14 Social Justice Practice in Human Services: An Individual Approach

The human services profession has always served culturally diverse populations in the United States. Early involvement in social issues demonstrates a commitment to social justice and advocacy to end discrimination, oppression, poverty, and other forms of injustice throughout the country’s history (Sue & Sue, 2016). As human services professionals, we must recognize how individual and historical power and privilege may prevent us from understanding our clients’ experiences and views.

In the human services field, professionals work with clients on various levels. Often, these levels are viewed through a systems lens. Bronfenbrenner’s (1979) systems theory, also known as the ecological systems theory, posits that different environmental systems influence the people we serve in the human services field. This theory identifies five systems that interact to shape individual development: the microsystem (immediate surroundings like family and school), the mesosystem (interactions between microsystems), the exosystem (external environmental settings that indirectly affect the individual), and the macrosystem (broader cultural and societal influences). The chronosystem (the dimension of time encompassing life transitions and historical events) was recently added to the model. Bronfenbrenner’s framework emphasizes the dynamic interplay between these systems and highlights the importance of considering multiple environmental contexts in understanding human growth and development (Bronfenbrenner, 1979).

Understanding the interactions between systems is essential in identifying the roles of power, privilege, and oppression in human services. Once we have identified how power, privilege, and oppression impact clients, we can look toward equitable change in the field. This chapter will focus on the microsystem and examine individual social justice experiences in human services.

Ethics and Social Justice

One of the core foundations of the human services profession is understanding our ethical responsibilities. Ethics is the study of what is right and wrong and how we make decisions when that choice is unclear. Many professions, such as counseling, social work, direct support professionals, and human services, have established ethical codes of conduct to help. The National Organization for Human Services (NOHS) provides an ethical code of conduct for those working in the Human Services field to follow (NOHS, 2024).

NOHS Ethical Code in Practice

The National Organization for Human Services (NOHS) has developed an ethical code of conduct for human services professionals (NOHS, 2024). The Ethical Standards for Human Services Professionals outlines standards for human services work to establish professional boundaries and facilitate healthy, appropriate client relationships.

Multiple NOHS ethical codes apply to social justice in human services. Standard seven states: “Human service professionals ensure that their values or biases are not imposed upon their clients” (NOHS, 2024, para 11). Additionally, the NOHS ethical code calls out the responsibility of human services workers to be self-aware. This includes awareness of how social and political issues may disenfranchise and impact clients. Standard 14 states: “Human service professionals are aware of social and political issues, comprehend their effects on clients, and recognize how the impact of such issues vary among individuals from diverse backgrounds,” (NOHS, 2024, para 18).

As ethical practitioners, human service professionals must examine their values and how they impact client relationships. Most ethical decision-making starts with an examination of values. This foundation for personal and professional choices profoundly impacts client services. All human service professionals have personal and professional values that can affect their work, and recognizing the similarities and differences between personal, professional, and client values is an important skill (Kenyon, 1999). In addition, boundaries are essential in the professional relationship, and if a human services worker does not maintain appropriate professional boundaries with their clients, power differentials become more apparent.

The human service professional has multiple responsibilities to their clients around social justice issues. The NOHS ethical code clearly states that supporting and developing a relationship with a client should be based on social justice principles. It outlines that human services workers must understand cultural norms within the client’s community and integrate them into their practice (Hays & Erford, 2018). Ethical human services workers acknowledge the impact of social justice issues by respecting diversity and difference and ensuring inclusion and accessibility to all. Human services workers make a transparent and open effort to foster equity in all client interactions (NOHS, 2024).

Human service professionals also have a responsibility to their employers. Statements 33 and 34 discuss providing clients with high-quality services. Workload issues are a common problem in human services, and it is unethical to allow excessive workload to result in poor services, particularly since the clients we serve are often marginalized. Additionally, statement 34 states: “When a conflict arises between fulfilling the responsibility to the employer and the responsibility to the client, human service professionals advise both and work conjointly with all involved to manage the conflict” (NOHS, 2024).

Personal Bias in Human Service Practice

Human services professionals are responsible for cultivating inclusivity and must be aware of personal biases and how they impact professional interaction (Hays & Erford, 2018). Biases are ingrained thoughts or feelings stemming from past experiences that significantly influence our actions and decisions. In general, biases are unconscious or implicit, and people are unaware of them. As Ross (2020) articulates in his book Everyday Bias, “If you are human, you are biased” (p. 1). This statement underscores the universality of bias, highlighting that everyone harbors some form of bias regardless of their background. Ross further elaborates that these biases can manifest in various ways, both constructive and detrimental. He explains that positive biases can sometimes lead to favorable outcomes, while negative biases can result in harmful consequences. Thus, the impact of bias is multifaceted, influencing our personal and professional perceptions and interactions in various ways (Ross, 2020). Understanding this dual nature of biases is crucial for fostering greater self-awareness and promoting fairer, more equitable services in the human services field.

Assessment and Social Justice

One of the tasks of human services is to administer standardized assessments and screening tools. Examples of screening tools used in human services include the PHQ-9 for depression, the GAD-7 for anxiety, the ACES questionnaire to look at childhood trauma, the CAGE questionnaire to identify drug and alcohol use, and the Mini-Mental Status Exam, which looks at cognitive functioning in adults. These screening tools help human services professionals in various fields, such as social work, counseling, healthcare, and education, to identify potential issues, assess client needs, and guide appropriate interventions and treatment plans. Screenings in human services are selected based on the population being served and should be informed by evidence-based best practices. Screening and assessment play a crucial role in developing personalized treatment plans and ensuring that individuals receive the support and services required to improve their quality of life (Mulvaney-Day. et al, 2017).

Assessment and screening tools often contain significant biases. Social justice issues arise not only from the personal bias of human service professionals in interpreting answers but also from bias in the screening tools themselves. Some contextual factors that have the potential to cause bias in a screening or assessment tool include racialized identity and ethnicity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and a client’s age (Bridgwater, 2023).

Reynolds and Suzuki (2012) identify seven specific categories when it comes to potential consequences of bias in screening tools:

1. Inappropriate content. Tests are geared to majority experiences and values or are scored arbitrarily according to majority values. Correct responses or solution methods depend on material that is unfamiliar to minority individuals.
2. Inappropriate standardization samples. Minorities’ representation in norming samples is proportionate but insufficient to allow them any influence over test development.
3. Examiners’ and language bias. White examiners who speak standard English intimidate minority examinees and communicate inaccurately with them, spuriously lowering their test scores.
4. Inequitable social consequences. Ethnic minority individuals, already disadvantaged because of stereotyping and past discrimination, are denied employment or relegated to dead-end educational tracks. Labeling effects are another example of invalidity of this type.
5. Measurement of different constructs. Tests largely based on majority culture are measuring different characteristics altogether for members of minority groups, rendering them invalid for these groups.
6. Differential predictive validity. Standardized tests accurately predict many outcomes for majority group members, but they do not predict any relevant behavior for their minority counterparts. In addition, the criteria that tests are designed to predict, such as achievement in White, middle-class schools, may themselves be biased against minority examinees.
7. Qualitatively distinct aptitude and personality. This position seems to suggest that minority and majority ethnic groups possess characteristics of different types, so that test development must begin with different definitions for majority and minority groups. (Reynolds & Suzuki, 2012, p. 87)

Some contextual factors which have potential to cause bias in a screening or assessment tool include racialized identity and ethnicity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and a clients age (Bridgwater, 2023).

Human service professionals can take a variety of steps to mitigate the harmful consequences of bias in screening tools. These steps include utilizing updated and culturally sensitive and inclusive assessments, incorporating feedback from clients on assessments into best practice, and regularly reviewing screening tools to ensure they continue to meet best practice in the field. One of the most important steps is to facilitate the use of screening tools through an interactive dialogue with the client (McClintock et al., 2021). In this, the human services professional asks the questions and discusses the answers given, versus just writing down the answers or leaving the client in a room to fill out a form. By treating assessment as a conversation, the human service professional offers the client the opportunity to explain their answers. This allows the client to incorporate their cultural differences into their explanations.

Another important step in addressing bias in screening tools and assessments is training. Staff training is essential prior to using any screening tools. Training should include discussions about cultural bias in assessment, including the specific tool being implemented (McClintock et al., 2021). This approach allows professionals to consider these issues before using the screening tool.

Bias in Assessment and Documentation

Completing an intake assessment, also known as a biopsychosocial assessment, is often one of the first tasks in setting up services. This intake assessment forms the basis for developing, implementing, and evaluating a client’s goals and progress. The human services professional collects information relevant to the client’s background and needs during intake. Biases can impact the client’s intake experience. For example, if a human service professional assumes an answer to a question and skips it, the client information in their chart or file may be incomplete. This may occur because of personal biases and preconceived notions and will result in an inaccurate assessment.

To promote equity and inclusivity, human services professionals must ensure that they provide clients with an environment conducive to genuine responses. Often, biases are evident in both the questions asked of a client and those that are not. Examples of this include not asking about military service if the client is female, assuming someone’s sexuality when they have stated they are married, or not asking a young student whether they have used substances or are sexually active. Additionally, documentation is a vital component for both the client and the agency, and often, reimbursement for services and accountability for the organization depends on appropriate documentation.

Charting

Human services professionals are responsible for recording client’s employment, family, medical, social, socioeconomic, and mental health information. Documentation should be balanced, nonjudgmental, and objective. A chart should always be current and contain reliable information so that any agency professional can read and understand it (Silvestre et al., 2017). The chart should also explain why the client sees the human service professional. Case notes should be written about every interaction between the professional and the client. Strong case notes allow other human services professionals to read about the client’s process thus far (Summers, 2016). The client’s chart should not contain personal feelings about the client or any judgmental comments.

Client Biases

It is important to recognize that clients also harbor unconscious biases that may affect their perceptions of us as professionals. Clients often feel anxious or uneasy about sharing their medical, mental health, employment, social, or familial information with providers (Summers, 2016), and this may be in part due to their assumptions and biases about both the individual they are working with or the human services field in general. It is the responsibility of the human services worker to identify when a client seems uncomfortable and work to establish rapport. It is also important to remember that sharing personal information and details about one’s life can be a complicated process for many. This could be for personal, professional, or cultural reasons. In addition, many clients are in new and vulnerable situations. Even when clients feel a strong rapport with an individual human services worker, they may have negative biases around the systems they are navigating. These can develop from past negative events, things they have heard in the community, and/or biases they hold around what kind of people receive or are entitled to help when they are struggling. At times, these biases can present as hostility or frustration, making building rapport difficult. It is our responsibility to be aware of this and mitigate it professionally and within the bounds of our employment agency’s parameters.

Equitable Distribution of Services

Triage, derived from the French verb “trier” meaning “to sort” (Christian, 2019), plays a crucial role not only in emergency room settings but also in human services agencies. Triage guides the prioritization of client services, starting during intake or initial assessments and continuing throughout the client’s service journey. Triage often follows policies established by funding sources, legislation, and human services agencies. As human services agencies are often underfunded, triage allocates limited resources efficiently and ensures timely access to care. However, concerns related to social justice arise as the triage process can inadvertently perpetuate systemic inequalities, affecting marginalized communities who may face barriers to accessing timely and appropriate services. These disparities highlight the importance of implementing equitable triage protocols prioritizing fairness, inclusivity, and respect for diverse client needs and circumstances (Christian, 2019).

The human service field also faces challenges related to wait times. From mental health visits to emergency departments, Black Americans experience the longest waiting times and are less likely to be transferred to another facility compared to White Americans (Macias-Konstantopoulos, 2023). Wait times are often influenced by over-triaging. This occurs when the human services worker identifies a high number of clients needing immediate care. When over-triaging occurs, already stretched resources are stretched even tighter, and human services agencies start to experience extended wait times for treatment, extended treatment times, errors in triaging, and overcrowding (Hitchcock et al., 2013).

An example of this is the scheduling of initial appointments. Often, there are same-day or similar appointment slots set aside for emergency intake cases. However, when clients have been over-triaged, those slots may be filled, and more urgent needs may still need to be met. A crucial step in addressing this issue is to ensure that intake specialists receive thorough training in triage protocols, encompassing a comprehensive understanding of policy regarding initial appointments, emergency cases, and triage procedures (Christian, 2019).

Access and Barriers to Resources

Human service workers assist clients in accessing essential resources. These resources can be tangible, such as housing, medicine, textbooks, transportation, or wheelchairs, or intangible, such as emotional support or education. When human service professionals strategize to provide clients with access to these resources, they must consider their circumstances and ability to utilize them effectively. Human service professionals must also consider realistic accessibility before referring clients to resources (Martin, 2018).

For example, we can tell a client, “If you go to the pharmacy, you can pick up your prescription.” However, it may not be that simple. Barriers to picking up a prescription include lack of transportation, the pharmacy’s limited hours, prescription coverage, and cost. Lee et al. (2021) identified that “non-Hispanic Whites had the highest health insurance coverage at 94.6%, followed by Asians at 93.2%, Blacks at 90.3%, and Hispanics at 82.2%” (2011, p. 1). In addition to these barriers, there may also be a language barrier or issues with health literacy that can impact medication adherence. It is a probability that all clients will experience some roadblocks in obtaining services. It is the responsibility of a human services worker to recognize these obstacles and assist clients in navigating around them.

Creating accessibility to resources requires creativity and brainstorming. Often, human services workers must think outside the box when it comes to generating access. Examples of this include contacting vendors who can provide resources at a lower cost, negotiating with community organizations to secure donated goods or services, coordinating with local transportation providers to arrange reliable travel options, leveraging social media and community networks to find support groups or educational opportunities, and partnering with businesses to create job opportunities or internships. By employing creative and resourceful strategies, human services workers can better meet the diverse needs of their clients. A bonus to identifying and managing barriers to resources is that increasing access to one resource often creates a path for future resources. For example, if we support clients in obtaining employment and stable housing, we open the door for them to access education (Martin, 2018).

Human service professionals must balance the quality of the resources against reasonability and accessibility (Martin, 2018). If the best resource is an hour’s drive away, but the client does not have access to transportation, then it is not the best resource for them. When this occurs, it is the responsibility of the human services worker to work with the client to determine what is accessible to the client. Sometimes, a lesser quality resource is better than the client not getting any resource due to lack of accessibility.

Education of the Human Services Professional

Effective social justice and diversity education prepares competent practitioners (Olcon et al., 2020), and human services educators set the tone and direction for professional discourse and practice. However, theoretical frameworks and strategies for teaching social justice and diversity in education have increasingly been criticized. Sue and Sue (2016) suggest that the educational focus on cultural competence and skills such as self-awareness and personal knowledge have become the focus in higher education as opposed to anti-racist practice (Dominelli, 2008). While many human service professionals call for eliminating racism and oppression, the field has remained mostly silent on the role that Whiteness and Eurocentrism play in systemic racism and structural injustice (Olcon et al., 2020).

Human service courses in social justice that teach students about power, privilege, and oppression are essential additions to professional education. Jeyasingham (2012) explains that White human service professionals should consider engaging with “Whiteness studies” because they provide insight into the invisible and dominant ways power operates (p. 682). Social justice-focused education allows human service professionals to understand White Privilege and its potential impact on their relationships with clients. This approach to incorporating social justice education into human services must include anti-racist pedagogy (Abrams and Gibson, 2007). It is the responsibility of the human services worker to introspect and consider individual and institutional causes of inequalities that may affect their relationships with clients.

One way for human services professionals to continue their education on social justice and diversity is through obtaining licenses and credentials. Many licensing entities require professionals to complete continuing education credits, which can include specific training, classes, or conferences. By maintaining an active license or credential, human services workers remain current on the latest research and best practices in their field. Since social justice is a field that is constantly evolving, these training sessions are essential for human service professionals.

References

Abrams, L. S., & Gibson, P. (2007). Teaching notes: Reframing multicultural education: Teaching White privilege in the social work curriculum. Journal of Social Work Education, 43(1), 147–160. doi:10.5175/JSWE.2007.200500529

American Counseling Association. (2014). Code of Ethics. ACA 2014 Code of Ethics (counseling.org)

Andreassen, R. A. (2016). Professional intervention from a service perspective. In Gubrium, J. F., Andreassen, T. A., Solvang, P., & Hamm, L. (eds), Reimagining the human service relationship (pp 33–58). Columbia University Press. https://doi.org/10.7312/gubr17152

Bridgwater, M. A., Petti, E., Giljen, M., Akouri-Shan, L., DeLuca, J. S., Rakhshan Rouhakhtar, P., Millar, C., Karcher, N. R., Martin, E. A., DeVylder, J., Anglin, D., Williams, R., Ellman, L. M., Mittal, V. A., & Schiffman, J. (2023). Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States. Frontiers in Psychiatry, 14, 1117022–1117022. https://doi.org/10.3389/fpsyt.2023.1117022

Buggs, M. D., Catalano, C. J., & Wagner, R. (2023). Sexism, heterosexism, and trans oppression: An integrated perspective. In M. Adams (Ed.), Teaching for diversity and social justice (4th ed., pp. 176–213). Routledge. https://doi.org/10.4324/9781003005759

Casad, B. J., & Luebering, J. E. (2023, August 18). Confirmation bias. Britannica. https://www.britannica.com/science/confirmation-bias

Caccavale, J. (2020, October, 12). What is contrast effect? And how it impacts recruitment. Applied. https://www.beapplied.com/post/what-is-contrast-effect-and-how-it-impacts-recruitment

Centers for Disease Control. (2023). Genderism, Sexism, and Heterosexism. Genderism, Sexism, and Heterosexism | CDC

Cherry, K. (2022, October 24). The halo effect in psychology: Attractiveness is more than looks. VeryWell Mind. https://www.verywellmind.com/what-is-the-halo-effect-2795906

Christian, M. D. (2019). Triage. Critical Care Clinics, 35(4), 575–589. https://doi.org/10.1016/j.ccc.2019.06.009

Crandall, A., Powell, E. A., Bradford, G. C., Magnusson, B. M., Hanson, C. L., Barnes, M. D., Novilla, M. L. B., & Bean, R. A. (2020). Maslow’s hierarchy of needs as a framework for understanding adolescent depressive symptoms over time. Journal of Child and Family Studies, 29(2), 273–281. https://doi.org/10.1007/s10826-019-01577-4

Dominelli, L. (2008). Anti-racist social work (3rd ed). Palgrave Macmillan.

Durante, F., & Fiske, S. T. (2017). How social-class stereotypes maintain inequality. Current Opinion Psychology. 18:43–48. doi: 10.1016/j.copsyc.2017.07.033.

Hays, D. G., & Erford, B. T. (2018). Developing multicultural counseling competence: A systems approach. 3rd edition. Pearson.

Hitchcock, M., Gillespie, B., Crilly, J., & Chaboyer, W. (2013). Triage: An investigation of the process and potential vulnerabilities. Journal of Advanced Nursing, 70(7), 1532–1541. doi.org/10.1111/jan.12304

Hoskovec, J. M., Bennett, R. L., Carey, M. E., DaVanzo, J. E., Dougherty, M., Hahn, S. E., LeRoy, B. S., O’Neal, S., Richardson, J. G., & Wicklund, C. A. (2018). Projecting the supply and demand for certified genetic counselors: A workforce study. Journal of Genetic Counseling, 27(1), 16–20. https://doi.org/10.1007/s10897-017-0158-8

Hughes, C. (2020). Critical employment, ethical, and legal scenarios in human resource development. University of Arkansas.

Hurd, S. (2018, September 29). What is attribution bias and how it secretly distorts your thinking. Learning Mind. https://www.learning-mind.com/attribution-bias/

Jeyasingham, D. (2012). White noise: A critical evaluation of social work education’s engagement with Whiteness studies. British Journal of Social Work, 42(4), 669–686. doi:10.1093/bjsw/bcr110

Kenyon, P. (1999). What would you do? An ethical case workbook for human service professionals (1st ed) Cengage.

Kowal, M., Sorokowski, P., Kulczycki, E.,& Żelaźniewicz, A. (2022). The impact of geographical bias when judging scientific studies. Scientometrics, 127(1), 265–273.

Lee, D.C., Liang, H., & Shi, L. (2021). The convergence of racial and income disparities in health insurance coverage in the United States. International Journal Equity Health, 20(1):96. doi: 10.1186/s12939-021-01436-z.

Macias-Konstantopoulos, W. L., Collins, K.A., Diaz, R., Duber, H.C., Edwards, C.D., Hsu, A.P., Ranney, M.L., Riviello, R.J., Wettstein, Z.S., & Sachs, C.J. (2023). Race, healthcare, and health disparities: A critical review and recommendations for advancing health equity. Western Journal of Emergency Medicine, 24(5):906-918. doi: 10.5811/westjem.58408.

Maccarone, D. (2003). The beauty bias. Psychology Today. The Beauty Bias | Psychology Today

Marsden, J., Newton, M., Windle, J., & Mackway-Jones, K. (2013). Emergency triage: telephone triage and advice. John Wiley & Sons.

Martin, M., (2018). Through the eyes of practice settings. Pearson.

McClintock, A. H., Fainstad, T., Jauregui, J., & Yarris, L.M. (2021). Countering bias in assessment. Journal of Graduate Medical Education,13(5):725-726. doi: 10.4300/JGME-D-21-00722.1.

McElroy, K., Moore, D., Hilterbrand, L., & Hindes, N. (2017). Access services are human services: Collaborating to provide textbook access to students. Journal of Access Services, 14(2), 80–91. https://doi.org/10.1080/15367967.2017.1296769

Myer, R. A., Whisenhunt, J. L., & James, R. K. (2022). Crisis intervention ethics casebook. American Counseling Association.

Office of Addiction Services and Supports. (2020). Part 822 Outpatient Services Clinical Standards. Clinical Standards (ny.gov)

Olcoń, K., Gilbert, D. J., & Pulliam, R. M. (2020). Teaching about racial and ethnic diversity in social work education: A systematic review. Journal of Social Work Education, 56(2), 215–237. https://doi.org/10.1080/10437797.2019.1656578

Reynolds, C. R., & Suzuki, L. A. (2012). Bias in psychological assessment. Assessment Psychology. In Weiner, I. B (Eds.), Handbook of Psychology. (82–113). John Wiley & sons, Inc. https://doi.org/10.1002/9781118133880.hop210004

Ricee, S. (2023, July 13). What is affinity bias? Diversity for Social Impact. https://diversity.social/affinity-bias-definition/

Ross, H. J. (2020). Everyday bias: Identifying and navigating unconscious judgements in our daily lives. Rowman & Littlefield.

Schippers, M. (2007). Recovering the feminine other: Masculinity, femininity, and gender hegemony. Theory and Society, 36(1), 85–102. https://doi.org/10.1007/s11186-007-9022-4

Silvestre, C. C., Santos, L. M. C., de Oliveira-Filho, A. D., & de Lyra, D. P. (2017). ‘What is not written does not exist’: The importance of proper documentation of medication use history. International Journal of Clinical Pharmacy, 39(5), 985–988. https://doi.org/10.1007/s11096-017-0519-2

Stiffler, M. C., & Dever, B. V. (2015). Mental Health Screening at School Instrumentation, Implementation, and Critical Issues (1st ed. ). Springer International Publishing. https://doi.org/10.1007/978-3-319-19171-3

Substance Abuse and Mental Health Services Administration. (2018). Crisis intervention team (CIT) methods for using data to inform practice: A step-by-step guide. HHS Pub. No. SMA-18-5065.

Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). Wiley & Sons.

Sue, D. W., Rasheed, M. N, & Rasheed, J. M. (2016). Multicultural social work practice (2^nd ed.). Wiley & Sons.

Summers, J. (2019). Theory of healthcare ethics. In E.E. Morrison & B. Furlong (Eds.), Health Care Ethics: Critical Issues for the 21st Century (4th ed., pp. 3–39). Jones & Bartlett.

Veesart, A., & Barron, A. (2020). Unconscious bias: Is it impacting your nursing care? Nursing Made Incredibly Easy!, 18(2), 47–49. doi: 10.1097/01.NME.0000653208.69994.12.

Walker, P. (2020). Triage in a pandemic; equity, utility, or both? Ethics & Medicine, 36(3), 147–131.