Chapter 2Handbook of Health Social Work, 2nd Edition

Created by Teri Browne

SOCIAL WORKER ROLES AND

HEALTHCARE SETTINGS

Chapter Objectives: Describe a biopsychosocial approach to health care and the

professionals who deliver it. Define the role of the social worker on the health-care team. Outline the tasks of health social workers related to the delivery

and design of healthcare. Discuss professional issues and challenges related to teamwork

and recommendations for effective collaboration.

SOCIAL WORKER ROLES AND HEALTHCARE SETTINGS

Biopsychosocial Model: Addresses the biological, social, environment, psychological and

behavioral aspects of illness. Expands on the traditional medical model of health care by

focusing primarily on the biological causes of disease. Considers the nonmedical determinants of disease in collaboration

with biological components. E.g. the biopsychosocial model of health takes into account

patient’s ability to purchase recommended medicine for diabetes when creating a treatment plan for patients rather than focusing only on laboratory results and physical status.

SOCIAL WORKER’S BIO PSYCHOSOCIAL APPROACH TO HEALTHCARE.

Biopsychosocial Model:For the purposes of this chapter, the term biopsychosocial is

used to indicate an approach to health service delivery that addresses the psychological and social aspects of health and

treatment that includes behavioral and environmental factors.

SOCIAL WORKER’S BIO PSYCHOSOCIAL APPROACH TO HEALTHCARE.

Health Social Workers directly address the social , behavioral and emotional concerns of the individuals and their social

support network as well as develop and administer policies and programs and conduct research that are attuned to the

psychosocial needs of individuals.

LIMITS OF THE MEDICAL APPROACH:PSYCHOSOCIAL ISSUES RELATED TO

HEALTH

Social Illness and Problems:• Illnesses and problems are psychosocial rather than biological

in nature.• Examples:• Child or elder abuse• Violence including sexual assault and family violence. • Substance abuse • Cutting• Bulimia and suicide attempt.

LIMITS OF THE MEDICAL APPROACH:PSYCHOSOCIAL ISSUES RELATED TO

HEALTH

The current health-care environment in the United States emphasizes cost containment through:

• Shorter hospital stays.• Briefer medical interventions.• The provision of fewer comprehensive services with fewer

personnel.

LIMITS OF THE MEDICAL APPROACH:PSYCHOSOCIAL ISSUES RELATED TO

HEALTH

Bateman and Whitaker( 2002) assert that social workers are needed in medical settings to address increased home care needs and in primary care settings addressing medical issues on a preventive level to decrease morbidity and the need for hospitalization

LIMITS OF THE MEDICAL APPROACH:PSYCHOSOCIAL ISSUES RELATED TO

HEALTH

Direct health services are provided in various settings such as:•Public and private hospitals•Outpatient clinics•Neighborhood health centers •Ambulatory surgery centers•Physician’s Offices•Mobile care units•Skilled nursing facilities•Military settings•Correctional facilities•Schools•Health maintenance organizations

HEALTH SETTINGS AND THE SOCIAL WORKER’S PLACE WITHIN THEM

Social workers are essential to the delivery and design of optimal health care. •They work on health teams comprised of direct patient-care professionals and as administrators overseeing program planning and implementation. •Tasks include:

• goals of the profession of social work.• helping clients problem solve and cope with life stressors.• Linking individuals with resources, services, and opportunities; • Promoting effective and human service systems.• Developing and improving social policy.

THE SOCIAL WORKER’S ROLE ON HEALTH TEAMS

Health social work tasks:• Interventions• Collaborations• Coordination• Advocacy• Supervision or administrationActivities of health social work include:• Assessment• Design, implementation of intervention.

HANDS-ON PRACTICE: SOCIAL WORKERS AS PART OF HEALTH-CARE.

Social Workers evaluate the strengths and needs of individuals and members of their social support network as part of a social work assessment to identify assets and potential barriers to care.

Social workers help health-care teams assess psychological and social issues such as domestic violence, and socioeconomic barriers to the attainment of quality health care, among other issues.

HEALTH SOCIAL WORK ASSESSMENT

Social Workers provide assistance and develop and implement interventions to address identified needs. This process includes:Explaining the diseaseTreatment Facilitating communication

Social workers are the health professional who process the “knowledge necessary to assess social services needs and to secure and coordinate community-based services (Berkman, 1996, p.545).

HEALTH SOCIAL WORK INTERVENTION

Health social workers can help patients gain needed resources by providing case management services that refer and link patients and their families to services and other resources.

Health social work dual focus:Enhancing social institutions responses to human needs. Enhancing the social functioning of individuals.

HEALTH SOCIAL WORK INTERVENTION

Social workers ensure that the social context of health is addressed in patient care and program planning.

Social workers in health care as mediators between the health-care system and consumers and involve advocating at the systems level for improvements in the delivery of care.

HEALTH SOCIAL WORK INTERVENTIONADMINISTRATION

The dual focus of social work are:

Enhancing the social functioning of individuals.

Responds of social institution to human needs.

SOCIAL WORK AS A PART OF THE DESIGN OF

HEALTHCARE

Health social workers design and implement community health programs and initiatives.

Social workers also may provide education to individuals, groups and communities on different health issues.

Health social workers are involved in preventive services and provide linkages to services via outreach programs.

On a maco-level, social workers are involved in research that directly and indirectly influences public policy, community, public health and clinical practice.

SOCIAL WORK AS A PART OF THE DESIGN OF

HEALTHCARE

Social workers roles include:Case management and Patient advocacyAssessment of NeedNeeds-based carePublic healthMultilevel interventionAdministration and design of health care

SURVEY OF SOCIAL WORK PROFESSIONALS

Social workers may work on teams that are:Multidisciplinary-

Each professional works autonomously with little interaction.Interdisciplinary

Professionals interact with one another to provide services but maintain clear professional boundaries dictated by distinct terminology and intervention planning.

TransdisciplinaryClose collaboration among professionals, common terminology and goal

setting

COLLABORATING WITH OTHER PROFESSIONALS

Challenges include:Professional of health care teams may not have equal voices in

the care planning process.Professional roles may not be clearly stated.Professional perspectives and ethics may clash. Workplace change Reduction in resourcesIncrease in cost and decreased hospital stays. Co-opting by other professions of tasks that historically have

fallen under the rubic of social workAmbiguity of roles and tasks and different disciplines may not

understand one another’s lexicon and procedures.

CHALLENGES TO PROFESSIONAL COLLABORATION

Cowles(2003, p.21) lists specific objectives that are essential to maximal team collaboration:Role clarity and flexibilityMutual respect and trustConsensus on group norms, values, commitment and purposeAn egalitarian attitude; a sense of equal importanceA sense of group bond and interdependence rather than

autonomyOpen communication and sharing

HEALTH SOCIAL WORK RECOMMENDATIONS

Cowles(2003, p.21) lists specific objectives that are essential to maximal team collaboration:Flexible leadership and decision making.Flexible membership composition based on case needs.A stable core membershipA sense of both group and professional identity.Ability to negotiate and reach consensusGoal focus and goal clarityRecord keeping of meetingAttention to both the task and maintenance functions of the teamA systems perspective.

HEALTH SOCIAL WORK RECOMMENDATIONSCONTINUED……

Social workers role in quality assurance:To obtain resources and the commitment from hospital

administrations to provide comprehensive servicesTo continually collect data that substantiates that they are the

professionals best trained for such responsibilities Deliverance of services in the most cost effective manner.

HEALTH SOCIAL WORK RECOMMENDATIONSQUALITY ASSURANCE

Social workers:Conserve institutional resources

Linking patients with insurance and resources Planning and linkage to outpatient resourcesIncreased service provision through outreach and program planning and mediating conflicts between patients and providers

Enhance revenue through the creation of new programs and services

Improve the productivity of the medical team by participating in employee assistance programs that support team members.

HEALTH SOCIAL WORK RECOMMENDATIONSFISCAL ADVANTAGES

Social workers:Must advocate for themselves as active members of health teams

By creating literature that informs other professionals and consumers about the role of health social workers

Provide team training about the social work activities and roles.

Provide evidence of the effectiveness of social work services.

Be visible parts of health settings by volunteering to be part of tasks forces and committees.

HEALTH SOCIAL WORK RECOMMENDATIONSADVOCACY

Social work function in biopsychosocial approach to healthcare.Romano(1981) suggests:

Social work occupies a unique position in that it has feet in:Health and mental healthHands in the social sciencesIts viscera in clinical intervention skillsHead and heart in a commitment to the issues of the

quality of life of disabled persons in society (p.15)

TREATING THE WHOLE PERSON: SOCIAL WORK’S PRIMARY ROLE.