Interdisciplinary expectations of the medical social worker in the hospital setting.

Nearly 500 physicians, nurses, and social workers affiliated with four general hospitals participated in a mailed questionnaire survey designed to compare interprofessional expectations of the medical social worker role in the hospital. As hypothesized, physicians and nurses expect the exclusive role of the social worker to be more limited to working with families, resolving social-environmental problems, and providing referrals than social workers expect of their role. In general, physicians and nurses do not disagree with medical social workers on what social workers expect to do in the hospital setting; rather, they disagree more on what social workers expect to be their exclusive role. Furthermore, it does not appear that other groups discredit either the biopsychosocial health care model or social worker competency. Instead, these groups perceive the special focus of the medical social worker in the hospital as enhancing the environmental support and resources of the patient, viewing the patient's family as part of that support system. These other groups may not understand or accept the person-in-environment focus of social work.     

A career in hospital social work: do you have what it takes?

Hospitals present a variety of complex challenges for social work practitioners. Clinical social workers deal with emotionally intense and potentially draining cases in a setting where they are often faced with threats to their identity or existence. They must balance their role as patient advocates with institutional needs and be able to adjust to ever-changing models of health care delivery. Why do some social workers thrive in this environment while others struggle to survive? This article draws upon the author's twenty-year career in hospital social work to provide a "snapshot" of the clinical social work role in teaching hospitals. Included in the discussion are observations about the unique aspects of clinical practice in the hospital and strategies for surviving power struggles, turf battles and hospital "politics."     

医务社工与志愿者在医院服务管理中作用的评价

目的 通过实证调查采集患者、医务工作者和志愿者对医务社工及志愿者工作的评价,解析医务社工及志愿者在医院服务管理中的作用.方法 采用问卷调查、文献查阅、深度访谈法,调研上海市3家三级甲等公立医院获取第一手资料.结果 调查结果显示,患者、医务人员及医务管理人员高度认可医务社工与志愿者在医院服务管理的作用.结论 医务社工和志愿者在医院服务管理中能发挥独特的作用,可以增进医患沟通,缓解或预防医患矛盾,给患者更多人文关怀和增值服务,一定程度上解决了医患之间的诊治经费问题,提升服务品质,降低人力成本,应当得到全社会更多的重视.     

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.     

澳大利亚卫生资金的筹集与分配

澳大利亚的卫生服务市场是一个在政府高度调控状态下的政府部门、私人部门共存的混合体，在卫生服务的提供和卫生资金的筹集方面存在着复杂的关系。其卫生资金是指全国用于卫生服务的所有费用的总和，主要包括为患病人群所提供的卫生服务，以及以健康促进和疾病预防为目标所提供的服务费用，不包括非卫生部门用于与健康改善有关的费用(如生产、开发营养食品的费用)。根据来源可分为政府提供和非政府部门提供两大部分。     

Social Work in the Academic Medical Center:

Although the total number of social workers within the academic medical center will probably decrease because of decreasing hospital bed usage, the role for those who remain will be that of a clinical specialist, a sophisticated and adaptable practitioner who can work flexibly under minimal supervision. The valued social work practitioner will be an independent player on the health care team who assumes a significant role which no other member of that team is equipped to take. Advanced training is more important today than ever before in the evolution of social work practice in academic health care. However, this training is not now available within the parameters of the two year master's program.     

The proper contributions of social workers in health practice

Current and potential future contributions of social workers to health practice are considered at the three levels of direct service to patients, influence on the processes and procedures of the health setting and influence on its future planning and service development. The capacity of U.S.A. and U.K. social work to contribute at these levels is compared in the light of their contrasting relationships to the health system. U.S.A. social work in health care is practised as employees of the health setting or as private practitioners and contains the majority of U.S.A. social workers. It remains a specialism that sustains a major body of published work, commitment to knowledge-building, standard setting and performance review, and a psycho-social orientation shared by a growing number of medical and nursing professionals. Its approach to the health system is that of the pursuit of professional credibility in the secondary setting by adopting the professional-technical practice model of the clinician. U.K. social work since the early 1970s has been committed to generic education and practice and to the development of its own primary setting in social services departments which now employ almost all U.K. social workers. Area team social work in these departments, typified by statutory work with the most deprived sections of the population, has become the dominant culture of British social work, with implications for the occupational identity and career prospects of those social workers who are outposted or attached to health settings but no longer employed by them. British social work and its management now approach the health system from a position of organizational independence which should strengthen their capacity to influence the health system. The cultural differences between social work and medicine, however, are experienced more keenly than ever as many social workers adopt a socio-political practice model that is at odds with the professional-technical model of the clinician. Provision of social work services to the health system has become a questionable priority and raises the issue of whether much of what is now termed "health care' could more appropriately be termed "social care' and provided in a primary social work setting to which medicine and nursing would make their "proper contributions'.     

Community Fieldwork Collaboration Between Medical and Social Work Students

This article describes an educational demonstration in interdisciplinary community field experiences between social work and medical students at The University of Kentucky Medical Center at Lexington. The joint training effort involved collaboration between the medical school, the hospital social service department, the school of social work, and community social and health agencies. The pilot program in which students from different professions lived for 6 weeks in outlying rural communities served by the medical center, provided an opportunity: (a) to study the feasibility of combining a broad community health study experience with casework services in a hospital-based educational program and (b) to assess the benefits of early interdisciplinary community and clinical work between future doctors and social workers. Students saw the advantages of cooperative teamwork in studying community problems, and were able to apply classroom theory about community organization to real community situations. The organizational structure and staff resources required to carry out such a demonstration are described, and the implications of the training project are discussed.     

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.     

Understanding the critical role of social work in safety net medical settings: framework for research and practice in the emergency department

Social workers in Emergency Departments (ED) provide counseling, community resource linkage, and discharge planning. The ED is a critical intervention point for patients with multiple unmet medical, psychological, and social needs, and little or no other contact with service providers. In part because of its role as a medical safety net for underserved populations, use of the ED has steadily increased over time. There is limited research examining the utility of social services in the ED. This article provides a brief history of hospital social work and a literature review of ED social work research with the goal of advancing current research and practice agendas.     

Home health care for the elderly.

Home health services must be expanded and must include ongoing social work services. In addition to the provision of direct service, social workers are encouraged to advocate for quality home health services, to develop effective techniques for providing social services to home-care patients, to incorporate these techniques into social work education, and to become involved in the education of their medical colleagues. In this way, the home health field can begin to fulfill its goals by providing patients with quality care in the home setting, thus allowing them to remain independent and at the same time meeting their health and social needs.     

Community fieldwork collaboration between medical and social work students.

This article describes an educational demonstration in interdisciplinary community field experiences between social work and medical students at the University of Kentucky Medical school, the hospital social service department, the school of social work, and community social and health agencies. The pilot program in which students from different professions lived for 6 weeks in outling rural communities served by the medical center, provided an opportunity: (a) to study the feasibility of combining a borad community health study experimence with casework services in a hospital-based educational program and (b) to assess the benefits of early interdisciplinary community and clinical work between future doctors and social workers. Students saw the advantages of cooperative teamwork in studying community problems, and were able to apply classroom theory about community organization to real community situations. The organizational structure and staff resources required to carry out such a demonstration are described, and the implications of the training project are discussed.     

The Value of the Presence of Social Work in Emergency Departments

The value of the presence of social work in emergency rooms is supported by directly examining the hospitalization rates of patients seen by social workers. It utilizes a 3-year-long data set of social work self-reports on medical emergency room outcomes at a large, teaching hospital in the New York Metropolitan area with a sample size of 3370. The study findings suggest that social workers in this acute care hospital's emergency room often are referred the most complex cases. The data on this site indicate that the majority of social work dispositions were to home (54%) or a nursing facility (8.4%). Only 16% of the patients seen by social work were admitted to the hospital. These findings support the cost-effective nature of social work in the emergency room setting and the importance of finding alternatives to hospital admissions. The results of a logistic regression suggest that the criteria used by social workers to assess patients are based on sound psychosocial factors. Patients who were assessed as having “Environmental” (p = .00) or “Relationship” problems (p = .00) were much less likely to be admitted. Conversely, patients with “Care/ADL” problems (p = .00) and behavior problems (p = .00) had a heightened chance of being admitted. Being African American has less effect but was still relevant.     

Understanding the Critical Role of Social Work in Safety Net Medical Settings: Framework for Research and Practice in the Emergency Department

Social workers in Emergency Departments (ED) provide counseling, community resource linkage, and discharge planning. The ED is a critical intervention point for patients with multiple unmet medical, psychological, and social needs, and little or no other contact with service providers. In part because of its role as a medical safety net for underserved populations, use of the ED has steadily increased over time. There is limited research examining the utility of social services in the ED. This article provides a brief history of hospital social work and a literature review of ED social work research with the goal of advancing current research and practice agendas.     

Using Theory to Explore Health,Medicine and Society,by Peter Kennedy and Carole Ann Kennedy

This paper, based on questionnaire data gathered in the summer of 1975, analyzes the ways in which social workers in the pediatrics departments of twenty-eight teaching hospitals define their roles and describe their activities. Data on the overall social work coverage in these hospitals is briefly described, with emphasis on hospital size, professional preparation of staff, academic rank, and staffing patterns. Within this context, data analysis focuses on the extent to which pediatric social workers exercise autonomy in direct service, teaching, and research. Areas on the pediatric service which are examined include worker-bed ratios, direct practice coverage, and participation in grand rounds, medical rounds, policy-level committees, teaching, and research. Social work role priorities and obstacles to quality role performance are also discussed.     

Social work in the veterans administration hospital system: impact of the work

Social workers in the Veterans Administration (VA) hospital system are faced with numerous challenges to best address the ongoing health and mental health needs of those who serve in the military. Social workers in the VA system serve diverse roles on the multidisciplinary medical teams and mental health services and are integral to the VA hospital environment. Most social workers feel positive about their work and their contributions to the care of the military. Despite positive feelings about their work, social workers are also prone to compassion fatigue and burnout as the work, especially with returning veterans from Afghanistan/Iraq, often extracts a toll. This article details the experience of social workers in the VA hospital system; it describes the impact of the work on the social workers, noting levels of compassion satisfaction, compassion fatigue, and burnout.     

Social Work in the Veterans Administration Hospital System: Impact of the Work

Social workers in the Veterans Administration (VA) hospital system are faced with numerous challenges to best address the ongoing health and mental health needs of those who serve in the military. Social workers in the VA system serve diverse roles on the multidisciplinary medical teams and mental health services and are integral to the VA hospital environment. Most social workers feel positive about their work and their contributions to the care of the military. Despite positive feelings about their work, social workers are also prone to compassion fatigue and burnout as the work, especially with returning veterans from Afghanistan/Iraq, often extracts a toll. This article details the experience of social workers in the VA hospital system; it describes the impact of the work on the social workers, noting levels of compassion satisfaction, compassion fatigue, and burnout.     

Evaluating social work discharge planning services for elderly people: access, complexity, and outcome.

The discharge planning role of hospital social workers has become increasingly important in services to elderly people. This article examines three issues: (1) the extent to which elderly people most in need receive social work services, (2) the extent to which the discharge planning performed is a professional task, and (3) the effectiveness of discharge planning for those who return to their homes after hospitalization. The study focused on 1,100 elderly patients from five Baltimore hospitals. Data were gathered from their social workers, from the patients themselves (by phone after discharge), and from medical records. Results show that only a minority of elderly patients who return to the community after hospitalization receive social work services while in the hospital but that those who do are likely to have posthospital needs. In most cases, the discharge planning uses professional skills, but 28 percent of cases are fairly routine. Finally, social work services were effective in reducing the level of unmet needs in the areas of nursing, medication, and physical therapy.     

A model of interdisciplinary adolescent health care in a developing country

In Argentina, an integrated program has been developed to provide health care to adolescents in a hospital setting. In order to describe the structure and operation of the program and the constitution and dynamics of the working team, data were gathered through observations and interviews. The objectives of the program are 1) to provide adolescents with health care which integrates their physical, psychological, and social needs; 2) to detect disorders in early stages; 3) to emphasize reproductive health; 4) to strengthen families; 5) to train health care professionals; 6) to extend the program; 7) to do research on the Argentine adolescent; and 8) to collaborate with professional organizations concerned with adolescents. This report relates the evolution of the program, which has its roots in a 1973 study on the effectiveness of hospital services to adolescents, and describes the building and equipment devoted to the adolescent program. The organization of the program is discussed in terms of administration, material and financial resources, and human resources. The functions of the program are detailed and, as indicated by its goals, include health care (clinical medicine, gynecology, obstetrics, and mental health), teaching (pre/post graduate workshops, annual intensive courses, and scientific meetings), research, and community outreach. Finally, each area of medical care is described, with data tabulated for the most frequent reasons for each type of clinical and gynecological consultation. Reproductive health care includes sex education, counseling, pregnancy or postabortion care, and social services to unmarried adolescent mothers. The mental health staff offers individual, family, linking, and group therapy as well as vocational guidance, parental guidance, and psychopedagogical diagnoses. The social workers on the team interact with the adolescent in question and other professionals. In conclusion, it is noted that adolescent medicine is developing as a distinct field, and there is a need for more medical centers to provide the range of services adolescents require as well as to afford training opportunities for health care professionals. The positive results of this program based on increasing demand and user satisfaction justify the work done to create the service.