Medical social work
Medical social work or Med.SW is a sub-discipline of social work, also known as Hospital social work and Healthcare 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.)
Britain and Ireland are the first nations who acknowledged the need of Medical Social Workers to extend the clinical care in administrative and support aspects. 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.
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.
In United States Richard Clarke Cabot in Massachusetts General Hospital created the position of Hospital Social Worker or Medical Social Worker in the early 1900s. This was important from an epidemiological point of view, as it made it easier to control and prevent outbreaks of syphilis and tuberculosis.
The Medical Social Worker (Med.SW) is part of the multidisciplinary healthcare team, providing interventions to support patients and their families, groups during recovery from and/or adjustment to illnesses. A Medical Social Worker provides Psychosocial support, Case Management, Psycho-education, Counseling and referrals for other services. They also perform administrative roles such as Program planning and management of health promotion and disease prevention & advocate to overcome or make availability and accessibility of certain healthcare services.
- Psychosocial assessment - assessing strength and resilience of the patient, family, and social support systems to help the individual function within the community.
- Family education and mediation-educating the family on the physical and psychosocial needs of its members and ways they can access internal and external resources, as well as mediating familial conflicts
- Counselling for individuals, couples and families-for situations in which patients suffer from poor mental health states (e.g. depression, anxiety), and coping and adjustment difficulties (e.g. due to loss of limb through amputation, loss of hearing, or caring for family members suffering from dementia)
- Risk assessment - assessing risk of self-harm (eg suicide) and to others (eg family violence, elder abuse, child abuse).
- Financial assessment and fund management - identifying and referring cases for financial assistance
- Discharge Planning -working together with medical, nursing and other allied health staff, patients and their families to develop and implement the post discharge care plan
- Information & Referral Services - linking patients and caregivers to community resources.
Role and required skills
Medical Social Workers help the patient's and their families to manage life crises due to acute or chronic medical conditions, and focus on improving their mental and physical well-being. This is a critical role which is done by psychosocial assessments, counseling and needs assessment.
An another role that Hospital Social Workers engage is in assisting 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.
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. It is also the responsibility of the Medical Social Worker to manage any dispute in the multidisciplinary team. Medical social workers also need to have good analytical and excellent assessment skills, an ability to communicate the medical language with both patients and the family is necessary, 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 well-being of patient or in any distress in the discharge process that might 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.
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. Often this job requires tolerance due to its lackluster nature and cross-departmental nature withe Nursing and Public Relations. The inadequate salary and restrained professional growth is also a major concern for Medical Social Workers. Medical social workers often deal with 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 tackle 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 care services. Sometimes situations as seemingly ordinary as the patient needing bus fare or a decent pair of shoes can lead to delays in discharge, which could incur social and healthcare costs 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.
- Kearney, N and Skehill, C (2005). Social work in Ireland: historical perspectives. Institute of Public Administration. ISBN 1-904541-23-2, ISBN 978-1-904541-23-3
- Beder, J. (2006).Hospital Social Work: The interface of medicine and caring. Routlege: New York
- Institute of Medical Social Workers on record at Warwick University
- Unsung Heroes - The Story of the Bellevue Hospital Social Work Department
- NASW - Medical Social Workers