Scaling Up Social Problems

Abstract

The Grand Challenges for Social Work Initiative aims to focus the profession’s attention on how social work can play a larger role in mitigating contemporary social problems. Yet a central issue facing contemporary social work is its seeming reticence to engage with social problems, and their solutions, beyond individual-level interventions. Social work research, we contend, must more consistently link case and cause, iteratively developing processes for bringing micro-, mezzo-, and macrostreams of information together. We further argue that meaningful engagement with the initiative requires social work scholars and practitioners to actively scale up practice and research inquiry. We detail two key strategies for employing a scaled-up social work practice and research ethos: (a) employing a critical economic lens and (b) engaging with diverse publics. As proof of concept for these arguments, we offer an early example of progressive era social workers scaling up responses to a pressing social issue: infant mortality.

Keywords

research innovation practice innovation grand challenges social work history

The Grand Challenges for Social Work Initiative announced at the 2015 Society for Social Work and Research conference aims to focus the profession’s attention on how social work can play a larger role in mitigating contemporary social problems. The initiative asserts that concentrating social work research and practice on a delimited but broadly engaging set of grand challenges can measurably accelerate solutions to vexing social issues, from homelessness to mass incarceration (Uehara et al., 2014). Undoubtedly, focusing social work efforts on grand challenges has the potential to expand the reach of social work research and elevate the field’s role in society. Inherent in the framing of the grand challenges, however, is the presupposition that social work scholars have the ability to engage effectively with large-scale research questions. Yet a central issue facing contemporary social work is its seeming reticence to engage with social problems, and their solutions, beyond individual-level interventions (Abel & Kazmerski, 1994; Hill, Ferguson, & Erickson, 2010).

Social work’s shift away from structural-level interventions began in the mid-1920s with a redefinition of community organizing and practice (e.g., Lane, 1939; Lurie, 1959; Steiner, 1925). Although the field has had periods of more structural focus, for example, in the 1930s and 1960s, in general the tendency to privilege individualized behavioral interventions that emerged in the years following World War I has persisted. In 1994, for example, Specht and Courtney (1994) noted that “social work has become the single largest mental health profession, and the development of the private practice of social work has become one of the most significant trends in the profession” (p. 107). More recent data on the social work labor force reflect a similar picture.

A 2008 survey of National Association of Social Work (NASW) members (Whitaker & Arrington, 2008) found that the largest group of NASW members identified as mental health practitioners (35%). To put this number in perspective, the second highest practice field (other; 16%) was composed of myriad practice areas including “community development (1%), criminal justice (1%), developmental disabilities (2%), displaced populations (1%), occupational social work (1%), public health (1%), violence (1%) and other (8%)” (Whitaker & Arrington, 2008, p. 2). More than half of the survey respondents identified their work as micro “because they provide direct intervention with individuals or work in clinical setting” (p. 7), compared to 14% who identified their work as macro and 18% as mezzo. Even bearing in mind the likelihood that social workers in direct practice are overrepresented in NASW’s membership, these data underscore the reality that many fewer social workers are involved in community or policy practice.

A similar trend can be identified in social work scholarship. For example, a search of the Social Work Abstracts database using the terms policy and state or national and analysis, with social policy as a filter, yielded just 238 peer-reviewed abstracts published between 1977 and 2015 on policy-oriented topics such as health care, immigration, welfare, and economics. In general, it seems social work research has moved away from large-scale problem analysis and solution generation toward a primary emphasis on supporting individual well-being (Dulmus, Bass, & Bunch, 2005).

The Grand Challenges Initiative represents an important opportunity for innovation in social work research and practice. Meaningful engagement with this opportunity, however, requires efforts that move beyond behavioral interventions. Social work research, we contend, must more consistently link case and cause (to borrow language from an earlier era), developing iterative processes for bringing micro-, mezzo-, and macro streams of information together. Addressing the grand challenges of social work research, in other words, necessitates scaling up social problems and their solutions.

Scaling up, as it is generally defined (e.g., in health care), typically focuses on expanding the coverage and reach of innovations and interventions (Darnton-Hill & Samman, 2015). In this article, however, we argue that scaling up must also entail strategic attention to three intimately connected processes: (a) the scale at which challenges are defined, to ensure consistent attention to multiple levels of social issues, from micro to macro; (b) framing or how challenges, issues, and processes are defined; and (c) marketing or the strategies by which various publics can be mobilized to ensure broad-based support for social work solutions.

With regard to scale, we argue for strengthening the connections between social work’s expertise at the individual level and its commitment to addressing the social, economic, and political contexts in which individuals find themselves. From this perspective, scaling up is a call to (re)embrace the person-in-environment framework that has been central to the definition and evolution of social work practice and research. Scaling up social problems and solutions requires recognition that behavioral interventions, important as they are, are not in themselves sufficient to address the structural causes of social problems, as evidenced by the current state of world affairs. Although changing behavior is useful in facilitating small-scale adaptation to current circumstances, the eradication of wicked problems such as poverty and homelessness requires a consistent focus on how politics and policy constrain possibilities for action (Meyers, 2014). Generating transformative solutions, in other words, necessarily entails acknowledging, tackling, and eliminating large-scale constraints on individual and collective well-being.

In the United States, two key policy arenas—social and economic—shape and constrain individual action (Meyers, 2014). Although they are central to the lives of social work clients and research participants, in-depth examination of these policy arenas has frequently occurred at the margins of social work research and practice. Furthermore, even when research studies and interventions purport to address structural issues (e.g., in poverty research and practice), scholars and practitioners often focus on individual and behavioral factors aggregated to the group or community level (Meyers, 2014; O’Connor, 2001). In her informative work Poverty Knowledge: Social Science, Social Policy, and the Poor in Twentieth-century U.S. History,” Alice O’Conner (2001) gave an example of the now infamous Personal Responsibility and Work Opportunity Reconciliation Act, passed in 1996. The social science that served as the foundation of the act, O’Connor asserted, reflects the “contemporary neoliberal drift in poverty research” (p. 10) that has reinscribed individual morality, rather than social factors, as the cause of poverty.

The current article argues that to bring a sharpened focus on sociopolitical and economic issues not only back into social work research but also to the forefront of public attention—and thus scale up the study of social problems and their solutions—social work scholarship should engage centrally with two key research and practice domains:

Critical economics: defined as understanding the relationship between people and the economic system in which they live by investigating the benefits and burdens of that system on social relationships.

Engagement with diverse publics: defined as the ability of the field to lead the identification and definition of social problems by shaping public opinion through two interlocking research and practice tactics: problem framing and marketing.

Moving social justice and equity forward in the current century, as called for by the Grand Challenges Initiative, necessitates a reengagement of social work research with the political and economic dimensions of social life in the United States. The second section of this article reviews the role of economic discourse in social work inquiry. It describes social work’s historical engagement with economics and highlights opportunities for recommitting social work scholarship to a public dialogue on the benefits and burdens of U.S. domestic economic policy.

The imperative for an economic lens in social work research and practice derives from the field’s mission and values. The codes of ethics of both the NASW (1998) and the International Federation of Social Workers (2012) stipulate that social workers must actively intervene on behalf of people when their environments do not allow for equitable access and distribution of resources. O’Connor (2001) illuminated the historical inability of liberal social science to decide whether poverty is fundamentally an individual or systemic failing. Social work has struggled with the same question, including debates over the role of economics in research and practice. The 22nd volume of the journal Social Work, for example, included a debate on the role of economics in social work (Aigner & Simons, 1977; Page, 1977a, 1977b). Because social work is inherently concerned with solutions to social problems, the main point of contention was whether infusing economics into social work education could help the field in this endeavor or whether it would merely make us strange bedfellows with a discipline that social work has long held as implicated in sustaining dominant constructions of social problems. In this article, we align with Page (1977b), who asserted that it is the duty of social work scholars and practitioners to extend the capacity of the field to “search for the best ways to solve social problems” (p. 309).

Also vital to the solving of social problems is the ability to move issues and analyses to the forefront of public attention and engagement. The third section of the article introduces perspectives from the problem framing and public opinion literature and describes the implications of incorporating central tenets of these discourses into social work research. To illustrate social work’s capacity for scaling up social problems in the ways we encourage, the final section describes an early example of social workers using social and economic evidence and arguments to scale up responses to a pressing social issue: infant mortality. This exemplar provides, in essence, proof of concept for our argument that social work research and practice intentionally focused at multiple levels, from individual- and household-level interventions to policy advocacy and public engagement, can effectively produce social change.

Bringing a Critical Economic Lens Back to Social Work Research

Social Work and Economics: A Brief History

As a field of inquiry and practice, professional social work emerged as a response to the market failures that plagued the American economy at the end of the 19th century. Unsafe working conditions, unsanitary streets in cities overflowing with rural migrants and international immigrants seeking jobs, unchecked child labor—all of these issues and more came to the attention of well-educated, middle-class men and women (both White and Black, although in racially segregated domains) concerned with societal well-being. Applying their knowledge of social science theory, these social reformers began to gather evidence on ways to best support individuals, families, communities, and the nation in the face of an economic system that was failing to safeguard the well-being of many. The interventions they devised spanned the individual, family, and community levels, the most salient examples being charity organization societies and urban settlement houses.

Settlement houses were community-based organizations that saw as their main charge fundamental change in the economic, environmental, and social conditions challenging poor urban neighborhoods (Addams, 1893). Charity organization societies, on the other hand, were predominantly concerned with helping poor families access the interpersonal and community resources required to navigate personal and economic difficulties (Richmond, 1899/1914). Despite the multilevel foci evident in these two organizational types, the 1920s saw a decided shift toward the individual level, thanks in large part to the growing importance placed on psychology in the United States. In addition, there was a developing assertion in the social work field that professionalization was necessary to cement the role of social workers in American society. Indeed, “by 1929 social workers … had narrowed the definition of social work to psychiatrically oriented casework building on the European developments in dynamic psychology. In the process of doing this they had all but eliminated public welfare, social and labor reform, as well as ‘less professional’ techniques such as liaison and resource mobilization. They had also eliminated techniques practiced by settlement workers such as group and community work” (Popple & Reid, 1999, p. 17).

The 1930s, when the Great Depression once again brought to the foreground of social work consciousness the economic and social concerns that had been central to the work of the settlement houses and charity organization societies, was perhaps the last time social workers fixed their collective attention on the economy. Social workers staffed the Federal Emergency Relief Administration, Works Progress Administration, Bureau of Public Assistance (part of the social security board), and the newly constructed public welfare offices that had sprung up across the country (Fisher, 1980). Social workers were also influential in constructing and implementing the Social Security Administration Act of 1935 (Kemp & Brandwein, 2010). Individuals in the rank-and-file movement (Fisher, 1980) and social workers of color were particularly strong advocates for social justice and social change.

Although a concern with economics permeated social work discourse in the 1930s, in the years after World War II the field once again turned its attention toward facilitating individual coping. Perhaps the largest blow to social work’s attempts to keep an eye on economic issues came in the 1950s with the spread of McCarthyism in the United States. During this time, the House Un-American Activities Committee and the Federal Bureau of Investigation collected untold amounts of information on the political and social activities of American citizens, using that information against individuals and the organizations for which they worked (Reisch & Andrews, 2001).

Social workers were particularly vulnerable to the violent political and social ostracizing of the McCarthy era. Prominent social workers of the day faced persecution and possible destitution for advocating solutions to economic issues that were central to social work only a few years prior. Jacob Fisher, a leader in the rank-and-file movement and editor of Social Work Today, the leading leftist social work publication of the time, was charged with disloyalty under President Truman’s Executive Order 9835 (Reisch & Andrews, 2001). Charlotte Towle (1945), a faculty member at the School of Social Service Administration at the University of Chicago, saw the original printing plates of her 1945 government-commissioned book Common Human Needs destroyed by the U.S. Government Printing Office in response to assertions that its overt support of public assistance and social insurance were decidedly un-American (Reisch & Andrews, 2001). Eventually, mainstream social work organizations such as the NASW and the Council on Social Work Education actively aided government investigations of suspected radicals in the profession’s practice and scholarly ranks (Reisch & Andrews, 2001).

McCarthyism’s effects continue to be seen, Reisch and Andrews (2001) asserted, in the profession’s reticence to speak out against the political and economic status quo, feature critical economic analysis in its research products, and actively participate in the problem framing and advocacy that have comprised recent efforts to scale up social problems. The repression of the 1940s and 1950s resulted in a social work profession that has largely eschewed the larger context of the individual—including the role of structural racism, the economic inequities of contemporary American society, and the human right to shelter—to focus instead on behavioral interventions that could facilitate a person’s adjustment to his or her current context, whether through professional intervention or the building of certain social relationships (Reisch & Andrews, 2001). In essence, contemporary social workers have confused the case for the cause.

Critical Economics and the Scaling Up of Social Problems and Solutions

McCarthyism can be understood as an unrestrained backlash against the expansion of the New Deal, the welfare state, and the infiltration of alternative political and economic models into the American psyche (Reisch & Andrews, 2001), a backlash that reverberates in the present day. Contemporary social work research and practice centered on economic issues (e.g., poverty and inequality research, financial capabilities, and asset-building research and interventions) has mainly focused on behavioral interventions (see, e.g., Meyers, 2014; O’Connor, 2001; Sherraden et al., 2015). Much of the contemporary work on critical economics (most often discussed as poverty research) in social work has failed to examine the social and political exchanges by which economic policy is developed and the consequences of those exchanges for the ability of American citizens to actively pursue life, liberty, and happiness (Meyers, 2014). Further, social work’s understanding of economics appears to be limited to short-term financial gains, such as increases in liquid assets (i.e., cash), rather than long-term wealth development and accumulation. To engage effectively with contemporary grand challenges, which are indeed social challenges, social work scholarship will need to expand its understanding of and engagement with the inner workings of American structural economic policies to incorporate more thoroughly and directly a focus on economic justice in its research and practice efforts.

Given the centrality of economics in the lives of American residents and social work’s limited engagement with economics to date, three strategies are suggested for reinvigorating a critical economic perspective in social work practice and research. These strategies involve changes in social work culture and concrete changes in social work research and practice in the United States:

Integration of social work knowledge across the micro–mezzo–macro divide in practice and research.

Strengthened policy analysis and policy process theory requirements in generalist social worker education, across levels (BSW, MSW, PhD).

Incentivization of public scholarship by social work faculties.

Integrating Knowledge Across the Micro–Mezzo–Macro Divide

Central to contemporary social work’s lack of engagement with structural issues has been the fracturing of the field into three overarching streams of research and practice: micro, mezzo, and macro. In part, these divisions can be traced to the previously noted 19th-century charity organization societies and settlement houses; the latter developed the now-mainstream social work methodology known as casework (direct or clinical social work practice, in contemporary terms), whereas the former can best be understood as the antecedent of what we now call community organizing and development. Although both relied heavily on social science, central tenets from American pragmatism and left-leaning political ideologies were significantly more readily found in the discourse of the settlement houses. These influences resulted in a decidedly more activist strain in the settlement houses than in charity organization societies, contributing to later divisions in the profession between micro and mezzo or macro practice.

As Cloward and Piven (1977) pointed out, however, “whether we work with individuals or with community groups is not the issue: the issue is what we do when we work with them” (p. 58). The artificial divides that social workers have erected among themselves have resulted in a research and practice field that fails to situate itself actively across the continuum of human experience. That is, the micro–mezzo–macro divide has prevented social work scholars and practitioners from actively learning from each other (Rountree & Pomeroy, 2010). Instead of developing multilevel research and practice teams spanning individual-level interventions through policy-level applications, social workers haven tended to silo themselves in areas of unidirectional information flow (Rountree & Pomeroy, 2010). To tackle society’s most pressing grand challenges, social work researchers and practitioners will need to reconsider what it means to collaborate not only across disciplines but also across social work’s intradisciplinary divides.

A concrete first step toward greater integration across social work’s three silos could be taken with the grand challenges themselves. The American Academy of Social Work and Social Welfare and the Society for Social Work and Research, as the primary sponsors of the grand challenges, might incentivize the development of social work grand challenge teams composed of scholars and practitioners spanning the three levels of social work inquiry. One such incentive, for example, might be inclusion in a special issue of the Journal of the Society for Social Work and Research of findings of teams that develop challenge interventions (i.e., solutions) that touch each of the three levels simultaneously.

Policy Analysis and Process Theory Requirements in Social Work Education

A secondary consequence of the micro–mezzo–macro divide is that policy process and analysis knowledge are concentrated in a handful of social work scholars and practitioners. This has resulted in a profession that, as a field, has very little general understanding of how policy works, from development through implementation. Further, social work education courses touching on social welfare policy are typically limited to surveys of the social welfare policy pantheon (i.e., English Poor Laws, Personal Responsibility and Work Opportunity Reconciliation Act, 1996; Patient Protection and Affordable Care Act, 2010). These courses dedicate most of their policy focus to describing when certain policies were enacted, their impact on the strength of the social safety net, and the inevitability of similar policies in the future. In too many instances, therefore, Cloward and Piven’s (1977) critique of social work education in the 1970s still holds true: Students are “taught more in the schools of social work about the English Poor Laws than about the rules and regulations of the contemporary welfare programs on which so many clients depend for their existence” (p. 62).

The second strategy that should be employed to strengthen the critical economic lens of social work research and practice is stronger integration of policy analysis and process theory in social work education. Concretely, this translates into two actions that social work research and practice must take collectively:

Accreditation of schools of social work by the Council on Social Work Education should be contingent on the development and execution of at least one foundation-level policy theory and analysis course in each program seeking accreditation (i.e., BSW, MSW) in the next 7 years.

Social work’s presence in conferences and publications specializing in policy analysis and process theory (i.e., Association for Public Policy Analysis and Management Conference, Policy Studies Journal, Journal for Policy Analysis and Management) should be increased by 20% in the next 10 years.

It is worth noting that there are several initiatives underway to address the lack of policy analysis and process theory in social work education; for example, the Association for Community Organization and Social Administration’s Special Commission to Advance Macro Practice and the Council on Social Work Education’s Coalition for Policy Education and Practice in Social Work. In addition to these noteworthy efforts, increasing social work’s presence in policy analysis and theory requires a concerted focus on policy research. By taking these two time-limited steps, social work research and practice can solidify its integration of information flow between the three silos in such a way so as to begin the development of a critical economic lens in both the research and practitioner body.

Incentivizing Public Scholarship

Building critical economic capacity in social work, however, is not sufficient. Scaling up the field’s impact on the structural conditions underlying individual and collective difficulties also requires a body of scholars that is able to translate social work research findings and theories to the general public. Many scholars have successfully communicated the concerns and contributions of their fields through public scholarship: Notable examples include Michael Sandel, Noam Chomsky, Howard Zinn, and Neil deGrasse Tyson. Sadly, public scholarship is not particularly encouraged in the academy, and social work is no exception.

The degree to which social work invests in public scholarship, we suggest, is directly correlated with our ability to shape the framing of social issues and directly influence public opinion. To significantly influence the grand challenges identified as being of critical social importance, social work as a discipline and profession must reach beyond its own borders to persuade the public at large that not only are these issues solvable but they are more easily solved with social work expertise. This requires an elevation of social work communication beyond the relatively small circle of social workers themselves; we need to either reach a broader audience or leave the grand challenges to those who can do so. Importantly, social work is not without models of public scholarship in its own ranks. Notable examples include Mimi Abramovitz, Bruce Jansson, Lorraine Gutiérrez, Richard Cloward, and social worker by action, if not educational degree Frances Fox Piven. In other words, public scholarship in social work is already in existence; amplifying this domain is now a matter of disciplinary priority.

Strategies to Engage Public Opinion

To solve the vexing problems identified by the Grand Challenges Initiative, social work must expand its communication bandwidth beyond its own field. Not only is broader communication necessary to elevate social work’s standing in American society, but how the field chooses to approach communication regarding the grand challenges will affect the public’s perception of the profession for decades to come. Realizing social work’s potential as a central contributor to the forces of social change will involve implementing two key research and practice strategies to shape public opinion: (a) becoming more actively involved as a field in problem framing and (b) engaging with diverse publics through a concerted marketing strategy.

Problem Framing

Framing can be understood as the process by which people develop a particular conceptualization of an idea or issue. Frames offer alternative descriptions that guide people’s understanding and in turn affect how they evaluate solutions (Nelson, 2004). Thus, issue or problem framing can influence how individuals evaluate policy options, which are in themselves applications of problem frames and solutions (see, e.g., Kingdon, 1995; Schneider & Ingram, 1997). In turn, a relatively small change in the way an issue is framed can have large effects on public opinion (Chong & Druckman, 2007).

The general public, as a collective, is understood to have no stable opinion on most issues, in the sense that there are a multitude of conflicting views. A current example is gun control laws. American public opinion on gun control varies widely, with some people wanting to ban all guns, some only certain kinds of guns, and still others none at all, with no one group able to claim a majority. This is also illustrative of how public opinion consists primarily of reactions to framing effects or how social issue questions are posed or portrayed by the media and other information sources (Chong & Druckman, 2007). For example, research has shown that people respond to frames based on the information presented to them most recently (Brulle, Carmichael, & Jenkins, 2012). If someone is shown a picture of a convicted criminal who appears to be African American and is then asked whether African Americans are predominantly criminals, they will answer in the affirmative merely because that was the last image they associated with criminality. Regardless of order, much of the information individuals consume is framed by the context in which it is presented, either conceptually through language or explicitly through the suggestion of thematic connections (Corner & Randall, 2011). Frames assist in articulating the criteria by which the public forms an opinion.

When strategizing about influencing public opinion, social work must endeavor to first win the problem framing game—the process by which a social issue is identified and operationalized. Problem frames affect the capacity of the field to generate solutions that are accepted by the public and policy makers alike. Which groups are seen as the victims or perpetrators of certain social problems will dictate the framing of the solution and decisions about whose responsibility it is to craft the solution. Ultimately, social work will meet its mission of serving the most vulnerable among us by directly influencing what groups are constructed as victims or perpetrators and leading the decision-making dialogue regarding whose responsibility it is to craft and implement a solution to the problem.

Three strategies are suggested for enhancing social work’s research and practice presence in the public sphere, toward the end of shaping public opinion regarding the social problems identified as part of the grand challenges: (a) building social marketing campaigns, (b) making effective use of social media, and (c) building a stronger presence in political organizing campaigns.

Social Marketing

Social marketing is commonly defined as the systematic application of marketing concepts and techniques to achieve specific behavioral goals relevant to the social good. For example, it is often used in fields like public health to promote healthy behaviors. Social marketing has been associated with neoliberal ideas about personal responsibility. It has also been critiqued for failing to situate individual behavior in a broader social change agenda (Luca, Hibbert, & McDonald, 2015). Herein lies a primary entry point for social work scholarship and practice: contextualizing social marketing in a broader framework of community and structural change. By engaging with social marketing from the perspective of the public good, we suggest, social work can begin to harness the promise of social marketing for the effective communication of social work solutions to social problems.

The promise of social marketing lies in its assumption of plural publics, evidenced by its emphasis on segmenting campaigns to address the contexts, attitudes, and values of smaller groups of people among which a behavior change is desired. However, segmentation can be counterproductive to attempts to engage the public in larger, more sustained policy changes and political attitudes. Without the consistent application of a social work lens, the most successful social marketing techniques may interfere with long-term strategies for social change. Nonetheless, more recent developments in social marketing have positioned it to be useful in environments where stakeholders interact to create resources of value, termed service systems (Luca et al., 2015). For example, commercial marketing has shifted to focusing on relationships and customer service to build long-term, mutually beneficial relationships (Hastings, 2003).

The overuse (or misuse) of segmentation techniques to appeal to groups through social marketing could result in emphasizing individualistic attitudes rather than those that benefit the collective. Social work has the capacity to overcome this deficiency as a result of its long-standing ability to build coalitions around shared interests despite difference. Detroit community activist Grace Lee Boggs (2000), for example, invoked the power of place—people’s shared investment in the places where they live—as a locus for collective action across (and despite) differences in race, ethnicity, class, or age. Another strategy to overcome the potentially individualistic bias of social marketing is through the use of social networks, as in the case of social media campaigns.

Social Media Campaigns

Contrary to earlier beliefs about social media isolating individuals from their communities, there is increasing evidence that the use of social network sites for information has prosocial benefits for civic and political participation (Gil de Zúñiga, Jung, & Valenzuela, 2012). Social networking sites can alter behavior and attitudes online and off-line. One possible explanation for this phenomenon is that the information people are exposed to on social network sites is linked to other trusted persons in their network. This may make it a particularly useful information source for political engagement, because people associate their personal connections with the information consumed (Gil de Zúñiga et al., 2012).

The role of individual opinion leaders on social media sites is another important aspect in the diffusion of ideas throughout social networks. Opinion leaders are individuals or organizations that understand opinions representative of several stances on an issue, generate information and thoughts synthesizing those broader stances, and then influence opinions and attitudes through the dissemination of their own opinions to the general public (Park, 2013). For example, Twitter opinion leaders have been shown to have greater information seeking and public expression motives than nonleaders (Park, 2013). In turn, these opinion leaders are able to have a significant influence on the political involvement of others in a given issue (Park, 2013).

Given social media’s proven efficacy in increasing civic participation, its capacity to develop and sustain opinion leaders, and its tendency to generate dialogue and debate, it could be a useful tool in social work’s endeavor to produce publicly supported solutions to the identified grand challenges. If harnessed strategically (say, with the expressed support of public scholars in the field), social media can be used as a tool to both generate public debate and carry forward problem framing strategies. Thus, strategic use of social media could help elevate the field’s status in society by actively pursuing public support for social work–generated solutions to social problems.

Political Organizing Campaigns

Opinion leadership and other social media strategies must be couched in the contemporary context of political organizing, which has become as hyperpersonalized as the aforementioned social networks. Scholarly work in communication and political science has suggested that social movements and political organizing have moved away from strict group identities in recent years, toward the strategic use of individualized motivation and mechanisms of action (Bennett, 2012). In general, when people identify with a group and experience a sense of group consciousness, they adopt progroup issue preferences, particularly when there is competition from another group for resources (Conover, 1988). Historically, social movements have recruited people on the basis of group identification, born out of a need to actively identify collective interests. More recently, political organizing has shifted to connective action, which provides opportunities for message personalization, typically facilitated by social media (Bennett & Segerberg, 2012). Social media and allied technologies allow people to organize themselves without established advocacy organizations that require membership or group affiliation (Bennett & Segerberg, 2012). As a result, to garner public support for social work solutions, the field will have to establish a social media presence beyond just its member organizations. Although those organizations will still be central to disseminating relevant information, the field also needs to strategize around ways to establish other social media presences that can better engage with a nonmember public.

To capitalize on the individualized nature of contemporary politics and motivations—and move people beyond mere self-interest to considering the public good—invitations to political action must employ easily personalized frames that do not require large amounts of persuasion or reconceptualizing to motivate participation (Bennett & Segerberg, 2012). Social media is an easy platform for further personalization because of the various forms of communication it offers, allowing individuals to frame the issue under consideration in their own terms.

These dual processes of individualizing and convening larger swaths of the public converge to make it an ideal time for social work to become one of the leading voices of social change on social media. Promoting group dedifferentiation, rather than exacerbating differences, provides a strategic opportunity for common struggles that promote compatible policy solutions (Swanson, 2005); social work has a long-standing expertise in identifying and sustaining dialogue across difference. This expertise can be paired with social media technology to raise awareness of key social issues (i.e., the grand challenges), build dialogue, shape public opinion through that dialogue, and build support for proposed solutions.

Indeed, the social work field is well poised to harness personalized politics and online activism in an era in which social media and social movements have had an increasingly direct effect on the forward march of social justice. The field’s current expertise on the individual level, combined with its historical focus on community organizing, denotes its inherent ability to shape public opinion and social change by employing social media.

U.S. Children’s Bureau’s Infant Mortality Campaign, 1912–1930

A compelling, if largely forgotten, historical example of the potential for social work leadership in strategically reframing a critical social issue, developing innovative mechanisms for addressing it, and taking vigorous steps to move it to the forefront of national attention is the U.S. Children’s Bureau’s campaign to reduce infant mortality. Established in 1912 after nearly a decade of intensive lobbying by prominent social reformers—including Lillian Wald, Florence Kelley, Jane Addams, Julia Lathrop, and Grace Abbott—the Children’s Bureau was mandated to “investigate and report … upon all matters pertaining to the welfare of children and child life among all classes of our people” (Abbott, 1923, p. 190). Given this ambitious social agenda, and the reality that issues such as child labor were political minefields, early in the bureau’s development its social work leaders made a strategic decision to focus on infant mortality as a key leverage point in their larger program of child welfare activities.

In the early 1900s, infant mortality, an experience affecting families of all social classes but particularly the poor, was a pressing but largely unaddressed social issue. As a starting point for a small, new, minimally funded, and politically marginal federal agency’s activities, it was a brilliant choice. Not only was the loss of children in infancy and early childhood an issue of great concern to the thousands of women who had advocated for the establishment of the Children’s Bureau, it was not yet the direct responsibility of any other government agency. Moreover, it provided a politically acceptable gateway to a range of critical but significantly more contentious social and economic issues, including child labor, industrial conditions, housing, sanitation, and municipal services (Muncy, 1991; Parker & Carpenter, 1981). As Julia Lathrop (1912), the first head of the bureau, noted at the National Conference of Charities and Correction in 1912, “The questions raised by the unnecessary death of one baby lay hold on all social economy” (p. 31).

To move their infant mortality campaign forward, the women of the Children’s Bureau took a multifaceted approach, taking to national scale the strategies they had developed and tested at the local level in urban settlement houses: coalition building; applied research; public education and outreach; multilevel interventions with individuals, households, and communities; and political advocacy (for a more extensive discussion of these activities, see Kemp, Almgren, Gilchrist, & Eisinger, 2001).

Coalition Building

Consistently, the Children’s Bureau turned to women’s networks and membership institutions—including women’s clubs and associations, statewide leagues of women voters, parent–teacher associations, the Women’s Christian Temperance Union, and a host of other private groups—as vehicles for disseminating knowledge and providing key resources and supports. One of Lathrop’s first actions after her appointment as head of the bureau, for example, was to board a train to San Francisco to attend the biennial convention of the General Federation of Women’s Clubs, where she enlisted members’ support of the bureau’s efforts (Parker & Carpenter, 1981; Skocpol, 1992). The bureau’s outreach strategy was both pragmatic (given the agency’s limited resources) and strategic in its focus on building capacity and political support at the community level and across the nation.

Epidemiological Data as a Basis for Action

At the Children’s Bureau, as they had at Hull House and other settlements, Lathrop and her staff prioritized data gathering and research as a necessary predicate to informed action. Answers to two questions were essential to their infant mortality efforts (Lathrop, 1914). First, they needed to find out how many babies were dying. Second, they needed to learn more about the reasons for these infant deaths.

To better understand the prevalence of infant deaths, Lathrop focused the bureau’s work on a national birth registration campaign, conducted in partnership with women’s clubs and other grassroots women’s organizations. Across the country, women’s clubs took on the daunting task of recording every birth in their home communities. These broad-based volunteer efforts, involving thousands of local women literally going door to door to identify and register children, not only significantly increased birth registrations but also created a new level of public consciousness about the problem of infant mortality. Between 1912 and 1921, the number of states included in the national birth-and-death registration area rose from 8 to 35. The resulting increase in birth registrations provided, in turn, a solid basis for meaningful analyses of the prevalence of infant mortality.

To learn more about the causes of infant deaths, Lathrop and her colleagues conducted a landmark series of community-level epidemiological studies in cities with large immigrant populations. As Paul Kellogg (1920) later noted, “The [surveyors’] method of approach was not from the medical side, but rather from the social and economic, as the infant mortality rate had come to be regarded by leading authorities as a sensitive index of social welfare” (p. 455). The findings of these studies underscored the fundamental relationship between child deaths and poverty: Children born into poor families were twice as likely to die as those born to more affluent families. In consequence, when she presented data from the studies to the American Public Health Association in 1918, Lathrop (1919) argued not for a range of medical interventions but for a “decent income” as “the strongest safeguard against a high infant mortality rate” (p. 274).

Multilevel Intervention and Advocacy

Connecting data to action, the Children’s Bureau staff used the findings from its community studies to advocate for a multilevel approach to the problem of infant mortality: at the federal level, advocacy for a family wage, universal health care for mothers and children, and reform in labor and industrial conditions; at the municipal level, efforts to ensure decent housing, sanitation, and food safety; and at the community, household, and individual levels, education “in the normal hygiene of maternity and infancy … for all girls and women” (Lathrop, 1919, p. 274). A hallmark of these activities was the bureau’s emphasis on education, both at the individual and household levels and as a pathway to broader social and policy change.

A key strategy in the bureau’s broader program of educational and outreach activities was the widespread dissemination of published literature. As Lillian Wald (1930) later noted, “Our Children’s Bureau remains unique in the combination of scientific research and popular publication” (p. 458). Many of these publications were enormously popular, particularly the bureau’s informative pamphlet Infant Care, which became the federal government’s best-selling publication (Condran & Preston, 1994).

The bureau harnessed its well-established partnerships with women’s organizations and networks as a national web for outreach efforts such as the birth registration campaign and as providers of educational activities such as Baby Weeks, Little Mothers classes, and dissemination of the bureau’s publications. During the bureau’s 1918 Children’s Year campaign, for example, some 11 million women nationally either sponsored or participated in a variety of “baby-saving” activities (Ladd-Taylor, 1994).

Paralleling and deeply informed by these research and interventive efforts was the bureau’s active program of legislative advocacy, culminating in the Sheppard-Towner Act of 1921, which emphasized child and maternal health. When President Warren Harding signed the act into law in November 1921, it represented a victory for Julia Lathrop and the social workers of the bureau, one in many ways attributable to the power of the bureau’s broad-based political coalitions and the value of multilevel empirical data in reframing social problems and mobilizing action. The leaders of the Children’s Bureau worked closely with allies in the women’s suffrage movement to ensure that this legislation was the top priority for newly enfranchised female voters. Lathrop also made judicious use of findings from the Children’s Bureau’s infant mortality studies in crafting and vigorously testifying before congress in support of the Sheppard-Towner legislation (Ladd-Taylor, 1992).

Impact and Implications

Between 1910 and 1930, infant deaths in the United States dropped from 122 per 1,000 births to 66 per 1,000 (Almgren, Kemp, & Eisinger, 2000). The bureau’s infant mortality campaign not only contributed significantly to reducing infant mortality rates but also shifted prevailing intervention paradigms (Almgren et al., 2000). In contrast to earlier understandings, which framed infant deaths as primarily a medical problem requiring health-related interventions, the bureau focused on the social and structural causes of adverse maternal and child health outcomes and emphasized a holistic, prevention-oriented approach targeting multiple interacting causative factors.

Several elements of the Children’s Bureau’s campaign align with the approach to scaling up social work interventions we advocate in this article. These include:

a strategic focus on a socially relevant, nationally important (nontrivial) issue affecting multiple constituencies but particularly those most socially and economically vulnerable;

the reframing of that issue in social, economic, personal, and household terms;

active outreach to and involvement of multiple, diverse constituencies as partners and champions, especially the bureau’s novel use of women’s networks, both local and national;

consistent investments in research and research dissemination as the basis for advocacy and action; and

a deliberately multilevel approach, from maternal education and household-level interventions to local, state, and national political advocacy.

Conclusion

We have argued that to effectively bring social work practice and research knowledge to bear on some of the most vexing social problems, social work must reorient itself to scale up social problems. To accomplish this, we have suggested three concrete strategies that combine a critical economic lens and engagement with diverse publics to scale up social problems and their solutions:

Integrating social work knowledge across the profession’s three major research and practice domains (micro, mezzo, and macro).

Increasing the amount of policy analysis and process theory in social work education and research.

Increasing the visibility of social work problem definitions and solutions in the public arena through public scholarship, social marketing, social media, and political advocacy and organizing.

We have also argued that the individual-level focus prevailing in social work research and practice for the last several decades is by itself insufficient to effectively scale up social problems and their solutions as the Grand Challenges Initiative requires. To illustrate our proposed shift to a holistic, information integrative micro–mezzo–macro approach, we turned to an historical example: the U.S. Children’s Bureau’s infant mortality campaign.

The Grand Challenges Initiative offers social work an invitation to focus our collective attention on the opportunities and demands that these challenges present. Social work has built a strong base of research evidence and research-informed practice at the individual and interpersonal levels. As signaled by the Grand Challenges Initiative, the profession is also primed for broader societal impact. To successfully realize that ambition, we suggest, social workers need a much firmer grasp, theoretically, empirically, and practically, on the vital role of economics and policy making in American society, endeavors that are “critical for reforming economic and social policies to build a more just and sustainable welfare state” (Meyers, 2014, p. 742). Achieving the goals embedded in the Grand Challenges Initiative will also require both active efforts to move beyond false distinctions among micro, mezzo, and macro levels of analysis and practice and deeper inquiries regarding actual and possible avenues of action that the social work field might take to produce social change (Cloward & Piven, 1977).

In sum, social work must remember that the case and cause are inseparable and mutually informing. The person-in-environment framework is not merely a heuristic tool; it is the premise from which social work practice and research begins. Individuals are not separate from their environment; environments act on individuals and individuals construct environments. Intervention at the individual level is only sustainable when there is simultaneous intervention at the mezzo and macro levels. Solving society’s most pressing challenges will therefore require that we move beyond our intradisciplinary silos, build robust connections across all levels of our research and practice efforts, effectively engage diverse publics, and actively pursue social change on the national stage.

Footnotes

Authors’ Note

Portions of this article were presented at the Islandwood Conference on Social Work Innovation, July 21–23, 2015.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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