TRAUMA CENTERS

The development of the trauma center is one of the latest concepts in the delivery of emergency medical care. This paper proposes that social workers can play an important role in the initial management of trauma patients and their families. Through assessment, consultation, and direct intervention, social workers can provide a psychosocial component to trauma care. A prototype of a trauma cancer center is discussed, along with case examples and implications for the role of social work.     

Social work at the heart of the medical team

This paper proposes one model of hospital social work delivery services that places social work in a facilitative role within the medical team, and describes a pilot project designed to evaluate these services. Social work's role in this teaching hospital setting was tailored to provide patients and medical staff access to social work services upon admission, rather than at the time of discharge. This change places social work at the pivotal juncture to improve medical care and addresses the social, cultural and environmental concerns as they surface during patient stay. Unique to this demonstration model is the added advantage of placing the social worker at the hub of the physician-led medical team. Medical students, residents, and attending physicians all learn, observe, and experience the advantages social workers bring to the process. Educating medical students on teams with social workers bodes well for the profession. The authors summarize the program design, results and implications for social work practice in a teaching hospital setting.     

Cultural sensitivity in social work practice and research with children and families

As children develop in an increasingly heterogeneous culture with multifarious influential factors and choices, social workers need to adjust their clinical practice and scientific pursuits accordingly. This article addresses the need for cultural sensitivity on the part of professional social workers in both practice and research capacities. Cross-cultural issues are unavoidable when serving and studying children and their families in any capacity. The authors discuss professional self-examination and awareness of personal biases and prejudices as an important area of focus to enhance sensitivity to cultural diversity. Additionally, they address issues surrounding cultural sensitivity in the context of client#shparticipant attendance, needs, attitudes, values, and motivations. Without attending to features inherent in the families we serve and study, social work services will not be properly delivered, and research will be inaccurate and#shor incomplete. Avoiding such unfavorable outcomes is key to assuring the health and well-being of the next generation of children.     

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.     

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.     

Social work and dentistry in clinical, training and research collaboration

The knowledge and knowledge building skills of social workers can improve in three ways the quality and type of services provided to dental patients. First, social workers can be involved in the training of dental professionals so as to improve their interactions with patients. Second, social workers may provide social work clinical services to dental patients. Finally, social workers can conduct research that can add to the body of knowledge on patient behaviors relevant to dental treatment. This paper outlines a program conducted by social workers that incorporates all three of these activities.     

Community care: changing the role of hospital social work

Health and social services have been subjected to many changes over the past decade. Legislative reforms in the National Health Service (NHS), the implementation of policies for care in the community, and the transfer of funding for social care have given Local Authorities the lead role in the assessment of need and development of a mixed economy of care. The challenge for the organization and management of health social work is how to adjust to the change, whilst ensuring that increased choices are made available to users. It raises questions as to whether the reforms will provide a real opportunity for innovation or lead to a different form of rationing of services—a ‘top-down’, imposed, technocratic solution to reducing public spending. This paper presents the findings of an exploratory research study which considers the effect of organizational change on the provision of hospital-based social-work services to adults with health and social care needs in four Local Authorities in England. Local Authorities have responded differently; some have integrated care management within a social-work perspective; others have moved towards employing care managers who need not be qualified social workers. Change is proceeding slowly, not surprisingly, for none has been wholeheartedly enthusiastic. This paper examines the limited evidence on how social-work managers and practitioners are meeting the changes imposed upon them. Managers are more optimistic and see the changes as challenging, offering opportunities for acquiring new knowledge and different skills; workers are more pessimistic, fearing that preventive, professional practice will be eroded, disempowering users. Both are in agreement that the process has been stressful and that the practice of social work in hospitals has changed.     

Health and labor-power: a theoretical investigation

In this historical materialist analysis of health and medical care, health is defined as a component of labor-power (capacity to work). Investment in health, including provision of medical services, represents part of the cost of maintaining the labor force. The primary determined of the level of health and medical care under capitalism is the tendency toward maximization of the rate of exploitation. The absolute level of health and medical care tends to decline as unemployment rises and individual workers become more "replaceable." Health differentials by socioeconomic status are similarly explained by the easier replacement of lesser-skilled workers. Medical care services in the context of the capitalist system constitute a drain on surplus-value. In periods of economic decline, attempts are made to conserve surplus-value through reductions in medical services ("social wages"). Institutional and ideological racism yields additional surplus-value savings and weakness public resistance to medical care retrenchment. The profits of health-related industries are shown to be merely partially recouped surplus-value losses. The social epidemiology of capitalism has been characterized as social murder. "Public health" measures appropriate to this systemic pathology are suggested.     

The ecology of social work departments: empirical findings and strategy implications

Despite the fact that social work departments are dependent upon hospitals for resources and support, little research has been conducted to analyze organizational factors that promote or impede their development. The researchers hypothesized that departments are most likely to expand in hospital settings with missions that are supportive of clinical, preventive, and community-oriented services; that stress innovation; and that emphasize hospital-funded services and programs. Further, it was hypothesized that social work services would be most likely to expand in settings where hospital administrators perceive them to be relevant to practical needs of the institution. Findings from a survey of 50 non-profit hospitals in Los Angeles County in 1980 confirm these hypotheses and suggest that social workers need to use knowledge of the organizational context to develop high-level support for their departments.     

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.     

医务社工在病房探访服务中的探索

基于某三甲医院社工在病房探访服务中的实践经验,实例分析社工在需求评估、情绪疏导、资源链接、转介与反馈、促进病友互助中的作用,总结医务社工在病房探访中的专业优势与独特意义,以期对其他医院社会工作服务的开展有所借鉴。     

以慈善助医服务为导向的医务社工职业融入

当前,医务社工在医院系统面临接受度不高、难以被理解和信任的困境。慈善文化是医院发展的软实力,慈善医疗的核心在于以患者为中心,为患者提供助医、人文服务,医务社工理应承担这部分“非临床治疗”的责任。南京市儿童医院将慈善助医变为医务社工的职业方式,社工通过临床实务工作获得职业认知,整合社会资源成为医院生产力,搭建多学科合作平台,打破在医疗系统内的融合僵局,为职业融入探索本土化路径。     

Social workers as care coordinators: Leaders in ensuring effective,compassionate care

The concept of care coordination is at the forefront of national conversations in the context of health care reform. As pediatric social workers, we are interested in how care coordination benefits our patients, and which disciplines are providing coordination services. We have determined that significant overlap exists between the work social workers are already doing in inpatient and outpatient medical settings and the literature’s definition of care coordination activities. This article outlines our process of literature review and creation of a working definition of care coordination, and frames the concepts we believe remain central to the process of care coordination.     

Knowledge and social work in health care - the case of Finland

Studies carried out in different countries have shown that there is a lack of a common and up-dated knowledge base in social work, and that social workers make use of research in their everyday practice only to a very limited extent. On the other hand it has been shown that social workers feel they need knowledge but not necessarily in the form it is produced by the researchers. This paper explores issues of knowledge and competence in health social work based on the results of a survey and a focus group interview conducted among social workers in Finland. According to the results, social workers in health care do feel they need new knowledge. Some significant differences were found in the way health social workers view the acquisition and maintenance of professional competence and in the way they seek knowledge, when compared to social workers working in the municipal social services.     

Social context for workplace health promotion: feasibility considerations in Costa Rica,Finland, Germany,Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.     

Social relations of production and consumption in the human service occupations

This paper presents a Marxist analysis of human service occupations. As the forces of monopoly capitalism increased the need for human services and destroyed the social institutions which previously satisfied those needs, employment in the human service industries grew rapidly, and may now exceed that in manufacturing. The nature of human services is discussed: production and consumption occur simultaneously; the social relations of consumption and production are closely related; and service workers play a direct social control role. These characteristics generate contradictions between service and control in service work, and between service workers' roles as both oppressed workers and oppressors. Discussions of the ideologies impacting on the relationships between workers and "clients," the dynamics of these relationships, and the struggles to which they give rise conclude the paper.     

Help seeking and barriers to utilisation of medical and health social work services among ageing immigrants to Israel from the former Soviet Union

The study aimed to examine utilisation of medical and health social work services among ageing recent and long-term immigrants, to identify barriers to service utilisation, and to examine factors related to utilisation. Participants (n = 402) recruited from a random community sample of immigrants from the former Soviet Union in Israel, aged 55 and over, residing in urban areas throughout the country were interviewed by telephone. Using an expanded framework of Andersen's behavioural model, the independent variables included predisposing, enabling and need variables, and additional variables--barriers to utilisation or difficulties encountered during utilisation of services. For multivariate analyses of the dependent variables, a linear multiple regression model was employed for utilisation of medical services and a logistic regression model for utilisation of social work services. The main findings show that utilisation rates were high for medical services, but low for social work services. Recent immigrants had similar utilisation rates of medical services but utilised more social work services than long-term immigrants. There were few barriers but numerous difficulties in utilisation of medical services, while there were barriers but negligible difficulties in utilisation of social work services. Predisposing and need variables explained utilisation of medical services, whereas a combination of predisposing, enabling and need variables explained utilisation of social work services. The findings suggest that different factors are associated with the use of non-discretionary versus discretionary (social work) services. There is a need to reduce difficulties in utilisation of medical services and to enhance awareness about health social work services among the immigrants.     

Family practice social work: a new area of specialization

Many physical problems presented to family physicians by their patients often involve psychosocial variables with stress being a major one. Though family medicine advocates a biopsychosocial focus, one that is compatible with social work, the psychosocial aspects of health are often ignored. The involvement of social workers in the private practices of family physicians to deal with such problems is discussed in this paper as a new area of specialization. Issues such as the medicine-social work gap and the financing of social work services in private family medical practice are also addressed. It is concluded that this should be considered a new area of specialization. However, social workers must take the initiative in its development.     

Social work services in home health care: challenges for the new prospective payment system era

The implementation of the Prospective Payment System (PPS) provides a unique opportunity for social workers to be better integrated into home health care. To do so, it is important for social workers to define their roles and eliminate any barriers to providing social workers services, which may improve patient outcomes. Two focus groups with home health nurses (n = 10) and social workers (n = 8) were conducted in a large urban home health agency to define social work roles and identify barriers to providing social work services. This paper categorizes the barriers to providing social work services into informational, systems/organizational, and inter-professional barriers and presents possible solutions to these barriers as home health agencies strive to provide care under PPS.     

社会工作理念与医患冲突调解机制的建立

社会工作作为一种综合性专业性的助人活动,其理念应用于医疗实践能以专业的价值观和科学的方法,通过提供各种辅导和服务,协助患者及其家属与医方进行有效的沟通,促使医疗技术和服务更人性化地满足患者的需要,从而构建和谐的医患关系。在此过程中,社会工作者针对医患关系发展的不同阶段,分别拓展出不同的工作策略,扮演不同的服务角色。