Social Workers in Pediatric Primary Care: Communication,Gender, and Scope of Practice

While many child mental health issues manifest themselves in primary care, few pediatricians have received mental health training, and their communication with social workers may be limited due to unfamiliarity with mental health professions. The purpose of this study was to use ethnographic interviews to investigate factors affecting communication satisfaction between social workers and pediatricians. The study found that scope of practice issues were a communication barrier. This barrier is significant because health reform may lead social workers and pediatricians to collaborate more frequently in the future.     

Health system factors affecting communication with pediatricians: gendered work culture in primary care

This qualitative study examined the roles that practice setting, education level, and gender may play in social workers' communication satisfaction with pediatricians. Taking an ethnographic approach, the researcher interviewed social workers and pediatricians who worked together to provide mental health services in primary care. The results suggested that gender at the health system level may be an issue and that gendered work culture in primary care was a factor in communication. In particular, reimbursement, an aspect of the gendered work culture, was a substantial communication barrier, and the implications for Medicaid billing 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.     

Interprofessional collaboration and integration as experienced by social workers in health care

Interprofessional collaboration in health care is gaining popularity. This secondary analysis focuses on social workers’ experiences on interprofessional teams. The data revealed that social workers perceived overall collaboration as positive. However, concerns were made apparent regarding not having the opportunity to work to full scope and a lack of understanding of social work ideology from other professionals. Both factors seem to impede integration of and collaboration with social workers on health care teams. This study confirms the need to encourage and support health care providers to more fully understand the foundation, role, and efficacy of social work on interprofessional teams.     

Job satisfaction and turnover intent among hospital social workers in the United States

Feelings of job satisfaction and turnover intentions among social workers affect work quality for both social workers and the people for whom they provide services. Existing literature on job satisfaction among hospital social workers is limited, and is overly focused on issues of compensation. There is job satisfaction research with hospital nurses available for comparison. Other informative social work research on job satisfaction and turnover exists in mental health and generally, across settings. Research on turnover intent in social work is primarily from child welfare settings and may not generalize. The literature notes gaps and contradictions about predictors of job satisfaction and turnover intent. Using a large national dataset of hospital social workers, this research clarifies and fills gaps regarding hospital social workers, and explores how Herzberg’s theory of work can clarify the difference between sources of job dissatisfaction and job satisfaction. Findings include hospital social workers reporting high job satisfaction and that demographics do not contribute to the predictive models. The findings do support centralized social work departments and variety in the job functions of hospital social workers, and are consistent with the theoretical framework.     

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.     

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.     

Interprofessional collaboration in the hospital: strategies and meanings

OBJECTIVES: Interprofessional collaboration is widely advocated in health and social care policies. However, existing research provides a relatively poor understanding of how professionals collaborate or the meanings they attach to their collaborative work. This paper aims to contribute to understanding of this activity by providing an in-depth account of interprofessional collaboration on medical wards in a large teaching hospital. METHODS: Ethnographic methods were used, including individual and group interviews with health and social care staff (i.e. doctors, nurses, therapists, social workers; n = 49) and participant observations of ward-based work. RESULTS: The organisation of medical teams, who cared for patients across a number of wards, and the task oriented nature of medical work, limited opportunities for collaboration with other professionals (e.g. nurses, therapists) who were usually based on a single ward. Consequently, collaboration tended to be task-based, terse and formalistic. Staff employed a range of informal and formal communication strategies to overcome these constraints. Professionals also gave contrasting accounts of collaboration: doctors viewed collaboration primarily as an activity involving work with their medical colleagues, whereas other professionals saw it more as an interprofessional activity. CONCLUSIONS: Temporospatial constraints and contrasting notions of 'collaboration' are important factors in shaping the nature of interprofessional collaboration. Policies that promote this activity cannot assume that shared understanding of collaboration exists. They also need to be mindful of the practical constraints that affect collaboration in hospital wards.     

Community care in practice: social work in primary health care

This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.     

Academic--practice partnerships in practice research: A cultural shift for health social workers

Academic practice partnerships in practice research support health social workers in engaging in research that is embedded within their practice. This shift in culture enables social workers to join in a health service discourse that is increasingly data -driven and focused on effective practice and demonstrated quality of care for patients. The mentoring model is described as enabling practitioners to superimpose research skills onto existing practice skills. An academic practice research collaboration can reduce the distance between research and practice, contribute to a body of knowledge for health social work and promote health social workers as 'research focused practitioners'.     

Experiences and implications of social workers practicing in a pediatric hospital environment affected by SARS

This phenomenological study's purpose was threefold: to detail the experiences of social workers practicing in a hospital environment affected by severe acute respiratory syndrome (SARS), to describe essential themes and structures of social work practices within this crisis environment, and to explore recommendations for better preparedness to meet similar crises in the future.The sudden onset of SARS in hospital settings created an immediate necessity to study this phenomenon as hospitals and health care professionals struggle to adapt to this new epidemic environment. This study is the first using qualitative research to investigate the unique perspective of social workers in an epidemic environment.The results reflect the social workers' subjective experience of their interventions with patients and families and indicate that a number of professional tenets, such as advocacy, family-centered approach, knowledge of systems, open communication, and ethics effectively supported social work practice in a crisis environment.     

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.     

Advance directive communication: nurses' and social workers' perceptions of roles

As a facet of advance care planning for future health care, advance directive communication represents an important aspect of professional health care practice with older patients. Nurses and social workers routinely discuss advance directives in acute care settings; however, communication practices by discipline are not well understood. This qualitative study explored differences in advance directive communication practices by comparing and contrasting nurses' and social workers' perceptions of their roles. Focus group interviews were conducted with nurses (n = 6) and social workers (n = 5). Five key themes emerged from the data. Findings suggest that both professions perceive primary educational roles, though their informational practices differed in content. The professionals reported differential pathways that led to their practices with patients. Both disciplines identified advocacy roles with families and providers. The practitioners reported distinct roles with families. There was mutual recognition of interdisciplinary roles. The findings suggest that nurses and social workers engage in both parallel and complementary advance care planning practices with their patients.     

Community Care in Practice

SUMMARY

This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.     

Academic-Practice Partnerships in Practice Research

Summary

Academic-practice partnerships in practice research support health social workers in engaging in research that is embedded within their practice. This shift in culture enables social workers to join in a health service discourse that is increasingly data-driven and focused on effective practice and demonstrated quality of care for patients. The mentoring model is described as enabling practitioners to superimpose research skills onto existing practice skills. An academic-practice research collaboration can reduce the distance between research and practice, contribute to a body of knowledge for health social work and promote health social workers as “research focused practitioners.”     

Social work at the Chinese Medicine system in Hong Kong: opportunities and challenges

Dealing with health and disease is an area of concern for social workers. The establishment of medical social service in a health setting has more than 100 years of history in the USA and more than 60 years in Hong Kong. Despite the increasing popularity of Chinese Medicine (CM) used by the Hong Kong people, there has been no medical social service presence in the CM system. A pilot project demonstrated a successful interdisciplinary collaboration model between social work and CM irrespective of different social work methods, that is, individual work, groupwork, and community-based services. In this article, we will relate the opportunities and difficulties that we encountered in setting up the first medical social service in the CM system. Drawing on our experience, we found that both professions benefited from the interdisciplinary collaboration. CM was able to expand its scope of service to increase the service quality and promote primary health care in the community with the support of social work. Conversely, social workers found that CM is a good resource for providing innovative services to meet the various needs of the people in the community. There was also a ripple effect of incorporating CM elements into social service. The interface between the disciplines of social work and CM can widen the scope of their contributions on health. Implications for CM social service in social work will also be examined.     

Advance directive communications practices:social worker's contributions to the interdisciplinary health care team

This article presents a comparative study about social workers' interdisciplinary advance directive communication practices with patients at several hospitals located in upstate New York. The sample consisted of physicians (n=32), nurses (n=74), and social workers (n=29). The research surveyed advance directive communication practices by discipline utilizing a self-administered questionnaire. Advance directive communication was operationalized as a cumulative process incorporating the following phases that were measured as scales: initiation of the topic, disclosure of information, identification of a surrogate decision-maker, discussion of treatment options, elicitation of patient values, interaction with family members, and collaboration with other health care professionals. Results suggest that social workers offer distinct skills in their advance directive communication practices and discuss advance directives more frequently than either physicians or nurses.     

Working on the interface: identifying professional responses to families with mental health and child-care needs

The gaps between mental health and child-care services constitute a recognised barrier to providing effective services to families where parents have mental health problems. Recent guidance exhorts professionals to coordinate and collaborate more consistently in this area of work. The present study aimed to identify the barriers to inter-professional collaboration through a survey of 500 health and social care professionals. The views of 11 mothers with severe mental health problems whose children had been subject to a child protection case conference were also interrogated through two sets of interviews. The study found that communication problems were identified more frequently between child care workers and adult psychiatrists than between other groups. Communication between general practitioners and child-care workers was also more likely to be described as problematic. While there was some support amongst practitioners for child-care workers to assume a coordinating or lead role in such cases, this support was not overwhelming, and reflected professional interests and alliances. The mothers themselves valued support from professionals whom they felt were 'there for them' and whom they could trust. There was evidence from the responses of child-care social workers that they lacked the capacity to fill this role in relation to parents and their statutory child-care responsibilities may make it particularly difficult for them to do so. The authors recommend that a dyad of workers from the child-care and community mental health services should share the coordinating key worker role in such cases.     

Educational approaches for preparing social work students for interdisciplinary teamwork on geriatric health care teams.

Interest in teamwork has fluctuated over the last several decades, with recent renewed interest. As social workers become more involved in working with older people in the coming years, their success will hinge on collaboration with other health providers. Schools of social work and clinical sites must address this through the development of educational curricula and clinical programs which prepare social workers to work on interdisciplinary geriatric health care teams. Based on the experience of the national Geriatric Interdisciplinary Team Training (GITT) Program, this article presents an overview of the necessary team skills for social workers, educational methods for teach ing teamwork developed at the GITT sites, and some teaching challenges.     

Collaborative models of patient care:new opportunities for hospital social workers

Hospitals are increasingly recognizing the importance of moving away from the traditional medical model of care to more collaborative models that integrate patients and families into the planning and delivery of healthcare. A few existing studies suggest that collaborative models of care result in higher levels of consumer satisfaction, treatment compliance, effective team performance, and increased care coordination (Gance-Cleveland, 2005; DiMatteo et al., 2002; Reid Ponte et al., 2004; Institute for Family-Centered Care, 2004). Key values underpinning social work practice make medical social workers well-positioned to play leadership roles as hospitals make the shift to more patient-centered care. Specific strategies are presented for medical social workers to use in advocating for change in the way health services are planned and delivered within hospital settings.