Future Trends in Health and Health Care: Implications for Social Work Practice in an Aging Society

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the “graying of America” promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.     

THE SOCIAL WORK HOME VISIT IN A HEALTH CARE SETTING

Along with many other professions, current social work interest is focused on exploring the relationship between people and their environment. When this environment is a health care delivery system, the relationships can give rise to many problems. The authors demonstrate how a social work home visit can ameliorate some of these problems in a home care setting ans suggest its applicability in other health care delivery systems.     

The future of health social work

The practice of social work in health care is at a critical juncture, and laces an uncertain future. The authors provide an overview of the challenges facing social work practice within the health care setting, as well as recommendations for enhancing social work practice and education. Challenges discussed include economic factors, demographic changes, and technological advances influencing the practice of social work in health care. The need for a proactive stance among social work professionals and educators is promoted. The proposed changes are intended to stimulate discussion and an exchange of ideas needed to maintain Social Work's relevance and integrity in the evolving health care delivery system.     

Research on organizational issues in health care social work

A rich body of knowledge spans organizational topics relevant to the practice, conceptual development and planning of social work health care services. At a time when health care organizations are experiencing major changes in their structure and financing; organizational research informs both the system adjustments and leadership which social work can offer the health care field. Organizational research on health care social work is grouped into three categories: management and administrative issues; interprofessional and interorganizational relations; and service delivery topics. Within each category, the major issues are presented with single site and multi-site research reviewed. Recommendations to improve the contributions of this body of research include greater attention to methodological rigor in designing and implementing research projects.     

Social work management in emerging health care systems

An overview of the health care industry's trend toward multihealth systems is presented and specific adaptive strategies for social work managers in health care are suggested. The challenges to social work leaders during this transition from largely free-standing, privately owned health care institutions to corporately owned, horizontally and vertically integrated delivery systems are discussed in terms of identity, style, and substance. Directors of social work departments in multihealth corporations will need to resolve issues of institutional versus corporate identity as well as those of corporate versus professional identity. A multioptional management style that incorporates networking and political expertise should be cultivated. Substantive demands in the areas of management information systems, productivity, quality assurance, and budgeting also must be addressed. The emergence of multihealth systems poses major challenges and unique opportunities to the social work profession. Awareness of managerial strategies and critical content areas can help social work leaders enhance the role and contribution of social work in these exciting and complex health care delivery systems.     

Identifying needs and setting priorities: issues of theory, policy and practice

The National Health Service and Community Care Act 1990 signalled an explicit shift away from a service-driven to a needs-led pattern of delivery for both health and social care. However, a definitive meaning of ‘need’ is elusive. Where the work of health and social care agencies is related closely, as in community care, recognition and careful handling of different approaches to need is important for effective inter-sectoral collaboration and supply of appropriate care to service users. This paper examines three dimensions of need: theory, policy and practice. Some key components of the theoretical debate about the meaning of ‘need’ are explored briefly, particularly in relation to health, and a set of questions is extracted that underpin the construction of need in policy and practice. These questions are then applied to a comparison of policy guidance documents for needs assessment for health and social (community) care. While the documents demonstrate some similarities in their view of need, there are also material differences. These differences have implications for the supply of services at the boundary between health and social care, some examples of which are discussed. Given a lack of consensus in defining and measuring need, the paper concludes with a framework of key questions which could enable purchasers and providers of health care to be more explicit about the bases upon which ‘needs-led’ services are defined and delivered.     

Education for social work in health care organizations.

The American health care delivery system stands on the brink of major change and reorganization. There are many opportunities for the social work profession to increase its influence and expand the scale of its activities within health care. These opportunities represent a challenge to the vision, creativity, and flexibility of social work educators. This article discusseses educators' roles within the context of a system conceptualization of the inputs throughputs, and outputs of education for social work in health care organizations.     

Social work in the health field.

Health care delivery systems are under careful and systematic scrutiny. Particular concerns are the availability and access of health care to those in the lower and middle income groups and the escalating costs of health care which until quite recently have exceeded annual inflationary rates of increase. Efforts in social work in the health field have reflected these developments. Programmatic trends in health and social work now emphasize ambulatory care and are reflected in the concept of primary care medicine. Deinstitutionalization as a preferred program for patients is under review with particular emphas -is on providing adequate supportive services to maintain patients in a home care environment. Social work is a major discipline contributing to these programs through appropriate interventive measures. Moreover, the role of the social worker, because of involvement with front line community activities, is particularly suited to make a substantial contribution to this trend.     

EDUCATION FOR SOCIAL WORK IN HEALTH CARE ORGANIZATIONS

The American health care delivery system stands on the brink of major change and reorganization. There are many opportunities for the social work profession to increase its influence and expand the scale of its actiuities within health care. These opportunities represent a challenge to the uision, creativity, and flexibility of social work educators. This article discusses educators' roles within the context of a system conceptualization of the inputs, throughputs, and outputs of education for social work in health care organizations.     

THE HMOs

New areas of practice are open to innovative social workers in an existing and expanding comprehensive health care delivery system-the health maintenance organization (HMO). In this article, four health plan models are described that document the experience of social workers in established HMOs. These illustration demonstrate the necessity and opportunity for expanded social work roles in humanizing and coordinating patient services in complex multidisciplinary health care delivery systems.     

The HMOs: new models for practice.

New areas of practice are open to innovative social workers in an existing and expanding comprehensive health care delivery system--the health maintenance organization (HMO). In this article, four health plan models are described that document the experience of social workers in established HMOs. These illustrations demonstrate the necessity and opportunity for expanded social work roles in humanizing and corrdinating patient services in complex multidisciplinary health care delivery systems.     

Managed care and its implications for social work curricula reform: policy and research initiatives

A multitude of social, economic, and health factors are forcing the health care industry to examine the effectiveness and efficiency of health and mental health care delivery. Managed care has emerged in this environment of cost containment, as a viable distributive mechanism for the allocation of health care resources. Schools of social work must consider additions and/or revisions to their curriculum, in order to adequately prepare social workers to practice in a managed care environment. A major barrier is the negative attitude held by many practitioners and educators towards managed care. This paper discusses the evolution of managed care, and the challenges to social work education, including the necessity for developing a more balanced view of managed care. Suggested curricular revisions are provided for two major content areas: policy and research.     

The teaching social worker in family medicine: a prototype for the hospital social worker?

The need for physicians to receive training in interpersonal skills as well as in preventive medicine to aid them in recognizing and addressing the psychosocial aspects of illness and to facilitate the delivery of more comprehensive care to patients, has been addressed in the Department of Family Medicine and several other specialties. In January, 1978 the author surveyed social work members of the Society of Teachers of Family Medicine to determine their activities and responsibilities and to identify the experiences which have proven most helpful as a preparation for their positions on medical school faculties. Results of the survey are reviewed in light of possible implications for the future hospital social worker as a medical educator.     

Social workers' role in disease management.

This article discusses social work's participation in a new paradigm for health care delivery, disease management. Attempts to improve health care quality havefocused on evidence-based methods of evaluating health care outcomes as well as quality of life issues with which social workers have been traditionally concerned. The fit between social work's ecological perspective and disease management and the needfor social workers to participate as patient case managers on interdisciplinary disease management teams are discussed. Quality and cost benefits can occur when social workers address such issues as adherence, psychosocialfactors, and depression in terms of the patient's global recovery and concurrent enhancement of quality of life. Potential barriers to disease management implementation with social work participation are discussed.     

Public accountability, quality assurance and social work.

The growing demand for public accountability and quality assurance mechanisms affords the social work profession an opportunity to take a more forceful hand in the shaping of the health care delivery system. This paper surveys the impact of public accountability developments on the practice of social work in the health care fields, analyzes what has been done in social work qualtiy assurance, and suggests some strategies for enlarging the scope of social work to include productive new endeavors. Emphasis is placed upon resolution of the conflict between medical and human service treatment models.     

Medico-social characteristics of mothers on leave to care for a child under 2 years of age

The article entitled "Medico-social characteristics of mothers on leave to care for a child" is devoted to the survey of medico-biological and socio-hygienic characteristics of mothers which are on leave to care a child up to the age of 1.5 years. Mothers surveyed were classified according to the groups of health, an estimation was provided of social factors which have an adverse effect on the health of mothers on leave to care for a child which made it possible to work out guidelines and specific measures for health care delivery aimed at mothers health protection and promotion.     

Understanding the meaning and role of gifts given to Ugandan mothers in maternity care settings: ‘The help they give when they've seen how different you are’

The provision of gifts to new mothers in Uganda is laden with significance that varies by the social location of the giver and receiver and the context and conditions under which the gift is made available. Here, we examine the act of gift giving and receiving within a Ugandan maternity care setting, describing the connections between these material objects and social relations. A study investigating the social organisation of maternity care in post‐conflict northern Uganda found that gift‐giving to new mothers functioned to create a material and discursive context wherein women's desire to access these goods was leveraged to create an incentive to attend formal maternity care during pregnancy and for delivery. In this article we describe the material and discursive processes surrounding gift‐giving to new mothers in this global South health care setting. This article contributes critical analyses of the function of gifts in healthcare settings as constructing shared identities, social differences and normative values about health citizenship, and an incentive politic that affects equitable access to maternity care. Drawing on intersectional theory and analysis of how specific practices function ideologically to reward or incentivise pregnant women, we integrate material culture studies into the sociology of women's reproductive health.     

Responsiveness to need: social work's impact on health care

Many factors and events have influenced the practice of social work in the field of health, but how has social work shaped health care delivery in turn? This examination of social work's impact indicates that the profession has succeeded in demonstrating the importance of considering the individual and his or her life as a whole in the provision of services.     

Educational Preparation for Contemporary Health Care Social Work Practice

Health and health care delivery continue as dominant issues in the United States. Health also represents a highly sophisticated social work practice area, requiring specific expertise for intervention with complex biopsychosocial patient care issues. Current social work curriculum content must reflect contemporary practice issues and educational resources must be improved to meet the documented need for adequately prepared health care professionals. This paper proposes a curriculum template for practice education and offers additional recommendations to enhance the educational process through increased field and academic collaboration.     

Social work and health restructuring in Canada and Finland

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.