Medical social work
Medical social work is a sub-discipline of social work, also known as hospital social work. Medical social workers typically work in a hospital, skilled nursing facility or hospice, have a graduate degree in the field, and work with patients and their families in need of psychosocial help. Medical social workers assess the psychosocial functioning of patients and families and intervene as necessary. Interventions may include connecting patients and families to necessary resources and supports in the community; providing psychotherapy, supportive counseling, or grief counseling; or helping a patient to expand and strengthen their network of social supports.
Medical social workers typically work on an interdisciplinary team with professionals of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.)
History
Britain and Ireland
Medical social workers in Britain and Ireland were previously known as Almoners, or Hospital Almoners. In Ireland, the origins of medical social workers go back to Dr. Ella Webb, who, in 1918, established a dispensary for sick children in the Adelaide Hospital in Dublin, and to Winifred Alcock, who trained as an Almoner and worked with Dr. Webb in her dispensary.[1]
In 1945, the Institute of Almoners in Britain was formed, which, in 1964, was renamed as the Institute of Medical Social Workers. The Institute was one of the founder organizations of the British Association of Social Workers, which was formed in 1970. In Britain, medical social workers were transferred from the National Health Service (NHS) into local authority Social Services Departments in 1974, and generally became known as hospital social workers.
United States
The Massachusetts General Hospital was the first American hospital to have professional social workers on site, in the early 1900s. The position was created by Richard Clarke Cabot to help patients to deal with areas of their life that made treatment difficult. This was important from an epidemiological point of view, as it made it easier to control and prevent outbreaks of syphilis and tuberculosis.[2]
The medical social worker profession
Role and required skills
Medical social workers play a critical role in the area of discharge planning. One responsibility of medical social workers is to collaborate in the development of a discharge plan that will meet the patient's needs and allow the patient to leave the hospital in a timely manner. There are a number of factors that influence the timing of discharge; in private, community hospitals, it can be costly to allow patients to remain inpatient when it is no longer medically necessary. Discharge delays can prove costly to the hospital and to the patient depending on the patient's funding source.
For example, a medical provider informs the medical social worker that a patient will soon be "cleared for discharge" and will need in-home services. Depending on the setting, it may be the medical social worker's responsibility to arrange in-home services to coincide with the patient's discharge date. If the home care service is not in place at time of discharge, the patient may not be able to leave the hospital, resulting in a delay in discharge and the patient being placed on alternate level of care status (that is, deemed no longer requiring acute level of medical care, for which the hospital will receive a substantially lower rate of payment) until the necessary services are arranged.
Another skill required of medical social workers is the ability to work cooperatively with other members of the multidisciplinary treatment team who are directly involved in the patient's care. Medical social workers also need to have excellent analytical and assessment skills, an ability to communicate clearly with both patients and staff, and an ability to quickly and effectively establish a therapeutic relationship with patients. But of paramount importance, medical social workers must be willing to act as advocates for the patients, especially in situations where the medical social worker has identified problems that may compromise the discharge and put the patient at risk.
For example, a medical provider may report that a frail elderly patient, who lives alone, is medically stable for discharge and plans to discharge the patient home with in-home services. After assessing the patient's psychosocial needs, the medical social worker determines that the patient does not have the ability to manage at home safely even with the intervention of a home care worker. The medical social worker informs the medical provider that the proposed discharge plan may place the patient at risk and the discharge plan is deferred pending further assessment. The medical social worker can then collaborate with multidisciplinary providers to develop a more appropriate discharge plan even if that leads to discharge delays.
Medical social workers value the ethical concept of patient self-determination although this value can conflict with the values and ethics of other disciplines in a medical setting. Medical social workers strive to preserve the patient's right to make his or her own decisions about goals of care, treatment planning, discharge, etc. as long as the patient is capable of making those decisions him/herself. Patients often make decisions that medical professionals disagree with but the medical social worker advocates for the patient's right to self-determination. If the patient is not able to make his/her own decisions based on a cognitive or other impairment, the right of self-determination can be superseded by concern that a patient is a risk to self or others.
Challenges
As medical social workers often have large case-loads and have to meet tight deadlines for arranging necessary services, medical social work is a demanding job. Medical social workers often deal with highly complex cases involving patients who come into the hospital with multiple psycho-social issues, all of which require assessment and treatment. It is not uncommon for medical social workers to treat cases involving homelessness, chronic unemployment, lack of income, lack of health insurance coverage, history of incarceration, and substance abuse problems. Any of these problems, separately and together, can impede timely discharge. Sometimes situations as seemingly mundane as the patient needing bus fare or a decent pair of shoes can lead to delays in discharge, especially if these needs are not identified quickly and early. This is why a complete and timely assessment of the patient's psychosocial needs is critical.