Our guiding practice frameworks must be broadened to include genetic variation as a core feature of developmental, social, and environmental assessment.
The identification of genetic variations that predispose individuals to a variety of conditions means that social workers must contend with a new risk concept, one that is microscopic.
In health contexts, genetic conditions are increasingly likely to be recognized and classified. Understanding of the etiology of genomic disease is likely to shape conceptualizations of health and mental health, and to inform treatment and reproductive decisions. Technologies are available before the ethical, legal or social implications (ELSI) are responsibly explored and before adequate treatment protocols exist. The movement towards personalized medicine threatens to widen gaps in health disparities, including access to care, health literacy, and longevity.
In social contexts, genomic discovery is challenging notions of human agency, identity, heredity and privacy. Genetics research may inadvertently (or deliberately) promote essentialist thinking, where environmental conditions that lead to health and mental health disparities are obscured in favor of explanations that look to deterministic and “inevitable” genetic variation. Efforts to understand the epigenome and the microbiome seek to revolutionize our understanding of gene/environment interaction on more balanced terms.
CHALLENGES FOR SOCIAL WORK:
In research contexts: Social workers must participate in and lead transdisciplinary teams to ask critical questions about the applications of genome technologies as they mature and evolve beyond research settings and into clinical care. Social workers are well positioned to advance the study of genomics to ask novel questions at the nexus of genes and environments and to test interventions that advance care for underserved populations affected by genetic conditions.
In practice settings, social work’s guiding person-in-environment lens must be broadened to include consideration of genetic variation as a core feature of developmental, social, and environmental assessment. Social workers are likely to encounter patients and families affected by genetic conditions across the lifespan and across clinical settings, making this a ripe area for professional development and practice. In our practice, we must attend to the ways genetic information is acquired, owned, understood, and used.
In academic settings, professional preparation for practice in the era of genomic medicine must enhance skills that already have roots in social work practice while building new knowledge, new language, and new tools. Social work education teaches students to map family illness legacies, address beliefs about disease risk and susceptibility, identify challenges in family and medical communication, distinguish important and urgent decisions, and promote client self determination. Genomic concepts may be infused across social work education, increasing content that address behavioral health and leading the charge away from essentializing genetics of social concepts such as race, sexuality, privilege, and mental health.