Specializations and Clinical Judgments of Social Workers in Cases of Children of Alcohol Abusers

A nationally drawn sample of 228 clinical social workers made clinical judgments on three case vignettes that represented typical cases involving children of alcohol abusers. Each vignette contained parental alcohol abuse, adult mental health problems, child behavior problems, and problems in family functioning. Respondents were classified as specialists in children and youth, families, mental health, or alcohol/drug abuse, generalists (three or more specialization areas), or non-specialists (no specialization areas) on specialization scales. Scales measuring case problem perceptions, referral patterns, and treatments were developed from factor scores of responses to vignettes. Construct and content validity were established. The primary hypothesis was that specialists would assess and develop treatment plans that were congruent with their specializations. Differences among groups in case problem perception, referral pattern, and treatment scales were analyzed via analyses of variance. Hierarchical regressions were employed to determine whether particular specialization groups developed congruent case perceptions and treatment plans. Some systematic differences in clinical judgments among specialists were found, primarily in predicted directions. Generalists were the most likely to make comprehensive clinical judgments. Regressions partially supported the main hypothesis. Specialization accounted for modest portions of the variance. Case perceptions accounted for little of the variance in referrals but for none of the variance in treatment. It was concluded that specialization interacts with other contextual factors to influence clinical judgments. Implications included the necessity for broad assessments that are connected to treatment plans and broader training for clinicians to better address the complex nature of these cases.