For Social Work to Work, People Need to Know They Belong (Op-Ed)

Alex Roth-Kahn, managing director of the Caring Commission, UJA-Federation of New York, contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

Most people, regardless of where they are in life, need a sense of belonging and purpose. 

In fact, there is empirical evidence that the need to belong is a fundamental human motivation. Belonging is a psychological lever that has broad consequences for people's interests, motivation, health and happiness, suggests Gregory Walton, a psychologist at Stanford University in California who has published a series of studies on the subject. Without that feeling, he says, people are less resilient in the face of life's obstacles. 

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In social work, it's just as important to help vulnerable clients build meaningful relationships and increase their sense of community as it is to deliver direct services, like food and shelter. When social service agencies fill basic needs for the impoverished, unemployed or lonely, progress is usually measured in meals served, people sheltered or jobs placed. However, are these services enough to enhance recipients' quality of life and perception of self? 

A hierarchy of needs

For decades, schools of social work have taught Maslow's hierarchy of needs. This theory, developed in the 1940s by American humanist-psychologist Abraham Maslow, places human needs in five different tiers, arranged in a pyramid: The base tier (1) is physiological well-being (including the needs to eat, drink and sleep), followed by the needs for (2) safety, (3) belonging and love, (4) self-esteem, and finally, at the peak of the pyramid, (5) self-actualization. 

Maslow also suggested that only after successfully mastering one tier and level of fulfillment can a person move on to the next. 

However, even when people are experiencing challenges, such as severe poverty, they are still capable of many of the "higher-order needs" in Maslow's hierarchy, such as love and belonging — despite not being able to meet basic needs, such as food and shelter. 

Human experience demonstrates that Maslow's tiers are fluid, not fixed, and that all levels of the pyramid are attainable and equally essential.

Life is more complex than a pyramid 

As a social worker, I've come to realize that Maslow's hierarchy vastly oversimplifies human needs, and poses troubling challenges. Perhaps paradoxically, the theory also exposes many potential flaws in today's social service system, in which agencies focus on just one element of a client's problem instead of taking a holistic approach. 

For example, in order to really make a difference in the life of a homeless single mother, you need to look beyond just providing a home. A social services provider must also consider employment, childcare, counseling, a support system and financial assistance — in addition to housing. 

Like Maslow's hierarchy, the welfare system in the United States mainly stresses units of service, goods provided and activities offered. Too rarely do welfare providers consider other intangible, human resources such as companionship and belonging, sense of autonomy and self-esteem, and spiritual well-being. 

Most social services do not adequately provide for quality-of-life improvements, such as social companionship, mental stability, freedom from depression, personal motivation and spirituality. Meanwhile, traditional welfare systems provide clients with services based on physical and cognitive abilities, social and economic status, and a set of criteria — a diagnosis and a label. 

A truly holistic approach, however, sees each person as an individual, empowers each person to develop a vision for him or herself, and provides each person with the tools needed to help that individual move forward in life and become more than the label society has assigned.

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From services to spirit

From our point of view, effective care means taking a more holistic approach, one that blends social connectedness with spirituality to care for vulnerable populations. 

These programs value respect for personal dignity, autonomy and access to the general community, putting as much weight on these needs as on Maslow's first-tier needs, such as number of people served, meals eaten, and transportation and housing provided.

This approach is far more effective because it helps people become a part of a community. When people feel they are connected and not alone, research shows they have a greater sense of well-being and are better able to weather negative life events.

What does this look like in practice? One current example is the Hoarding Initiative, an effort funded by UJA-Federation of New York and executed by the Educational Alliance's Project Ore in partnership with Mount Sinai Beth Israel. This initiative delivers comprehensive and critical mental-health support to older adults who are poor, mentally ill, socially isolated and hoarding. 

A notoriously difficult mental illness to treat, hoarding increases in severity with age. It also exacerbates social isolation; poses health and safety risks from falls and fires; creates hazards due to poor sanitation, hygiene, nutrition and medical mismanagement; and places people at risk for eviction and homelessness.

The initiative's holistic approach to treatment starts at the moment a social worker identifies someone with hoarding disorder; at that point, the person is immediately referred to a psychiatrist for evaluation. Once the individual is properly diagnosed as a hoarder, the initiative offers cognitive behavior therapy, proven to be the disorder's most effective treatment. 

Since many clients are in crisis when city agencies refer them to the Hoarding Initiative, the program provides free legal, financial, social and emotional support, as well as access to social and recreational activities. To lessen social isolation, volunteers meet with individuals in a community setting, serve meals and interact in meaningful ways. The approach reaches across Maslow's hierarchy to meet immediate needs while simultaneously recognizing and treating the human need for connection  and self-esteem.

Spiritual care also plays a role in holistic human-service delivery. Chaplains from UJA-Federation counsel individuals struggling with mental illness, homelessness and job loss, teaching critical coping skills while affirming that every human being can be in considerable, if not complete, control of his or her own destiny. We respect the yearning for self-actualization, the peak of Maslow's pyramid, even as people cope with excruciating challenges and their own mortality. 

Spirituality does not have to be connected to a specific religion. Rather, it is a path to help people find meaning and purpose in their lives.According to Kenneth Pargament, editor in chief of the American Psychological Association's "Handbook of Psychology, Religion and Spirituality" (APA, 2013) religion and spirituality generally help people cope, especially those individuals who have the fewest resources and face the most uncontrollable problems.

The Jewish Communal Fund's Single Parent Network was created based on research showing a prevalence of single parents living in poverty in the New York area. The program operates out of several YMCAs and Jewish Community Centers to help move poor and near-poor single-parent families toward self-sufficiency. 

The initiative provides personalized access to safety nets, employment and other critical services while creating a safe and social environment for single-parent families to connect. 

Philanthropy is much more than finance

We believe that effective philanthropy must be driven by values that are inclusive of all types of individuals and communities, so social services must evolve from human-service-oriented providers to community builders. 

And what better way to build community than to harness the power of those who want to help? The holistic-care paradigm requires building a team that supports holistic care, combining service delivery with companionship. As such, we believe volunteerism is crucial to the fabric of the care structure. 

In addition to line workers delivering excellent care, we are creating a volunteer network to augment social work care and help build community for our clients. In practice, these volunteers are deployed across service programs, including helping low-income, émigré college students network and prepare for interviews; visiting with the elderly in their homes to share meals and stories; or helping individuals with terminal diagnoses and other conditions to navigate the healthcare system. Volunteers strategize to ensure that clients are seen as people who are vital to the general community, in need of friends and personally meaningful activities. 

To foster engagement among volunteers, the Engage Program harnesses the energy, talents and enthusiasm of baby boomers. Slated to retire at the rate of about 8,000 a day for the next 15 years, many baby boomers are looking for meaning and purpose during the next phases of their lives. The program is directed and sustained by its volunteers, who have the autonomy to create and implement programs, and the flexibility necessary for retirees who have many interests and obligations. 

At the JCC of Manhattan, volunteer job coaches help developmentally disabled adults deal with challenges they face at work. At TechSoup, another JCC program, volunteers help seniors learn to use smart phones that are mostly gifts from the seniors' children. Another group of volunteers hosts a weekly lunch and movie for seniors on Manhattan's Lower East Side. These programs enlist volunteers for the long haul, so they form connections and relationships with the people they help. 

Social workers need to develop more standardized tools to quantify the personal, social and psychologically meaningful personal client experiences associated with this type of community approach. To do so, we must develop a better system of measurement to track successes and challenges, and allocate resources accordingly. 

If society is to meet the challenges of unprecedented social crises — including increased longevity leading to more social isolation, populations struggling financially, and increased poverty combined with mental illness — we must be prepared to find more effective and holistic ways of delivering human services, building community and integrating strategies. 

Schools of social work are now changing their curriculums. Fifteen years from now, the way organizations prioritize and the programs that the government funds will look very different. The result will be services geared to a deeper appreciation for the multifaceted and interconnected needs of clients.

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google+. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.