Clin Soc Work J (2015) 43:225–235
DOI 10.1007/s10615-014-0508-z
ORIGINAL PAPER
Benefits and Challenges of Online Education for Clinical Social
Work: Three Examples
Sally Hill Jones
Published online: 17 October 2014
Ó Springer Science+Business Media New York 2014
Abstract As growing numbers of social work programs
offer online delivery of course content, the positive aspects
described in the literature, such as student access and
flexibility, as well as concerns about quality, instructor/
student relationships, and academic honesty of students,
need to be examined as they relate to clinical social work
education (Pelech et al. 2013; Reamer 2013). Three
examples of fully online courses offered to clinical social
work students by an experienced clinician and online
instructor are examined in the context of the benefits and
challenges put forth in the literature. A foundation inter-
viewing course, diagnostic assessment course, and course
on social work with older adults with a service-learning
component are described in terms of quality, comparison to
face-to-face courses, advantages, and disadvantages. These
examples illustrate that online courses which are strategi-
cally and rigorously developed are comparable to face-to-
face courses in many ways, including activities, assign-
ments, assessments, outcomes, student quality, and meth-
ods of addressing academic dishonesty. Yet, differences
exist in quality and quantity of interaction and skill
development. Methods of ensuring quality are explored,
including intense instructor presence, real time meetings
online, and well-formulated discussion questions that
require students to interact with the material and each other
in ways that are potentially more demanding and engaging
than courses taught face-to-face. Further challenges of
technology, class size and requirement of additional faculty
time are discussed, as well as clinical content that is
S. H. Jones (&)
Texas State University School of Social Work, 601 University
Drive, San Marcos, TX 78666, USA
e-mail: Sh29@txstate.edu
currently more appropriately taught with a face-to-face
component.
Keywords Online education
Social work

Clinical practice
Direct practice
Introduction
Online delivery of social work content is reported to be a
growing trend in universities across the US (Regan and
Youn 2008). A 2006 self-report survey of CSWE-accred-
ited programs found substantial growth of distance-edu-
cation delivery from the previous decade, with 50 % of
graduate programs offering distance-education programs,
another 19 % considering this possibility, and 24 %
offering courses entirely online (Vernon et al. 2009).
Online learning has been heralded as a potential paradigm
shift (Flynn et al. 2013), while others view it as simply an
alternative form of content delivery (Blackmon 2013;
Kurzman 2013). Although the merits and limitations of this
development are debated in the literature, the substantial
growth in numbers of online social work courses indicates
it has become a reality in social work education (Reamer
2013).
The literature describes advantages and challenges of
Web-based social work courses. Access for students in
rural areas, with full-time responsibilities, or with other
limitations is cited as one clear benefit of online offerings
(Blackmon 2013; Kurzman 2013; Reamer; Reeves and
Reeves 2008; Vernon et al. 2009). Another is the potential
to enhance engagement of students for whom online
communication is the norm and preference, or whose
learning or communication styles are conducive to online
learning (Ferrera et al. 2013; Lawrence and Abel 2012;
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Moore 2005). Blackmon points out that distance learning
will help meet workforce demands for qualified social
workers, especially ‘‘digitally literate’’ workers able to
assist clients using technology (2013, p. 516). Others
highlight that Web-based education lends itself to the
constructivist model, shifting more responsibility and
power to students to participate in their own learning
(Lawrence and Abel 2012; Ouellette et al. 2006; Reeves
and Reeves 2008). The challenges described in the litera-
ture include ensuring comparable quality, the potential lack
of interpersonal interaction between instructors and stu-
dents and among students, and gatekeeping and dishonesty
issues (Kurzman 2013; Reamer 2013). Some also warn that
the move toward online delivery is too heavily influenced
by revenue and the misperception that more students can be
taught with fewer resources than traditional models (Pelech
et al. 2013; Reamer 2013; Reeves and Reeves 2008).
Of particular concern is the type of content that can
effectively be taught online, especially practice skills
(Moore 2005; Regan and Youn 2008; Vernon et al. 2009).
While practice courses have been listed as the most fre-
quent type of course taught online, experienced online
social work educators express concerns about the effec-
tiveness of learning practice skills solely in this format.
They specifically question the ability of students to dem-
onstrate and educators to observe self-awareness, use of
self, cultural competency, and relationship skills without
face-to-face interaction (Vernon et al. 2009; Moore 2005).
Clinical functions described by the American Board of
Examiners in Clinical Social Work (ABECSW) include
assessment, diagnosis, treatment planning, intervention/
treatment, evaluation of outcomes, and case management
based on a broad theoretical knowledge base (ABECSW,n.d.).
Regan and Youn (2008) define clinical skills as those ‘‘utilized
when working with clients, usually within a counseling-ori-
ented setting’’ (p. 97) such as rapport-building, empathic
communication, and active listening skills. In their literature
review, they note that research has shown no differences
between online and traditionally taught clinical courses in
student grades/test scores, but that some student perception
ratings are lower for distance or Web-based methods than
face-to-face formats. Although they conclude that online
delivery of clinical content is promising, they make clear that
‘‘it would be ethically and professionally irresponsible to
develop entire asynchronous Web-based learning environ-
ments for teaching clinical skills at this stage of uncertainty’’
(p. 106) and recommend more research on actual practice skill
outcomes.
Recent investigation of individual courses and programs
have added to the effectiveness research on distance
learning of clinical skills. A group practice course, taught
online with additional weekend in-person sessions, was
compared with traditional delivery, with no significant
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differences found in learning of leadership skills, grades, or
student perceptions (Cummings et al. 2012). Lawrence and
Abel compared a fully online version with traditional
delivery of a psychosocial pathology course (2012).
Although online students reported significantly less change
in their confidence levels, age, experience, and learning
styles were viewed as potential factors. In a programmatic
evaluation, Noble and Russell (2013) reported student
perceptions of 11 courses, including two with direct prac-
tice content, in a primarily asynchronous online MSW
program. Qualitative data revealed very positive student
responses, with quality and quantity of instructor interac-
tion described as ‘‘of utmost importance’’ (p. 511). Wilke
and Vinton (2006) analyzed differences between asyn-
chronous online and face-to-face cohorts of a clinical
advanced standing program and found few differences in
educational outcomes and satisfaction scores. However,
while field instructors rated all students highly, online
students were rated significantly lower on several mea-
sures. The authors considered the possibility that fully
online students may not have sufficient opportunity for
skill development. Other descriptive reports have outlined
the advantages of hybrid or blended synchronous and
asynchronous formats in direct practice and clinical cour-
ses (Ferrera et al. 2013; Flynn et al. 2013; Levin et al.
2013). Further descriptions of online courses with clinical
content will add to the body of literature on the topic.
I came to academia with over 20 years of clinical
experience. My introduction to distance education was
driving to a town 2 hours from the university once a week
to teach MSW courses. The next step was developing one
course as part of the development of an online MSW
program. The program has since evolved into a sizable and
vibrant aspect of the graduate curriculum, and faculty have
had opportunities to develop considerable expertise in
online instruction. I have developed and taught three online
courses and regularly present to faculty on online course
management. Based on this experience, I will describe the
infrastructure and resources required for quality online
learning, examine the benefits and challenges of teaching
three online clinical social work courses compared to their
face-to-face counterparts, and discuss the impact of the
differences on students, educators, and practitioners.
Infrastructure and Resources
For online curriculum delivery to be effective, a substantial
investment of resources is required from the university,
educator, and student. As such, a clear understanding of the
structural support and resources required for students and
educators to be prepared and for the course to be developed
and delivered is essential to evaluating the value of this
Clin Soc Work J (2015) 43:225–235
format for clinical social work education. Without these
foundational elements, the risks are high for social workers
educated online to move into clinical practice without the
necessary skills.
Structural Support
The university infrastructure available to support online
coursework is foundational to ensure quality. An office of
distance learning is needed for establishing and maintain-
ing standards of quality. With technology playing a central
role in this format, universities must have the equipment
and capacity to support online learners and educators
through an instructional technology department. An
effective, reliable, learning management system, working
computers, webcams, software tools, and qualified per-
sonnel for infrastructure maintenance, educator training,
and around-the-clock technology support are essential.
Experienced instructional course designers are indispens-
able to building high quality online courses and providing
support during at least the initial course offering. Student
support services available to on-campus students must also
be provided to online learners. For example, librarians,
library materials, disability services, and writing assistance
must be available from a distance.
On the college and departmental levels, investment is
required to ensure quality and to prepare instructors and
students. Curriculum oversight committees must examine
online courses as they compare to face-to-face courses, and
admission and advancement requirements must be equally
rigorous for online students and on-campus students.
Instructors need time allotted for training and course
releases for development and revision of courses, and
online clinical social work courses need to be smaller than
on-campus courses, requiring additional faculty. Depart-
ments must ensure students are aware of the differences
between online and face-to-face learning. The additional
requirements of time, equipment, skills, and fees must be
clearly described to prospective and newly admitted stu-
dents, with an agreement of understanding signed. An
online orientation is needed that takes students through a
sampling of online tasks to ensure they have the required
technological skills.
Student and Instructor Preparation
In addition to the preparation all graduate students need for
graduate-level social work education, online students must
also invest in additional equipment, skill development,
time, and course fees. Online learning requires computers
with the correct hardware and software, webcams, micro-
phones, and internet connections that allow access to all
required course elements. Computer skills are needed for
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tasks such as videoconferencing, recording, and accessing
streaming media. Online courses offer more flexibility than
on-campus courses, since students can complete the work
from anywhere with an internet connection, but they also
require more time, discipline, and self-direction. While on-
campus students are structured by the weekly classtime,
online students must discipline themselves to participate in
activities and ongoing discussion forums throughout the
week. Students may also feel ‘‘e-solated’’ (Okech et al.
2012) in online courses because of the solitary nature of
online work and reduced face-to-face contact. In addition,
there are extra fees for online courses.
Online instructors also need additional equipment,
skills, and time to successfully teach in this format.
Instructors need the same equipment as students, as well as
training in online course development and delivery and
advanced use of technological tools incorporated into the
course. Similar to the student learning curve, quality online
teaching allows for more flexibility, but requires more time
than the traditional mode in course development and
delivery. Along with the extensive pre-planning required,
intensive instructor presence is crucial, including time-
consuming written communication, prompt replies to
emails, and daily involvement in discussion forums. The
structure also differs from the traditional format, requiring
a continuous tending of the course versus specific, delin-
eated times each week for class meeting, preparation, and
grading. Online instructors must adjust and find their own
rhythm, providing sufficient presence while avoiding
feeling perpetually ‘‘on call.’’
Course Preparation and Delivery
Online course development and delivery is time-intensive
and requires attention to aspects of the course that differ
from face-to-face courses, specifically a user-friendly
course website, a variety of activities that build in oppor-
tunities for engagement and interaction, intense instructor
presence, and technology management. Because the web-
site becomes the hub of the course versus the classroom in
face-to-face learning, the website’s structure must simplify
course navigation. Weekly tasks must be laid out in the
order they are to be completed, with needed resources and
instructions easily located. Engagement of students with
the material must be more intentional than in face-to-face
instruction, with innovative use of a variety of media and
learning activities designed to draw students into the
material and provide opportunities for critical thinking,
reflection, application of content, and engagement with
peers. Because most communication is written, clarity of
instructions takes on added importance. In addition, a
course information page is needed that includes time
expectations, hardware and software requirements, links to
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download software and add-ons, as well as links to tech-
nological assistance, university support services, and other
information tailored to each course. The instructor must
conduct weekly technology walk-throughs to assure that
links are working, to troubleshoot problems, and to develop
‘‘work-arounds’’ for occasional technology interruptions.
Because more interaction occurs in written, asynchro-
nous form in online courses compared to face-to-face
courses, interaction must be built into the course design
more intentionally. Discussion forums, group activities,
and videoconferencing are the main avenues of interaction
and must be well-planned to assure stimulating and
engaging dialogues. Unlike face-to-face courses, graded
discussions are a central component of online learning.
Students are expected to make an initial post and respond
to other students in a substantial way that contributes to the
discussion and includes evidence of having read the course
materials. The instructor facilitates discussions to direct
and deepen the dialogue and ensure respectful communi-
cation. Permanent discussion forums for general questions
and informal student interaction (‘‘cyberlounge’’) are
included to provide additional venues for interaction.
Group activities require setting up discussion forums or
videoconference ‘‘rooms’’ where groups meet and plan
projects.
Given the central role of relationships in clinical social
work, classroom relationships are seen as the vehicle for
mentoring, role modeling, and socializing students into the
profession (Siegel et al. 1998). Making relationships cen-
tral and personal in an online format is challenging and
labor-intensive. Audiovisual connections must be planned,
beginning with a video-recorded introduction and wel-
coming message from the instructor and students posting
introductions. Brief recorded lectures, accompanied by
powerpoints, introduce each learning module, cover
material difficult to convey in writing, and provide weekly
audiovisual input from the instructor. At the end of each
module, a document or brief video summarizing the week’s
discussion themes is needed to help students pull together
the content and segue into the next module. Intensive
instructor presence in the course is required for relation-
ships to develop in online courses. In contrast to on-campus
courses in which the instructor teaches a weekly 3 hour
class with some email and one-on-one contacts with stu-
dents in between classes, the online instructor must make
her presence felt continuously, through prompt and fre-
quent feedback in e-mails, discussion forums, graded
assignments, and videoconferences throughout the week.
This is especially important at the beginning of the course,
with some lessening of that role as group cohesiveness
develops.
Therefore, the online endeavor, at its best, is expensive
and labor-intensive for the university, department, student,
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and educator, requiring considerable commitment of time
and resources. It is important, then, to examine its benefits
and challenges in teaching clinical skills and the impact on
students, faculty, and the field.
Benefits and Challenges
The central issues of effective clinical social work education
when delivered online as described in the literature include
student access, curriculum quality, degree of interpersonal
interaction, and clinical skill development, in addition to
upholding gatekeeping and academic integrity standards, the
effects of dependence on technology, and appropriate use of
resources. These concerns will be discussed using examples
from three MSW courses taught face-to-face and online. The
first is the foundation course that teaches interviewing and
basic counseling skills, which I have taught eight times face-
to-face and four times online. The second course is the
concentration course on diagnostic assessment, which I have
taught eight times face-to-face and twice online. The final
course is an elective course on gerontology in which students
learn interviewing and assessment skills as they apply to
practice with older adults. I developed this course for online
delivery and have taught it twice, but will compare it to an
undergraduate face-to-face version of the course I taught one
time.
Access
Increased access for students who would not otherwise be
able to obtain a graduate education was evident in these
courses. Many students lived in rural areas far from a
university that offered graduate social work education.
Some students with caregiving responsibilities in addition
to full-time employment were unable to attend on-campus
courses. Students from several states and countries were
included in these courses, as well as students who were in
the military or had military partners, allowing them to
continue their education despite frequent moves.
Some of the limitations to access described by Reamer
(2013) have also been evident. The required access to high-
speed internet for real-time video-conferencing and
streaming video has affected those living in rural areas,
exactly those students often touted as benefitting from
online education. Although some students struggled with
this when the courses were first taught, access has steadily
improved as high-speed internet has become available in
more geographical areas, and this is now much less of a
barrier. The online fees added approximately $1,800–
$3,000 to each student’s total tuition. Although there may
be cost savings from not driving to and parking on campus,
these extra costs could prevent some students from access
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to online education. Two of the courses, diagnostic
assessment and gerontology, were accessible to students
with hearing impairments without the use of interpreters, as
no video-conferencing was required. All of the courses had
transcripts or subtitles for video-recorded content.
Curriculum Quality
All three courses were developed over two semesters with
the guidance of a university instructional designer, who
also assisted during course delivery and revision. Ensuring
that the content quality of online courses is comparable to
face-to-face versions required little adaptation for many
course components, while more modification was needed
for other aspects.
Much of the content of the courses was identical in face-
to-face and online versions, including the learning objec-
tives, textbooks, and supplemental readings, as well as
many assignments, grading rubrics, assessments, videos,
film clips, and some activities. Hands-on activities, such as
a sensory deprivation simulation in the aging course, was
built into both formats. However, developing lectures and
student presentations for online courses required adapta-
tion. I recorded 15–20 minute lectures in my office using
Camtasia Relay software provided by the university and
posted them online for students to view. Guest lectures
were also video-recorded by the Instructional Technology
department and posted for online students in the diagnostic
assessment course, and six faculty members recorded guest
lectures for the interdisciplinary gerontology course.
Although online students may also record and post class
presentations, it is difficult to assure that students view all
the presentations. Therefore, while students in the face-to-
face diagnostic assessment course gave in-class presenta-
tions on their research paper topics, online students posted
abstracts of their research papers. They were required to
read others’ abstracts, comment on the usefulness of that
topic to their practices in the discussion forum, and request
copies of the papers that interested them. They often
requested at least half of the papers.
Some activities fit one format but not the other, such as
activities that included an interactive game-like element to
engage students. In the face-to-face diagnostic assessment
course, an activity was used to introduce students to finding
diagnostic criteria in the Diagnostic Statistical Manual
(DSM-IV-TR, APA 2000). A diagnostic category written
on a slip of paper was attached to each student’s back.
Using the DSM-IV-TR (APA 2000), they then asked
classmates yes and no questions to discover the diagnostic
name assigned to them. Although this was not transferrable
to online delivery, some self-directed activities were used
only in the online version of the course. Activities were
designed and built by the Instructional Design team to
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assist students to differentiate one disorder from another,
such as drag-and-drop matching of mood episodes with
mood disorders or matching withdrawal symptoms with the
correct substances using a drop-down menu. Although
these could be formatted into a quiz for face-to-face stu-
dents, the lack of immediate feedback and game-like ele-
ment would make them less engaging.
Therefore, it is very feasible with the proper resources
and support, that online content quality is comparable to
face-to-face delivery. A common deficit of these adapta-
tions is that less interaction is involved in the online ver-
sions. The online drag and drop activities are done alone,
and, as Edmundson points out in his critique of online
education, listening to an online lecture is a solitary activity
compared to the interaction that can occur during a face-to-
face classroom lecture (2012). Students cannot stop the
instructor and ask questions or comment. Although the
discussion forums are designed for interaction around the
content of the lectures and readings, they are not in real
time and do not provide the immediacy of in-class lecture
and dialogue. This can mean less engagement for students
and faculty and less of the interpersonal context of class-
room learning.
Interpersonal Interaction
This lack of interpersonal interaction is a central difference
between the two formats that is highly relevant to clinical
social work, given the importance of relationships in our
field. Interpersonal interaction is the medium through
which instructors mentor students and role model profes-
sional behavior and clinical skills. The extent to which this
is possible online affects the skill level and professionalism
of social work students who move into clinical practice. Is
the quality of interaction in online courses capable of
providing these same opportunities to students? Online
interaction that occurs within the context of consistent
instructor and student presence in the course, regular
interaction structured into course expectations, and course
content that engages student interest, appears to have
advantages and disadvantages compared to face-to-face
courses.
In terms of quantity of interaction, considerably more
interaction occurred in online versions of the courses
compared to face-to-face versions. Weekly group discus-
sions played a central role in group interaction in all three
online courses. For example, in the diagnostic assessment
course, students discussed differential diagnosis for a given
case scenario each week, as well as topics such as validity
of diagnostic criteria, the experience of living with a spe-
cific type of mental illness, the effect of labeling, and how
culture affects the manifestation, diagnosis, and treatment
of someone with a specific mental illness. Similar to face-
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to-face discussions, I was very involved in the discussion,
asking questions to deepen the dialogue, correcting mis-
conceptions, elaborating on important aspects of student
observations, and sharing examples from my own practice.
Discussion forums, as a central focus of these courses, were
graded. With these expectations and facilitation, it was
more difficult for students to hide in online discussions, as
described by Levin et al. (2013), and there was less ten-
dency for a few students to dominate. It also appeared that
students who were reluctant to participate in face-to-face
classrooms participated more online. The net result was
more participation in discussions online compared to the
face-to-face classroom.
The quality of the discussions, as in face-to-face cour-
ses, is dependent on the quality of the prompts, students’
abilities and investment, and the facilitation that guides and
deepens the dialogue. In addition, students being in online
courses with their cohort enhanced cohesion and group
interaction, since they have most of their courses together.
In all three courses, discussions were substantive, demon-
strating comprehension of and critical thinking about the
topic. Several factors went into online students investing
more effort into discussions compared to face-to-face stu-
dents: their discussion grades, which constituted a third of
the total grade points, were determined by the quality of
their contributions; there was a written record of their
participation; and discussions lasted for a week, allowing
them to comment, get a response, think about it, and come
back another day with additional comments. It is possible
that online interaction enhances the practice of reflection
before responding. For example, in the online interviewing
course, in a discussion about the effects of students’ cul-
tures-of-origin on interviewing practice, students delved
into more types of effects and ways to address them
compared to the face-to-face course.
The quality of the interaction is definitely affected by
the differences in formats, with asynchronous and written
dialogue more cumbersome and requiring more work
than synchronous, verbal dialogue. Face-to-face, real
time discussions were more spontaneous than asynchro-
nous written interaction, giving them a livelier character
and offering the immediacy of an in-person dialogue.
There were also differences in the ‘‘flow’’ and rhythm of
the dialogue, with face-to-face discussions occurring in
one 3-hour period, while online discussions occurred in
fits and starts over an entire week. It took more work to
sustain the online dialogue over that period of time, and
some students who entered the discussion late in the
week got little response from others. In addition, written
interaction required more conscious effort to discern the
meaning behind someone’s words without nonverbal
cues, although students tended to be aware of this and
checked out potential misperceptions.
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Some authors question whether it is possible for inter-
personal connection to occur, as well as accurate assess-
ment of students’ professionalism and relationship skills,
without face-to-face interaction (Okech et al. 2012;
Reamer 2013). In my experience, the students’ character-
istics and professional behavior came through in their
written expressions, especially in the discussion forums
and responses to each other. Tone of voice came through in
writing, as did respect, consideration for others, and
appropriate boundaries in personal sharing. I was able to
demonstrate professional behavior in similar ways. The
mentoring and role model aspects of the instructor–student
relationship occurred in both online and face-to-face
courses in terms of sharing case examples from my prac-
tice, mistakes I have made, and lessons I have learned, as
well as personal anecdotes as appropriate. In addition, I
offered individual feedback regarding their skills in both
formats.
However, interpersonal relationships require face-to-
face, real-time interaction. My experience supports the
findings of others that weekly synchronous meetings using
videoconferencing software in small practice classes
showed promise in addressing concerns about lack of face-
to-face interaction in online courses and adding a more
classroom-type experience (Flynn et al. 2013; Levin et al.
2013). The use of real-time videoconferencing allowed
more observation of students’ abilities and more interper-
sonal connection to occur. Videoconference interaction
allowed connection in real-time meetings through Adobe
Connect, a university-owned software program. No pur-
chase or download by students was required, and training
was provided through an online tutorial and technical
assistance by phone or live chat. A virtual room with its
own url address was assigned to each student group. The
virtual room consisted of a computer screen showing par-
ticipants’ images contained inside a series of boxes. Par-
ticipants were able to see and talk to each other in real
time, and if desired, record the discussion and post it for
others to view. Used extensively in the online interviewing
course, students met in pairs on multiple occasions to
record role-plays of beginning interviewing skills, post
recordings, and discuss them online. These provided
opportunities for observation of students’ development of
use of self, interviewing and teamwork skills, cultural
competence, and use of feedback.
Students also used Adobe Connect for small group
activities that were similar to those in face-to-face courses.
They met in virtual group meeting rooms, and the group
product was shared with the entire group through online
discussion forums. For example, in the gerontology course,
small groups investigated different countries’ elder care
policies and compared their findings in a discussion with
the entire class of changes needed in US policies. In
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addition, for all online courses, Adobe Connect was used
for online office hours and several scheduled real-time
meetings with small groups of students to discuss the
course and talk in real time.
Therefore, the quality and quantity of online interaction
differed from its on-campus counterpart, with online
interaction having a higher volume, more even distribution
among students, as well as more reflection and engagement
with the course material. At the same time, asychronous,
written communication takes more work and lacks the
immediacy of real-time verbal dialogue. Interpersonal
connection remains one of the most challenging areas for
online instruction in clinical social work. As the world
becomes increasingly technology-dependent, online inter-
action has become second-nature to social work students
and faculty. However, although high quantity and quality
interactions occur online, the central role of interpersonal
relationships in clinical social work suggests that ongoing
efforts are needed to incorporate real-time interactions, and
some face-to-face components are needed in any social
work program that has an online clinical track. While it is
possible that online students will have fewer interpersonal
skills upon graduation compared to their on-campus
counterparts, videoconferencing adds significantly to the
quality of interpersonal interaction, and refinements of this
technology will likely make online interaction between
students and instructors more comparable to face-to-face
interactions in the future.
Skill Development
Another significant challenge of online courses highly
relevant to clinical social work is adapting the use of role
plays to teach skill development. Learning to effectively
and ethically build rapport with clients, conduct thorough
assessments, develop and implement effective intervention
plans, as well as end well with clients are core skills of
clinical work for which actual practice is necessary. Sev-
eral adaptations for online students were used to provide
experiences comparable to face-to-face role plays. How-
ever, there were some limitations.
Preparing students for role-plays by having them
observe and critique others can be accomplished effec-
tively in online courses. In face-to-face courses, students
observed the instructor role play with a student or watched
video-recorded interviews. For online courses, profession-
ally recorded role plays specifically designed for the
assignments were developed using the university’s media
production unit. For example, online students in the diag-
nostic assessment course viewed professionally recorded
role plays of a suicide assessment interview and a mini-
mental status exam interview, which stopped at key points
and required students to write what they would say or ask
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next. Their responses were automatically collected into a
document submitted to the instructor for feedback, and
discussion followed with classmates. In the online inter-
viewing course, students watched and critiqued video-
recordings of faculty members conducting role play inter-
views. Video-recordings of depression and substance abuse
screenings with older adults found on websites, such as the
Gero-Ed Center site, were also viewed by the gerontology
students (Council for Social Work Education 2014).
Adaptations were also needed for student role plays.
One adaptation used effectively was for online students to
complete role plays with a friend, family member, or col-
league, record them, and post the recordings on the course
website for classmates and instructor to view and discuss.
For example, in the interviewing course, face-to-face stu-
dents practiced nonverbal communication skills in class
with each other involving eye contact, body posture, and
facial expressions. Online students recorded and posted
their practice of the same skills with a friend or family
member and discussed them online. This was repeated with
skills of reframing and relaxation techniques.
For both formats of the interviewing course, the central
assignment was a video-recorded simulated client inter-
view in three sections, in which students demonstrated
skills of building rapport, obtaining informed consent,
exploration, assessment, intervention, and ending with
clients. In the face-to-face format, students formed groups
of three and took turns playing the roles of client, social
worker, and supervisor. They video-recorded their role
plays while physically together outside of class and showed
them during class, receiving feedback. Since online stu-
dents were not able to physically gather in one location,
they each selected a colleague to play the client role instead
of a classmate, but also video-recorded it and posted it. In
pairs, they played the role of supervisor to evaluate each
other’s role plays. The limitation was that online students,
being in different physical locations, could not effectively
role play with each other using videoconferencing soft-
ware, as it was not comparable to a face-to-face interview.
This was primarily because the software does not allow
direct eye contact, as each person is looking into a webcam
rather than at the image of the other person’s face. The
image is also usually limited to the person’s head and
shoulders. However, role playing with colleagues worked
well, and the quality of online students’ basic interviewing
skills demonstrated in this project were indistinguishable
from those of face-to-face students.
The gerontology course included a service-learning
component for building clinical skills in both the online
and face-to-face formats. Students were paired with older
adults in their communities and developed skills to com-
municate effectively and assess functioning, using a variety
of tools and concepts learned in the course. Discussion of
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real-life examples of skill-building provided lively and
relevant content that rivaled that of role plays.
Therefore, current technology allowed role plays in
these online courses to be used as effectively as in face-to-
face courses. Adaptations were needed, requiring work and
training for students and instructor. In addition, the online
use of role plays did not allow the live instruction that is
possible in synchronous, face-to-face classrooms, during
which the instructor is able to stop the role play at key
moments, provide feedback, and elicit student feedback.
Synchronous videoconferencing also does not allow stu-
dents to be in the same geographical location to conduct in-
person role plays. However, for basic interviewing skills,
diagnostic assessment, and a graduate introduction to ger-
ontology, the adaptations were effective. New technologies
show potential for improving online capacity for role play,
including an expanded bulletin board that allows live
instruction and virtual avatars (Flynn et al. 2013; Shibus-
awa et al. 2006).
Technology
The adaptations used in these three courses were highly
technology-dependent. The quality of the videoconferenc-
ing technology and equipment used, as well as the
instructor’s and students’ ability to use it effectively, were
significant factors in the quality of the courses and their
capacity to teach and learn clinical skills. Although it was
my experience that current technology was effective in
teaching the clinical skills focused on in these courses,
there were limitations that must be considered, especially
for use in courses that teach more advanced clinical skills.
Levin et al. (2013), who held weekly synchronous class
meetings using videoconferencing software, described
issues regarding image resolution quality and less oppor-
tunity for nonverbal communication, which I also experi-
enced. Microphones and webcams varied in quality and
sometimes resulted in low visibility and highly variable
voice volumes, and simultaneous eye contact was not
possible since each participant was looking into the web-
cam. New devices that make eye contact possible in web
conferencing are beginning to be developed, and when
these are perfected, they may make individual interview
simulations more viable while students are located in dif-
ferent physical locations. However, for role plays that teach
more advanced skills, such as family or group intervention,
students in different physical locations using current vid-
eoconferencing software will still view each other in boxes
on a computer screen.
Use of avatars in 3-D virtual worlds allows students in
different physical locations to create online self-represen-
tations that interact virtually. Wilson et al. (2013) described
using virtual simulation as part of a face-to-face course to
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Clin Soc Work J (2015) 43:225–235
teach direct practice skills used in home visits. While the
authors found this technology promising in skill practice
and role-play, they noted that considerable time was nee-
ded for training students and faculty before they could
focus on skills acquisition. Using existing class time to
learn the technology detracts from other course content. In
addition, universities must have access to this technology
and provide technical support for students and faculty for it
to be successful. It is possible, as this technology evolves,
that training could be provided as part of an extensive pre-
program orientation to equip students to use it in several
courses. However, its effectiveness in teaching clinical
skills in fully online courses has yet to be determined.
Gatekeeping
Academic honesty is extremely relevant to clinical social
work, given the significance of ethical clinical practice.
The prevalence of academic dishonesty issues was the
same in both formats, and they were addressed similarly.
Assessments included papers, essays, and skills demon-
strations, not objective exams. Therefore, academic dis-
honesty concerns tended to focus on plagiarism.
Antiplagiarism software was used in both formats. The
class sizes, ranging from 16 to 25, allowed detection of
plagiarism or inconsistencies in assignment quality. Dis-
cussion content also revealed whether students had read the
material or watched the assigned videos. The amount of
written communication in online courses allows for an
increased ability for the instructor to know a student’s style
and quality of work, also enabling detection of dishonest
practices.
Resources
Delivery of these online courses took approximately twice
the time needed for their face-to-face counterparts.
Because interaction and observation of practice skills are
especially important in clinical social work courses,
instructor presence was more intense, requiring more time
for course delivery. A review of the literature on this topic
by a group of social work faculty highly experienced in
online teaching (Pelech et al. 2013) revealed reports of up
to 40 % more time required. They pointed out several
influencing factors, including instructor experience, extent
of interaction desired, and class type and size. They rec-
ommended a class size of 25–35 for online courses and
smaller sections for practice skills courses. For the courses
described here, class sizes ranged from 16 to 25. Online
advanced clinical skills courses need smaller class sizes.
One fully online clinical social work program described by
Flynn and colleagues (2012) reported class sizes of 12
students.
Clin Soc Work J (2015) 43:225–235 233

Table 1 Averages of anonymous student ratings of online versus Implications

face-to-face formats
Course Interviewing Diagnostic Gerontology Online clinical social work education has both potential
assessment and limitations that are important for the profession to
Format Online F2F Online F2F Online F2F consider in light of the implications for clinical competence
and effective intervention with clients. The examples of
Overall 4.7 4.7 4.8 4.7 4.8 4.7 three online courses that deliver clinical content demon-
Student learning 4.6 4.6 4.8 4.9 4.8 4.7 strate that a well-designed online course with sufficient
Instructor enthusiasm 4.7 4.7 4.9 4.8 4.6 4.7 structural and technological support has the capacity for
Individual rapport 4.7 4.8 4.8 4.8 4.8 4.7 effectively teaching skills in foundation-level interviewing,
Course organization 4.7 4.8 4.8 4.8 4.6 4.8 beginning intervention, diagnostic assessment, and practice
Assignments 4.6 4.6 4.5 4.7 4.7 4.4 with older adults. Content can be presented in highly
Scale of 1 (lowest) to 5 (highest) engaging ways, using media-rich and varied methods, and
F2F face-to-face expectations can be rigorous, making the content quality
comparable to face-to-face courses. Most assignments and
assessments are identical or very similar, and many
Impact on Students, Educators, and Clinical Social learning activities used in face-to-face delivery can be
Work creatively adapted to meet their objectives in online cour-
ses. Academic honesty issues are not significantly different
Therefore, the online experience for students in these and can also be handled similarly.
courses compared favorably with their on-campus coun- Online courses require intensive instructor presence in
terparts (Table 1). Based on my experience in these cour- frequent, consistent, and highly responsive interaction with
ses, the impact of online content delivery on students students and a variety of structured and well-facilitated
includes increased access to graduate social work educa- opportunities for student interactions. When these elements
tion and increased flexibility in where and when they are present and real time meetings using videoconference
complete coursework, while they can also expect that more software are included, the quantity and quality of interac-
time, money, and self-discipline will be required to be tion may surpass face-to-face formats in terms of increased
successful. They will experience comparable quality of student participation and more thoughtful, considered dis-
content, a greater quantity of written, asynchronous inter- cussion. However, because online discussion is written,
action, and more engagement in the material. While online asynchronous, and occurring over a week’s time, it is less
students can expect to be mentored and receive feedback spontaneous and immediate than face-to-face dialogue and
on their skills and professionalism, they will experience requires more work to sustain and to compensate for lack
more loneliness and work harder for interpersonal inter- of nonverbal cues. Given the reduced opportunities for
action with their instructors and peers. Online instructors face-to-face interaction among online students, the cohort
can expect to discover, develop, and use their creative model may be more important for this format. Mentoring
abilities to engage students in this format and to develop and role modeling can occur in online interaction, but
the interpersonal relationships needed for clinical social increased quality and ease of use of videoconferencing
work education. They can also expect to work harder and software may enhance these possibilities. The central
longer for course development and delivery, structuring reliance on technology also heightens the importance of
their time to allow for more intensive instructor presence technological infrastructure, effective learning manage-
throughout each week. The potential impact on clinical ment systems, instructional design guidance, and appro-
social work is positive in terms of a greater number of priate equipment and training.
social workers able to move into clinical practice, partic- Of particular importance for clinical content is effective
ularly in rural areas, providing more clinical services to skill instruction, which frequently includes in-class role
rural clients. The field can also expect clinical social plays in face-to-face courses. Videoconference software
workers who are better skilled at online aspects of practice, makes role-play a viable option in online courses with
with foundation level skills comparable to on-campus some adaptations. However, it requires time for training,
students, but possibly a steeper learning curve in advanced does not allow simultaneous eye contact or the live
level skills going into their field placements and clinical instruction possible in the face-to-face classroom, and
supervision after graduation. The risks for the field lie in some technological barriers impair the quality of the
sub-quality online programs and fully online clinical tracks interaction. One alternative to fully online practice courses
graduating social workers who go into clinical practice ill- recommended in the literature is to include face-to-face
prepared and therefore potentially harmful to clients. components for teaching these skills, such as intensive

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weekend skills institutes or students meeting with mental
health professionals in their communities for role play
practice (Cummings et al. 2012; Siebert et al. 2006). One
fully online program description appeared to support this
idea, as students are required to have in-person training in
interviewing before their first field placements (Flynn et al.
2013). Further support comes from the evaluation of a fully
online advanced standing MSW program with a clinical
focus that indicated that online students may not have
sufficient opportunity for skill development (Wilke and
Vinton 2006). Regan and Youn (2008), in their literature
review of clinical social work education, concluded that an
entirely asynchronous Web-based program was not yet
recommended for teaching clinical skills.
My experience was that foundation level direct practice
skills and diagnostic skills can be effectively taught online
using existing technology if the quality is rigorous, but that
technology has not developed to the point that other
advanced practice skills, such as family and group inter-
vention, can be effectively taught without a face-to-face
component. This is primarily due to the need for in-person
practice of these skills, which is not possible or practical in
a fully online format using current technology. Although
videoconferencing software allows several people to be in
a virtual room together, the quality of the experience does
not adequately simulate an actual family or group meeting.
New and developing programs, such as 3-D virtual worlds,
may improve these experiences and render them closer to
reality. However, until these technologies are further
developed and researched, and do not require substantial
classtime for training, learning advanced practice skills
requires a face-to-face component.
Providing quality online education for clinical social
work skills is a time- and resource-intensive endeavor.
Given the appeal to universities and social work depart-
ments of cost savings in brick and mortar structures and
increased tuition fees, the risk is that online formats will be
developed without the required infrastructure and resour-
ces, resulting in poor quality curricula, high faculty
workloads, and graduating social workers poorly prepared
to become clinical practitioners. Clinical social workers
must insist upon standards of quality and effectiveness that
include technological infrastructure and support, appro-
priate class sizes, and instructor workload adjustments.
Future Research
Research in several areas is needed to clarify the effec-
tiveness of teaching clinical skills online. Comparison of
models of Web-based learning of clinical skills, including
variations of blended (asynchronous and synchronous) and
hybrid models (partially online and partially face-to-face)
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Clin Soc Work J (2015) 43:225–235
is vital. To establish standards of quality, further exami-
nation is needed into which clinical skills are effectively
taught online and which are not, as well as the elements
required for effective online learning of clinical skills,
including structural and technical support, course design,
instructor presence, student learning styles, and class size.
Finally, as suggested by Regan and Youn (2008), practice
outcomes need to be measured to determine effectiveness.
Possibilities include evaluation of clinical skills by an
independent expert (Ouellette et al. 2006), field instructors
(Wilke and Vinton 2006), and/or employers of alumni. The
effectiveness of technological tools also needs systematic
study. For example, research to determine how effectively
clinical skills used in 3-D virtual worlds transfer into face-
to-face interactions are needed. The quality of current
videoconference software also needs to be examined sys-
tematically in terms of its effectiveness for use in advanced
clinical social work courses.
Conclusion
The growth in online clinical content delivery significantly
affects the quality of clinical social work education. Because
of the ultimate impact this has on clients, it is imperative that
we assure that the impact is positive. As such, we must not
underestimate or overestimate the potential of online social
work learning of direct practice skills or the capabilities of
the technology that plays such a central role in online for-
mats. If we overreach the potential, the danger is poorly
prepared clinical social workers and harm to clients.
Underestimation, however, means the loss of valuable
opportunities to increase access to clinical social work edu-
cation. Therefore, an approach that strongly holds to a high
standard of quality is needed. Online clinical courses must be
rigorously designed, effectively delivered with sufficient
support and assistance, utilize technology that fits learning
objectives, and demonstrate desired outcomes. Further
research on the effectiveness of online learning of clinical
skills is paramount to fulfilling its very real potential for
creatively engaging students in innovative ways, for making
clinical social work education possible for students outside
the reaches of traditional delivery formats, and thus making
clinical social work services available to more clients.
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Sally Hill Jones PhD, LCSW is an associate professor at Texas State
University School of Social Work. She has over 25 years of clinical
experience, 10 years of experience as a social work educator, and
8 years of experience teaching online social work courses.
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