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.     

Health inequities: evaluation of two paradigms

Social work practice in health is shaped by underlying paradigms.To effectively target health inequities, practitioners need to consider appropriate paradigms. In this exploration of how six health paradigms shape theory and practice, the two health paradigms that most attended to health inequalities are social determinants of health and political economy. The article undertakes a critical review of the social determinants of health paradigm and the political economy paradigm regarding how they might shape social work theory and practice targeting health inequities.     

Research and practice an ongoing relationship

Although social work research and practice are sometimes viewed as the opposite ends of a continuum, research studies have a continuing impact on practice. In a review of noteworthy trends in social work in the health field, this discussion indicates that research influences practice in both direct and indirect ways.     

Health benefits of primary care social work for adults with complex health and social needs: a systematic review

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self‐management of long‐term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care.     

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'.     

Social work in health settings in the U.S.A.

The review of the literature on social work focuses on the development of the profession in the United States, its involvement in health areas, and some of the recent directions with which writers in the profession are concerned. The diversity of the literature, as well as the culturally defined practice nature of the profession, make cross-national comparison of patterns of development of less value. The relationship between social work in health and mental health settings is mentioned, but the literature in psychiatric social work is large enough to be the subject of a separate survey. The profession is now represented in most primary-care-giving agencies in the United States, and in public health settings as well. Practitioners meet standards of training and education in common with nationally defined norms. Future concerns of social work in health include the effects of advancing medical technology on the patient care system, the increasing life expectancy with emphasis on old age, and controlling the increase in population.     

Coordinating In-Patient and Out-Patient Services

It has been observed that there are problems in the conceptual base of social workers' practice with groups in health settings. This article suggests that to develop a sound conceptual base and to improve the integration of work with groups into the operating structures for delivering social work services in health care, it is necessary to distinguish social work groups from other groups. Criteria for social work practice with groups are identified. Criteria are based on fundamental principles of social work practice in health care and principles of social work practice differentiated to take account of group processes.     

When is it social work? Another look at practice with groups in health care

It has been observed that there are problems in the conceptual base of social workers' practice with groups in health settings. This article suggests that to develop a sound conceptual base and to improve the integration of work with groups into the operating structures for delivering social work services in health care, it is necessary to distinguish social work groups from other groups. Criteria for social work practice with groups are identified. Criteria are based on fundamental principles of social work practice in health care and principles of social work practice differentiated to take account of group processes.     

SOCIAL WORK EDUCATION FOR HEALTH CARE PRACTICE

The probably future developments in social work education for health care practice are viewed from a systems perspective. The developing needs of social work in health care are examined within the context of the developing needs of the broader field of social work practice, since changes in this larger system cannot but impact upon the health care social work subsystem. Similarly, education for health care social work practice is seen within the perspective of the broader system of social work education for practice in general, because developments in this larger system determine the directions that will be taken by the smaller system of educational training. The interfacing of the two systems, social work practice and social work education, is examined.     

Serving Families on the Frontline: Challenges and Creative Solutions in Rural Hospice Social Work

Focus on the social service and health care needs of rural dwellers has emerged due to changing demographics and advocacy efforts. All rural health providers are faced with numerous unique challenges. As a valuable part of hospice teams, social workers are well equipped to have an integral role in understanding and addressing the specific challenges in end-of-life care in rural communities. In this study, a Web-based survey was completed by 339 hospice social workers spanning 40 states in the United States. Both quantitative and qualitative methods and data analysis strategies were utilized. The results reveal environmental and cultural challenges impacting social work practice. The results also unveil solutions and suggestions for addressing challenges such as creative use of resources and increased collaboration within the local resident, health care, and social work communities. Implications include potential strategies for enhanced social work practice in rural areas, yielding a quality end-of-life care for individuals and families.     

Low Health Literacy and Older Adults: Meanings,Problems, and Recommendations for Social Work

Many older adults struggle to manage their health care problems. Low health literacy exacerbates such struggles and contributes to a variety of adverse health behaviors and outcomes. Addressing how health literacy impinges on the lives of older adults is a neglected area of social work practice and knowledge. This article explores seven areas: defining health literacy, the problem and prevalence of low health literacy among older adults, health inequalities and health literacy, a brief literature review, neglected issues in the literature, suggestions for macro and micro social work interventions to improve health literacy for older adult populations, and conclusion.     

The future of health social work

The practice of social work in health care is at a critical juncture, and laces an uncertain future. The authors provide an overview of the challenges facing social work practice within the health care setting, as well as recommendations for enhancing social work practice and education. Challenges discussed include economic factors, demographic changes, and technological advances influencing the practice of social work in health care. The need for a proactive stance among social work professionals and educators is promoted. The proposed changes are intended to stimulate discussion and an exchange of ideas needed to maintain Social Work's relevance and integrity in the evolving health care delivery system.     

Social capital in its place: using social theory to understand social capital and inequalities in health

Social capital has been controversially linked to public health benefits, particularly as an explanation for the relationship between economic inequalities and health. This paper focuses on social capital in this context, particularly a recent emphasis on social capital in neighbourhoods and growing use of Bourdieu's social theory in empirical investigations. A review of some of this work is used to suggest the need for a more coherent theoretical approach to using Bourdieu and to introduce an ethnographic study of social connections in New Zealand. Forty-six residents of, a rural town, a deprived city suburb, or an affluent suburb, volunteered to be interviewed about their social connections. Their talk was transcribed and analysed in terms of everyday practice. The results of this study suggest that social connections are not necessarily located in neighbourhoods, and that social capital will be better understood in a broader social context which includes competition for resources between deprived and non-deprived groups, and the practices of all citizens across neighbourhoods. When considering social capital, an exclusive focus on deprived neighbourhoods as sites for research and intervention is not helpful.     

Not just a middle-class affliction: crafting a social work research agenda on postpartum depression

Postpartum depression (PPD) is a major mental health disorder that affects at least 13 percent of new mothers and has detrimental consequences for populations that are of concern to social workers, such as low-income women, women of color, young women, and single mothers. Despite the relevance of PPD to multiple social work problems and populations, the social work literature contains sparse information about the causes of, consequences of, and treatments for PPD among vulnerable groups of new mothers. In this article, the authors review the literature on PPD with specific attention to the sociocultural dimensions of the disorder, barriers to treatment, and the relationship of PPD to social work theory and practice. The authors argue that social workers should set an agenda for PPD research that draws on the profession's biopsychosocial perspective, advances a culturally competent understanding of the experience of PPD, and informs social work practice with diverse groups of new mothers.     

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.     

Social work and health restructuring in Canada and Finland

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.     

Health care for children: perspectives for community health services

The study aims at analysing the community health nursing practice in the care of children and to point out the perspectives for the coming millennium. The study was conducted by review of the literature. It provides a brief synthesis of the current social context and a short historic reflection about health practices with children and community health nursing practice. It is observed that the practice of nursing is conducted according to the official Health Assistance Program for Children. Despite its goals, however, the program has not been efficient. In this way it will be valued the multiprofessional work in the accompaniment of the growth and development, domiciliary visit, and "groups of mothers" in which the nurse will be a co-participant of the staff, with the great contribution that health professionals with preventions and promotions background frequently offer.     

Medical social work practice and SARS in Singapore

This article reports on the findings of a qualitative study exploring the impact of SARS on social work practice in five different hospitals in Singapore. The study sought to examine the range of interventions adopted by 28 medical social workers and the theoretical orientations underpinning them. The findings discussed include the impact of infection control practices on social work intervention, the range of interventions undertaken, respondents' reflections and self-awareness, the role of values and ethics, creativity and training, and their recommendations for future emergencies. While the findings of the study relate specifically to hospital social work practice, the crisis and trauma nature of the work makes it applicable to a broader range of practice in these areas and a range of populations. The findings from this study could also inform the development of training programs for social work and other clinical health workers, and emergency management planning.     

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.