Exploring Religion and Spirituality in Social Work Practice: A Wisconsin Case Study

Abstract

Research suggests spirituality is linked to positive health outcomes, but social workers report barriers to incorporating it into care planning. The literature suggests general interest in learning and executing social work practice involving religion/spirituality (R/S) intentionally. While some empirical study has been conducted, this work is largely superficial and undeveloped. Finally, a changing R/S landscape in the United States further establishes the need for deeper, more nuanced examination. This article explores the actual role that R/S have in social practice and who supports these practices. Wisconsin social workers were surveyed (n = 578) using the Religious/Spiritual Integrated Practice Assessment Scale and other items of original design. Results confirm interest among social workers to include R/S in practice, but formal training is lacking. The data reveal a profile of practitioners who incorporate R/S, correlated with religiosity, religious conservativism, age, and race. Implications include enhancing mentorship, internships, and education to increase efficacy in utilizing R/S in the field.

This study examines the way religion and spirituality (R/S) are utilized in social work practice and the nuances of who in the profession are doing so. Holders of social work credentials through the Wisconsin Department of Safety and Professional Services were invited to participate in an anonymous online survey. The Religious/Spiritually Integrated Practice Assessment (R/SIPAS) was included in the survey instrument, along with demographic questions, measures of religiosity, and measures of social work experience.

Results from this study note significant relationships between social demographics and years of practice experience, advanced licensure, area of specialty, and type of employment. The roles that religious conservativism and religious intolerance play are also noteworthy. These results help identify barriers to the integration of R/S by social workers in healthcare, clinical, and other settings and provide implications for practice, such as increased professional development, ethics training, structured mentorship programs, and the formation of partnerships between social work programs and faith-based organizations in field education.

Background

There is general international consensus that R/S can serve as important resources in social work practice and in assessing client needs (Askeland & Dohlie, 2015; Crisp, 2013). Furthermore, there is a historical precedent that R/S have positively served in the social work profession (Seinfeld, 2012). For instance, spirituality is generally recognized as an important aspect of end-of-life and palliative care. The literature further indicates that when client/patient R/S are incorporated in healthcare planning, there is evidence of positive outcomes, such as decreases in anxiousness, depression, and other types of emotional distress (Stieber & Hatala, 2018). However, spiritual care has been inconsistent across a range of healthcare settings due to a lack of resources, training, and practical tools (Puchalski & Ferrell, 2010). Some insights into the practical ways that R/S can be embedded in social work practice, education, and training have been mentioned (Chigangaidze, 2021; Streets, 2009), but this literature is underdeveloped.

A key development in the study of R/S within social work practice is the R/SIPAS (Oxhandler & Parrish, 2016). This instrument has served as a reliable empirical tool for measuring the interest, efficacy, and proficiency of using R/S in social work practice. Studies show high levels of self-efficacy and positive attitudes toward using R/S in social work practice but low levels of actual engagement (Oxhandler & Ellor, 2017) and note the lack of appropriate training and education as a particular hindrance (Oxhandler & Giardina, 2017). Further research reveals potential fear from practitioners of being viewed as “proselytizing” and a general lack of ethical and practical training (Oxhandler & Giardina, 2017).

Generally, the literature presents a picture of overall interest in learning and executing social work practice involving R/S intentionally (Furness & Gilligan, 2014; Oxhandler et al., 2015). However, there is reason to suspect that more nuance exists. For instance, Larsen (2011) finds significant variation in attitudes toward the role of R/S across age. Hodge (2015) emphasized the importance of client-centered definitions, or “common views,” of R/S to better equip practitioners. Indeed, the effect that demographics and other background characteristics may have on attitudes and implementation of R/S in social work care requires deeper examination.

Study Objective

The purpose of this study is exploratory: to further examine the demographic, sociopolitical, and professional profiles of practicing social workers regarding their attitude toward and use of R/S in client care. While some work has established an interest and initial importance in the way R/S can be embedded in effective social work practice, this is largely superficial. This study will contribute by presenting a deeper understanding of the nuance in social workers actively using R/S in practice.

The changing demographics of worker and client populations, particularly regarding the shifting religious landscape, is an important consideration for this study. As new research suggests (Scheitle et al., 2018), the proportion of Americans who identify with institutionalized religious organizations is waning, and there is a dramatic increase in noninstitutionalized affiliations. The so-called religious “nones” include individuals who identify as agnostic, atheist, or religious and spiritual with varying degrees of belief but who do not necessarily affiliate with institutionalized religious organizations. Data collected from the General Social Survey illustrate these trends (see Figure 1). The eastern north central region of the United States, which includes Wisconsin, mirror national patterns for changes in both formal religious identity and frequency of attendance. However, the proportion of individuals who identify as a spiritual person has not changed. Indeed, the reality that much of the literature posits around an increasingly unchurched but still spiritual populace is evident and, considering the implications for social work practice and training, an important characteristic to consider for this article.

Method

Data were collected via a statewide online anonymous survey sent to all Wisconsin state certified and licensed social workers (N = 3,836). Practitioners were identified and invited through the Wisconsin Department of Safety and Professional Services. A total of 578 social workers completed the survey.

Statistical Analysis

To explore the profile of social work practitioners who utilize R/S in client care, data were analyzed using SPSS (Version 28). Data analyses were preformed using descriptive statistics, bivariate correlation tests to determine association between variables, and factor analysis (principal component) to examine multicollinearity between items measuring religious conservativism and items on the R/SIPAS.

Measures

Independent Variables

To obtain a comprehensive profile, basic demographics were included (age, gender, race, political orientation) as well as measures of religiosity and social work experience. Measures of religiosity include affiliation, behavior (frequency of church attendance), strength, as well as religious conservativism (Biblical literalism) and religious tolerance (equal treatment of religious groups in the United States). Social work experience was measured with years of practice, licensure type, and specialty area.

Some initial takeaways from the demographic breakdown of participants show a general spread across age and years of social work practice (see Table 1). Demographics skew heavily toward a female, White, and liberal profile. For religiosity, the data present a higher proportion of participants as Protestant or Catholic, a fifth for each, but a similar proportion for “other” as well. Finally, a spread exists for frequency of religious attendance and strength of religious identity, all of which depicts an appropriate window into contemporary self-described religious identity today (Scheitle et al., 2018).

Dependent Variables

The study objective was to explore a deeper profile of social work practitioners who utilize R/S in their practice. The dependent variable was R/SIPAS, a survey tool developed to measure attitudes toward implementing R/S in social work practice. Development, implementation, and reliability of the R/SIPAS is well documented (Oxhandler & Ellor, 2017; Oxhandler & Parrish, 2016; Oxhandler et al., 2015). Specifically, the R/SIPAS indexes self-efficacy and attitudes about, feasibility for, and how often R/S was incorporated in social work practice. The items from the R/SIPAS load to four thematic sections. All four scales are positively correlated (medium to high) with one another—see Table 2. While this parallels what earlier research suggests, we provide further insight into the nuances of these attitudes and the profiles that are more likely to espouse them.

Results

Clearly the role and importance of R/S in social work practice is noteworthy for many practitioners as depicted in the initial results. Once demographics are also considered, a richer picture is presented—see Table 3. In a finding familiar from the sociology of religion literature, female respondents were more likely to show positive attitudes about religious/spiritually integrated practice than male respondents. White social workers were also more likely to present interest and positive attitudes. Political orientation was not significantly correlated, but examination into the intersectional quality politics has with religion shows different findings.

Further investigation into the type of social work experience, area specialty, and place of employment provides additional insight (see Table 4). Results indicate a positive, moderate relationship between variables, suggesting that the more advanced social work licensure, the more agreement toward R/SIPAS items. Furthermore, older and more seasoned social workers show higher likelihood across most areas. In terms of social work specialty, R/SIPAS measures suggest interconnected results, meaning most of the items are significantly correlated with the specialty area or not at all. Of particular note, mental health, clinical/direct care, hospice care, and addiction specialties demonstrate positive correlations with self-efficacy and frequency of R/S reference. These findings run parallel to an established literature presenting varied relationships between R/S and health, well-being, and end-of-life care (Green & Elliot, 2010; Schefold et al., 2023) and encouragement to establish these connections even more directly (Okamura et al., 2018). Specialty areas with youth, such as schools, child welfare, and youth justice, are negatively correlated with R/SIPAS items. These specialty areas tend to be high crisis and emergency settings, focusing on whether basic safety needs are met, and may not be conducive to valuative conversations on R/S.

Finally, the type of organization where a social worker is employed appears to matter as well. Government agencies and K–12 schools are either not significant or present negative correlations with R/SIPAS items. For-profit and private institutions show positive correlations and, curiously, faith-based organizations were not significant. For-profits and private agencies may have different and/or less direct policies and cultural norms pertaining to the use of R/S in practice, which may help explain the positive correlations. The fact that faith-based organizations did not show significant associations with any of the R/SIPAS measures might suggest that the reference to R/S is so ingrained in everyday colloquy that isolating such content is not done. This is a phenomenon observed in other settings as well, where religion is conflated in other identify formations such as politics and national identity (Barry, 2019). Attention to these potentialities is examined further.

Given the nature of R/S integrated practice, the role of religiosity and spirituality of the practitioner may also be significant. Specifically, we find that dispositions of religious tolerance and conservativism are critical (see Table 5). Social workers that are affiliated with Christianity, attend church regularly, and were self-described as religiously strong were more likely to have positive attitudes about embedding R/S in practice. Additionally, religious conservativism and religious intolerance correlated with more positive attitudes. While politics was not a significant marker of R/SIPAS measures, it does matter when tied to religion (i.e., religious conservatism). In other words, politics work as a proxy for religiosity, melding the two together. These results extend a preliminary profile of practitioners who support R/S integrated practice as religious, specifically Christian, and who wed political conservativism and religious intolerance. The potentiality of conflating religion, politics, and social work practice presents a significant concern as further insight into the religious demographics of practitioners deepens.

Discussion

R/S do indeed matter in social work practice, as detailed in a growing literature and as evidenced in the empirical results of this study. The implications of positive rhetoric around including R/S in social practice is heightened given the growing body of work establishing positive correlations between R/S and health and well-being. While the results from this study confirm the R/SIPAS as a useful empirical instrument to understand the interest, attitude, knowledge, and implementation of R/S in social work practice, further insight into the idiosyncrasies of R/S profiles of practitioners should be considered. Moreover, the changing national religious landscape requires additional attention.

Indeed, exploring deeper into the social and religious profile of individuals who are more likely to espouse interest and positive attitudes toward embedding R/S is telling. A particular, and particularly narrow, background emerges. Practitioners who identify as Christian, with strong institutional attachment, and who hold religious conservative dispositions and indicate less religious tolerance are more likely to hold positive attitudes about including R/S in social work practice. This religious profile, as the literature indicates, is suggestive of higher rates of proselytizing, nativism/populism, anti-intellectualism (Glass, 2019), and a general support of dubious religiopolitical behavior in healthcare, such as gay conversion therapy (Tenorio de Souza et al., 2022). Furthermore, the literature notes that religious conservatives are far more likely to support (more) religion in public life, including politics and general social morals (Silver, 2020). In other words, the practitioners who appear to be the most vocally supportive of including R/S in social work practice are more likely to push biased religious doctrine and to be skeptical of data-informed care and supportive of increasing such dispositions and regulations in society—while providing care to the most marginalized and vulnerable.

However, a note on age and changing demographics may offer some suggestive insight into future trends. In short, younger practitioners are more likely to identify as religious “nones” and not attend religious services (see Table 6). This aligns with the changing religious landscape noted earlier. We also know from previous literature that R/S-related content is not easy to discuss in social work practice, regardless of the perceived importance from practitioners. Fear of extending personal bias and low confidence in ethical training on the subject are common points of hesitation (Oxhandler & Giardina, 2017). The results from this study concur, indicating that younger practitioners are less satisfied with R/S training.

The consequences of this are significant and have impact on how care takes place, where and how discussion on the role of religion is facilitated, and the way that education and training programs are developed. If, for instance, a brand of R/S content espoused by the most vocal group is privileged, a potential for violation of National Association of Social Workers’ (NASW; 2021) Code of Ethics is eminent. However, if considerations into the changing religious landscape and demographics within the social work industry itself are made, opportunities for authentic implementation and use of R/S may prove more successful. Further discussion in the next section explores the impact on social work education, training, and what can be done to address these concerns.

Further Implications

Potential implications for practice should include increased R/S topic-specific ethics and workshops, course offerings within BSW and MSW programs, professional development opportunities, formalized mentorship, and expanded field internship opportunities.

Ethics Training

The NASW (2021)Code of Ethics encourages social workers to demonstrate an understanding of culture and provide services in a culturally sensitive way that respects diversity, including R/S (Section 1.05, Cultural Competence). The deliberate recruitment of workshop facilitators who can prepare social workers to incorporate clients’ R/S from an evidence-based practice perspective will increase ethical practice. Effective ethics workshops could also provide clear guidance in the ways to prevent evangelizing and avoid bias in working with clients.

Social Work Education Course Offerings and Professional Development

Recent research on MSW program course offerings revealed gaps related to R/S in professional practice within implicit and explicit curriculum (Oxhandler et al., 2023). The Spiritual and Religious Competencies Project (n.d.) aims to strengthen education in R/S competency through the development of standards and course materials that can be incorporated into already existing clinical courses. This initiative will be an important way to standardize curricula on R/S traditions to ultimately improve practice. Currently, there are 32 accredited MSW programs that offer dual graduate degrees in theology and divinity and social work (Council on Social Work Education, 2023). Making this curriculum accessible more broadly to practicing social workers would also increase practice tools and skill development among the larger body of practicing workers. Agency and organizational investment in providing spiritual assessment models and other tools will help workers develop effective treatment approaches from a R/S-informed perspective.

Formalized Mentorship

Our findings indicate that older and more seasoned social workers were more likely to incorporate R/S into the therapeutic treatment process with clients. Utilizing the practice wisdom of the more seasoned workers, organizations could formalize peer mentorship programs among seasoned and newer workers to increase support, guidance, and knowledge transfer. Further, mentorship opportunities may be an important way for newer workers to self-assess how their own religiosity could enhance or hinder the helping relationship. However, mentorship programs would need to be regularly evaluated through ethical decision-making models to ensure adherence to the NASW (2021)Code of Ethics and to avoid value conflicts.

Field Education

Our study revealed that social workers in mental health, clinical/direct care, hospice, and addiction settings expressed positive correlations with self-efficacy and frequency of R/S reference. Increased partnerships between universities and these settings and among practitioners that utilize faith-based approaches would be an effective way to increase skill development in the use of R/S in treatment planning. Additionally, social work programs and field sites could work collaboratively on providing students with evidence-based R/S assessment and evaluation tools as further guidance.

Conclusion

In short, we know from a long-established literature that R/S can positively impact health and wellness outcomes. We also know that the way R/S are understood, identified, and lived is extremely nuanced and dynamic. For instance, recent U.S. trends suggest significant increase in noninstitutional but still spiritual affiliations. At face value there is an understanding among social work practitioners that R/S have a purpose and should be included in client care. However, those most supportive and engaging in implementing R/S hold worldviews (i.e., religious conservativism and intolerance) that pose potential ethical risks. Yet, our research also identified that those newest to the profession acknowledge the current ineffectiveness of appropriate training and education related to implementing R/S in social work practice. Therefore, considering the further implications that we have outlined, the profession is at a crossroads for making change in how R/S can be used professionally or perpetuating the status quo.

This study examined the role that R/S has in social practice and the types of practitioners that utilize it. Wisconsin social workers were surveyed (N = 578) using the R/SIPAS and other items measuring social, political, and religious dispositions. Results reveal that older, White, female, Christian social workers are most likely to support R/S in their practice. Furthermore, advanced credential holders and social workers who work in clinical, substance use, and end-of-life care are also more likely to utilize R/S. Finally, support for R/S in practice was correlated with religious conservativism and religious intolerance. While these findings suggest an interest to incorporate R/S in social work practice, equitable and diverse R/S-informed education and professional development are urgently needed.

References