To say that any two cases are the same would be an oversimplification, but even inexperienced social workers can recognize consistent themes throughout their caseload. Yes, the nuanced details will always be different in terms of what clients struggle with. The driving forces behind these seemingly circumstantial problems, though, are firmly planted.

Example scenario: A social worker refers to their behaviorally challenged client to a mental health specialist. The specialist diagnoses the client with fetal alcohol syndrome and ADD. After being prescribed medication, the client doesn’t medicate regularly because his parents don’t enforce it. He eventually medicates with illicit substances, drops out of school and turns to a life of crime.

On the surface, this bleak and all-too-common scenario may point to poor parenting as the root cause of the client’s problems. While poor parenting is a cause, what caused the poor parenting? It is this examination of the social forces that created the environment, not the placement of responsibility on individuals alone, that allows for social change. To answer this question, we will turn to five of the greatest crises affecting Americans today: economic inequality, violent crime and drugs, the health care gap, the education crisis and the state of child care.

Economic Inequality

Most have heard the statistic about the top one percent of Americans controlling approximately half of the country’s wealth. Though America is indeed a “superpower” that ranks among the most profitable nations in the world, wealth doesn’t guarantee economic equality. In America’s case, it’s the opposite. The one percent are leveraging their wealth to influence the country’s political and industrial infrastructure to their advantage. When industry profits, the one percent profit. When the one percent make mistakes, the 99 percent pay for it.

Unfortunately, the state of wealth distribution in the USA has firmly rooted both the rich and the poor in place. Large corporations controlled by the one percent – especially banks – keep poor people poor with climbing interest rates, fines, fees and so on. It costs more to be poor in America.

Considering the above, almost every vein of social work is filled with low-income clients. For social workers, this means that they have to appreciate and recognize the economic factors that drive client behaviors. We’ve listed this crisis first for a reason – it contributes heavily to the four that follow.

Violent Crime and Drugs

Along with poverty comes greatly elevated crime rates at both the individual and societal level, says a Bureau of Justice Statistics study. This report details the staggering difference in violent crime between those below the poverty line, who demonstrated a 3.98% crime rate, and their high-income counterparts who demonstrated a 1.69% crime rate (both figures out of 1,000 people). As mentioned, the social worker promotes social change by addressing causes to problems instead of “symptoms,” so appreciating this correlation is extremely important.

When it comes to drug use, which is also firmly correlated with poverty, social workers need to lean heavily on a number of skills to affect any positive change. Drug-seeking behaviors and addiction bring several problematic tendencies with them:

  • Habitual lying and manipulation
  • Stealing/fraud
  • Intense mood swings and erratic behavior
  • Scapegoating others
  • Violent crime
  • Other forms of self-harm

Social workers need to think critically to see through the deception. Most importantly, drug-addicted clients need to be encouraged, but it’s a balance. Too strict, and they will not engage in the services and programs you recommend. Too lenient, and they’ll take advantage of you in order to gain money, eligibility for aid and so forth.

Health Care

While this post is not intended to provide political commentary, one can’t examine the state of healthcare in the US without mentioning the people and institutions that created this crisis. Long before heedless pharmaceutical executives were jacking up life-saving drug prices by 5,000 percent, silent bias in many forms was busy creating what’s known as “the healthcare gap.” Low-income communities and minorities, once again, are disproportionately affected by the prohibitive costs of health insurance.

Instead of consistent visits with the same doctor, people in low-income areas have to bounce around ERs and free clinics, increasing opportunities for mismanagement across multiple providers. Also, the supreme court decision allowing states to opt-out of Obamacare’s Medicaid expansion widened the healthcare gap for people living in states like Idaho. If your clients exist in this gap, managing their cases is much more complicated when health issues present themselves.


A report published by the Council on Foreign Relations in 2012 illuminates the struggles of public education in the United States across many metrics, including:

  • High school graduation, retention and dropout rates.
  • Standardized test scores
  • Disproportionately lower science and math scores.

While there have been several initiatives at the state and federal levels to increase funding, target failing subjects, increase retention rates and so forth, the consensus is that many schools are suffering across the country.

Once again, inequality is inescapable with this issue. Schools and districts in low-income areas are consistently subjected to greater funding cuts than their counterparts. This contributes heavily to the high school and college dropout rates, which are seven times higher in the case of poor students. reports that, before entering fifth grade, African-American, Hispanic and poor students are two or more years behind.

One of your greatest tools as a social worker is the ability to build a solid rapport with your clients and engage them in ways that corporate institutions can’t or won’t. This means that you will have to be sensitive to the client’s level of education. You have to understand that, with poor access to education, the above risk factors are ever-present.

Child Care

The cost of child care in the USA is rising at a seriously alarming rate. The average costs for nannies and child-care facilities have risen 26 and 14.5%, respectively, over the past five years. Parents who didn’t anticipate changing careers are now scrambling to find more flexible schedules or higher-paying jobs. Many parents opt to stay home. Either way, the crisis-level hike in child care costs is affecting parents’ ability to work, which of course affects their take-home income. Hence, dipping below the poverty line and dealing with the above-mentioned problems that come with it is a major challenge for new parents.

When it comes to social work, the need to directly provide child-care or work extra hours to pay for it can interfere with the client’s access to the services and programs that you recommend. This is why it’s always helpful to have child-care assistance programs and other local initiatives ready, regardless of your specialty.

With dedicated reform efforts and time, the impact of each crisis can be softened, but there will always be social forces and institutions affecting our well-being. The most important thing for social workers is to identify and address these macro-level concepts (economic inequality, for example) in a micro-level scenario, i.e., one-on-one interactions with clients. Think beyond the behavior, recognize the driving force, adjust your approach to the client and create a positive change.

Tim Kalantjankos

B.S. Sociology | University of Nebraska at Omaha

A.S. Physical Therapy | Clarkson College

September 2019

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