of these individuals may have functioned at a minimal level with no help at all. However, they flourished with the additional resources, skills, and information provided by the project participants; they learned new coping skills and experienced a sense of success, triggering their sense of competence and ability to meet ongoing challenges in life. In essence, these interventions served to promote and enhance positive mental health. Group work approaches in the health care facility were equally productive in promoting competence in persons dealing with transitions of role and status. For example, a student formed an education and support group for firsttime mothers and mothers-to-be who received obstetric and pediatric care at the facility. The purpose of the group was to share information and give support around this major life experience. Subjects discussed in the group included care of oneself during pregnancy, the birth process, nursing, and care of a young infant. These topics promoted the capacities and skills of the participants for negotiating the anticipated life task of parenting. The mix of pregnant women and young mothers was a positive experience, enabling the latter to be "helpers" to the mothers-to-be. For both groups, competence and selfesteem were enhanced and the possibility for successfully negotiating the task of parenting increased. Conclusion
P r e v e n t i o n is a n idea w h o s e t i m e h a s come (Klein a n d Goldston, 1977)! We w h o a r e p a r t of t h i s f o u r t h m e n t a l h e a l t h r e v o l u t i o n ( P r e s i d e n t ' s C o m m i s s i o n on M e n t a l H e a l t h , 1978) m u s t s e e k w a y s to t a k e t h e w e a l t h of a v a i l a b l e k n o w l e d g e a n d r e s e a r c h a n d t r a n s l a t e it into s t r a t egies a n d t e c h n i q u e s t h a t can b e c o m e a p a r t of t h e r e p e r t o i r e of all h u m a n service personnel. T h e c o m p e t e n c e p e r s p e c t i v e offers one app r o a c h for i n t e g r a t i n g p r o m o t i o n into ongoing p r a c t i c e a c t i v i t i e s w i t h a wide r a n g e of persons. P r a c t i t i o n e r s utilizing t h i s a p p r o a c h , w i t h its
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ecological orientation, will find ways to enhance and strengthen the coping strategies which human beings use to deal with life's demands, while at the same time working with and for clients to restructure environments. The field of primary prevention is compelling, even addictive (Kessler and Albee, 1975). For the authors of this paper, competence-centered practice is a viable and valuable approach that makes prevention and promotion attractive, addictive, understandable, and achievable!
Notes 1. A special issue of the American Journal of Community Psychology, (Vol. 10, No. 3 - - J u n e 1982) describes a number of programs whose major outcome is the promotion of competence. 2. See Perlmutter (1983) for a comprehensive discussion of promotion programs in human service agencies. 3. A recent issue of the Journal ofPrimaryPrevention, (Vol. 3, No. 2--Winter 1982) focuses on programs of prevention that involve the mobilization and strengthening of various forms of social support and reduction of risk.
References Albee, G.W. (1980). A competency model must replace the defect model. In L. Bond & J. Rosen (Eds.), Competence and coping during adulthood (pp. 75-104). Hanover, NH: University Press of New England. Albee, G.W. (1983). Psychopathology, prevention, and the just society. Journal of Primary Prevention, 4, 5 - 40. Bloom, B.L. (1979). Prevention of mental disorders: Recent advances in theory and practice. Community Mental Health Journal, 15, 179-191. Bond, L.A. & Joffe, J.M. (Eds.) (1982). Fostering infant and early childhood development. Hanover, NH: University Press of New England. Bond, L.A. and Rosen, J. (Eds.) (1980). Competence and coping during adulthood. Hanover, NH: University Press of New England. Borus, J., et al. (1980). Coordinated mental health care in neighborhood Health Centers.
Mental Health Service System Reports--Series DN: 3, Health~Mental Health Research. Washington, DC: U.S. Department of Health and Human Services. Cardoza, V.G., Ackerly, W.C. & Leighton, A.H. (1975). Improving mental health through community action. Community Mental Health Journal, 11,215-227. Cowen, E.L. (1982). The special number: A complete roadmap. American Journal of Community Psychology, 10, 239-250. Cumming, J. & Cumming, E. (1962). Ego and milieu. Chicago: Aldine-Atherton. Dohrenwend, B.S. (1978). Social stress and community psychology. American Journal of Community Psychology, 6, 1-15. Germain, C.B. & Gitterman, A. (1980). The life model of social work practice. New York: Columbia University Press. Goldston, S.E. (1977). An overview of primary prevention programming. In D.C. Klein & S. Goldston (Eds.), Primary prevention: An idea whose time has come. DHEW Publication No. (ADM) 77-447. Washington, DC: U.S. Government Printing Office.
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Gottlieb, B.H. (1981). Preventive interventions involving social networks and social support. In B.H. Gottlieb (Ed.), Social networks and social support (pp. 201-231). Beverly Hills, CA: Sage Publications. Hartman, A. (1979). The extended family as a resource for change: An ecological approach to family-centered practice. In C.B. Germain (Ed.), Social Work Practice: People and Environments, (pp. 239-266). New York: Columbia University Press. Kelly, J.G. (1973). Ecological constraints on mental health service. American Psychologist, 28, 535-539. Kessler, M. & Albee, G.W. (1975). Primary prevention. Annual Review of Psychology, 26, 557-591. Klein, D. (1969). The meaning of community in a preventive mental health program. American Journal of Public Health, 59, 2005-2012. Klein, D.C. & Goldston, S.E. (Eds.) (1977). Primary prevention: An idea whose time has come. DHEW Publication No. (ADM) 77-447. Washington, DC: U.S. Government Printing Office. Libassi, M.F. (1983). An integrative approach to primary prevention in the field. In J.P. Bowker (Ed.), Education for primary prevention in social work, (pp. 75-92). New York: Council on Social Work Education. Libassi, M.F. & Maluccio, A.N. (1982). Teaching the use of the ecological perspective in community mental health. Journal of Education for Social Work, 18, 94-99. Lowenthal, M.F. & Berkman, P.L. (1967). Aging and mental disorders in san francisco. San Francisco: Jossey-Bass. Maluccio, A.N. (1979a). Learning from clients--Interpersonal helping as viewed by clients and social workers. New York: The Free Press. Maluccio, A.N. (1979b). Promoting competence through life experiences. In C.B. Germain (Ed.), Social work practice: People and environments (pp. 282-302). New York: Columbia University Press. Maluccio, A.N. (1981). Competence-oriented social work practice: An ecological approach. In A.N. Maluccio (Ed.), Promoting competence in clients--A new~old approach to social work practice. (pp. 1-24). New York: The Free Press. Maluccio, A.N. and Libassi, M.F. (1984). Competence clarification and social work practice. Social Thought, 10, 51-58. Naparstek, A.J.; Biegel, D.E. & Spiro, H.R. (1982). Neighborhood networks for humane mental health care. New York: Plenum Press. Perlmutter, F.D. (1983). Partnership for mental health promotion. Journal of Primary Prevention, 4, 96-106. President's Commission on Mental Health (1978). Report of the task panel on prevention. Washington, DC: U.S. Government Printing Office. Sarason, S.B. & Lorentz, E. (1979). The challenge of the resource exchange network. San Francisco: Jossey-Bass. Seligman, M. (1975). Helplessness: On depression, development and death. San Francisco: Freeman. Siefert, K. (1983). Using concepts from epidemiology to teach prevention. In J.P. Bowker (Ed.), Education for Primary Prevention in Social Work (pp. 54-74). New York: Council on Social Work Education. Solomon, B. (1976). Black empowerment: Social work in oppressed communities. New York: Columbia University Press. Spivack, G. & Shure, M.D. (1974). Social adjustment of young children: A cognitive approach to solving real life problems. San Francisco: Jossey-Bass. Stephens, R.; Blau, Z.; Oser, G.I.; & Millar, M.D. (1978). Aging, social support systems and social policy. Journal of Gerontological Social Work, 1, 33-45. Studt, E. (1968). Social work theory and implications for the practice of methods. Social Work Education Reporter, 16, 22-24 and 42-46. Sundberg, N.D.; Snowden, L.R. & Reynolds, W.M. (1978). Toward assessment of personal competence and incompetence in life situations. Annual Review of Psychology, 29, 179-211.
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Tobin, S. & Neugarten, B. (1961). Life satisfaction and social interaction in the aging. Journal of Gerontology, 16, 344-346. Tolsdorf, C. (1976). Social networks, support and coping: An exploratory study. Family
Process, 15,407-418. White, R.W. (1963). Ego and reality in psychoanalytic theory. New York: International Universities Press.
