Perceived self-efficacy - the belief that one can perform a novel or challenging task or achieve a desired goal - is a well-documented driver of motivation and health behavior change. It is also an important ingredient of effective and competent Social Work practice. Understanding factors that contribute to self-efficacy is critical to retaining MSWs in the workforce and cultivating leaders in the field, since high self-efficacy is associated with lower risk for burnout, greater job satisfaction, persistence, and coping with challenges. However, few studies have examined characteristics of field placements as potential facilitators or barriers to the development of self-efficacy in students. In this study we examined the influences of exposure to quantity of patient encounters and services provided during field placements on self-efficacy among MSW interns using weekly assessments.
Participants were MSW students enrolled in Cohort 1 of BHWELL, a 4-year HRSA-funded training program in Integrated Behavioral Health and Healthcare, including specialized coursework and 2-semester field placements throughout Illinois. Half the participants were from rural background and 75% knew economic disadvantage; all were women, including two persons of color. Cohort 1 (n = 15) completed weekly Friday Feedback (FF) questionnaires during field (n = 275 observations), and pre and post field placement surveys. The FF questions (13 items) included items such as the numbers of patients seen that week, perceived effectiveness with patients, and services provided. Surveys included three self-report subscales of the Healthcare Social Work Self-Efficacy scale: teamwork (14-item), documentation (10-item), and clinical skills (13-item; range 0% to 100% confidence to perform task).
Over a 2-semester experience, 15 interns reported working with 2,316 patients (149 patients/intern), and they documented how their services made a difference for 70% of their patients each week on average. They reported a total of 541 ways in which their work made a difference for patients the previous week including improved access to care (57% of observations) and improved patient experience of care (57%), improved linkages to community resources (51%), family engagement (42%), and improved team-based care (37%). Interns reported observing 159 DSM-5 conditions that impacted patient’s physical health the prior week, and their responses included discussing it with the team (66%), supervisor (62%), or patient/family (54%); providing a brief intervention (34%) or tailored resources to patient/family (37%), and referral to additional services (41%). Students’ scores on self-efficacy related to teamwork, documentation, and clinical skills all increased from pre to post field experience. Gains in self-efficacy were not associated with quantity of patients seen, services provided, or diversity of DSM-5 conditions addressed.
MSW interns reported gains in self-efficacy from pre to post field placement regarding working with teams, documentation, and their skills from pre to post field survey. Findings suggest that contributors other than quantity of patients seen or services provided may contribute to growth in self-efficacy. Further work is needed and underway to identify changes over time in self-efficacy and additional factors in the curriculum or field placement that may facilitate growth in self-efficacy.