While studying at university, David, like many other young men, was full of ambition and enthusiasm. As a social work major he chose to intern at a number of hospitals during his freshman and sophomore years to prepare himself for a job in the field. His life took a sudden turn, however, when he was diagnosed with leukemia during his junior year.
David suspended his schooling for one year and received a bone marrow transplant at Taipei Veterans General Hospital. After the procedure, his illness went into remission and he was able to complete his studies and earn a degree. Sadly, three months after graduation, the cancer returned and David died at the age of 24.
During his fight against the illness, the one person who was always there to accompany David and help him learn to cope with his physical pain and emotional distress was Wen Xin-xue (溫信學), a certified social worker at Taipei Veterans. “I knew from experience that he didn’t have much time left so I went to have a deep talk with him and encouraged him to leave nothing unsaid,” Wen recalls of his advice to the young man as his illness took its toll. “He thanked his mom for taking care of him and me for helping him do some of the things he liked. Though he was unwilling to part with his loving family and friends, he came to accept what was happening to him.”
David fell into a coma and passed away one week later. He was the only child in his family and his stepfather had died of a heart attack just four months before David’s death. David’s mother was left totally alone after losing the two beloved men in her life within a few months. After the young man’s death, Wen then turned his attention to David’s mother, to help the woman by offering counseling services.
This is just one of the numerous life stories that Wen has come across during his 12 years of working for Taipei Veterans’ Department of Oncology, which treats patients with cancerous tumors or hematologic malignancies. At any one time, he usually has to attend to around 40 patients and their families. “Sometimes, people think the plots in television drama series are exaggerated. But as a social worker, I’ve encountered situations that are even more dramatic and unfortunate,” he says with a sigh.
Medical social worker Wen Xin-xue attends to a patient at Taipei Veterans General Hospital. (Photo Courtesy of Wen Xin-xue)
Wen says the main missions of medical social workers are to support patients and their families through the economic, physical and psychological problems that arise because of an illness and most importantly, to improve patients’ quality of life. “Life has many imperfections. We hope that through counseling, emotional support and connecting people with the welfare resources available, we can help them tackle difficulties they meet along the way or at least have no regrets at the end of their lives.”
Wen notes that there are actually quite a few avenues of help available for those in need, and his job is to assess each client’s individual situation and help them access that assistance. For example, Make-A-Wish Taiwan helps children with life-threatening conditions realize a dream, while Ronald McDonald House Taiwan offers temporary accommodation near hospitals to families with children who are seriously ill and receiving medical treatment. Taipei Veterans operates a foundation based on the generous donations it has received from local residents to help those from poor families pay medical or funeral expenses.
According to an estimate from the Medical Social Work Association, there are approximately 1,300 social workers employed by medical centers, regional hospitals, community-based hospitals and rehabilitation centers, says Wen, who serves as the association’s vice chairman. Some 60 percent of those staff members are certified, a figure that accounts for around one-fifth of the total number of certified social workers in Taiwan.
Kate Wang (王永慈), chairwoman of the Graduate Institute of Social Work at National Taiwan Normal University, says medical institutions and government service centers are the major employers of certified social workers. A number of nongovernmental organizations (NGO) including the Child Welfare League Foundation, Eden Social Welfare Foundation, Garden of Hope Foundation, Genesis Social Welfare Foundation and Taiwan Fund for Children and Families also retain a considerable social services workforce.
School for Social Work
There are three main career opportunities in social work—academia, administration, including policymaking, and direct social work practice. At the same time, the growing demand for qualified social workers has necessitated an improvement in their professional education.
The Taipei City Government has set up social welfare service centers in each of its 12 administrative districts, including this one in Shilin. (Photo by Huang Chung-hsin)
Social work education has developed in Taiwan for more than 50 years. Nevertheless, in the initial period, it was considered a sub-discipline of sociology. It was not until National Taiwan University in Taipei devised separate curricula for social work and sociology students in 1973 and Tunghai University in Taichung, central Taiwan followed suit with separate social work and sociology departments in 1979 that social work started to be recognized as an independent academic discipline.
In addition to international trends in the field, the economic, political and social changes in Taiwan over recent decades have had an impact on local social work education, Wang says. Political democratization that started in the late 1980s facilitated the rise of social movements and the formation of many NGOs that have actively lobbied for social welfare legislation and increased spending for related programs.
The establishment of professional organizations such as the Medical Social Work Association in 1983, the Taiwan Association of Social Workers (TASW) in 1989 and the National Union of Professional Social Worker Associations (NUSW) in 2002 has helped build the professional status of social workers, Wang says. The groups also provide training for social workers and lobby for improved pay and working conditions.
Meanwhile, Taiwan faces an increasing number of social problems amid its transformation from an economy based on agriculture to manufacturing and, now, services. Thus, the number of welfare policies and schemes to address those problems has also grown, Wang says. As a result, social welfare services have expanded substantially in recent years, especially in the public sector.
All these developments have prompted local universities to set up or enhance existing social work programs, as well as encouraged more students to study social work. Currently, there are 28 undergraduate, 24 master’s and four doctoral programs offered by universities in Taiwan. The annual enrollment of students in these programs is about 3,000 in total.
A social worker, center, at Shilin Welfare Services Center seeks to address the problems of two homeless people. (Photo by Huang Chung-hsin)
One major regulatory mechanism that affects social work curricula, Wang says, is the Social Worker Act from 1997. The act introduced a certification system that includes exams in social work theory, administration, research methods, human behavior and the social environment, direct practice, and social policy and legislation. The requirements have impelled local universities to standardize the structure of their courses.
In recent years, Wang continues, a number of social issues including domestic violence, an increase in the number of immigrant spouses, campus bullying, an aging population and long-term care have received a great deal of attention in Taiwan. Social work education programs have responded by providing specialized courses and cooperating with social welfare agencies on internships to help students become familiar with such problems and methods of intervention, she says.
Cheng Li-chen (鄭麗珍), president of TASW, says that issues such as those involving family violence, poverty, single parenthood and unemployment are complicated, so social workers need professional knowledge and skills in order to help their clients improve their lives. But while the number of social work departments established at domestic universities has doubled over the last 10 years, the quality of some of the programs is falling short, says Cheng, who is also the director of the Department of Social Work at National Taiwan University. A lack of specialists in certain fields means that some programs are taught by staff members without a background in social work and are failing to meet the needs of graduates who enter social work practice, she says. In response, TASW runs on-the-job training in the form of conferences, lectures, reading clubs and workshops.
Cheng says that one of TASW’s major achievements has been pushing for the passage of the Social Worker Act and the resultant certification system, which has had the effect of promoting the professional status of social work. TASW also guided amendments to the act in 2009 so that the certification system now comprises a number of required courses, internship training and more case studies in the final exam. The amendments also provide for an advanced certificate that allows staff to specialize in a particular aspect of social work. For the time being, five areas of practice—medical, mental health, elderly, disabled and family services—have been identified. The advanced qualification should help social workers render better services to their clients, Cheng says.
The amendments also require certified social workers to complete 180 hours of continuing education if they want to renew their licenses, a requirement they must fulfill every six years. Cheng says this rule can help staff meet the demands of new social challenges.
The Social Welfare Bureau of the Taoyuan County Government holds an activity in July this year to honor dedicated social workers. (Photo Courtesy of Taoyuan County Government)
Chang Su-hui (張淑慧), chairwoman of NUSW and director-general of the Social Welfare Bureau of the Taoyuan County Government, notes that difficult working conditions often go with the job. For example, when making family visits, social workers might have to work in a dirty or dangerous environment. She says some social workers report visiting clients’ homes that were filled with garbage and infested with cockroaches, or, in cases of abuse, having to work with a potentially violent family member. Moreover, social workers are on-call 24 hours a day for their clients. For all this, the average starting salary for a social worker outside the government sector is around NT$25,000–$28,000 (US$820–$920) per month.
TASW’s Cheng says that the generally low pay, long working hours and risks associated with social work result in a high turnover rate and shortage of professionals in the social service sector. Department of Health guidelines, for example, suggest that hospitals employ one certified social worker per 100 beds. While this goal is usually achieved in urban medical centers, smaller hospitals or those in rural areas are often short-staffed. In fact, less than one-fourth of social work graduates enter the social service sector, Chang Su-hui says. To address this lack of qualified personnel, the government has made greater efforts to retain and increase social service staff by raising the pass rate for the certification exam and increasing pay for certified social workers in the public sector. Chang says she hopes these measures will encourage more people to pursue a career in social work.
Hsu Chia-ni (許嘉倪) is the director at Zhongzheng Social Welfare Service Center, which was set up by the Taipei City Government’s Department of Social Welfare. Hsu has been working in social services for 17 years. “Social workers are human beings, not gods. We are not almighty,” she says. “Members of the public expect too much from us, thinking that we can iron out any kind of problem. If we fail to do so, then we are to blame.”
Social workers, Hsu explains, need to deal with a wide variety of complaints on a daily basis, and must be able to work with people from all walks of life including children, teenagers, women, the disabled, the elderly and the homeless. In addition, they risk assault when handling clients with mental illness or a history of violent behavior.
Passion for the Job
“We must train ourselves to understand quickly the problems our clients face, then make an overall assessment and see what resources we can connect them with to address their needs,” Hsu says. “It’s hard to stick with social work without great passion and a sense of mission to help others.”
A social worker, left, accompanies her young client to visit a psychological counselor. (Photo by Huang Chung-hsin)
Jessica Kao (高昭美), director of Zhongshan Social Welfare Service Center, also in Taipei, echoes that sentiment. “During my first few years as a social worker, I constantly thought of finding a new job,” she says. “But eventually, with ongoing training to help me tackle such tangled problems, I gained confidence and discovered the joy of helping others and now I’ve been on the job for 30 years.”
When she started in the field, Kao says social work was simply focused on offering financial aid to low-income families. But given substantial social changes over time and the government’s implementation of various welfare projects, the job descriptions and duties for social workers have become very diverse. Social work now includes a wide range of protection, prevention and support services rather than direct payments.
In her years as a social worker, Kao says she has encountered many dark aspects of society including child abuse, child custody disputes, domestic violence, drug addiction, homelessness and suicide. Yet those experiences have inspired her to appreciate what she has and have compassion, empathy and tolerance toward people that need help.
Medical social worker Wen Xin-xue says he and his colleagues get together for about two hours every month to talk about their work as a way to help them cope with the ups and downs of the job. “As we share our thoughts and experiences, we offer emotional support and practical tips to each other,” he says. “This kind of peer support helps to relieve the stress of our job and it’s particularly helpful for junior social workers.”
Despite all the difficulties, Wen says that after working with so many people whose lives have included great tragedy, he has learned to cherish happiness in his own life and hopes he can do more to help those in need. “My sense of achievement comes from seeing my clients change for the better because of the things that I’ve done for them,” he says. “That’s the driving force behind my commitment to and enthusiasm for social work.”
Write to Kelly Her at kelly@mail.gio.gov.tw