What factors induce health care decision-makers to use clinical guidelines? Evidence from provincial health ministries, regional health authorities and hospitals in Canada

This paper addresses three questions: What is the extent of clinical guideline utilization by decision-makers in provincial health ministries, regional health authorities and hospitals in Canada? Are there differences between these work settings in regard to the extent of clinical guideline utilization? What are the determinants of clinical guidelines utilization in health ministries, regional health authorities and hospitals? Based on a survey of 899 decision-makers from Canadian provincial health ministries, regional health authorities and hospitals, the results indicate that there are large differences between work settings in regard to clinical guideline utilization. Not surprisingly, work settings like hospitals rely more intensively on clinical guidelines than the other work settings (health ministries or agencies and regional health authorities). The results of the regression models indicate that cognitive factors, social factors, technological factors, organizational factors and individual attributes significantly predict the utilization of clinical practice guidelines by decision-makers. However, the results of the regression models also indicate that some factors that predict clinical guideline utilization by decision-makers in hospitals do not predict clinical guidelines utilization by decision-makers working in ministries or in regional health authorities. Therefore, these results suggest that customized interventions would be appropriate in order to efficiently increase the utilization of clinical practice guidelines in different work settings. The paper concludes with suggestions for future research.     

Coordinating In-Patient and Out-Patient Services

It has been observed that there are problems in the conceptual base of social workers' practice with groups in health settings. This article suggests that to develop a sound conceptual base and to improve the integration of work with groups into the operating structures for delivering social work services in health care, it is necessary to distinguish social work groups from other groups. Criteria for social work practice with groups are identified. Criteria are based on fundamental principles of social work practice in health care and principles of social work practice differentiated to take account of group processes.     

Health benefits of primary care social work for adults with complex health and social needs: a systematic review

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self‐management of long‐term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care.     

Professional Competencies and Training Needs of Professional Social Workers in Integrated Behavioral Health in Primary Care

The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform.     

When is it social work? Another look at practice with groups in health care

It has been observed that there are problems in the conceptual base of social workers' practice with groups in health settings. This article suggests that to develop a sound conceptual base and to improve the integration of work with groups into the operating structures for delivering social work services in health care, it is necessary to distinguish social work groups from other groups. Criteria for social work practice with groups are identified. Criteria are based on fundamental principles of social work practice in health care and principles of social work practice differentiated to take account of group processes.     

APPLICATION OF KNOWLEDGE ABOUT PREVENTION IN SOCIAL WORK EDUCATION AND PRACTICE

The status of preventive social work in the United States is reviewed, as are the three knowledge sources used in the teaching and practice of prevention: public health, mental health, and social work. The integration of concepts of prevention in social work curricula and practice are discussed, and new directions for its use are projected.     

Application of knowledge about prevention in social work education and practice

The status of preventive social work in the United States is reviewed, as are the three knowledge sources used in the teaching and practice of prevention: public health, mental health, and social work. The integration of concepts of prevention in social work curricula and practice are discussed, and new directions for its use are projected.     

Can the Hazard Assessment and Critical Control Points (HACCP) system be used to design process-based hygiene concepts?

Recently, the HACCP (Hazard Analysis and Critical Control Points) concept was proposed as possible way to implement process-based hygiene concepts in clinical practice, but the extent to which this food safety concept can be transferred into the health care setting is unclear. We therefore discuss possible ways for a translation of the principles of the HACCP for health care settings. While a direct implementation of food processing concepts into health care is not very likely to be feasible and will probably not readily yield the intended results, the underlying principles of process-orientation, in-process safety control and hazard analysis based counter measures are transferable to clinical settings. In model projects the proposed concepts should be implemented, monitored, and evaluated under real world conditions.     

Communicating With Pediatricians: Developing Social Work Practice in Primary Care

While social work models of interdisciplinary collaboration suggest that communication is important, the research literature on social worker–physician collaboration infrequently considers work with pediatricians or practice outside the hospital setting. A cross-sectional survey was sent to a stratified random sample of social workers to assess their communication satisfaction with pediatricians. The study found that social workers in health settings were more satisfied than those in mental health settings. The implications of this finding for the development of colocated, collaborative care models are discussed.     

Social work education for health care: addressing practice competencies

The study discussed in this article examines how social work graduates are prepared to help clients and families who need health and mental health services. The study identifies recent shifts in social work practice in health care settings, calls for greater integration of practicum and classroom education, and proposes curriculum enhancement to ensure competence in three key areas: self-directed practice, population-based practice and a refocus on basic skills. Findings are based on a New York Academy of Medicine study conducted from 1997-1999 which included a survey of course offerings at 128 CSWE-accredited schools; literature review of current practice models, focus groups, and review by an expert advisory council.     

HIV/AIDS Prevention in New York City: Identifying Sociocultural Needs of the Community

This article is a call for those who design social work courses to recognize the complexity and richness of aged care social work in health care and to social workers to shake off ageist attitudes and consider working with older people as a positive option in this rapidly expanding area of social work practice. A mixture of practice experience together with findings from the literature, this article explores social work practice with older people in hospital settings. Social work with older people has both therapeutic and practical components. The importance of integrating a therapeutic approach into all aspects of social work practice with this population cannot be overestimated.     

Goodness of fit: social work education and practice in health care

This study addresses the fit between social work education and practice in health care. A random sample of NASW members identifying with health care (N = 179) responded to a mail survey about the utility of core knowledge and roles that we had identified by reviewing seven commonly used health care social work texts. Quantitative data revealed knowledge and roles most frequently used in health care settings as well as differences in roles used dependent upon department name; and different professionals supervising social workers. Qualitative data from four open-ended questions provided suggestions for what knowledge and skills should be taught in social work programs, the best forums/methods for teaching this content, and topics for continuing education. Findings are discussed in relation to six key areas of the peer-reviewed literature: vulnerable populations/diversity, ethical dilemmas, interdisciplinary collaboration, mental health, managed care/accountability, and advocacy. Implications for social work practice, education, and research are discussed.     

Social work with older people in a hospital setting

This article is a call for those who design social work courses to recognize the complexity and richness of aged care social work in health care and to social workers to shake off ageist attitudes and consider working with older people as a positive option in this rapidly expanding area of social work practice. A mixture of practice experience together with findings from the literature, this article explores social work practice with older people in hospital settings. Social work with older people has both therapeutic and practical components. The importance of integrating a therapeutic approach into all aspects of social work practice with this population cannot be overestimated.     

Applying a theory of expertise in health social work administration and practice in Australia

Social workers in health care have been urged to identify the nature of their expertise and to articulate profession specific roles (Peckuconis et al., 2003). This paper reports on the use of a theory of professional expertise (Fook, Ryan, & Hawkins, 2000) in management and clinical practice within two Australian hospital social work settings. This theory, directly applicable to social work, was applied within these hospitals to differentiate levels in social work industrial awards, in staff selection, in supervision and continuing professional development. Specific and broader implications for application of this theory are discussed.     

社会工作理念方法融入全科医师规范化培训的探讨

全科医学教育是全科医学发展的核心,我国多数医学院校临床医学教育本科阶段并未细分全科医学专业,全科住院医师规范化培训是现阶段全科医学教育的重点之一。全科医学强调“生理-心理-社会”为一体的全人关怀,社会工作作为一门社会科学,其理念方法与全科医学在目标、内容、功能、作用等方面具有趋同性、相似性、互补性和互促性。探讨从教育理念、课程设置、考核标准、管理体系等四个维度将社会工作理念方法融入全科住院医师规范化培训,丰富全科住培内涵建设,有利于帮助全科住培医师提升服务质量和医疗职业道德等水平。     

Peer counseling in health care: a collaboration of social work and voluntarism

Professional-volunteer collaboration is a growing trend in social work practice in health care. The social work profession can benefit from partnerships with volunteers to extend, enhance, and maximize the scope and quality of patient care. This article examines a program of social work collaboration with volunteers, trained as peer counselors, in a hospital setting. A model is described which provides long-term social support to chronically and terminally ill patients and their families during hospitalization and after discharge. Implications for replication in other settings are discussed.     

Preparation of social workers for a changing health care environment

Rapid changes in health care have provided the impetus for social workers to reexamine their professional preparation for effective practice in health care settings today. Faculty teaching students and field instructors were asked to indicate on a questionnaire where specific subject matter is taught to social work students: in the classroom, in the field, or in both settings. Results of the study show a communication gap between school and field and a need for teaching models that enable educators to convey more of the profession's expanding knowledge base and to prepare students to deal with concurrent demands for expertise and expediency in practice. Programmatic changes to address these issues are suggested.     

The Challenges of Health Care Reform for Hospital Social Work in the United States

This article examines the potential impact of the Patient Protection and Affordable Care Act (ACA) of 2010 on the practice of hospital social work in the United States and its implications for social work education and training. It briefly traces the history of hospital social work, outlines some contemporary issues in the health care field, particularly those that create persistent health disparities, summarizes the major provisions of the Act that have implications for social work practice, and discusses how social workers in hospital settings might respond effectively to the changes produced by the legislation.     

Best practice case management for improved medical adherence

Less than optimal treatment adherence for many health conditions impedes clinical progress, leading to increased morbidity, mortality and health care costs, particularly for low-income and racial and ethnic minority patients. When properly understood as a complex phenomenon involving patient, provider, and health system interacting factors, adherence improvement is a natural target for social work's multi-system model of case management. We present five key elements for a generic "best practice" case management blueprint applicable to a range of medical settings. The theory and evidence base for the elements are discussed and illustrated with SAFe, a tested social work case management program to improve adherence following abnormal cancer screens.