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.     

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.     

Community nurses and social workers learning together: a report of an interprofessional education initiative in South Wales

Collaboration between different professional groups and agencies is an essential element in the provision of high quality community care for people with complex health and social needs. There are, however, a number of barriers to effective interprofessional working. These include: the differing structures and operational philosophies of organizations; the differing languages and values of professional groups; professional and agency rivalries; and the fact that professional groups are, still, largely educated and trained in isolation. Interprofessional learning has been advocated as a possible solution to some of these problems. In this paper the rationale, planning, delivery and evaluation of one interprofessional education initiative are presented. Twelve months of planning between a team of three university teachers working in South Wales, United Kingdom, led to a combined group of community nursing and social work students following post-qualifying courses at undergraduate diploma and first degree level participating in two shared learning sessions. Using an interactive approach the student group explored, first, professional roles and responsibilities and secondly, engaged in group work focused on the discussion of case studies. Student evaluation of the sessions indicated an overwhelming appreciation of the importance of interprofessional education in unidisciplinary education programmes.     

Opportunities for social work under the Affordable Care Act: A call for action

The Affordable Care Act (ACA) has profoundly restructured American health care. Numerous social work authors have commented on the importance of the ACA’s reforms to social work practice, education, and research. This article summarizes the literature, adds relevant information, and makes recommendations for future actions. The policy, opinion, and peer-reviewed literatures were systematically reviewed. Sixty-three publications appeared between 2010 and 2015 are included. Five themes emerged, as follows: 1) the crucial provisions of the ACA, 2) the natural affinity of social work and the ACA reforms, 3) curricular adaptations needed to address changing workforce needs, 4) areas for continued social work advocacy, and 5) opportunities for high-impact social work research. This article provides a comprehensive introduction to the ACA, its reforms, and opportunities for social work to assume a high visibility leadership role in implementing the reforms, with particular emphasis on needed curricular changes and opportunities for research.     

Optimizing the role of social workers in advance care planning within an academic hospital: an educational intervention program

Advance Care Planning (ACP) promotes communication to help patients express future health-care preferences and goals for their medical care. Social workers (SWs) are trained to facilitate complex conversations and assist in various ACP tasks across clinical settings. This three-part mixed-method interventional study implemented a comprehensive education and training program for SWs of a large academic hospital, which used pre- and post-training evaluations, chart review, and qualitative data from debrief sessions to examine ACP skills and confidence, and assess the number of ACP conversations initiated with patients. Self-reported level of preparation to facilitate ACP conversations improved significantly (n = 26; pre 36% versus post 82%; p < .05). A 4-month post-intervention chart audit showed an 8.69 fold increase in the number of initiated ACP conversations. Qualitative analysis identified key themes regarding barriers and enablers of initiating ACP conversations during standard care from the perspective of SWs.     

Social policy formulation and the role of professionals: the involvement of social workers in parliamentary committees in Israel

The aim of this study is to contribute to a better understanding of the role of social care professionals in the social policy formulation process by studying social workers' involvement in parliamentary committees in Israel. The study methodology is a quantitative content analysis of the minutes of parliamentary committees that met between the years 1999 and 2006. The findings indicate that social workers participated in 13% of the deliberations of parliamentary committees concerning diverse social policy and social care issues and that two-thirds of these participants are affiliated with non-profit organisations and local government. The findings also offer an insight into the types of parliamentary committees in which social workers participate, and the subjects upon which these focused. Finally, the data shed light on organisational and demographic characteristics of the social workers participating in parliamentary committees in the Israeli parliament. These findings appear to offer support for the discourse within international social work literature that advocates greater involvement of social workers in social policy formulation.     

Organisation and features of hospital, intermediate care and social services in English sites with low rates of delayed discharge

In recent years, there has been significant concern, and policy activity, in relation to the problem of delayed discharges from hospital. Key elements of policy to tackle delays include new investment, the establishment of the Health and Social Care Change Agent Team, and the implementation of the Community Care (Delayed Discharge) Act 2003. Whilst the problem of delays has been widespread, some authorities have managed to tackle delays successfully. The aim of the qualitative study reported here was to investigate discharge practice and the organisation of services at sites with consistently low rates of delay, in order to identify factors supporting such good performance. Six 'high performing' English sites (each including a hospital trust, a local authority, and a primary care trust) were identified using a statistical model, and 42 interviews were undertaken with health and social services staff involved in discharge arrangements. Additionally, the authors set out to investigate the experiences of patients in the sites to examine whether there was a cost to patient care and outcomes of discharge arrangements in these sites, but unfortunately, it was not possible to secure sufficient patient participation. Whilst acknowledging the lack of patient experience and outcome data, a range of service elements was identified at the sites that contribute to the avoidance of delays, either through supporting efficiency within individual agencies or enabling more efficient joint working. Sites still struggling with delays should benefit from knowledge of this range. The government's reimbursement scheme appears to have been largely helpful in the study sites, prompting efficiency-driven changes to the organisation of services and discharge systems, but further focused research is required to provide clear evidence of its impact nationally, and in particular, how it impacts on staff, and patients and their families.     

Working with children with autism and their families: pediatric hospital social worker perceptions of family needs and the role of social work

ABSTRACT

Social workers with knowledge of autism can be valuable contributors to client- and family-centered healthcare services. This study utilized a qualitative design to explore pediatric hospital social workers’ experiences and perceptions when working with children and youth with autism and their families. Interviews with 14 social workers in a Canadian urban pediatric hospital highlighted perceptions of the needs of families of children with autism in the hospital and challenges and benefits related to the role of social work with these families. Results suggest that pediatric social workers may benefit from opportunities to develop autism-relevant knowledge and skills.     

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.     

Investigating healthcare brand communities: The impact of online hospital reviews

This study examines hospital brand communities to improve the understanding of what patients value and how they view the opinions and experiences of other community members. Results from the empirical analysis of brand communities of 364 hospitals involving over 22,000 patient reviews on Yelp.com show that the brand community influences patient decision making in a number of ways. While determining the usefulness of reviews, online hospital review readers consider a combination of factors like affective language, the communication, environmental conditions, and quality of care provided in the hospital, and to a lesser extent the responsiveness of the provider.     

The role of social work in free healthcare clinics and student-run clinics

Background: The role of social work in free healthcare clinics and student-run clinics remains an understudied topic. Method: We conducted a literature review of the published studies through four online databases: Google Scholar, Social Work Abstracts, Academic Search Complete, and PsycInfo. Results: The literature review revealed 449 possibly relevant studies, but only nine met the criteria for the final review. Based on these findings, social work is not fully utilized in free healthcare clinics and student-run clinics. Conclusion: Our literature review provides evidence for the need for social work in free healthcare clinics and student-run clinics.     

Evaluation of an early discharge from hospital scheme focussing on patients’ housing needs: The ASSIST Project

This study calculated a return on investment of an early discharge from hospital scheme focussing on improved responses to patients’ housing needs. The study identified critical success factors of the scheme that will inform potential spread of the intervention to other localities. Financial return on investment based on service costs and benefits were calculated and the critical success factors were identified through interviews with key stakeholders. The annualised return on investment of the scheme was £3.03 for each £1 invested. Close working relationships between health and housing and aspects of the local housing stock (such as direct local control) were key to realising the return on investment.     

当前县级医院医患关系处理引入社会工作的研究

以G县人民医院为个案,探索医务社会工作与处理医患纠纷之间的适应性,以期提供一种新的思路解决县级医院的医患纠纷问题。该文通过调查分析,认为在县级医院处理医患纠纷的过程中,现有的制度和处理方式已经无法适应新的医疗环境变化。从医务社会工作的角度出发,厘清该专业方法对于县级医院医患纠纷处理的正向功能。     

Forms and functions: assessing housing need in the community care context

The National Health Service and Community Care Act of 1990 has been criticized for its marginalization of housing issues. This marginalization, although corrected in part by subsequent guidance and research (for example Department of the Environment/Department of Health 1992, Department of Health 1993, Arnold & Page 1992) has perpetuated a lack of understanding about housing issues amongst those involved in community care assessments. The initial failure to involve housing organizations has had unfortunate results in terms of integrated approaches to community care issues. There has been a situation of poor communication and lack of comprehension of different working practices and priorities which is only now beginning to be overcome. Little is known about the assessment of housing need in the community care context, although it seems likely that it is driven by the perceptions and values of organizations, rather than any real understanding of individual need. In order to understand these issues more fully a research project was set up to investigate the assessment of housing need by both housing organizations and social work teams located in community and hospital settings. Interviews were conducted with a wide range of professionals; generalist and specialist housing workers, care managers, social workers, occupational therapists and health professionals. In addition observations were made of the assessment process, and users and user groups were consulted. The results suggest that professionals have different approaches to housing need, driven by procedures, practices and professional grounding in place before the implementation of the community care legislation, but that awareness is growing about the limitations of these existing approaches, and the need to develop greater insight. The most holistic approach to housing needs assessment was evidenced in planned discharge from long stay hospitals, where there was evidence of an integrated approach, examining all aspects of the significance to individuals of house as home.     

Early steps in implementing the new community care: the role of social work practice

This paper presents findings from a research project in which needs-led assessments and care management were examined during the early years of implementation of the 1990 NHS and Community Care Act. The findings are analysed in relation to a model of social work processes, i.e. phases of assessment, intervention and evaluation. A purposive sample of 24 cases was used, spanning elderly, physical disability, learning disability and community mental health teams in two divisions of a 'county' social services department. Practitioners, providers, users and carers were interviewed. The research illustrates the enduring importance of social work values, knowledge and skills in situations of rapid organizational change and policy development.     

Conducting an advance care planning group among older adults living in residential care homes: An initiative of social workers in Hong Kong

This study aimed to examine the effects of an advance care planning (ACP) group which was developed by social workers in Hong Kong for older adults. A quasi-experimental study was conducted. Participants were recruited from 14 residential care homes. The ACP intervention group included 59 participants for analyses, and the control group 58. Three major outcomes were measured at two time points: (a) Quality-of-life concerns, (b) End-of-life preference and (c) Advance directive (AD)-related outcomes (awareness of AD, AD completion, willingness to complete AD and communication with family members about AD). Findings indicate that the ACP group enhanced participants’ awareness of AD compared with the control group. Participants were also more willing to complete AD, and more participants communicated with family members about AD after participating in the ACP group. No significant difference was found in other outcomes. This study demonstrates the efforts of social workers in promoting ACP in Hong Kong and the effectiveness of an ACP group for enhancing older adults’ awareness of AD. Findings support the role of social workers in promoting ACP for deprived groups, like frail older adults. The ACP group could be considered a first step in enhancing older adults’ awareness of and willingness to discuss end-of-life issues. Further follow-up is required to develop individualised ACP for older adults.     

The role of social workers in addressing nonmedical needs in primary health care

Nonmedical needs are intricately linked to health. Unaddressed nonmedical needs often result in poorer health and increased healthcare costs. Although social workers are well positioned to address nonmedical needs, their role in healthcare environments to address nonmedical needs is limited. The limited role relates to a lack of reimbursement streams, which stems from poor articulation about their unique contributions. An analysis of a case study in which a social worker using AIMS, a protocolized care coordination model, was undertaken to highlight specific activities performed by social workers. Implications for patient health outcomes and healthcare costs are discussed.     

A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention

A longitudinal quantitative study in an English faculty of health and social care explored the effects of a pre-qualifying interprofessional curriculum for students from 10 professional programmes. Students on the interprofessional curriculum completed questionnaires containing four attitude scales on entry to the faculty, during their second year and at the end of their final year. At qualification, 581 students (76.9% of those qualifying) completed scales concerning their communication and teamwork skills, their attitudes towards interprofessional learning, their perceptions of interaction between health and social care professionals, and their opinions about their own (inter)professional relationships. Questionnaires were completed at both entry and qualification by 526 students (69.8% of those qualifying), and at all three points by 468 students (61.9% of those qualifying). A comparison group of 250 students (67.6% of those qualifying) on the previous uniprofessional curricula also completed questionnaires at qualification. Students on the interprofessional curriculum showed no significant change in their self-assessment of their communication and teamwork skills between entering the faculty and qualification. However, there was a negative shift in their attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own professional relationships at qualification. Students with previous experience of higher education were comparatively positive about their communication and teamwork skills, as were female students about interprofessional learning. However, the strongest influence on students' attitudes at qualification appeared to be professional programme. This suggests that interprofessional education does not inhibit the development of profession-specific attitudes. Students who qualified on the interprofessional curriculum were more positive about their own professional relationships than those who qualified on the previous uniprofessional curricula. These data suggest that experiencing an interprofessional curriculum has an effect on students' attitudes at qualification, particularly with regard to their positive perception of their own professional relationships.