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Journal of Social Work Education

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Social Work Practitioners’ Educational Needs in Developing Spiritual Competency in End-of-Life Care and Grief

Elizabeth C. Pomeroy, Audrey Hang Hai & Allan Hugh Cole Jr.

To cite this article: Elizabeth C. Pomeroy, Audrey Hang Hai & Allan Hugh Cole Jr. (2021) Social Work Practitioners’ Educational Needs in Developing Spiritual Competency in End-of-Life Care and Grief, Journal of Social Work Education, 57:2, 264-286, DOI: 10.1080/10437797.2019.1670306

To link to this article: https://doi.org/10.1080/10437797.2019.1670306

Published online: 04 Dec 2019.

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Social Work Practitioners’ Educational Needs in Developing Spiritual Competency in End-of-Life Care and Grief Elizabeth C. Pomeroy, Audrey Hang Hai , and Allan Hugh Cole Jr.

ABSTRACT This study’s purpose was to assess social work practitioners’ educational needs for developing spiritual/religious competencies with end-of-life care and grief. Competency levels and factors associated with educational courses and content on developing spiritual/religious competencies were identified. Data were collected in 2017 through an online Qualtrics Survey Tool at a large public university in the Southwest. An online survey was sent to 3,845 social work practitioners via email and 437 practitioners who met eligibility criteria participated in the survey. Results suggest that social work education and trainings would benefit from better integration of spiritual- ity/religion competencies, both in general and specifically in the area of end-of-life care and grief. Implications for social work education improve- ment are provided.

ARTICLE HISTORY Accepted: March 2019

Death and grief are an inevitable part of human life, and they often present challenges to people’s physical, mental, and emotional well-being. The National Association of Social Workers (NASW, 2004) reminds social workers that regardless of their field of practice, they will inevitably be confronted with managing grief because of illness, dying, death, and decision making related to the relief of suffering in their work with clients. By 2030, all baby boomers in the United States (those born between 1946 and 1965) will be age 65 years and older and for the first time outnumber children (U.S. Census Bureau, 2018). The increasingly older U.S. population will have wide-ranging implications for the country as well as social workers. As this trend in aging and longer life expectancies continues, the need for end-of-life (EOL) care, grief management, and palliative care curricula, training, and guidelines in schools of social work, nursing, and medicine will increase (Boschert, 2013; Morrison & Meier, 2015; Richardson, 2014; Wang, Chen & Chow, 2018). Anticipating this need, the field of social work has called for ethical standards and professional guidelines that address EOL, hospice, and palliative care (NASW, 2004, 2009). The Institute of Medicine (IOM, 2015) identified the need to expand and improve the quality of EOL care and knowledge among clinicians across educational institutions and the health care delivery system. Current practices call for the establishment of career incentives and training for social workers to build capacity in the field of palliative care and to support educators who can integrate palliative care into postgraduate training curricula (Institute of Medicine (IOM), 2015; Morrison & Meier, 2015). Furthermore, courses in EOL care have applications beyond traditional palliative care practice in other practice settings (Supiano, 2013).

However, tensions exist in the preparation of graduate students who will work with issues of grief and loss in health care settings on what the workforce needs, what is pedagogically required, and what students want to learn (Breen, Fernandez, O’Connor, & Pember, 2012). Greater experience and training integrating spirituality and religion (SR) into EOL care has been seen as an important factor to support patients dealing with EOL issues (Balboni et al., 2013; Richardson, 2014). Lack of EOL and grief competencies related to SR and the need to better prepare social work students has been seen as a barrier for social work practice with EOL care and grief (Kramer, 2013; Zollfrank et al., 2015). Those in the social work profession recommend a holistic approach to social work practice, including spiritual health and the biopsychosocial-spiritual

CONTACT Elizabeth C. Pomeroy [email protected] Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., 3.106B, Austin, TX 78712. © 2019 Council on Social Work Education

JOURNAL OF SOCIAL WORK EDUCATION 2021, VOL. 57, NO. 2, 264–286 https://doi.org/10.1080/10437797.2019.1670306

issues that affect well-being (NASW, 2016; Richardson, 2014). The National Consensus Project for Quality Palliative Care, an evolving consortium of numerous organizations in palliative care (including the NASW), has created clinical practice guidelines that contain the SR aspects of care (Ferrell, Twaddle, Melnick, & Meier, 2018; National Consensus Project for Quality Palliative Care, 2013). This study aims to fill a gap in the literature by examining the educational needs of social work practitioners in multiple practice settings for developing SR competency with EOL and grief. The following literature review provides an overview of contributions as well as gaps in knowledge and points to subjects for future research.

Literature review

Social workers practice in a variety of health care, hospice, palliative, and integrated care settings and play an important role in helping individuals and families with EOL and grief issues (Bailey, 2012; Cacciatore, Thieleman, Killian, & Tavasolli, 2015; Fraher, Richman, de Saxe Zerden, & Lombardi, 2018). Social work pedagogy focuses on building EOL and grief competencies that reinforce the comprehensive philosophy of palliative care (Bosma et al., 2010). Palliative care is understood as a holistic approach to providing care to individuals and their families affected by life-threatening illnesses, with a focus on symptom relief and improving the quality of life. It encompasses EOL care but is more expansive (National Academies of Sciences, Engineering, and Medicine, 2016). Moreover, social workers in other non-health-care settings are also likely to encounter individuals who are dealing with EOL issues, illness, dying, death, and grief experiences (Bosma et al., 2010). The promotion of a client’s right to self- determination as informed by professional standards requires continued education in EOL issues (e.g., advanced directives), not only for direct practice but also to support policy work (Galambos, Starr, Rantz, & Petroski, 2016; Lupu, Deneszczuk, Leystra, McKinnon, & Seng, 2013). The literature shows a critical need for social workers with specific knowledge and competencies who can help individuals and families cope with bereavement, grief, and EOL decisionsaswellastheculturalandSRaspectsofEOLandpalliativecare(Adshead&Dechamps,2016;Bosmaetal., 2010; Forrest & Derrick, 2010; Morrissey, 2005; Morrissey, Herr, & Levine, 2015; Wang, Chan, & Chow, 2018).

The literature consistently shows a shortage of social workers prepared to provide quality palliative and EOL care (Gardner, Gerbino, Walls, Chachkes, & Doherty, 2015; Gwyther et al., 2005). One large study (n=641) of social workers who practice in hospice palliative care settings in the United States reported a lack of clarity in roles and responsibilitiesfor socialworkersinthispracticesettingandtheneedforCenterforMedicareandMedicaidServices reimbursementpoliciesthatacknowledgesocialworkcontributionsinadvancecareplanning(Stein,Cagle,&Christ, 2017). Another study (n=102) of students at a school of social work in the southeastern United States showed that experiential EOL-specific education and training, field and service learning are effective ways to increase the level of comfort with EOL issues. Making EOL and grief courses compulsory across disciplines and connecting with experienced practitioners could also reduce the gap in practice knowledge (Kwon, Kolomer, & Alper, 2014). The literature also lacks significant articles on the evolving field of EOL care in addition to a gap in and a call for social workers to take on empirical research to better represent their important contribution in EOL care (Henry et al., 2015; National Academies of Sciences, 2016).

The growth of EOL care and palliative services in the United States and globally is well supported (Dumanovsky et al., 2016; Hughes & Smith, 2014), which has expanded the need for relevant knowledge and skills training on the cultural and SR issues related to grief and loss and EOL and palliative care (Etkind et al., 2017; Hauser, Preodor, Roman, Jarvis, & Emanuel, 2015; Murty, Sanders, & Stensland, 2015).

There is a shortage of practitioners who have palliative care expertise and recognized knowledge in the skills that are culturally and spiritually appropriate (Berkman & Stein, 2018; Kramer, 2013). This supported earlier research by Bosma et al. (2010) that identified the need for further profes- sional development and educational curricula related to SR (of self, team, and others). Additionally, there appears to be a gap between students’ academic learning of SR and their practice skills related to grief and EOL care (Dickinson, 2013, 2017; Duncan-Daston, Foster, & Bowden, 2016; Harris, Yancey, Myers, Deimler, & Walden, 2017; Kwon et al., 2014; Richardson, 2014; Rothman, 2009; Turner, Kuyini, Agustine, & Hunter, 2015). Even among advanced social work practitioners, the

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need for training in the integration of clients’ SR practices and the evaluation of such practices had been demonstrated (Oxhandler & Ellor, 2017). Fang, Sixsmith, Sinclair, and Horst (2016) showed that spiritually and culturally relevant practice knowledge related to EOL care was limited, especially with underserved minority populations. In addition, research revealed the need for continuing education on EOL and grief issues and training on compassion fatigue and secondary trauma (Chan & Tin, 2012; Quinn-Lee, Olson-McBride, & Unterberger, 2014; Sansó et al., 2015).

Those in all levels of social work education, including the bachelor’s level, master’s level, and continuing education, could benefit from training and knowledge about how to assist grieving or dying clients (Bosma et al., 2010). Middleton, Schapmire, and Head (2018) conducted a qualitative content analysis of a reflective writing assignment from 27 master’s level social work students enrolled in a palliative care clinical setting. Findings indicated experiential interdisciplinary learning, shadowing experienced social workers, and train- ing helped to better prepare social work students for future in practice. Murty et al. (2015) studied the integration of EOL field of practice in the social work curriculum at a school in the United States. Findings demonstrated that specific education on EOL care helped build foundational competencies among social work learners as well as a cross-pollination of knowledge on EOL care. A comprehensive review of the 50 most cited papers in social work in EOL care, showed a scarcity of relevant literature and a field needing further research (Henry et al., 2015). Other studies point out the lack of content on EOL practice and grief in social work textbooks and the need of faculty with specialized training in EOL care (Murty et al., 2015; Wang, Chan, & Chow, 2018). Wang et al. (2018) reported that textbook curricula focused generally on death and dying, with limited clinical supervision in EOL care and advance care planning (ACP) practices. Simons and Park-Lee (2009) surveyed 272 social work students (mostly MSWs) in the United States and Canada and found that positive attitudes toward EOL planning were associated with higher levels of comfort when discussing death and with more experiences working with clients in EOL situations. These results were reinforced in a later study by Kwon et al. (2014), which showed the need for hands-on-experience related to EOL care issues and suggested that academic education may improve students’ competence and comfort in EOL decision making.

Many variables contribute to students’ level of comfort working with EOL care, including self- awareness and experiential training in academic settings (Kwon et al., 2014; Wang et al. 2018). Research shows the need for the social work profession to develop and integrate evidence-based interventions for EOL-related issues (Murty et al., 2015). A study by Dickinson (2013) reported the results of a 2012 survey that investigated 88 U.S. graduate social work programs’ curricular offerings in EOL and palliative care and compared the results with those of a similar survey in 1990. There has been some progress, yet the preparation at the master’s level for EOL care is far from adequate. Major progress was found in separate death and dying course offerings, which increased from 40% to 64%. Although schools were offering more curricula and course work, only 42% of master’s level students actually completed these courses. Ninety-four percent (94%) of programs offer at least one lecture on death and dying, but the number of teaching hours averaged only seven (Dickinson, 2013). In addition, inter- disciplinary education on EOL care was found to be limited. Seventy-six percent (76%) percent of programs offered at least a lecture or two on palliative care, with the average number of hours being almost three times that of death and dying offerings; yet only 30% of students were exposed to palliative care courses (Dickinson, 2013). Ruth et al. (2017) reviewed 4,831 courses across four domains (BSW, MSW, DSW, PhD, and continuing education) and recommended the need for a clearer framework for “health social work,” (p. S267) and for expanding its health content to better prepare graduates for integrated practice. A core curriculum for all MSW students was agreed on, as well as curriculum development on palliative care knowledge and skills for nonspecialty scopes of practice across settings to prepare more MSWs. Findings also called for curriculum development on hospice and palliative care at the graduate level for specialty and nonspecialty practices (Ruth et al., 2017). Dickinson (2017) showed that efforts to enhance training in EOL topics and issues and greater experiential exposure for medical students were seen to enhance their EOL skills. Specifically, helping students face their own anxiety over death and dying was seen as a win-win for students and their patients. It does not seem like much of a jump to conclude that the same would apply to social work students. The educational needs of students

266 E. C. POMEROY ET AL.

who are learning SR aspects of EOL care (e.g., advance directives) benefit from real-life situations with repeated exposure in clinical placements and when supported by role modeling and mentorship (Baldacchino, 2015).

SR competency and EOL care

Evolving research on the integration of SR into social work practice shows that it has the potential to improve mental and physical health outcomes (Koenig et al., 2012; Oxhandler & Ellor, 2017; Oxhandler & Pargament, 2014). Spirituality and religion is an area of diversity requiring cultural competence for social work practice as directed in the NASW (2017) Code of Ethics. The Council on Social Work Education (2015) recommends diversity standards and guidelines for developing SR as a core competency. Trends in research continue to support the need to develop SR competencies and place them on the same footing as cultural competence (Canda & Furman, 2009; Darrell & Rich, 2017; Hodge, 2015; Husain & Sherr, 2015; Kvarfordt & Herba, 2018; Oxhandler, Parrish, Torres, & Achenbaum, 2015).

Social work and SR have had a long but intermittent history in the United States. The profession’s origin was deeply influenced by SR practices, and its relationship with SR continues to ebb and resurge (Canda & Furman, 2009; Crowder, 2013; Sheridan, 2015). Therefore, social workers in every field of practice may benefit from training and content on SR (Husain & Sherr, 2015), whether to assist with EOL care or to inform appropriate public policy. By integrating knowledge on the general public’s SR views, social workers are better able to provide ethical and professional services that respect the SR beliefs and values of the individuals they serve (Hodge, 2015; Sheridan, 2015).

The lack of education on religious beliefs and spiritual issues among health care providers is a significant barrier to the integration of SR care into health care services (Richardson, 2014; Zollfrank et al., 2015). The need to improve education about EOL and palliative care, including SR perspectives on death and dying, is greatly needed (Roze des Ordons et al., 2016). In terms of social work education on EOL care and grief, education on the SR aspect is especially lacking. Knowledge of SR factors that influence advance care planning may help providers address racial disparities in advance care planning for the growing population of minority older adults (Huang, Neuhaus, & Chiong, 2016). To ensure effectiveness in practice and a well- qualified workforce, social workers are called to use practice-based research and other continuous methods of knowledge as foundations for practice (Pockett, Dzidowska, & Hobbs, 2015).

Most research on social workers’ educational needs in the SR aspect of EOL care mainly focused on the hospice setting. Little attention has been paid to a generalist social work education. This study attempts to answer the following research questions: Do social work practitioners feel competent in the area of SR in EOL and grief? Do social work practitioners feel comfortable in the area of SR in EOL and grief? What are their educational needs in the interface between SR and EOL and grief? What forms of education would be most beneficial? The findings of this study can inform social work curricula and education policies with the goal of improving social work education to better equip social work practitioners with competencies and skills in serving clients with EOL care and grief issues.

Methods

Instrument

This study was approved by the institutional review board of a large public university in the Southwest. We developed an online survey using Qualtrics survey software to assess social work practitioners’ educational needs in SR competencies in the area of EOL care and grief. The survey inquired about social work courses, specific content and forms of education in regard to developing SR competencies in EOL care and grief that practitioners have or have not received and consider necessary, and identifies practitioners’ current confidence and competence levels in this area. We invited an expert panel of hospice social workers, who deal with EOL care and grief on daily basis, to review the preliminary survey

JOURNAL OF SOCIAL WORK EDUCATION 267

for content validity, and we revised the survey according to their feedbacks. The survey contained 45 items and took about 15 minutes to complete (see Appendix for the complete survey).

Recruitment

Staff in the Office of Professional Development of a large southwestern university’s social work department sent an e-mail with the link to the survey to 3,845 social work practitioners on its electronic mailing list inviting them to participate in the study. The first invitation was sent in August 2017, and three follow-up reminder e-mails were sent 7, 14, and 21 days after the initial invitation. The eligibility criteria to participate in this study were that participants (a) must be social work practitioners, (b) have a degree in social work, and (c) have a minimum of 6 months of practice experience in the field of social work. The opportunity to enter a drawing to win a $100 Amazon gift card or a continuing education course was provided as an incentive to participate in this survey. Data collection lasted from August to October 2017. Data analysis included descriptive statistics to examine sample characteristics and participants’ responses to the survey.

Results

Participants

A total of 465 social work practitioners participated in the survey, 437 (11.4%) of whom met our eligibility criteria and were included in the analysis. Twenty-eight participants were excluded because they were not practicing as a social worker at the time of the survey and thus did not meet our eligibility criteria. Table 1 presents the background information of the study participants. The participants were social work practi- tioners from diverse backgrounds. On average, they were 44 years old (ranging in age from 22 to 76). A majority were female (89.05%), although some were male (9.95%), transgender (0.25%), or other gender (0.75%). About 65% of participants were White (65.62%). The second largest racial group was Hispanic (19.78%), followed by Black and African American (7.42%), Asian (2.92%), and American Indian or Alaska Native (1.57%). About 45% of the participants reported being Christian (45.74%), about 20% were spiritual but not religious, and about 10% reported being agnostic. A majority of participants had a master’s degree in social work (92.64%). About a third of the participants obtained their highest social work degrees between 2010 and 2017 (36.27%), and a third obtained their highest social work degrees between 2000 and 2009 (36.13%). Participants’ practice experience ranged from 1 to 47 years (mean=14 years). In addition, participants came from a variety of practice settings, including school, mental health center, hospital, child welfare, hospice, skilled nursing, private practice, nonprofit, and religious congregations.

Competency in EOL, grief, and related educational needs

A majority of participants reported that they encounter EOL and grief issues in their practice (often or very often, 39.63%; sometimes, 42.86%). However, almost 40% considered themselves not prepared at all to address these issues when they began practicing social work (Table 2). We asked participants who reported not feeling prepared (n=166) what would have helped them. Among the forms of social work education we suggested (i.e., bachelor’s level course, master’s level course, continuing education courses, discussion in supervision meetings, resources in the community, extracurricular readings, lectures, job training, and other), the most endorsed ones were courses on EOL and grief at the master’s level, continuing education courses on EOL and grief, and discussion about EOL and grief in supervision meetings. We also asked participants who reported feeling prepared (n=35) or somewhat prepared (n=232) what had prepared them. The forms of social work education that were endorsed by most participants included courses on EOL and grief at the master’s level, discussion about EOL and grief in supervision meetings, and extracurricular readings on EOL and grief (Table 3).

268 E. C. POMEROY ET AL.

Continuing education on EOL and grief About half the participants (53.86%, n=230) have taken a continuing education course on EOL and grief; and among these practitioners, more than 80% think the course increased their competency in addressing their clients’ EOL and grief needs (82.02%). About 70% of all participants reported a need for more continuing education course on EOL and grief (70.40%). A majority of participants (96.68%) reported that interventions for EOL and grief would be one of the most helpful topics for a continuing education course, about 60% considered case studies on EOL and grief (61.46%), and about 45% considered theories on EOL and grief (44.19%) as among the most helpful topics for continuing education.

Table 1. Background information of participants (N=437).

Frequency (%) Frequency (%)

Gender Race or Ethnicity Female 89.05 White 65.62 Male 9.95 Hispanic 19.78 Transgender 0.25 Black or African American 7.42 Other 0.75 Asian 2.92

American Indian or Alaska Native 1.57 Religious Affiliation Native Hawaiian or Pacific Islander 0.45 Christian 45.74 Other 2.25 Spiritual but not religious 20.79 Agnostic 9.98 Social Work Degree Nothing in particular 6.24 MSW 92.64 Jewish 4.57 BSW 15.40 Atheist 3.74 PhD 3.22 Buddhist 3.12 DSW 0.46 Muslim 0.42 Hindu 0.42 Highest Social Work Don’t know 0.42 Degree Obtained Other 4.57 2010s 36.27

2000s 36.13 Practice Setting 1990s 16.48 Schools 21.52 1980s 9.48 Mental health centers 21.21 Pre-1980s 4.21 Hospital 13.78 Child welfare 9.75 Practice Area Hospice 5.73 Urban 56.72 Skilled nursing facilities 2.79 Suburban 24.63 Grief centers 1.55 Rural 17.72 Oncology and dialysis clinics 1.39 Other 0.93 Other 22.29

Note. Mean age=44; age range=22–76; mean practice experience (years)=14, practice experience range (years)=1-47. Percentages may not sum to 100% because of rounding.

Table 2. End-of-life and grief issues in social work practice and education (N=437).

Questions About Competency Respondents’ Answers Frequency (%)

Frequency of end-of-life and grief issues in social work practice Never 2.30 Rarely 15.21 Sometimes 42.86 Often 26.96 Very Often 12.67

How prepared to address end-of-life and grief issues when first started practicing Not prepared at all 38.34 Somewhat prepared 53.58 Prepared 8.08

How prepared to address spirituality and religion issues when first started practicing Not prepared at all 47.53 Somewhat prepared 47.53 Prepared 4.94

JOURNAL OF SOCIAL WORK EDUCATION 269

The interface between SR and EOL: Educational needs

Table 4 presents the frequency of SR issues in social work practice and practitioners’ competency in addressing these issues. A majority of participants reported that they encounter SR matters in their work (often or very often, 37.06%; sometimes 49.42%), and nearly half the participants (49.18%) encounter these matters often or very often when working with clients with EOL and grief issues. More than a third of participants (35.28%) reported that their grieving or dying clients initiate discussions about SR often or very often, whereas less than 25% of participants themselves (23.82%) initiate SR discussions with their grieving or dying clients, and about a third of participants (33.73%) never or rarely initiate these discussions. In addition, the majority of participants agreed with the statement that “SR is an important part of clients’ grief and EOL care issues” (52.49% totally agree, 39.90% agree, 7.60% neutral, 0.00% disagree or totally disagree). A majority of participants agreed with the statement that “social work should incorporate clients’ spirituality in our biopsychosocial framework” (57.21% totally agree, 33.17% agree, 8.17% neutral, 1.44% disagree or totally disagree), and a majority agreed that “social work should incorporate clients’ religiosity in our biopsychosocial framework” (42.93% totally agree, 35.49% agree, 17.03% neutral, 4.56% disagree or totally disagree). However, more than a third (36%) of participants do not feel their last social work education program provided an environment in which they could feel free to discuss SR as these issues related to practice.

SR competency

When asked about how competent they feel to address the spiritual issues of their grieving and dying clients (spirituality was defined as a human quality to search for meanings, well-being, and profundity through connections with ourselves, others, and the universe), more than 20% of participants considered themselves incompetent (17.26% somewhat incompetent, 6.15% very incompetent). When asked about how compe- tent they feel to address the religious issues of their grieving and dying clients (religion was defined as an institutionalized system of beliefs, values, and practices that are oriented toward spiritual concerns and transmitted over time by a community), more than 30% of participants considered themselves incompetent (23.70% somewhat incompetent; 8.53% very incompetent). Additionally, more than a third of participants reported that their personal SR poses a challenge when working with clients who have a different SR from theirs (34.07% sometimes, 2.70% often). Table 5 shows practitioners’ self-reported comfort levels and competencies when working with clients from various religious backgrounds. Comfortable was defined as not experiencing uneasiness caused by personal opinions, beliefs, or values, and competent was defined as having adequate skills and tools to address the issue. Results show that many social work practitioners reported feeling uncomfortable or incompetent to address the SR issues of clients from various religious background.

Table 3. Helpful forms of social work education on end-of-life and grief (N=437).

Forms of Social Work Education Not Prepared at All (%)

(n=166) Somewhat Prepared (%) (n=232)

and Prepared (%) (n=35)a

Courses on grief and loss at bachelor’s level 35.15 19.77 Courses on grief and loss at master’s level 75.76 55.89 Continuing education courses on grief and loss 73.94 44.11 Discussion about grief and loss in supervision meetings 60.00 46.39 Resources in the community 36.36 36.12 Extracurricular readings on grief and loss 34.55 45.25 Lectures on grief and loss 48.48 25.86 Job training 44.24 33.08

Note. Subsample n values do not sum to overall sample because prepared status was unknown for four respondents. aAnalyses are based on reporting into one collapsed category where responses somewhat prepared and prepared were summed.

270 E. C. POMEROY ET AL.

Directions for social work education improvement Nearly half the participants (47.53%) considered themselves not prepared at all to address SR issues when beginning to practice. To offer some direction for social work education improvement, we asked participants who reported not feeling prepared (n=202) what would have helped them. Among the forms of social work education we suggested, the most endorsed forms of social work education were continuing education courses on SR, courses on SR at the master’s level, and discussion about SR in supervision meetings (Table 6). We also asked participants who reported feeling prepared (n=21) or somewhat prepared (n=202), what has prepared them. None of the forms of social work education that were most endorsed by them (i.e., resources in the community, extracurricular readings on SR, and discussion about SR in supervision meetings) were provided by formal social work education (Table 6). In addition, the social work courses that were identified by most participants as needing to include SR content include diversity and special population courses (21.90%), practice courses (21.74%), theory courses (15.31%), and field courses (13.34%) (Table 7). Table 8 presents participants’ opinions on and educational needs in various SR interventions. The SR interventions most participants wanted more training in include conducting a spiritual assessment (69.74%), using or recommending religious or spiritual books or writings (59.69%), helping clients clarify their religious or spiritual values (58.92%), using religious or spiritual language or concepts (53.23%), and meditating with a client (46.56%).

Table 4. Spiritual or religious issues in social work practice and practitioners’ competency (N=437).

Questions About Competency Respondents’ Answers Frequency (%)

Frequency of spiritual or religious issues in social work practice Never 0.70 Rarely 12.82 Sometimes 49.42 Often 27.74 Very often 9.32

Frequency of spiritual or religious issues when working with clients with end-of-life or grief issue

Never 2.33 Rarely 13.99 Sometimes 34.50 Often 32.40 Very often 16.78

Frequency of grieving or dying clients initiating discussions about spirituality or religiosity

Never 1.17 Rarely 15.19 Sometimes 38.55 Often 24.77 Very often 10.51 Never had grieving or dying clients 9.81

Frequency of practitioners initiating discussions about spirituality or religiosity when working with grieving or dying clients

Never 11.32 Rarely 22.41 Sometimes 33.96 Often 16.27 Very often 7.55 Never had grieving or dying clients 8.49

Self-rated competence in addressing the spiritual issues of their grieving or dying client

Very competent 12.77 Somewhat competent 58.16 Somewhat incompetent 17.26 Very incompetent 6.15 Not sure 4.96 Don’t think social workers need to address spiritual or religious issues

0.70

Self-rated competence in addressing the religious issues of their grieving or dying client

Very competent 8.29 Somewhat competent 50.24 Somewhat incompetent 23.70 Very incompetent 8.53 Not sure 8.29 Don’t think social workers need to address spiritual or religious issues

0.95

How prepared to address spiritual or religious issues when first started practicing

Not prepared at all 47.53 Somewhat prepared 47.53 Prepared 4.94

JOURNAL OF SOCIAL WORK EDUCATION 271

Continuing education on SR About 25% of participants (24.76%, n=105) have taken a continuing education course on SR, and among these practitioners, more than 70% think the course increased their competency in addressing their clients’ SR needs (73.33%). However, about 10% did not consider the continuing education course they took as a resource for helping to increase their SR competency (10.48%), and more than 15% were not sure (16.19%). About 70% of all participants reported a need for more continuing education courses on SR (69.50%). Interventions for SR was the continuing education topic that was considered helpful by most participants (93.20%) followed by case studies on SR (67.01%) and theories on SR (60.54%).

Discussion

Social workers in many fields of practice are called on to assist with EOL issues. SR is a practice core competency relevant across social work care settings and an essential part of EOL care as discussed previously by Bosma et al. (2010). However, there is a lack of recent research on social work education for SR competency in EOL care. Moreover, most existing research on social workers’ educational needs in the SR aspect of EOL and grief mainly focused on the hospice setting, and little attention has been paid to generalist social work education. Supiano (2013) suggests that the content and process of graduate EOL course work could benefit students in a variety of fields beyond

Table 5. Practitioners’ comfort level and competency when working with clients from various religious affiliations.

Client’s Religious Affiliation Uncomfortable (%)a Incompetent (%)b

Agnostic 16.79 27.14 Atheist 21.05 27.75 Buddhist 19.20 43.10 Catholic 11.91 17.75 Evangelical Protestant 25.56 34.99 Hindu 24.25 52.64 Historically Black Protestant 15.79 32.66 Jehovah’s Witness 37.91 53.51 Jewish 16.29 35.84 Mainline Protestant 12.03 24.88 Mormon 30.25 49.25 Muslim 24.87 51.88 Protestant 10.53 21.31

Note. Comfortable was defined as not experiencing uneasiness caused by personal opinions, beliefs, or values. Competent was defined as having adequate skills and tools to address the issue. aIndicates item is on the 5-item subscale: Uncomfortable, Somewhat uncomfortable, Somewhat comfortable, Comfortable, and I'm not sure. bIndicates item is on the 5-item subscale: Incompetent, Somewhat incompetent, Somewhat competent, Competent, and I'm not sure.

Table 6. Helpful forms of social work education on spirituality and religion (N=437).

Forms of Social Work Education Not Prepared at All (%)

(n=202) Somewhat Prepared (%) (n=202)

or Prepared (%) (n=21)a

Courses on spirituality or religiosity at Bachelor’s level 33.50 19.09 Courses on spirituality or religiosity at Master’s level 71.50 27.27 Continuing education courses on spirituality or religiosity 74.00 23.18 Discussion about spirituality/religiosity in supervision meetings 67.50 35.91 Resources in the community 30.00 44.09 Extracurricular readings on spirituality or religiosity 34.50 43.18 Lectures on spirituality or religiosity 47.50 28.64 Job training 37.00 27.27

Note. Subsample n values do not sum to overall sample because prepared status was unknown for 12 respondents. aAnalyses are based on reporting into one collapsed category where responses Somewhat Prepared and Prepared were summed.

272 E. C. POMEROY ET AL.

palliative care. This study provides an update to the field and narrows the literature gap by examining the educational needs of social work practitioners from all settings in developing SR competency in EOL care. Specifically, this study examined social work practitioners’ (1) self- perceived competency, (2) comfort level, and (3) educational needs in areas of SR in EOL and grief, and (4) solicited their suggestions for helpful education forms.

Table 7. Social work courses that should include spirituality and religion content (N=437).

Course Frequency of Endorsement (%)

Practice courses 21.74 Theory courses 15.31 Policy courses 4.47 Research courses 4.95 Diversity and special population courses 21.90 Field courses 13.34 Field practicum 9.89 All courses 6.75 None 0.47

Note. Participants could select more than one category.

Table 8. Social work practitioners’ educational needs in spirituality and religion interventions.

Spirituality and Religion Intervention

I Think I’ve Had Adequate Training on This (%)

I’d Like More

Training on This (%)

I Don’t Think It’s Appropriate to Use This

as a Social Work Intervention (%)

I Think It’s an Appropriate Social Work Intervention, But I Would

Not Use This for Personal Reasons (%)

Other (%)

Conduct a spiritual assessment 9.93 69.74 6.15 6.38 7.80

Use or recommend religious or spiritual books or writings

7.40 59.69 12.50 11.73 8.67

Pray privately for a client 22.47 13.33 21.23 17.78 25.19

Pray with a client 14.29 23.06 30.33 15.54 16.79 Meditate with a client 21.12 46.56 10.69 10.18 11.45 Use religious or spiritual language or concepts

19.15 53.23 8.96 6.22 12.44

Help clients clarify their religious or spiritual values

15.40 58.92 11.49 6.36 7.82

Recommend participation in a religious or spiritual program

15.17 40.55 21.14 8.46 14.68

Refer clients to religious or spiritual counselors

32.09 40.05 7.71 5.22 14.93

Recommend religious or spiritual forgiveness, penance, or amends

7.00 31.50 39.50 7.50 14.50

Perform exorcism (expelling evil spirits)

0.00 3.50 82.50 6.00 8.00

Help clients develop ritual as a clinical intervention (e.g., house blessings, visiting graves of relatives)

13.86 43.32 21.53 8.66 12.62

Participate in client’s rituals as a clinical intervention

4.50 28.75 38.25 11.50 17.00

Share your own religious or spiritual beliefs or views

10.17 16.87 43.67 15.14 14.14

Touch clients for healing purposes

6.27 17.29 51.63 12.53 12.28

JOURNAL OF SOCIAL WORK EDUCATION 273

Consistent with previous research findings (Berkman & Stein, 2018; Dickinson, 2013; Kramer, 2013; Morrissey, 2005; Morrissey et al., 2015; Oxhandler & Giardina, 2017), results from this online survey show that more than a few social work practitioners who participated felt incompetent and unprepared by their social work education to address SR and EOL and grief issues. Social work practitioners reported not feeling prepared by their social work education at either the bachelor’s or master’s level to feel competent or confident in their knowledge and abilities to address these very important issues with their clients. These findings echoed research by Zollfrank et al. (2015), who suggested that a lack of education on spiritual care was a significant barrier to integrating SR into EOL care. In addition, participants also felt a lack of comfort in discussing these issues with their supervisors. It could be that faculty and supervisors may have been taught that these topics were beyond the scope of social work practice, and clients should be referred to their spiritual leaders for assistance in these areas. On the other hand, it could be that faculty and supervisors lack the necessary education to address these issues with their students. Either way, it appears that faculty development in the areas of EOL, grief, and SR education could be beneficial.

Similar to other research findings (Baldacchino, 2015; Dickinson, 2017; Gardner et al., 2015), social work practitioners in our survey desire more continuing education seminars and case studies concerning the areas of SR and grief and loss. This was also consistent with research by Zollfrank et al. (2015) that showed SR comfort among practitioners was improved by further training, especially when the EOL provider and the client had religious discordance. This finding warrants further research, especially because more than a third of our study’s social work participants reported that their personal SR poses a challenge when working with clients with different SR affiliations. Also, in support of earlier research (Kwon et al., 2014; Simons & Park-Lee, 2009; Turner et al., 2015), study participants believed that supervisors need to be knowledgeable about these topics so they can instruct social work supervisees on how to work with clients who discuss these issues with their practitioners. Future curriculum research should investigate why the most endorsed forms of social work education among the survey participants who self-reported feeling prepared to address SR issues were provided outside their formal social work education.

Limitations

This study relied on self-report measures, which can only measure perceived competency. Future studies should incorporate objective measures to identify areas of improvement in social work practitioners’ competency in SR and EOL and grief. In addition, our findings have limited generalizability because (1) our sample was drawn from the mailing list of a large southwestern university’s social work department and hence was not nationally representative, and (2) the low response rate further limited the generalizability. Future research should replicate this study with a nationally representative sample of social work practi- tioners. Although care was taken to send reminder e-mails and a small offer was made to incentivize participation, the lower response rate indicates there is the potential for nonresponse bias. We believe that the electronic mailing list selected is comparable to the social work practitioner population at large in terms of key characteristics. However, there is the possibility of selection bias and self-selection bias as only social work practitioners on the mailing list were able to participate in this survey, and findings are not generalizable to the total population of social work practitioners. Caution is needed in the interpretation of findings in regard to educational needs and spiritual competency. As with other self-reported research, the social work practitioners who decided to participate in this survey may be influenced by social desirability bias, especially because an educational mailing list was the source for finding participants. The structure of the survey questionnaire on practice fields could have been more comprehensive, given that more than 22% of our survey participants indicated that they practice in a setting other than the eight specified. Answers provided by survey participants in the Other category covered a broad range of practice settings, including police, nonprofit housing, adult day care, an HIV/AIDS service center, criminal justice, and military, to mention just a few. A more inclusive answer choice may have provided greater detail on the demographics of our sample population and provided a better reflection of the diversity of respondents’ practice settings, all of which have an impact on whether results are generalizable to the target population.

274 E. C. POMEROY ET AL.

Implications for social work practice

This study sought to inform practice on social work educational demands and identify self- reported competencies in the area of SR and grief and loss in social work practice. Future research should be conducted to further our understanding of best practices for integrating SR and grief and loss services into social work education and practice with clients across cultures and belief systems. Social workers who obtain in-depth knowledge about a diversity of SR beliefs and practices in the United States will be able to assist their clients with these issues in a more comprehensive manner. On the other hand, social workers can be helpful to clients by learning how to address these issues even if they have limited knowledge about any one particular SR practice by allowing the client to teach them about the client’s culture and practices. Feeling comfortable collaborating with clients and developing a relationship in which the client and practitioner mutually inform each other about SR, EOL, or grief issues may ultimately be an effective intervention.

In the same vein, social workers need to be competent in working with clients and their grief and loss experiences. It can be difficult to separate personal beliefs and feelings from professional reasoning when working with grief and loss and SR. Developing self-awareness related to these issues is necessary to assist others. A greater emphasis on SR and grief and loss care needs to be addressed in social work education at the bachelor’s and master’s levels. Schools of social work should focus on developing sensitive and flexible educational resources for social work students that are easily accessible across different levels of learning. Whether schools develop courses specifically designed to address these issues or infuse these topics into existing courses, it’s beneficial for graduates of social work programs to feel comfortable and confident that they can address these issues in practice. Considerations for tailoring resources to support practical experiential learning, mentoring, and in-the-field learning through field placements as well as online learning are recom- mended. The use of casework and decision cases can be especially helpful to build generalist competencies as well as the advanced skills needed for interdisciplinary EOL teamwork. In addition, administrators of continuing education programs could emphasize SR and grief and loss topics in their curricula. Practitioners who may have never received any formal education on SR or grief and loss can benefit from conference presentations and workshops related to these areas of social work practice.

In today’s world in which violence, trauma, and tragedies abound as well as the more common- place struggles with the loss of loved ones because of illness or aging, social workers are often called on to assist individuals, groups, families, and communities with these difficult occurrences. Being well equipped to address the issues of SR and grief and loss needs to be an important component of social workers’ knowledge and skill set. In the end, the dilemma for social work schools and the profession is developing capacity (i.e., faculty, field instructors, etc.) and competency-based practice in an already crowded curriculum field with so many competing needs. To improve the quality of EOL care for aging populations, it is important to train social workers at the specialist and generalist levels of competence in SR and grief services. These findings add to the growing understanding of the need to fund research as well as incentivize awards to build the training of social work students and faculty on these core issues.

Funding

This work was supported by the Bert Kruger Smith Professorship in Aging and Mental Health.

Notes on contributors

Elizabeth C. Pomeroy is distinguished professor at The University of Texas at Austin and holds the Bert Kruger Smith Professorship in Mental Health and Aging. Audrey Hang Hai is a PhD candidate at The University of Texas at Austin. Allan Hugh Cole Jr. is senior associate dean for academic affairs and professor at The University of Texas at Austin.

JOURNAL OF SOCIAL WORK EDUCATION 275

ORCID

Audrey Hang Hai http://orcid.org/0000-0003-0385-0281

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Appendix

Social work practitioners’ spiritual competency in end-of-life care and grief

Q1 Consent to Participate in Internet Research Principal Investigator: [Elizabeth Pomeroy] Purpose of Study: The purpose of this study is to examine the educational needs of social work practitioners in

developing spiritual competency in end-of-life care and grief. You are invited to participate in a research study, entitled “A survey of social work practitioners’ educational needs

in developing spiritual competency in grief and end-of-life care.” The study is being conducted by [Elizabeth Pomeroy].The purpose of this research study is to examine the educational needs of social work practitioners in developing spiritual competency in end-of-life care and grief. Your participation in the study will contribute to the development of social work education in end-of-life care and grief. You are free to contact the investigator at the above address and phone number to discuss the study.

To participate, you must be at least 18 years old, have a degree in social work, and have a minimum of 6-month practice experience in the field of social work. The study will exclude practitioners in fields other than social work, such as psychologists, psychiatrists, and licensed professional counselors.

If you agree to participate

● The survey will take approximately 15 minutes of your time. ● At the end of the survey, you will have a chance to put your name in a drawing to win a $100 Amazon gift card or

a continuing education course of your choice provided by the University of Texas School of Social Work Continuing Education Program. In order to maintain your anonymity, you will be directed to an external survey to enter into the drawing upon completion of the main survey.

Risks/Benefits/Confidentiality of Data

If you recently lost a loved one in your life, there are some possible minimal risks of experiencing emotional distress. Should you experience any emotional distress during the survey, please feel free to contact the investigator at the above address and phone number. The investigator can provide some resources and/or hotline numbers to help you address the emotional distress. The survey is anonymous. The potential risk of damage on anonymity by online hacking is no bigger than a person’s everyday use of the Internet. There will be no costs for participating, nor will you benefit from participating. Your name, email address, and IP address will not be kept during the data collection phase. You will be asked to provide your first name and email address in the external survey should you want to participate in the drawing, but the information you enter will not be connected to the survey. A limited number of research team members will have access to the data during data collection.

Participation or Withdrawal

Your participation in this study is voluntary. You may decline to answer any question and you have the right to withdraw from participation at any time. The researcher will be unable to extract anonymous data from the database should you wish it withdrawn. Withdrawal will not affect your relationship with The University of Texas in anyway. If you do not want to participate either simply stop participating or close the browser window. If you do not want to receive any more reminders, you may email us at [email protected].

Contacts

If you have any questions about the study or need to update your email address contact the researcher Audrey Hai at [email protected].

This study has been reviewed by The University of Texas at Austin Institutional Review Board and the study number is 2017-03-0106.

Questions about your rights as a research participant

If you have questions about your rights or are dissatisfied at any time with any part of this study, you can contact, anonymously if you wish, the Institutional Review Board by phone at (512) 471–8871 or email at [email protected].

JOURNAL OF SOCIAL WORK EDUCATION 279

If you agree to participate in the study, click NEXT to start the survey. If you need to leave the survey before finishing, you can return to it by clicking the link provided in the email to continue the survey. By completing the survey you are giving consent for your response to be included in the study.

Thank you.

Q2 Are you currently practicing as a social worker?

○ Yes ○ No

Q3 Do you have at least 6-month experience of practicing as a social worker?

○ Yes ○ No

Q4 Approximately how many years have you practiced as a social worker? ________________________________________________________________

Q5 How old are you? (years) ________________________________________________________________

Q6 What types of social work degree do you have? (Check all that apply)

□ Associate’s degree in social work □ BSW □ MSW □ Ph.D. in social work □ DSW □ I do not have a degree in social work

Q7 How often do matters involving end-of-life/grief issues arise in your work as a social worker?

○ Never ○ Rarely ○ Sometimes ○ Often ○ Very often

Q8 When you first started practicing, how prepared did you feel to address the end-of-life/grief issues of your clients?

○Not prepared at all ○Somewhat prepared ○Prepared

Q9 If you did not feel prepared when you first started practicing, what would have helped? Check all that apply.

□ Courses on grief and loss at Bachelor’s level □ Courses on grief and loss at Master’s level □ Continuing education courses on grief and loss □ Discussion about grief and loss in supervision meetings □ Resources in the community □ Extracurricular readings on grief and loss □ Lectures on grief and loss □ Job training □ Other (please specify) ________________________________________________

Q10 If you did feel prepared when you first started practicing, what prepared you? Check all that apply.

□ Courses on grief and loss at Bachelor’s level □ Courses on grief and loss at Master’s level □ Continuing education courses on grief and loss □ Discussion about grief and loss in supervision meetings □ Resources in the community □ Extracurricular readings on grief and loss □ Lectures on grief and loss □ Job training □ Other (please specify) ________________________________________________

280 E. C. POMEROY ET AL.

Q11 Have you ever taken a continuing education course on end-of-life care/grief?

○ Yes ○ No

Q12 Do you feel that the continuing education course on end-of-life care/grief increased your competence in addressing your clients’ end-of-life/grief issues?

○ Yes ○ No ○ I’m not sure

Q13 Do you need more continuing education courses on end-of-life care/grief?

○ Yes ○ No ○ I’m not sure

Q14 What topics might be most helpful? Check all that apply.

□ Theories on end-of-life care/grief □ Interventions for end-of-life care/grief □ Case studies of end-of-life care/grief □ Other (please specify) ________________________________________________

Spirituality

Q15 How often do matters involving spirituality/religion arise in your work as a social worker?

○ Never ○ Rarely ○ Sometimes ○ Often ○ Very often

Q16 How often do matters involving spirituality/religion arise when working with clients who have end-of-life/grief issues?

○ Never ○ Rarely ○ Sometimes ○ Often ○ Very often

Q17 How often do your grieving/dying clients initiate discussions spirituality/religion?

○ Never ○ Rarely ○ Sometimes ○ Often ○ Very often ○ I’ve never had any grieving/dying clients

Q18 How often do you initiate discussions spirituality/religion when working with grieving/dying clients?

○ Never ○ Rarely ○ Sometimes ○ Often ○ Very often ○ I’ve never had any grieving/dying clients

JOURNAL OF SOCIAL WORK EDUCATION 281

Q19 How competent do you feel to address the spiritual issues of your grieving/dying clients? (Spirituality is defined as a human quality to search for meanings, well-being, and profundity through connections with ourselves, others, and the universe.)

○ Very competent ○ Somewhat competent ○ Somewhat incompetent ○ Very incompetent ○ I’m not sure ○ I don’t think I need to address clients’ spiritual issues as a social worker

Q20 How competent do you feel to address the religious issues of your grieving/dying clients? (Religion is defined as an institutionalized system of beliefs, values, and practices that are oriented toward spiritual concerns and transmitted over time by a community)

○ Very competent ○ Somewhat competent ○ Somewhat incompetent ○ Very incompetent ○ I’m not sure ○ I don’t think I need to address clients’ spiritual issues as a social worker

Q21 Have you ever taken a continuing education course on spirituality/religion in social work?

○ Yes ○ No

Q22 Do you feel that the continuing education course on spirituality/religion in social work increased your competence in addressing your clients’ spirituality/religion issues?

○ Yes ○ No ○ I’m not sure

Q23 Do you need more continuing education courses on spirituality/religion in social work?

○ Yes ○ No ○ I’m not sure

Q24 What topics might be most helpful? Check all that apply.

□ Theories of spirituality/religion in social work □ Interventions for spirituality/religion in social work □ Case studies of spirituality/religion in social work □ Other (please specify) ________________________________________________

Q25 When you first started practicing, how prepared did you feel to respond to the spiritual/religious needs of your clients with end-of-life/grief issues?

○ Not prepared at all ○ Somewhat prepared ○ Prepared

Q26 If you did not feel prepared when you first started practicing, what would have helped? Check all that apply.

□ Courses on spirituality/religiosity at Bachelor’s level □ Courses on spirituality/religiosity at Master’s level □ Continuing education courses on spirituality/religiosity □ Discussion about spirituality/religiosity in supervision meetings □ Resources in the community □ Extracurricular readings on spirituality/religiosity □ Lectures on spirituality/religiosity □ Job training □ Other (please specify) ________________________________________________

282 E. C. POMEROY ET AL.

Q27 If you did feel prepared when you first started practicing, what prepared you? Check all that apply.

□ Courses on spirituality/religiosity at Bachelor’s level □ Courses on spirituality/religiosity at Master’s level □ Continuing education courses on spirituality/religiosity □ Discussion about spirituality/religiosity in supervision meetings □ Resources in the community □ Extracurricular readings on spirituality/religiosity □ Lectures on spirituality/religiosity □ Job training □ Other (please specify) ________________________________________________

Q28 To what degree do you agree with the following statement: “Spirituality/religiosity is an important part of clients’ grief and end-of-life care issues”

○ Totally agree ○ Agree ○ Neutral ○ Disagree ○ Totally disagree

Q29 To what degree do you agree with the following statement: “Social work should incorporate clients’ spirituality in our bio-psycho-social framework”

○ Totally agree ○ Agree ○ Neutral ○ Disagree ○ Totally disagree

Q30 To what degree do you agree with the following statement: “Social work should incorporate clients’ religiosity in our bio-psycho-social framework”

○ Totally agree ○ Agree ○ Neutral ○ Disagree ○ Totally disagree

Q31 Which statements apply to you in terms of your needs and opinions on these particular spiritual/religious interventions for grieving/dying clients? (Check all that apply)Please tell readers what the numbers in the tables in the appendix refer to; what are the periods after the numbers for? unless there is a specific purpose for them, please remove periods

I think I’ve had adequate trainings on

this

I’d like more

trainings on this

I don’t think it’s appropriate to use this

as a social work intervention

I think it’s an appropriate social work intervention, but I would

not use this for personal reasons Other

Conduct a spiritual assessment □ □ □ □ □ Use or recommend religious or spiritual books or writings

□ □ □ □ □

Pray privately for a client □ □ □ □ □ Pray with a client □ □ □ □ □ Meditate with a client □ □ □ □ □ Use religious or spiritual language or concepts

□ □ □ □ □

Help clients clarify their religious or spiritual values

□ □ □ □ □

(Continued)

JOURNAL OF SOCIAL WORK EDUCATION 283

Q32 What are some other spiritual/religious interventions you think social workers can use to help clients with grief and/or end-of-life care issues?

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

Q33 How often do you feel your personal spirituality/religiosity poses a challenge when working with clients who have different spirituality or religion than you?

○ Never ○ Rarely ○ Sometimes ○ Often ○ Very Often

Q34 What courses do you think should include spirituality/religiosity content? Please check all that apply.

○ Practice Courses ○ Theory Courses ○ Policy Courses ○ Research Courses ○ Diversity/Special Population Courses ○ Field Courses ○ Field Practicum ○ All Courses ○ None ○ Other (please specify) ________________________________________________

(Continued).

I think I’ve had adequate trainings on

this

I’d like more

trainings on this

I don’t think it’s appropriate to use this

as a social work intervention

I think it’s an appropriate social work intervention, but I would

not use this for personal reasons Other

Recommend participation in a religious or spiritual program

□ □ □ □ □

Refer clients to religious or spiritual counselors

□ □ □ □ □

Recommend religious or spiritual forgiveness, penance, or amends

□ □ □ □ □

Perform exorcism (expelling evil spirits)

□ □ □ □ □

Help clients develop ritual as a clinical intervention (e.g., house blessings, visiting graves of relatives)

□ □ □ □ □

Participate in client’s rituals as a clinical intervention

□ □ □ □ □

Share your own religious or spiritual beliefs or views

□ □ □ □ □

Touch clients for healing purposes

□ □ □ □ □

284 E. C. POMEROY ET AL.

Q35 How comfortable do you feel about addressing the spiritual/religious issues of clients who come from this religious background? (Comfortable is defined as not experiencing uneasiness caused by personal opinions, beliefs, or values.)

Q36 How competent do you feel about addressing the spiritual/religious issues of clients who come from this religious background? (Competent is defined as having adequate skills and tools to address the issue.)

Q37 Do you feel your last (or current if you’re a social work student) social work education program provided an environment where you could feel free to discuss spirituality related to practice?

○ Yes ○ No ○ I’m not sure

Q38 Do you feel your last (or current if you’re a social work student) social work education program provided an environment where you could feel free to discuss religion related to practice?

○ Yes ○ No ○ I’m not sure

Uncomfortable Somewhat uncomfortable Somewhat comfortable Comfortable I’m not sure

Evangelical protestant ○ ○ ○ ○ ○

Mainline protestant ○ ○ ○ ○ ○

Historically black protestant ○ ○ ○ ○ ○

Protestant ○ ○ ○ ○ ○

Catholic ○ ○ ○ ○ ○

Mormon ○ ○ ○ ○ ○

Orthodox Christian ○ ○ ○ ○ ○

Jehovah’s witness ○ ○ ○ ○ ○

Jewish ○ ○ ○ ○ ○

Muslim ○ ○ ○ ○ ○

Buddhist ○ ○ ○ ○ ○

Hindu ○ ○ ○ ○ ○

Atheist ○ ○ ○ ○ ○

Agnostic ○ ○ ○ ○ ○

Incompetent Somewhat incompetent Somewhat competent Competent I’m not sure

Evangelical protestant ○ ○ ○ ○ ○

Mainline protestant ○ ○ ○ ○ ○

Historically black protestant ○ ○ ○ ○ ○

Protestant ○ ○ ○ ○ ○

Catholic ○ ○ ○ ○ ○

Mormon ○ ○ ○ ○ ○

Orthodox Christian ○ ○ ○ ○ ○

Jehovah’s witness ○ ○ ○ ○ ○

Jewish ○ ○ ○ ○ ○

Muslim ○ ○ ○ ○ ○

Buddhist ○ ○ ○ ○ ○

Hindu ○ ○ ○ ○ ○

Atheist ○ ○ ○ ○ ○

Agnostic ○ ○ ○ ○ ○

JOURNAL OF SOCIAL WORK EDUCATION 285

Q39 Around what year did you obtain your highest level of social work degree? ________________________________________________________________

Demographic information

Q40 What type of settings do you practice in? Check all that apply.

□ Child welfare □ Schools □ Mental health centers □ Hospice □ Hospital □ Oncology/dialysis clinics □ Skilled nursing facilities □ Grief centers □ Other (please specify) ________________________________________________

Q41 What type of area do you practice in? Check all that apply.

□ Rural □ Urban □ Suburban □ Other (please specify) ________________________________________________

Q42 Choose one or more races that you consider yourself to be:

□ Hispanic □ Black or African American □ White □ American Indian or Alaska Native □ Asian □ Native Hawaiian or Pacific Islander □ Other ________________________________________________

Q43 What is your gender?

○ Male ○ Female ○ Transgender ○ Other ________________________________________________

Q44 What is your religious affiliation? Check all that apply.

□ Christian □ Jewish □ Muslim □ Buddhist □ Hindu □ Atheist □ Agnostic □ Nothing in particular □ Spiritual but not religious □ Don’t know □ Other (please specify) ________________________________________________

Q45 Is there anything else you would want us to know? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

286 E. C. POMEROY ET AL.