Understanding the Landscape of Social Work Impairment Research: A Scoping Review

Background & Purpose: Up to one-third of social workers will experience professional impairment during their careers. The consequences of impaired professionals can adversely impact client outcomes. Despite knowing several precipitating causes contributing to professional impairment, no review has combined these to develop a comprehensive landscape. What remains unclear is who is most vulnerable and why. The scoping review sought to answer: 1) What are the precipitating causes of professional impairment in social workers and other clinical professions? 2) Which theoretical frameworks are used to describe or explain professional impairment within the extracted studies? 3) Within the extracted studies, how is professional impairment measured in mixed method and quantitative studies? 4) Within the extracted studies, how is professional impairment identified in qualitative studies?

Methods: A scoping review sought to identify studies regarding social work and similar counseling professionals. The primary search strategy employed the following search engines to find relevant literature: PsycINFO, Social Work Abstracts, and CINAHL. The following search terms were utilized: (("social work*" OR “mental health counselor” OR “mental health therapist” OR “psychologist” OR “marriage and family therapist”) AND ("impair*" OR “burnout” OR “caregiver burden” OR “wounded healer” OR “professional competence” OR “fitness to practice”)) AND ((“absenteeism” OR “missed appointment” OR “emotional dysregulation” OR “boundary”) AND “(physical health" OR "substance use" OR “mental health” OR "emotional stress" OR "grie*" OR “loss” OR “bereav*” OR “secondary trauma” OR “adverse childhood experiences”)). Inclusion criteria: 1) peer-reviewed; 2) published in English; 3) used qualitative, quantitative, or mixed methodology; 4) qualitative results reported themes pertaining to professional impairment and/or quantitative studies reported statistical associations between precipitating causes and professional impairment, and 5) the study population included social work, mental health therapist, mental health counselor, psychologist, or marriage and family therapists. Studies that did not meet these criteria were excluded. An additional exclusion was a population that was too broad, for example contained physicians and nurses, due to different ethical principles.

Results: After merging similar studies, the review identified 15 studies. The precipitating causes for impairment encompass three domains: early life experiences (ACEs and attachment style); work related (secondary trauma, caseload); and personal stressors (mental health, work environment). Theories varied across studies or were absent. Quantitative measurement of professional impairment utilized varied instruments. Qualitative studies identified impairment as additional themes.

Conclusions & Implications: Professional impairment is a threat to social work practice and despite a call to action from NASW Social Work Speaks, the research remains scarce. Comparing studies is challenging due to the lack of a consistent measurement tool for professional impairment. With no clear consensus theory, I propose the stress process theory provides structure to who and why some social workers and other counseling professionals are at higher risk for professional impairment. This is a first step to identify what is known and have identified individual stress causes such as divorce, caregiving are missing from the review. Future research can address these gaps and formulate a reliable quantitative measurement tool.