The social worker's role in the hospital: seen through the eyes of other healthcare professionals

Social workers in hospitals necessarily work alongside other healthcare professionals, and the perspectives on social work held by doctors and senior nurses are relevant both to their relationship with social workers and to the smooth running of the hospital. An exploratory investigation in the East Anglian Region has produced profiles of perceived social work practice in six different patient-care categories: surgical and orthopaedic, accident and emergency, medicine for the elderly, psychogeriatric medicine, psychiatry and paediatrics. The social worker's functions are recognized as including statutory responsibilities in child protection and mental health, and there are some secondary roles that often reflect a social worker's personal interest or sphere of expertise. The social worker's primary role, however, is deemed to be that of discharge planning - a task which has been given statutory force under the National Health Service (NHS) and Community Care Act 1990. The nurses and doctors interviewed rated the quality of social work practice predominantly by the extent to which the social worker was seen to identify unambiguously with the hospital and its ethos; but they also set great store by the presence and easy accessibility of a social worker, and they preferred regular contact with the same person. They saw the social worker as a key agent within the health care framework, and acknowledged that the social care role and the social worker's link with the community were crucial components of good hospital practice.     

Key factors impeding discharge planning in hospital social work: an exploratory study

Despite its long historical tradition in Northern Ireland, there is a dearth of research studies on the role of hospital social work and the professional challenges involved at the health and social care interface. This is the first small-scale exploratory study in Northern Ireland that sought to identify the key factors that hospital social workers perceive as impeding their practice in the discharge planning process. A 15-item postal questionnaire was developed and distributed to 30 hospital social workers from four hospital social work departments in a city in Northern Ireland. The study group comprised social workers based in a range of hospital directorates who had differing levels of hospital social work experience. Data generated from the questionnaires suggested that deficits in community resources impacted most negatively on social workers' practice in discharge planning. The length of time respondents had been in their current post was also shown to influence their responses to the perceived impediments in their discharge planning role. The implications of the study and recommendations are discussed in relation to in-service training, social work practice and continuing education in Northern Ireland.     

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.     

The Use of Theoretical Constructs and Research Data to Establish a Base for Clinical Social Work in Health Settings

This article suggests a means for organizing a base for clinical social work practice in health settings. Membership, as a theoretical construct, is used to explore the essentials of social work, to explicate its key practice concepts, and to review characteristics of the health field. Selected findings from a secondary analysis of data from the New England Regional Survey of Social Work Practice are considered with reference to theory and essential concepts of health social work practice. Questions are raised and implications drawn for the practice of clinical social work in health settings and for education for that practice.     

Changing needs of patients and families in the acute care hospital: implications for social work practice

Much attention has been given in recent years to changing reimbursement for hospital care, shortened lengths of stay, and changes in the delivery of health care. The corollaries to these changes are more restrictive admission criteria, increased severity of patient illness, and changes in patient care. The purpose of the present paper is to describe the inpatients who remain in the acute care hospital, and to examine both how the patients and families in need of social work consultation are identified and the implications of these methods of identification for social work practice.     

Reducing older patients' reliance on the emergency department.

Older adults tend to avoid mental health services and rely on hospital emergency departments for medicalization of these conditions. An intervention was designed for use in emergency departments to refer older adult patients with mental and social health problems to appropriate services within the hospital and community. Most of the patients in the study used the services to which they were referred; further, the intervention was found to decrease repeat utilization of the emergency department. Social work practice and policy implications of the findings are also discussed.     

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.     

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.     

Challenges in the new prospective payment system: action steps for social work in home health care

The Balanced Budget Act of 1997 changed the reimbursement rules for Medicare home health benefits from a fee-for-service system to a prospective payment system (PPS). As with Medicare's hospital reimbursement system, home health agencies have to provide appropriate and adequate care for a flat rate reimbursement for each patient. As a result coordination and collaboration among all members of the home health care team (that is, nurses, social workers, physical therapist, occupational therapist, speech therapist, and home health aides) is critical to provide home care for frail and chronically ill populations. The authors provide background on the PPS, home health care, and social work roles in home health care and propose policy and research action steps for the social work profession.     

Hospital social work and discharge planning: an exploratory study in East Anglia

An exploratory research study in one district health authority demonstrates the significant impact of the NHS and Community Care Act 1990 on hospital-based social workers. Their work is overwhelmingly concerned with the discharge planning process, in which they have developed patterns of collaboration with a range of other professional groups while retaining a specific commitment to the interests of the patient and carers. The social workers interviewed differ in the degree to which they feel a sense of corporate identity with the hospital and the healthcare system. The study identifies five practice elements in the social worker's range of responsibilities: interdisciplinary collaboration, assessment, providing a link between hospital and community, networking and negotiation, and the use of financial acumen. Two areas of debate and dissonance are identified: counselling is not now something that looms large in the social worker's daily round; while the defence of patient rights sometimes involved the social worker in conflicting relationships with other professional groups.     

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.     

Hospital Social Work and Community Care

SUMMARY

This paper presents the findings of an exploratory research study which considers the effect of organisational change on social work practice in hospitals in four local authorities in England. Its aims were (1) to obtain the views of hospital social workers and their managers about the effect of implementing the NHS (National Health Service) and Community Care Act of 1990 and policies for Care in the Community on the practice of social work and (2) to elicit issues of concern to form the basis of a national study.

Semi-structured interviews were carried out in hospital social work departments which were providing a service to adults with health needs. Interviews with a representative sample of 85 workers and 36 managers (including Assistant Directors and Principal Training Officers) in 11 hospitals were held between June-December 1993, three months after the introduction of the policies. The interviews were tape-recorded and transcribed, A questionnaire provided some quantitative data, and additional information was obtained through non-participant observation at team meetings.

The interviews covered four topic areas: the nature of social work in hospitals; the changes introduced by implementing the legislation; the management ofthat change; and the effect of the new policies on practice.

Results show an increase in the volume of referrals particularly in assessment for nursing home care; and an overwhelming amount of administrative work to process the new procedures for providing community care. Most relates to filling in forms, duplication of assessments and repetitive bureaucracy. Workers struggle to meet their expectation of professional practice with organisational demands.

The discussion centres on three issues raised by practitioners: the changing nature of social work due to the alternative models of service being imposed by local authorities; the lack of consultation and involvement by management of the frontline workers in the management of this change; the dissonance felt by hardworking and committed practitioners to whom the increasing paper work is yet another obstacle to user involvement.

This may have clear implications for management, for the degree of stress and perceived pressure resulting from these organisational changes is counterproductive to job satisfaction. If the reforms are not to be undermined, they need proactive management. This requires a sensitivity to workers¹ needs, investment in training and working together to integrate the care management role into social work practice.     

Social work practice with children in the United Kingdom: Trends and issues for the 1990s

This article examines the effects of major new legislation on services for children in the United Kingdom. The Education Reform Act #op1988 and 1993#cp and the Children Act #op1989#cp operate under different principles, creating tensions and difficulties for social work practice. The authors examine challenges facing social work practice in relation to educational social work issues and children in public care. The article argues that traditional social work services for children are threatened by the delivery of welfare designed under notions of a market economy, further adding to disadvantage for children.     

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.     

Social work practice with children in the United Kingdom: Trends and issues for the 1990s

This article examines the effects of major new legislation on services for children in the United Kingdom. The Education Reform Act #op1988 and 1993#cp and the Children Act #op1989#cp operate under different principles, creating tensions and difficulties for social work practice. The authors examine challenges facing social work practice in relation to educational social work issues and children in public care. The article argues that traditional social work services for children are threatened by the delivery of welfare designed under notions of a market economy, further adding to disadvantage for children.     

INTERDISCIPLINARY LEARNING IN THE REHABILITATION HOSPITAL

A project designed to teach effective collaboration to professional students in patient-centered health care included as one evaluative measure retrospective interviews with patients, preceptors, and students. This paper analyzes those responses that have implications for social work, reports on the rehabilitation hospital as a social setting, and identifies factors that enhanced or interfered with learning. Interviews highlighted student and preceptor roles as clearly reciprocal and the importance of students bringing to collaborative practice a sense of their own professional identity, skills, and knowledge base as resources to be pooled in team activity.     

Hospital Social Work in Australia: Emerging Trends or More of the Same?

Social work in health care has been established for more than 100 years and is one of the largest areas of practice for social workers. Over time, demographic changes and growth in the aging population, increased longevity rates, an explosion in rates of chronic illness together with rapidly increasing cost of health care have created serious challenges for acute hospitals and health social workers. This article reviews the Australian health care system and policies with particular emphasis on the public hospital system. It then examines current hospital social work roles, including the continued role in discharge planning and expanding responsibility for emerging client problems, such as patient complexity, legal, and carer issues. The article concludes with a discussion of evolving issues and challenges facing health social work to ensure that social work remain relevant within this practice context.     

Health education for social workers: a primer

Health education, as a discipline and specialization, is often overshadowed by other branches of public health (e.g., bio-statistics, epidemiology, and policy management). Although social workers have been performing health education for decades, social work students may not know the history of health education as a practice profession and its uses in a social work context. The purpose of this article is to introduce the field of health education to social work students who are currently, or anticipate, practicing health education in their careers. We conclude with implications for social work education and a discussion about the impact of collaborative social work and health education efforts in the reduction of health disparities.     

Health Education for Social Workers: A Primer

Health education, as a discipline and specialization, is often overshadowed by other branches of public health (e.g., bio-statistics, epidemiology, and policy management). Although social workers have been performing health education for decades, social work students may not know the history of health education as a practice profession and its uses in a social work context. The purpose of this article is to introduce the field of health education to social work students who are currently, or anticipate, practicing health education in their careers. We conclude with implications for social work education and a discussion about the impact of collaborative social work and health education efforts in the reduction of health disparities.     

Crossing the organisational divide: family support services

The 1989 Children Act has consolidated and in some cases considerably extended the duties and responsibilities of social services departments. A major departure from earlier approaches is a central and explicit focus on the need for family support work, which is now to be undertaken within a broader framework than in the 1963 and 1980 legislation. In addition to the emphasis on providing services for children in their own families, there are new requirements for local authorities to work in partnership with voluntary agencies and other key statutory organisations, particularly health authorities and trusts. The 1989 Act needs to be reviewed in the context of parallel legislation, especially the NHS and Community Care Act (1990) which puts new emphasis on the process of planning, through the mandatory requirement for community care plans. Children's services plans are comparable although without mandatory requirement. A picture is slowly emerging of the extent to which social services departments, and health authorities and trusts are collaborating to plan and provide services. This paper outlines the new legislative framework; reviews the evidence available from the national study of the implementation of Section 17 of the Children Act (the ‘children in need’ clauses) on social services and health planning activities; reviews the SSI (1994) survey on children's service plans, providing a case example of policy and practice in one local authority; and assesses the progress made so far.