SOCIAL WORK IN HEALTH CARE: A CURRICULUM PROPOSAL
FOR A HEALTH CARE CONCENTRATION IN THE GRADUATE PROGRAM OF
THE DIVISION OF SOCIAL WORK AT CALIFORNIA STATE UNIVERSITY,
SACRAMENTO
A Project
Presented to the faculty of the Division of Social Work
California State University, Sacramento
Submitted in partial satisfaction of the requirements for the degree of
MASTER OF SOCIAL WORK
by
Kassy Mason
Jocelyn Merino
SPRING 2013
SOCIAL WORK IN HEALTH CARE: A CURRICULUM PROPOSAL
FOR A HEALTH CARE CONCENTRATION IN THE GRADUATE PROGRAM OF
THE DIVISION OF SOCIAL WORK AT CALIFORNIA STATE UNIVERSITY,
SACRAMENTO
A Project
by
Kassy Mason
Jocelyn Merino
Approved by:
______, Committee Chair Dale Russell, Ed. D., LCSW
______Date
ii
Student Name: Kassy Mason Jocelyn Merino
I certify that this student has met the requirements for format contained in the University format manual, and that this project is suitable for shelving in the Library, and credit is to be awarded for the project.
______, Division Director______Robin Kennedy, Ph.D. Date
Division of Social Work
iii
Abstract
of
SOCIAL WORK IN HEALTH CARE: A CURRICULUM PROPOSAL
FOR A HEALTH CARE CONCENTRATION IN THE GRADUATE PROGRAM OF
THE DIVISION OF SOCIAL WORK AT CALIFORNIA STATE UNIVERSITY,
SACRAMENTO
by
Kassy Mason
Jocelyn Merino
There is a need for an emphasis in medical social work in graduate programs.
Students who have not had this educational training are not adequately prepared to work as medical social workers. 14 current medical social workers at Sutter General Hospital and Sutter Memorial Hospital were evaluated. The survey included questions to assess how effective their Master of Social Work program was in preparing them for medical social work. The study confirmed that participants with an emphasis in healthcare found their courses to be beneficial upon entering the medical field.
______, Committee Chair Dale Russell, Ed.D., LCSW
______Date
iv
TABLE OF CONTENTS Page
List of Tables ……………………………………………………………………… viii
Chapter
1. STATEMENT OF THE PROBLEM………………………………………… 1
Background of the Problem ………………………………………………. 2
Statement of the Research Problem ……………………………………….. 4
Study Purpose…………………………….………………………………... 4
Theoretical Framework ………………….………………………………… 5
Definition of Terms ……………………..………………………….….…... 9
Assumptions ……………………………………………………………….. 11
Social Work Research Justification ………………………………..…..….. 11
Study Limitations ………………………………………………………….. 13
Statement of Collaboration ………………………………………………... 13
2. REVIEW OF THE LITERATURE …………………………………………… 14
Impact of Illness and Disease on the Whole Person ………………………. 15
Importance of Social Work Roles in the Healthcare Setting…...... 19
Knowledge and Skill Set…………………………………………………… 23
Impact of Healthcare on GDP and Concerns of Cost…………………...... 25
Challenges of Evidence Based Research…………………………………... 26
Value and Effectiveness of Social Work in Healthcare……………………. 27
Agency and Policy Involvement………………………………………….... 29 v
Other Challenges of Social Work in the Healthcare Field………………… 30
Implications of a Health Emphasis in a Social Work Graduate Program ..... 33
Access...... 34
Knowledge of Emerging Trends…………………………………………... 34
Population-Specific Knowledge…………………………………………. 36
Field Instruction……………………………………………………………. 36
Research…………………………………………………………………… 37
Current Programs and Courses Available…………………………………. 38
Conclusion………………………………………………………………… 38
3. METHODS…………………………………………………………………….. 40
Study Design ………………………………………………………………40
Sampling Procedures ……………………………………………………… 41
Data Collection ………….. ……………………………………………… 41
Instruments ……………………………………………………………… 42
Data Analysis Plan ………………………………………………………… 42
Protection of Human Subjects …………………………………………….. 43
Conclusion…………………………………………………………………. 44
4. STUDY FINDINGS AND DISCUSSIONS…………………………………… 45
Overall Findings …………………………………………………………… 45
Specific Findings …………………………………………………………. 46
Interpretation to the Findings …………………………………………….. 50
Proposed Curriculum……………………………………………………… 52 vi
Summary …………………………………………………………………. 53
5. CONCLUSION, SUMMARY, AND RECOMMENDATIONS …………….. 54
Implications for Social Work ……………………………………………. 55
Recommendations …………………………………………………………. 56
Limitations ………………………………………………………………… 57
Conclusion ………………………………………………………………… 57
Appendices………………………………………………………………………… 59
Appendix A. California State University, Sacramento Master of Social Work Program
(MSW) Guidelines for a Concentration in Health Care Setting…….. 60
Appendix B. Human Subjects Approval Letter…………………………………... 65
Appendix C. Letter of Consent …………………………………………………... 66
Appendix D. Survey ……………………………………………………………… 67
References …………………………………………………………………………. 71
vii
LIST OF TABLES Tables Page
1. Graduate Program Participants Attended for MSW……………………….. ….46
2. Participants that Attended a MSW Program with a Health Concentration…….46
viii
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Chapter 1
STATEMENT OF THE PROBLEM
In today’s modern society, there has been significant advancement within the medical field. As people are living longer with both acute and chronic illness, there are increasing emotional, psychological, environmental and spiritual factors that are contributing to a person’s overall quality of life as it relates to their experience with an illness. While physicians and nurses have maintained steady roles working with patients in these aspects, their roles have been limited to what they can provide as long-term intervention. Because of the extensive education and training received on these concepts, it has become more understood that social workers can be a vital part of a patient’s experience in both inpatient and outpatient care (Auerbach, 2007).
Throughout the graduate level social work program at California State University,
Sacramento, the researchers concluded that concepts and interventions, such as education around specific disease information, relevant resources and case management for the physically and mentally ill have not been of focus in our courses, therefore they felt inadequately prepared for the roles as medical social workers during the required internship. Although the courses that focus on the generalist perspective gave the researchers a general overview of social work theories, practices and intervention methods, it can be difficult to apply many concepts discussed in practice courses to the medical placements. In the researchers current medical placements, along with familiarizing with the role expectation of the social worker, it was also necessary to assimilate to medical terminology, the effects of illnesses, and become familiar with the
2 medical staff and system wide hierarchy.
The researchers began to look at other graduate level social work programs that did emphasize education of social work in the healthcare field. Due to the personal experience with attempting not only to developed skills as clinicians, but also establish the skills necessary to work within a medical system, the researchers found it imperative to create guidelines for a curriculum with an emphasis in medical social work for future students pursuing this field. The study will be analyzing surveys taken by current medical social workers to determine what courses they found beneficial in their master’s of social work program. The study will also examine whether the skills and knowledge they are currently practicing were learned in the field or in the classroom setting. After reviewing relevant literature on the role expectations of a social worker in the health care setting, as well as studying concepts and experiences current medical social workers found valuable during their education, the researchers will conclude the study with creating a guideline for a curriculum for future students of a graduate level social work program seeking an emphasis in medical social work.
Background of the Problem
Physician’s roles were released from the responsibility of assessing home, work, and other life situations as it pertained to a patient’s medical care during the turn of the twentieth century. During this transition the role of social workers was introduced into the healthcare field (Cowles, 2003). Ida Cannon and Dr. Richard Cabot were the first to establish a social work department in 1914 in Massachusetts General Hospital. Social workers evaluated the patient and family dynamics and their adjustment to the presenting
3 illness as well as assisted physicians in recognizing how social and environmental conditions could contribute to the spread of disease (Gregorian, 2005). Since the field of social work was introduced almost 100 years ago, the role of the medical social worker continues to focus on addressing family and patient psychosocial factors. As the expansion of health centers increased the role of social work was developed in practices such as psychiatric, public health agencies, nursing homes, rehabilitation centers, health maintenance organizations, community clinics, private practice, hospice agencies, and veteran administration (Cowles, 2003).
Signs of role confusion began early in the career of medical social work as Dr.
Cabot saw the role of social workers as the liaison to remove barriers and to bridge the gap between the community and the hospital setting. Meanwhile, Ida Cannon had a different view, Ida viewed her role as providing the patient and their family direct service in treating the patient’s social and psychological factors that could potentially be hindering the patient’s compliance with the medical treatment plan (Cowles, 2003). To this day, the social work department continues to fight for the importance of their roles in the medical setting. Due to confusion of the social work roles and a rise in healthcare cost, the social work department has been particularly vulnerable to “down-sizing”
(Gregorian, 2005). Due to the relatively new emphasis of medical social work, there is a lack of research that proves the ability of social workers to play as key members in reducing lengths of stay and managing complex cases. In turn, social workers struggle to be seen as key participants of the interdisciplinary team in contributing to the cost- effectiveness of the medical organization.
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Statement of the Research Problem
As social workers are becoming more common with in the medical setting, there is a growing need for an emphasis in training for future medical social workers. While there are some universities that offer this emphasis, most masters programs maintain a generalist perspective or have an emphasis in other common fields such as child welfare or substance abuse. Because of this lack of education within social work master programs, most medical social workers do not receive adequate practice in the healthcare setting until they obtain a position that provides this training. Inversely, it is difficult to obtain a position in the medical field without having a background medical foundation.
Study Purpose
This study aims to gather opinions and experiences of current social workers in the medical field, as well as programs that currently provide an emphasis on medical social work. In doing so, we will propose a curriculum that is geared for students who are pursuing a career in medical social work. Along with this proposal, we will explore available literature that discusses the unique practice of medical social work, so that the researchers can further develop concepts that may be beneficial to adequately train and prepare social workers for a future career in the healthcare field. The purpose will be to better prepare students who are pursuing a career in medical social work so they can confidently navigate their way through the healthcare systems with proper knowledge and skills.
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Theoretical Framework
Generalist Perspective
The generalist perspective takes on the approach of assessing and planning. This theory focuses on problem solving through all of the systems involved with the client, which include individuals, families, groups, organizations, and communities. Social workers work with the individual to problem solve by identifying strengths, creating interventions, and evaluating the intervention (Boyle et al., 2009). The generalist perspective recognizes that social environment plays a role in how the person views their quality of life, interventions must be tailored to focus on deteriorating barriers that are inhibiting the individual from achieving their desired goal (Boyle et al., 2009). The generalist perspective theory is broad and prepares graduate level social work students to practice this model when working with a various populations.
Person in Environment
The person in environment theory states that people are better understood in relation to their experience within their social environment and the resources it provides.
As an underlying theoretical perspective in social work, this framework allows social workers in healthcare to address a person in terms of their experiences to help provide medical treatment in addition to focusing specifically on the illness. Social environment can play a role in the inheritance of acute and chronic illness. As social workers by exploring the person’s attitudes, beliefs, values, and functioning in social role professionals can help provide the most effective plan of care. With an emphasis in healthcare in a graduate level program, an advanced person in environment approach can
6 be taught to student social workers so that they can explore patient’s experience with illness, barriers to medical treatment and relevant resources.
General Systems Theory
The general systems theory relies on the assumption that various systems are interdependent of one another. The interaction between systems results in a chain of causes and effects. Social workers subscribe to this theory, and in a health care system they understand that although an illness can affect quality of life, quality of life can also affect the impact of disease and illness. This understanding can help the interdisciplinary team to address causes and effects of physical illness.
Bio-Psycho-Social Model
The biopsychosocial model, which was born out of the general system theory, ascertains the assumption that a person encompasses a complex interaction of biological, psychological, social, cultural, spiritual and physical experiences that all impact their life
(Fort Cowles, 2003). The model also assumes clinicians must asses all of these experiences of the person in order to effectively provide interventions. In the health care setting, it is often that one who seeks medical treatment is experiencing other biopsychosocial challenges that are affecting ones physical health status. In a health care setting, medical professionals are experts in treating biological and physical ailments.
However, with the assumption that a person is comprised of more than biology, other professionals, such as social workers, who are experts in assessing these other aspects impacting a persons life are necessary and bring additional efficacy when providing medical intervention.
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As social workers receive their education in a graduate level social work program, they are exposed to this biopsychosocial model in theory and practice courses. When taught, this model is generalized and approached with an emphasis in a long-term clinical setting, so that it can apply to various fields across social work practice. However, as a social worker in the healthcare setting, it is necessary to develop an advanced understanding of this method and its approaches in short term setting. Without this advanced knowledge and skill set taught specifically tailored to medical social work roles, practitioner’s transition from students to effective professionals in the field can be difficult and inadequate.
Empowerment Approach
The empowerment approach is considered “an integrated method of social work practice driven by the unified personal/ political construct and a commitment to the unleashing of human potentialities toward the end of building the beloved community, where justice is the rule” (Lee, 2001, p. 31). This approach understands that marginalized and oppressed populations are a direct result of the surrounding political system and encompasses holistic work with individuals at a micro, mezzo and macro level. By working through clinical and community-based contexts, those empowered populations can work together to work toward social justice.
In the health care setting, this can be a particularly important approach when working with people experiencing illness. If one too sick to care for themselves or their families, it may result in a cycle of poverty, emotional distress and stressed family dynamics which may effect quality of life. Inversely, if a person is impoverished or
8 marginalized, they may not have the ability to afford proper medical care or receive adequate attention to their health challenges. As social workers in the health care setting approach clients with this perspective, they can contribute to the social work goal of social justice.
Curing vs. Caring
In the 20th century, medicine began to have a hospital center focus due the growth of human disease and medical specialty (Fort Cowles, 2003). This allowed for medical practitioners to cure the patient’s illness, without focusing on the person as a whole. As technology and cost of care continued to rise, the primary concern for medical professionals was to effectively treat and cure in the shortest amount of time and contact.
Although curing is an important part of the healing process, caring, which is generally received as a secondary level of health care, is equally significant. Caring refers to the type of intervention that addresses the biopsychosocial aspects of a persons experience with illness (Fort Cowles, 2003). The supportive assistance is seen as to
“Promote health growth and development sustain function and relieve distress during a temporary problem episode and maximize comfort and function when a problem is permanent or even terminal” (Fort Cowles, 2003). Social work can be key in this caring role of a health care system. However, social workers need to be adequately educated and trained in the barriers and needs that a patient may experience with various illnesses.
Again, as this is generalized in a graduate level social work program, the unique methods of intervention in the health care setting can be further emphasized with an advanced health concentration.
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Interdisciplinary Teamwork
In a health care setting, the ability to work as part of an interdisciplinary team is key for success. As an interdisciplinary team, expertise from various professions collaborate to maximize efficiency and effectiveness in the delivery of care. Objectives of the interdisciplinary team include; comprehensive service delivery, effective use of staff resources, improved quality of patient care and cost effectiveness (Fort Cowles,
2003). Bope and Jost explained that some functions of interdisciplinary teamwork include; shared assessment of patient problems and needs, team teaching, addressing ethical dilemmas, delegation of tasks and responsibilities, modifications and evaluation
(as cited in Fort Cowles, 2003, p. 21).
Because the heath care setting organizational success relies on this interdisciplinary teamwork, social workers should be provided with advanced education in this approach.
Aspects such as objectives, functions, requirements and challenges, as well as methods for effective communication techniques and decision making styles should be addressed in a graduate level social work program that includes and emphasis in health care. This will allow for social workers to effectively advocate for their patients as they navigate through a system that is not comprised of a majority of social workers.
Definition of Terms
1. Medical Social Worker: Provides bio-psycho-social assessments to the patient and family, consults with medical staff, addresses barriers (substance abuse, mental health, grief) in a medical setting (Gregorian, 2005).
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2. Chronic illness: An incurable illness that requires medical treatment by a physician over a period of time such as Cancer, AIDS or Diabetes.
3. Inpatient Care: Inpatient care refers to treatment during a hospitalization.
4. Outpatient Care: Outpatient care refers to treatment that only requires a patient to visit a hospital or clinic.
5. Case Manager: A case manager is a person who is a part of the interdisciplinary team that focuses on discharge planning.
6. Biopsychosocial model: A model used to determine how genetic inheritance, learned behavior, cultural influences, the quality of physical environment, socioeconomic status, age, sex, stress, coping skills, diet/ exercise, substance use, support, and access to medical care can influences a person (Fort Cowles, 2003).
7. Holistic Perspective: Treating the patient as a whole including physical, emotional, social, environmental, cultural, and cognitive interpretations (Fort Cowles, 2003).
8. Interdisciplinary team: Medical staff, which includes disciplines such as physicians, nurses, case managers, nutritionists and anyone else who may contribute to the care of a patient.
9. Intervention: The treatment modality in what is set in place in order to address the patient’s barriers (Fort Cowles, 2003).
10. Length of stay: Prolonged stay of acute care need (Fort Cowles, 2003).
11. Complex Case: Patients who experience multiple medical challenges (Fort Cowles,
2003). This may include patients with significant barriers that complicate interventions and medical treatment.
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Assumptions
This research will elaborate on the idea that people are not solely comprised of physiology, and that they have an emotional, social, psychological and environmental capacity that needs to be addressed when implementing healthcare treatment. Just as medical professionals are expected to have extensive training and knowledge of physiology and treatment, the healthcare system should equip its practice settings with other professionals, such as social workers whom have extensive training and knowledge of these emotional, social, psychological and environment factors that can also affect treatment of the person. Because the foundation of social work is comprised of a framework, which includes this bio psychosocial approach, social workers are better equipped with interventions to assist patients who are experiencing other challenges, in conjunction with their medical treatment that may be inhibiting their ability to live well.
Social Work Research Justification
As social workers are continuing to become involved in working with the interdisciplinary team, clinicians entering the field of medicine need to be equipped with proper knowledge and skills. As professionals working alongside other disciplines in the medical field, clinicians must be skilled in assessing various biopsychosocial dynamics, as it pertains to medical treatment. Without knowledge of medical terminology, pathology, and communication skills to collaborate with the interdisciplinary team, the social worker will be challenged when attempting to effectively provide holistic intervention to the patient in the medical setting.
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This study is particularly important because it identifies the necessity of a unique set of professional skills a medical social worker should possess, and argues that these skills should be educated with emphasis in a graduate level social work program to students who wish to work as a medical social worker. By providing future medical social workers with competencies, such as a physiology of a disease, it allows the medical social worker to be able to confidently communicate with a physician or nurse about the patient’s medical treatment and how social work intervention may have an impact on patient care. In turn, by being able to discuss a patient’s care with the interdisciplinary team in their language, the organization that has been known to have traditional and outdated biases about the social work profession will be able to relate to social workers as a specialty. By deteriorating biases about the profession all of the disciplines can come together to effectively treat a patient and enhance the quality of care and life.
Social workers abide by a code of ethics that guide micro, mezzo and macro level social work. Core values that provide a foundation for social work include; service, social justice, dignity and worth of the person, importance of human relationships, integrity and competence (NASW, 1996). The research conducted in this study is significant because it aims to address the unique role expectation of a medical social worker and propose a curriculum with a medical emphasis that promotes these core values. As service providers, medical social workers attempt to advocate for social justice by working with marginalized populations, such as the chronically ill, mentally ill and impoverished to address the barriers that may be hindering their capacity to
13 experience a good quality of life. An emphasis in medical social work within a graduate level social work program will be able to provide social workers with advanced level of competencies to more effectively work in the health care setting.
Study Limitations
The researchers will not be studying the effective delivery method to patients or identifying interventions that have been proven to reduce recidivism in hospital settings.
This study is not indented to focus on the intervention of the medical social worker or to assess the effectiveness of the intervention. Furthermore, the participants of this study comprised of medical social workers from one hospital located in Sacramento, Ca.
Although the data is significant for the study, it cannot be generalized to the entire population of medical social workers.
Statement of Collaboration
The researchers Kassy Mason and Jocelyn Merino will be co-authoring this research project.
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Chapter 2
REVIEW OF THE LITERATURE
The literature review will be examining the importance of courses that have an emphasis in medical education in the Master’s of Social Work program for those pursuing a career in Medical Social Work. This chapter will be organized into different concepts. The findings of the impact of illness and disease on the whole person will focus on taking a holistic approach to treating each individual patient. Acknowledging a patient’s perspectives allows the medical team to understand the patient’s perspective.
This chapter will also examine the roles of social workers in the healthcare setting and the knowledge and skill sets that medical social workers possess. Recognizing the social worker’s role and skills asserts the value of medical education for social workers.
Consequently social workers have a significant effect on patient care. The second portion of the chapter will discuss the impact of healthcare, Gross Domestic Product and concerns of cost, research effectiveness of social work in the medical field, research discussion on the value and effectiveness of social work in healthcare, challenges of social work in the healthcare field, staffing and disciplinary realm, and what a graduate program should entail in order to prepare those pursuing a career in medical social work.
This section is particularly important because it will articulate the significance of social workers in the medical setting and acknowledge why a medical social worker should enter the field educated and trained in these particular concepts. This section will outline how the role of the social worker has an impact of lowering length of stay and dealing with complex cases by addressing psychosocial issues. Lastly, this chapter will also
15 review the access of medical social work programs and the importance of being knowledgeable of emerging trends in the healthcare field. The research will include key educational components that medical social workers should be competent in when entering the field of healthcare.
Impact of Illness and Disease on the Whole Person
Social workers work with individuals, families, physicians, nurses, and case managers as a liaison between the interdisciplinary team and the patient. A variety of barriers inhibit their adherence to treatment. Many times a physician is unable to assess the patient’s psychological functioning and their lack of resources. These factors play a major role in the person’s treatment and directly affect their capacity to comply with treatment. A patient’s treatment should incorporate physical, psychological, spiritual, emotional, financial, gender, and ethnicity. Working with the patient and their environmental familiarity with will increase outcome in treatment (Zimmerman &
Dabelko, 2008.) With an increase in readmission to the hospital, more attention should be given to psychological and environmental factors to reduce the numbers of recidivism and caregiver stress. The interdisciplinary goal should be to treat a patient holistically not just to attend to their medical condition (Zimmerman & Dabelko, 2008).
During a hospitalization a person’s life becomes compromised to treat their immediate medical need. As the patient goes through treatment different stressors arise that compromise their usual way of coping (Berkman et al., 1988). Psychological factors such as depression, anxiety, denial, and anger emerge particularly if a patient has never experienced such a stressor before (Berkman et al., 1988). A patient with a history of a
16 mental illness or previously existing disabilities could react differently to an added stressor than a person who has never experienced a medical condition. In order to identify potential barriers a patient’s external and internal stressors need to be assessed to effectively treat a patient’s medical condition. (Berkman et al., 1988).
Family dynamics also play a major role during a hospitalization. It is very common for patients to reevaluate their relationships with others during this time and find meanings with people that surround them. Families are an important factor during a hospitalization and even greater in the patients recovery depending on their prognosis
(Koenig, 2004). The involvement of the patient’s family helps establish the type of care giving or living situation the patient will encounter upon discharge. By bringing together families, physicians, and patients medical compliance could be improved with the collaboration of everyone (Zimmerman & Dabelko, 2004).
Along with psychological and emotional changes there are also spirituality factors that could determine how a patient proceeds or copes with treatment. Some patients turn to religion to help them get through their crisis. A study from Duke University in North
Caroline showed that 90% of the patients admitted for general medicine, cardiology, and neurology reported that they used religion in some way to help them cope and more than
40% stated religion was the biggest motivator for them (Koenig, 2004). Although many patients do find faith to be a part of their support system, others begin to lose hope in something they once believed. Most importantly, a person’s spirituality can also determine how the patient moves forward with their treatment (Koenig, 2004). It is
17 important for the medical team to be sensitive of a patient’s spiritual views as it pertains to their plan of medical care.
Financial burdens are an important factor on the patient’s treatment. The patient’s lack of insurance and insurance coverage could unfortunately impact a patient’s compliance with their plan of care (Aaron, Scwartz, & Cox, 2005). This is mostly affected after the patient leaves the hospital and is faced with the need of caregivers, prescriptions, and in some cases nursing facilities for rehabilitation. When patients are admitted to a hospital, the uninsured or under insured responsibilities fall on the interdisciplinary team. The team must create a plan on how the patient will fulfill their medical requirements with finances as a barrier.
In some cases gender may disqualify a patient for medical coverage specifically in situations where the patient may be transitioning to male or female. Sex change surgery and treatment for the transgender population are not covered by insurance. Treatments may include transition assistance, counseling services, hormone replacement therapy, and surgeries for sex reassignment (Cray & Baker, 2012). Transgender patients are also at higher risk for added health issues. For example, a recent survey found that transgender patients are four times more likely than the national average to be infected with HIV. Due to the prejudice of society they are also more likely to turn to drugs and alcohol to cope
(Moskowitz, 2010). Because social workers act as advocates for equality and social justice, which include awareness of these progressive challenges for the transgender community, they need to have a place at the interdisciplinary table to share their knowledge of these issues.
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As the rise of minority groups continues to grow in the United States it is important to be culturally competent, especially in a healthcare setting where the patient may not be able to speak for themselves. Culture is defined by shared beliefs and learned behaviors of members of a group. The definition of a group includes geographic location, faith, values, age, ethnicity, race and heritage (Dees, 2007). A culture can greatly impact how a person decides to continue with their treatment. Different cultures have different beliefs and some opt to treat their medical ailment with complementary and alternative medicine found in their own community. For example, Curanderas, or healers, are a widely accepted form of treatment in the Hispanic culture and an elder Hispanic woman may see the role of the Curandera as a more appropriate form of treatment. Concepts like this may be difficult for physicians to understand without proper knowledge of cultural awareness.
Other challenges that can inhibit a patient may be language barriers or immigration status. People that live in tight knit communities may not have the necessity to learn English, therefore, communication can become a problem. Immigrants that are not naturalized citizens live in fear that seeking medical treatment could place them in a situation where they may be deported (Dees, 2007). Poverty is also a huge barrier when it comes to compliance with medical care. The homeless population usually waits until their medical condition becomes a crisis because a person that is homeless has food and shelter as their first priority rather than filling prescriptions and attending follow up appointments (Dees, 2007).
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There are many factors that play a role in how the patient perceives and continues their medical treatment. Spiritual, cultural, physiological, emotional, and financial all contribute to the stress of the person seeking medical treatment. By considering the patients comprehensive lifestyle it benefits the patient but the also the medical team to better understand a person as a whole. Treating a patient as a whole is vital for everyone involved.
Importance of Social Work Roles in the Healthcare Setting
Social workers have many roles in the medical setting. Some social workers work directly in the hospital with the interdisciplinary team and are constantly interacting with physicians, nurses, and families. While in the hospital there are social workers assigned to every department, which includes Medical/Surgical, Emergency Room, Intensive Care
Unit, Orthopedics, Oncology, Bone Marrow Transplant, and Telemetry. While each department requires different duties from a social worker, the goal of the social worker is the same in assessing barriers to discharge. Social workers also work to assess the family’s social situation, dynamic, and capacity to cope with the patient’s medical condition and hospitalization. Social workers then consult with the interdisciplinary team to assist them in understanding how to effectively interact with a particular family. Social workers provide counseling and support at bedside to families and patients that are dealing with end of life situations and bereavement grief. Social workers also make mental health evaluations and discuss substance abuse issues (Gregorian, 2005).
Hospitals are increasingly providing patients and families with supportive counseling groups that are dealing with end of life and bereavement issues. Support
20 groups have been more widely seen with oncology patients but are also seen in diabetic,
Alzheimer’s, dementia, caregiver groups and other chronic or progressive illnesses.
Groups can serve as supportive or educational. In support groups the goal is to focus around patient or their family as they are coping with the impact of the illness. Often, the patient and the family support groups are separated and aim to concentrate on addressing different concerns depending on the culture of the groups.
In educational groups the purpose of the social worker is to be an educator and educate the patient or the family on what the illness entails, the prognosis, and decisions that will need to be made. This type of group is usually formed as a classroom-like manner and the presentation is topic centered. Participants have the opportunity to engage in a question and answer discussion (Berkman et al., 1988). On the other hand social workers also facilitate support groups that particularly provide members the ability to express their emotions and to discuss how they are coping with their illness or the illness of a loved one. In this type of group members identify their feelings and have the ability to share personal experiences as well as challenges. Members also have the opportunity to contribute community resources to the group and offer mutual knowledge (Fort
Cowles, 2003).
During the crucial stage of end of life and hospice care the role of the social worker role is present in inpatient and outpatient settings. There are many components that are vital during this process. The most important role of the social worker during this time is to serve as a counselor about the grieving process for the patient and the family.
As a counselor the social worker assesses the patient and their families emotional status
21 and provides counseling or support as necessary. The counselor assists the patient and family in coping with this transition or loss as well of the pursuit of peace of mind (Fort
Cowles, 2003). In this role social workers also assist the patient by becoming a broker.
In this process the social worker works with the family in eliminating financial barriers that arise during the end of life stages (Fort Cowles, 2003). Financial challenges are a major concern for some families. The social worker can help the families find coverage for burial and comfort care services along with respite care.
The role of the social worker as a manager in a medical setting has a different purpose than line staff. The manager has less direct practice with individual patients and often only work with other staff members in the hospital from other departments. The managerial role works alongside case management and focuses on the cost effectiveness of the organization as well as resource allocation. The social work manager position also serves as a liaison to link the social services department to other operations in the hospital and advocates for the importance of the social work role. (Berger et al., 2003).
The role of the social worker in the emergency room is vital and has many components. The emergency room social worker deals with a variety of cases on a daily basis with a wide range of concerns. In the emergency room the social worker assists the family in brief counseling, referral and resource finding for patients and families who are there for a threat or attempt of suicide, child abuse, domestic violence, chemical dependency, acute psychiatric problem, rape, assault and battery, and homelessness. The emergency room is also places that patients have learned to use who have underlying psychosocial issues that were not properly addressed in a previous hospitalization (Fort
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Cowles, 2003). The emergency room is often the middle ground for people who are in need of further assistance. From the emergency room patients can go to other psychiatric facilities, shelters, and sometimes jails.
A mental health assessment is a method for gathering information about the patient’s mental health status. During this procedure the clinician addresses the patient’s appearance, attitude, activity, mood and affect, speech and language, thought process, insight and judgment (Gehlert & Browne, 2006). The purpose of the mental health assessment assists the clinician in determining which intervention to proceed with.
Differentiating between non-compliance, a mental illness, and symptoms following a traumatic event are also key factors in the mental health assessment. The sole purpose of the mental health assessment is to gather information about the patient’s current mental status, unlike taking a person’s history and environment into consideration, to determine whether further assessments should be made (Gehlert & Browne, 2006).
Clinical interventions are present in each meeting with the patient. Depending on the referral determines what kind of intervention may be practiced. For example, a person with a substance abuse problem may benefit from having a discussion with a social worker about a harm reduction model before being discharged. In the interest of each patient the social work clinician must determine which model, theory, or method best fits a particular client. According to the informed clinician he or she should have the skills and ability to determine, based on the client’s history, culture, life, and style which treatment approach would benefit them most. Additionally, the clinician must determine which modalities (individual, family, or group) will meet the needs of the client and
23 proceed with the intervention based on their clinical decision (Johnson & Grant, 2005).
Social workers also encourage one another as clinicians. Due to high intensity cases and disagreements with the multidisciplinary team, supervision has been a space for social workers to de-brief. Having open discussions about feelings is helpful to social workers to distinguish between positive and negative empathy (Rehr et al., 1998).
Knowledge and Skill Set
The background knowledge and skill set of a medical social worker can be similar to that of a clinical social worker in a therapeutic setting. However, the difference comes in the individual himself or herself and on the job training they have acquired since beginning their practice in the medical setting. Unlike most social services where the social worker is the most important professional role and are often the primary administrator, in the hospital the medical social worker is seen as collaborating with many different disciplines each day who are used as a more of a consultative role instead of an administrative one (Gregorian, 2005). A medical social worker understands that their role may not be seen as important to others and will not always be appreciated.
Some people in the medical field may not even feel that social work interventions contribute to the well being of the patient. More often that not, people are unaware of the capacity of the social work role therefore creating a struggle for credibility.
Social workers who are able to be successful in the medical setting have to develop strong personal and professional boundaries. Due to the medical social worker dealing with different specialties, departments, and patients the medical social worker is easily pulled in different directions (Gregorian, 2005). It is also important for a medical
24 social worker to have a good sense of self worth since some of their work may be educating others of the importance of their role. Having these skills professionally and personally will assist the medical social worker in navigating their way through the healthcare system.
The hierarchical system within the healthcare setting can be old-fashioned in their organization and still remain male-dominated. If social workers are unable to understand and recognize the politics of the system then they are more likely to feel dis-empowered
(Gregorian, 2005). Being able to understand the politics and the hierarchical system is key to minimize frustrations between physicians, nurses, and social workers. Once mutual respect is established the scope of the social worker can be seen as a united one rather than as a separate entity.
Along with working alongside members of the interdisciplinary team a social worker also has the opportunity to work with team changes as physicians rotate through departments and specialties. Due to the rotation of different physicians, this may increase or decrease social work referrals and treatment plans. As a result of rotating physicians and the variety of cases encountered, there is interaction with many different styles of doctoring. While engaging with physicians of different specialties the social worker should also be informed of the patient’s disease, course of illness, and treatment offered
(Gregorian, 2005). This is crucial when conversing with physicians about the physiology of a disease and relating it to the patient’s holistic needs.
Although working in a hospital requires understanding the medical hierarchy and having knowledge about the physiology of a disease, the work of the medical social
25 workers continues to apply clinical skills in their everyday practice. The social worker uses their assessment skills to assess family dynamics and emotional capacity to deal with the loss and grief of an illness, hospitalization, and treatment. During this time we have the opportunity to provide counseling around bereavement to the patient and family or provide skills to manage anxiety. Medical social workers advocate for their patients to the rest of the medical team as well as facilitating a conversation between the two parties.
At times, referrals may be around substance abuse, child abuse, and elder abuse. The social work role is to provide education and serve as brokers to community resources that are available to the patient if they are seeking abstinence or care giving assistance. Most importantly, social workers identify any barriers that could interfere with discharge. This concept entails viewing the person holistically meaning that the medical team takes the patient’s spirituality, living situation, other medical condition, support system, and resources into consideration when creating a treatment plan (Gregorian, 2005).
Impact of Healthcare on GDP and Concerns of Cost
After health care inflation rose from 5.1% in 1960 to a high of 13.4% of the annual
GDP in 1994, cost control became a prime concern of hospitals (Fort Cowles, 2003).
Among the various values of both for profit and non-profit healthcare systems, the importance of cost effectiveness and cost benefit drive the overall operations of healthcare systems because of this inflation. More recently, in 2010, the annual GDP in healthcare was a new high of 17.9% (American Hospital Association, 2012). As the cost of healthcare continues to rise, hospitals have been frugal with their funds, only to spend money on programs and medical interventions that prove to be most effective. Cost
26 driving factors such as length of stay, speedy discharge plans, rate of reoccurring hospital visits and adherence with recommended medical treatment have become the units of measurement used to assess the effectiveness of not only the overall hospital operations, but also social work interventions.
Challenges of Evidence Based Research
Social workers have fought for a long time to establish a professional presence in the health care field. With the rise in emphasis on cost effectiveness, social workers increasingly have to prove that they are a justifiable expenditure within the health care setting (Keefler, Duder, & Lechman, 2001). This has been difficult due to the lack of evidence-based research on the effectiveness of the social work role. Furthermore, social workers have not developed adequate research that gives them meritorious professional credibility. In the research that is available, the reports provide detail on the social work intervention used, but they fail to measure the effectiveness of those interventions, as well as the overall outcomes (Auslander, 2003). Auslander (2003) argues that in order to continue the presence of social work in the health care setting, social work professionals need to focus their research on outcomes that entail not only the psychosocial outcomes of the clients, but also the outcomes that improve functioning of the hospital as an organization. “As “institutional guest,” social work departments must show that they contribute to that organization if their welcome is to be extended” (Auslander, 2003, p.
35).
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Value and Effectiveness of Social Work in Healthcare
Further literature in the field discusses roles, knowledge and skill sets needed that are necessary to be an effective social worker in the healthcare field. Because of the many types of unique services and interventions a social worker can provide and the need to provide evidence based research, a limited amount of research has been conducted to investigate the impact and effectiveness of this social work role. A study conducted by
Auerbach, Mason and LaPorte (2007) used various measurements in an attempt to research evidence that supports the value of social work in Hospitals, specifically in the medical/surgical units. This article begins by addressing the recent trends of the social work profession in the hospital. As it is becomes increasingly more common for hospitals to cut social work departments, they resort to relocating specialized social workers within various departments, such as oncology and emergency response
(Auerbach, Mason, & LaPorte, 2007). Because of this change, social workers are often left to share the roles of other healthcare professionals in areas including case management and discharge planning, which has created challenges in assessing the importance and effectiveness of social workers in hospitals (Auerbach, Mason, &
LaPorte, 2007). Despite these challenges, “Mazrahi and Gerger’s (2001) survey of 340 social work leaders in hospitals showed a resiliency in adapting to hospital needs through redefining roles of social work staff” and more than half had a positive outlook on working in the healthcare environment. (Auerbach, Mason, & LaPorte, 2007, p. 19).
In efforts to find evidence that these social work roles were not only important but also effective, Auerbach, Mason, and LaPorte (2007) surveyed a sample of 64,722
28 patients that were admitted into the med/surg department between January 1, 2002 and
June 6, 2004. Of this sample 15.7 % had experienced social work involvement. Overall, it was found that although the length of stay was longer for cases that had social work involvement, the cases also proved to be more complex. For example, 36.5% of the social work dispositions were to institutions such as nursing homes, which presented other complex challenges including availability of beds, insurance eligibility, and family compliance (Auerbach, Mason, & LaPorte, 2007). “Social workers who often are trained in the psychosocial biological modes of practice are well suited for resolving these complex combinations of discharge issues” (Auerbach, Mason, & LaPorte, 2007, p. 29).
Therefore, this article concluded that although the debate of the necessity of the social work department is still at large, social workers are an important part of assessment and discharge services, and “as the current findings suggest, many of the cases assigned to social workers involve an array of complex factors beyond the scope of diagnosis alone further confirming the importance of social work in acute care hospitals” (Auerbach,
Mason, & LaPorte, 2007, p. 30).
In another attempt to research effectiveness of social work in the health care field,
Rizzo and Rowe (2006) comprised a literature review that was commissioned by the
National Leadership Coalition in response to the need to understand the cost effectiveness of social work services in the area of aging. Although their focus was on aging, the issue of efficacy and cost effectiveness was also addressed in terms of the impact of social work intervention in the healthcare setting. They first conducting a comprehensive search of literature available between 1987 and 2003 that included key terms, such as
29 evidence based practice, managed care, cost outcomes, healthcare qualified with other phrases such as, “social work and…” If the articles included evaluation of social work intervention and target sample populations of aging individuals and their caregivers, they were then organized by intervention type and summarized for further analysis. “The results suggested that high levels of informational support services provided by social workers had a significant and positive impact on total hospital charges.” (Rizzo, 2006 p.
70). They also found that a majority of the projects resulted in at least one positive outcome improving quality of life for individuals who received social work intervention
(Rizzo & Rowe, 2006).
Agency and Policy Involvement
Although there is an overwhelming debate on the need to continue to justify social work presence in the health care field, current policies and agencies recognize that the presence is necessary. The National Association for Social Work (NASW) recognizes social work in the health care setting as a legitimate occupation as defined by the NASW Center for Workforce Studies and Social Work Practice (NASW, 2011).
Furthermore, there have been a number of recent studies conducted by the National
Institutes of Health and National Academies with common themes of an emphasis for social, cultural, economic, family and community factors that influence health conditions
(Fort Cowles, 2003). The National Research Council has also invested in researching the impact of behavioral, social and biomedical sciences with a focus on ten priority areas which include pre-disease pathways, positive health, healthy communities, interventions and more (Fort Cowles, 2003). It is also important to mention the impact that changing
30 governmental policies have on the healthcare field and the social work role. With changes on healthcare polices, such as the new affordable care act, Medicare and
Medicaid, the role of social worker will become more necessary than ever.
Other Challenges of Social Work in the Healthcare Field
Among other challenges, fiscal pressures have forced hospitals to advance in order to continue their maintainability. This has led to changes in staffing delegation of professions within various departments, including social work departments (Berger et al.,
2003). As social workers continue to advocate for their necessary role, there are different management structures that they must navigate in order to function. Berger et al. (2003) explains that there is a continuum of organizational structures that include various degrees of centralized control:
At one end of the continuum are traditional, bureaucratic pyramidal organizations with distinct departments that are autonomous but interdependent. In the middle of the continuum are matrix models where professional staff is equally responsible to their department and to their program/patient care unit. At the far end of the continuum lies a pure program management, which eliminates discipline-specific, functional departments such as social work and relies on programs/patient care unit administrators to hire, supervise, and evaluate professional staff. (p. 2).
This phenomenon is important for social work managers of other social worker professionals in the healthcare setting to be critically aware of, especially when defending their roles. Berger et al. (2003) explains that social work leaders can play an important role in this systematic structuring. If they are able to help shape organizational changes mentioned above, they can increase strategies to limit the risk to social work staffing when they are challenged by political and environmental factors (Berger et al., 2003).
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One of the major and widely debated functions of the role of the social worker in the healthcare field is the contribution to an interdisciplinary team. Much of the literature supports the idea that one who works in this role must be comfortable and able to work well with colleagues of other various professions. Actually, it is argued that the key to social work survival in the medical setting is based on collaboration and cooperation in a way that complements, rather than competes with other professionals (Ruster, 1995).
However, this has been difficult because the role identity of social work in the hospital setting has been unclear (Cowles & Lefcowitz, 1992). Lack of clarity of this role has made collaboration between professional roles ambiguous, compounded and sometimes ineffective.
In a two-part study conducted by Cowles and Lefcowitz (1992, 1995), 500 physicians, nurses and social workers were surveyed to compare professional opinions on the expectations of medical social workers in the hospital. First, they found as the medical professionals have begun to shift from the medical to the biopsychosocial model, there has been an overlap of role expectation. Furthermore, at least 60 percent of physicians and nurses studied felt as though they shared the responsibility with other professionals, including social workers, to assess for emotional and social barriers, as where over one-half of the social workers expected this to be their unique role (Cowles &
Lefcowitz, 1992). It was concluded that social workers need not worry about proving their competency, but presenting a clear image of their profession and person-in- environment perspective to other professionals in the field (Cowles & Lefcowitz, 1992).
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Another study completed by Mizrahi and Abramson (2000) paired 50 physicians and 50 social workers as collaborators on an inpatient case with an unusual long-term length of stay in an acute care hospital setting. The purpose was for the physician and social worker to share perspectives about the case. It was found that although the physician addressed biopsychosocial challenges, there was fewer psychosocial barriers addressed and those that were addressed were rarely referred to community resources.
They concluded that, “as physicians deal with ever increasing numbers of elderly and chronically ill patients and with those diseases where psychosocial factors most strongly affect medical outcomes, they will increasingly need to depend on social workers as partners in improving the health of their patients” (Mizrahi & Abramson, 2000, p. 21).
As this social work role continues to evolve, there is some debate on the terms of interdisciplinary vs. multidiciplinary. For example, Volland et al. (2003) describes this trend of social work practice in a “multidisciplinary structure” working with doctors, nurses and case managers, however, Auslander (2000) argues that social workers must be cautious because there is a difference between interdisciplinary and multidisciplinarily approaches. She explains that a multidiciplinary approach entails members of different professions working side-by-side and not necessarily in collaboration (Auslander, 2000).
This is presenting in a phenomena that results in professionals of other fields conducting research on topics that should be done by social work professionals. As mentioned earlier, social work is already criticized for its gap in research of effectiveness, therefore this further threatens the professional credibility of social work in the field (Auslander,
2000). Social work professionals must be cautious and critical of this difference and
33 continue to promote interdisciplinary teamwork, but also be protective of the research that will promote the needed role of social work in the healthcare field.
Implications of a Health Emphasis in a Social Work Graduate Program
The role of social work in the health care field is unique, and should be treated with such opinion when considering adequate curriculum in a graduate level social work program. From the literature reviewed, it is clear that there is a role for social workers in the health care field. While this role is evolving and becoming more developed and credible with advanced research, it is important that social work professionals and social work students in the healthcare field advocate for a concentration in health education.
For the current programs that already exist, it is important for students advocate for updated, effective curriculum so that they are prepared for the healthcare field after they graduate.
Although social work prides itself on having an eclectic approach using various theories and practices so that a social worker can be prepared to work in any setting, this can be a superficial method when educating and training future medical social workers.
For example, it is argued that social workers who are trained in short term approaches using individual and family group interventions are more likely to be effective in the medical setting and better able to adapt to the rapid changes normal to the health care field (Mailick & Caroff, 1996). Furthermore, it is argued that if student social workers are educated about long-term models and their demands early in the program, they can become apt to prefer these models, even when they may not be utilized in their current field of practice (Mailick & Caroff, 1996). Therefore, student social workers in graduate
34 program that are interested in entering the health care field should be able to begin their education in their first year with concepts, such as short term intervention models, that will provide them with effective tools for their future work in the medical setting. A concentration in healthcare within a social work graduate program should also emphasize several various areas unique to its field.
Access
Social work students who wish to work in the healthcare field need to be educated and trained to effectively work in all roles unique to the healthcare setting. As argued by
Volland and colleagues (2000), graduate social work level education should offer healthcare education more extensively (as cited in Fort Cowles, 2003, p. 355). Volland and colleagues also argue that a larger range and number of courses should be offered that mirror the events, trends and expected roles of the professional in the current healthcare system (as cited in Fort Cowles, 2003, p. 355). Throughout the United States, there are only a limited number of accredited social work programs that offer an actual emphasis in healthcare education. Current medical social workers, social work professors and student social workers need to continue to advocate for the importance of the presence of a health emphasis in order for future social work students to be better prepared and trained for the demands of working in healthcare field.
Knowledge of Emerging Trends
Volland and Colleagues (2000) argue that the graduate level social work curriculum on healthcare should include advanced education on the current and changing healthcare system, including information on what will be expected from social workers employed in
35 the field (as cited in Fort Cowles, 2003, p. 355). For example, beginning in 2014 the
Affordable Care Act will define ten broad categories of “essential health benefits,”
(EHB) which will be customized by each state (Collins, 2012, p. 1). “Social workers should be aware of the EHB development process in their states, to ensure that their state
EHB plan addresses the needs of the people with chronic disease, disabilities and other complex health issues, including individuals with mental health and substances use disorders, and that access to social work services is maintained and strengthened”
(Collins, 2012, p. 1). Within the health concentration, students should be provided with access to advanced education on these specific emerging trends and their impact on the client population.
Furthermore, Fort Cowles (2003) explains that health care delivery trends are moving towards patterns such as: moving from acute care to chronic illness and diseases of aging, increased emphasis on market forces and cost control, increased recognition of social and environmental determinants of diseases, and increasing role of families in provision of home care. This has many implications on the focus of the medical social worker clinician. Medical social work needs to pay new attention to brief interventions and solution-focused therapy. It also must encourage a greater emphasis on patient outcomes research and evaluation of social work services, increased need for patient education about health coverage and financing, and increased emphasis on prevention and population-specific practice (Fort Cowles, 2003).
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Population-Specific Knowledge
Berkman (1981, 1985a, 1985b) explains that in the medical setting, “Effective patient care intervention requires an understanding of the epidemiology of disease including social environmental risk factors” (as cited in Spitzer and Nash, 1996, p. 23).
This knowledge must also be supplemented by an understanding of various cultural, racial and ethnic populations as it relates to medical treatment. Socio-environmental factors of patient’s situations play a key role in their understanding and agreement to treatment options. This population specific knowledge is necessary for social work clinicians to implement effective interventions in patient care. Further knowledge on medical terminology, policies, regulation as well as ways to access and utilize systems of care pertaining to specific disease or populations being served will also provide effective intervention in managed care (Fort Cowles, 2003).
Field Instruction
Modalities and responsibilities of field education are being reconsidered as healthcare delivery changes. “Specific content modifications are recommended for health care curriculum underscoring a shared mission of class and field in education for practice competence and service delivery” (Spitzer & Nash, 1996, p. 10). With these modifications, the consideration of medical social workers that are provided training and supervision in settings other than inpatient hospitals has been implemented so that social work students have a comprehensive understand of the entire health care continuum (Fort
Cowles, 2003). These setting include public health agencies, nursing homes, home care agencies, hospice programs and support groups for patients with disease specific
37 challenges. In settings where social work departments have become decentralized, there is a concern for the collaboration between fieldwork education and schools of social work
(Mailick & Caroff, 1996). As community based programs address medical needs outside of the hospital, these placements will become increasingly important for students interested in medical social work, especially as placements in hospital inpatient settings become increasingly limited and competitive.
Research
As mentioned earlier, one of the major challenges of medical social work includes the lack of research to prove its effectiveness. Therefore, Volland and colleagues (2000) argue that more training in research and methodology, as appropriate use of rapid assessment tools and outcomes research should be emphasized in order for future medical social workers to further accredit the role of social work in the healthcare field (as cited in Fort Cowles, 2003, p. 355). Furthermore, Fort Cowles (2003) suggests that health care social workers need to be engaged in advanced education on experimental design research, as this type of research is more widely accepted in the healthcare setting. Hall et al. (1996) argues that by having standardized practicum experience with research opportunities, there is room for further interaction between social work students and practitioners. Students offer an important link between academic research, practitioners and future social work students, and by becoming involved with this research, social workers of all experience levels can create a strong knowledge base for effective practice
(Hall et al., 1996).
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Current Programs and Courses Available
While the literature gives a comprehensive analysis of various important and necessary competencies needed for a social worker to thrive within a healthcare setting, the researchers also found it important to further their understanding of current curriculum within a social work program that has a health concentration. The researchers examined various graduate level programs in which a health emphasis was incorporated, some including University of Southern California, Loyola University, Chicago, Indiana
University, Indianapolis, and University of California, Los Angeles. Among these various schools, reoccurring themes showed that the two-year programs included a construct of first year generalist foundations of social work with the second year including required courses compiled to address the advanced competencies needed for effective social work in the health care field. Other programs offered dual-degrees, which provided opportunities for students to receive both a Master of social work and a Master of Public health. With this education from relevant, yet separate departments, graduate level education for social work in the healthcare setting can be more extensive and provide opportunity for further critical expertise.
Conclusion
By understanding the roles, knowledge base and skill sets of the social worker in the medical setting, professionals can identify the vital necessity of the function of the social worker. While there is debate on when and how much social work intervention should be implemented, it is evident that by addressing psychosocial barriers, goals of the larger medical system, such as length of stay, can be better realized. While other medical
39 professionals may have knowledge of psychosocial challenges to medical treatment, social workers provide a more extensive knowledge of interventions and community resources that can benefit overall patient care outside of the medical realm. The role of social work in the medical setting continues to evolve and develop with further advocacy and research as it navigates its way through a larger healthcare system. As student social workers become increasingly interested in the growing field of medical social work, graduate level education social work programs must tailor their curriculum to this need.
Graduate level programs should include a healthcare emphasis that prepares social work students with knowledge of various population groups, navigating through an interdisciplinary work environment, effective intervention strategies and research experience.
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Chapter 3
METHODS
The purpose of this study is to develop a curriculum of best practices for a student in the Master of Social Work program who is pursuing a career as a medical social worker. The researchers used a mixed methods research study and asked current medical social workers at Sutter General and Sutter Memorial Hospital in Sacramento, California to participate in the study created. The study was formed to evaluate what medical social workers valued as helpful when working as a medical social worker. The survey included questions regarding their careers and educational background to assess how effective their Master of Social Work program was in preparing them for medical social work. The intention for this study is to find what was most helpful to a variety of medical social workers to be able to compose an educational curriculum for graduate students seeking a career in medical social work.
Study Design
The study design of this project is a descriptive, using a mixed methods approach.
The research constructed is a structured questionnaire with open-ended questions and forced-response questions. The object of the survey is to gather a greater knowledge about the education that was most helpful to current medical social workers at Sutter
General Hospital and Sutter Memorial Hospital and apply it to a general knowledge of what the literature states is vital. With the results of this study the researchers will gain a better understanding of the educational needs of a graduate student pursuing a career in medical social work and be able to formulate a curriculum with an emphasis in medical
41 social work. Although this study was only formulated on medical social workers in one medical organization, the researchers hope to gain more insight on what may benefit medical social work students in their future education.
Sampling Procedures
The study conducted was a non-probability form of sampling, specifically a criterion sampling approach due to the selected sample. The participants selected were key informants from Sutter General and Sutter Memorial Hospitals in Sacramento, CA.
The participants were medical social workers who were selected due to their expertise and knowledge about medical social work. The participants were surveyed during a required monthly staff meeting for all social workers in the Sutter organization from
Sutter Memorial and Sutter General Hospital. The researchers conducted their study at
Sutter Memorial Hospital in January 2013. The researchers presented the survey and informed consent form and proceeded to distribute the surveys at this meeting.
Data Collection
The researchers contacted Julie Abbott, the social work manager from both hospitals to explain the survey and the intention of the research. Julie Abbott provided a letter of access to the researchers and invited them to conduct their survey at their monthly staff meeting at Sutter Memorial Hospital. The researchers explained the survey and informed consent form to the participants and instructed them to review it and inquire about any possible concerns. The surveys were distributed and attached with envelopes that the participants could use to enclose their survey in. The surveys were to be returned
42 to the unit secretary at Sutter Memorial Hospital or to the researchers direct supervisor in the social work department at Sutter General Hospital at a later date.
Instruments
The instrument used to collect data was a 31 question based survey that included open-ended questions and forced response questions. The instrument included nominal questions such as age and gender, but also used interval-scaling questions regarding the participant’s perception of their experience of the usefulness of their Master of Social
Work program as it pertains to their career in medical social work. The questions were scored using a 7-point Likert Scale, being Completely Agree (1), Partially Agree (2),
Neutral (3), Partially Disagree (4), Completely Disagree (5), Unsure (6), Not Applicable
(7). The rest of the survey consisted of open-ended questions that produced qualitative data for the researchers to analyze.
Data Analysis Plan
The researchers conducting this survey will assess the data manually. The most acknowledged courses and educational guides from the open-ended questions that participants explain as most helpful to them for their current work now will be grouped together to find emerging themes. The researchers will tally up manually the results from the Likert scale to identify whether or not the participants found their social work program useful for their current career. After evaluating both segments, the researchers will determine what current medical social workers would have found useful in their education with their present careers. With this information the researchers will provide a
43 template in the following chapter for curriculum in a graduate social work program that has an emphasis on medical social work.
Protection of Human Subjects
The researchers submitted a Human Subjects Review application to the
Sacramento State Institutional Review Board. The Human Subjects Protocol #: 12-13-
039 and was accepted under exempt conditions under the federal guidelines 45 CFR 46.
101(b)(2). The exempt status was accepted due to the study’s intention to evaluate established courses and the effectiveness of instructional techniques. Participants were informed of possible psychological or emotional discomfort that may arise from the survey. If the participants at any moment experienced discomfort they were encouraged to discontinue the survey. The signed informed consent form indicated that the participants were willing to complete the survey. A survey without an attached informed consent form will not be considered as a valid and automatically be destroyed.
The social work professionals asked to participate in this study will remain anonymous. They will not be questioned about their specific place of employment or their name. The age of the participant is asked in a nominal form so that their age cannot identify a participant. The researchers are the only two people who will have access to the results. After assessing the data the surveys will be destroyed in June 2013. Conflict of interest will be avoided by stating in the informed consent form as well as the survey that previous professors, colleagues, and students are to be kept anonymous to avoid the risk of power relationships and ill mentioning of any previous educational encounters.
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Conclusion
This chapter provides an overview of the methodology used to conduct this study. The purpose of the study is to gather information about medical social workers perceptions of the usefulness of their masters of social work program pertaining to their current career. The study used a mixed methods approach by using open-ended questions and forced response questions. The instrument used to collect the data had nominal questions as well as ordinal response type questions, which, were scaled using the Likert scale. The researchers will be analyzing the data manually. The participants from this study were social work professionals from Sutter General and Sutter Memorial Hospital in Sacramento, CA. The participants were chosen on a criterion sample method due to their expertise and knowledge about the subject. Their confidentiality and privacy of the participant is the top priority of the researchers.
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Chapter 4
STUDY FINDINGS AND DISCUSSIONS
In this study, the researchers intended to explore relevant concepts and theories that would be necessary to include in a curriculum with a health emphasis in a graduate level social work program. After review of the literature to explore the unique knowledge and skill set needed to be a successful medical social worker, the researchers conducted a study of current medical social workers employed at Sutter General and Sutter Memorial
Hospital in Sacramento, CA. These social workers were asked a range of questions meant to assess (1) if there was a health emphasis in their program available, (2) if their program adequately prepared them for social work in the healthcare setting and how, (3) what concepts and theories they were exposed to that they felt were beneficial to their current medical social work role, and (4) what recommendations they would consider necessary in a graduate level social work program for those student social workers looking to work in the healthcare field? For clearer presentation, relevant findings are presented in graphs and tables.
Overall Findings
Background of the Participants
The participants that were surveyed for this study were all social workers who are employed by Sutter General and Sutter Memorial Hospital in Sacramento, CA. Of the 27 surveys handed out, 14 were returned to the researchers. All 14 of the respondents were female. Six of the respondents were between the ages of 31 and 40, four were between the ages of 41 and 50 and four were between the ages of 51 and 60. None of the
46 participants were younger than 30 or older than 60. Of the 14 participants, ten attended
California State University, Sacramento while obtaining the Master in Social Work. Two participants attended University of California, Berkley, one attended University of
Southern California and one attended University of California, Los Angeles while obtaining their Master in Social Work.
Table 1.1
Graduate Program Participants Attended for MSW
# of Respondents CSU, Sacramento 10 UC, Berkley 2 USC 1 UC, Los Angeles 1 Total 14
Table 1.2
Participants that Attended a MSW Program with a Health Concentration
# of Respondents Yes 4 No 10 Total 14
Specific Findings
Previous fields of employment
Of the 14 participants, 2 stated they have only worked in the healthcare field, 2 did not answer the question, and the remaining 10 stated that they had previously worked in other various fields. Five social workers had previously worked in a mental health
47 setting, four worked for child protective services, three worked in foster care/adoptions, two worked with the homeless population, and two worked in geriatrics.
Participants educated in graduate program with a health emphasis
Two of the ten participants that attended CSUS stated that they had an emphasis in health social work. Two of the social workers that attended UC, Berkley did not have a health emphasis. The other two social workers that attended UCLA and USC stated that they completed their MSW program with an emphasis in health social work.
Overall, only 29% of the sample received education with a concentration in healthcare and social work.
Courses found beneficial in MSW program attended
Of the four samples who participated in a health concentration, the courses they took included; Social work in hospital/medical setting, social policy in the healthcare setting, research for health concentration, program planning and evaluation in healthcare, and advanced theories and clinical intervention in healthcare. For the other participants who did not receive education with a health emphasis, courses they found beneficial were; practice class, hospital social work, death and dying, DSM and client advocacy class.
Benefits of MSW program attended
The social workers were asked what they found helpful within their program, as it relates to their experience as a medical social worker. The participants who had a health concentration stated that their field experience, class discussion with peers who were working in the same field and education around psychopathology were the most
48 beneficial part of the program. One participant stated that the DSM, practice and theory courses were beneficial. Other participants who did not receive a health emphasis stated that the DSM and medical social work class, field experience, discussion of substance abuse, change theory, motivational interviewing, emphasis on trauma, support from professors and practice courses were beneficial when developing their skills as a medical social worker.
Concerns of the MSW program attended
Participants were asked to address the concerns about their MSW program as it related to their experience as a medical social worker. Of the four participants who received an emphasis in medical social work, only one answered this question. The participate found concern with placement with a social work supervisor who was ill prepared to supervise the social work student. 50% of the participants who did not have a health concentration stated that their concern with their MSW program included that they did not have a medical emphasis and that the medical social work elective, which was provided was not helpful in preparing them for practice in the field. The other 50% did not answer the question or their answer did not relate to their experience as a medical social worker.
Opinions about changes to MSW program attended
The participants were also asked what they would change about the program they attended. Participants who had an emphasis in healthcare stated they would have liked more medical course electives. Those who did not receive an emphasis in health care stated they would have like more courses with a health concentration, to include theory
49 application to the healthcare setting and more exposure to the role of the social worker in the hospital, palliative and hospice setting. Two would not have changed anything and one would have liked to see more opportunities for students of color.
Theories currently used as a medical social worker
All of the participants were asked about the theories and methods they currently use. The theories and methods mentioned included: motivational interviewing, change model, grief stages, systems theory, family dynamics, CBT, crisis intervention, child development, practice for clinical skill development, brief intervention theory, client centered approach, Erikson’s stages of development, solution focused theory, strengths based perspective, personality theory, mindfulness, attachment theory, substance use model, crisis counseling, DSM psychotherapy model, poverty advocacy, dialect behavior therapy and medical language.
Overall satisfaction with attended program
Three of the four participants who had a medical emphasis in their program agreed that they were placed in a hospital-based placement during their program. Of the ten participants who did not have a medical emphasis in their program, six agreed they had a hospital-based placement, three completely disagreed and one stated it was not applicable.
This survey assessed the opinion of overall satisfaction of the MSW program attended by participants as it relates to their experience as a medical social worker. Of the ten participants who did not attend a graduate MSW program with a health emphasis, six disagreed that they were satisfied with the medical emphasis in the MSW program
50 they attended, three stated the question was not applicable and one stated they were neutral. Of the four of participants who did attend a graduate MSW program with a health emphasis, two agree, one disagreed and one was neutral about their satisfaction with the medical emphasis.
When asked if they would recommend their program attended to future social workers that are interested in working in the medical field, out of the four who had a health emphasis, one partially agreed, one completely agreed, two were neutral. Of the ten who did not receive health emphasis, three completely agreed, one partially agreed, two were neutral, one partially disagreed, one completely disagreed and two stated it was not applicable when asked if they would recommend their program to future medical social workers.
Interpretation to the Findings
In order to assess more specifically the types of courses that would be useful and effective for education in a health concentration, respondents were asked their opinion about courses they attended. Courses that were found beneficial included: social work in hospital/medical setting, social policy in the healthcare setting, research for health concentration, program planning and evaluation in healthcare, and advanced theories and clinical intervention in healthcare, practice class, hospital social work, death and dying,
DSM and client advocacy class. The respondents who had attended a school with a health emphasis were found to include courses with specific health related objectives.
However, respondents who did not attend a school with a health emphasis included only practice and DSM courses.
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Furthermore, for six of the respondents who did not attend a school with a health emphasis, they included information about a course for social work in the healthcare setting. Of this six, five disagreed that they were satisfied with the content of the class, one stating, “the class was not worthy of the name.” All five respondents who were dissatisfied with the course attended CSU, Sacramento. Because CSU, Sacramento does not have a concentration in health for social work, this sole class may have been inadequate in preparing students for social work in the healthcare setting.
Respondents who attended a MSW program that offered a health emphasis were either neutral, or agreed they were satisfied with the concentration they received.
Inversely, 60% of respondents who attended a MSW program that did not offer a health emphasis disagreed, implying they were not satisfied. 30% reported it was not applicable, which may have been a result of the lack of an emphasis in the program. This overall dissatisfaction may have resulted in further recommendations to implement a health concentration for a MSW program.
Respondents were ask to write a brief narrative of recommendations they might have that would help in guiding a MSW curriculum with a heath emphasis. Overall, it was found that a majority of the respondents recommend that MSW programs have a health emphasis for those who want to work in the healthcare setting. Also, it was recommended student social workers that want to work in the medical field pursue a graduate level program offering this concentration. Furthermore, students should have an opportunity to work as an intern in field placement in a healthcare setting.
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Although the survey was meant to evaluate current medical social worker opinions about their MSW program and how it prepared them for the field, the researchers found that various forced answer questions were not applicable to the purpose of this survey. Although they provided further insight, they were not analyzed due to their irrelevancy.
Proposed Curriculum
With the overall findings from this study, as well as concepts researched through the literature review, the researchers propose guidelines to which can be considered by the
Graduate Social Work Program at California State University, Sacramento (CSUS) in order to implement a concentration of social work in the healthcare setting (See
Appendix A). The proposal of this curriculum will include objectives and goals of a health concentration. It will also include courses already offered by the social work program at CSUS, modifications to current courses offered at CSUS, and new courses that can be added to the health concentration. Each course will be provided with a description of course content that will briefly discuss how it will benefit a social work student who would like to pursue a career in the healthcare field.
While these guidelines are important considerations, they are not approved through the Counsel in Social Work Education (CSWE), who is responsible for the accreditation of social work curriculum in a Master’s of social work program. It is the responsibility of the Social Work Department to ensure that their concentration meets CSWE accreditation guidelines.
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Summary
Overall, it was found that of the population studied, respondents who attended a school with a health emphasis felt that they were better prepared to be in a medical setting by the courses offered in their program. These respondents were found to have more appreciation of and better able to embrace social work in the healthcare setting due to their exposure to relevant class discussion, policies and theories. Although participants who did not attend a program with a health emphasis were able to utilize concepts learned towards their current role as a medical social worker, they were not satisfied with the minimal education they received about medical social work. Although this is a small sample, it demonstrates that a concentration in healthcare in a MSW program may not only be beneficial for future social workers perusing the field, but encouraged by social work professionals currently working in the field.
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Chapter 5
CONCLUSION, SUMMARY, AND RECOMMENDATIONS
In this study it was found which theories/models and courses were beneficial to medical social workers that are currently working in medical settings. The medical social workers that were interviewed that had an emphasis of health in their curriculum in graduate school had different opinions about their experience of their master of social work program than those who did not. The social workers that attended schools that particularly had an emphasis in healthcare expressed that they found their emphasis valuable in their current career. These participants reported that dialogue between their colleagues was enriching when discussing similar field and theory practices in the classroom as related to healthcare.
The researchers found that the majority of those respondents who attended a school that did not have an emphasis in healthcare in their Master of Social Work program enrolled in the only one elective course that was available to them regarding healthcare. However, the results showed that overall they were dissatisfied with the elective course available and even expressed that the course “Social Work in Healthcare was not worthy of the name”. More surprisingly the participants that reported to have enrolled in this particular Social Work in Healthcare class all attended CSU, Sacramento.
Although one particular respondent that claimed to have an emphasis in healthcare disclosed she attended CSU, Sacramento graduate class of 99. This participant stated that she felt overall satisfied with her master of social work program and recommended that a health emphasis should be reiterated at CSU, Sacramento.
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The results of our study confirmed that social workers interested in working in the healthcare setting need to be competent in models that are tailored to working with patient’s with chronic and acute illnesses. The medical social worker should be able to treat a patient holistically as it pertains to their healthcare need. Without basic knowledge of the medical setting it can become very difficult to navigate through the healthcare system while providing proper quality of care to each patient. The role of the medical social worker includes defining how the impact of the illness and disease affects the patient. By addressing psychosocial challenges, the medical team is better prepared to treat each patient as a whole and effectively continue to diminish the challenges that come with complex cases. Inversely, when recognizing that social, environmental, cultural, spiritual, emotional, and financial factors play a key role in compliance with medical treatment the interdisciplinary team can have a better understanding of the person’s barriers that could be inhibiting proper medical care. By taking into account the person’s comprehensive lifestyle the interdisciplinary team can be more effective in treating each individual, which in turn reduces lengths of stay and recidivism.
Implications for Social Work
When working in the medical setting, a majority of the time is spent working with individuals. Because medical social workers interact with vulnerable and oppressed populations on a micro level of practice as it pertains to healthcare, lack of resources to those who are uninsured and impoverished becomes more apparent. As social workers strive towards enforcing social justice, awareness of ineffective polices and necessity for new polices is imperative. By being informed of the discrepancies in the community that
56 directly affect a patient’s quality of health, social workers have the responsibility to advocate for those populations in need of more assistance. The profession of social work has a mission statement to which entails that social workers must work together to enhance the well-being and meet basic needs of the people (NASW, 1996). Social justice is a core value of the social work profession. There is a responsibility of professionals to advocate on behalf of their clients and to raise awareness of social problems in the healthcare setting.
Recommendations
There is a lack of research about the overall effectiveness of medical social work intervention in a medical setting. Due to the lack of research there are no clear indications that promote the need for social workers in the healthcare field. Because the information about the social work interventions is minimal it can be difficult for members of different professions to understand the quality of our practice. Further research of the importance of the social work profession in medical settings will aid in deteriorating biases about our practice and work towards benefiting the healthcare organization as a whole.
Additionally, an analysis of current medical social workers regarding their education should be further explored. The difference of benefits of attending a Master of
Social Work program with an emphasis on medical social work versus those that attended a school without an emphasis could determine the importance of implementing a health emphasis in a curriculum. With this knowledge schools that offer master of social work programs have the ability to decide whether there is a need to implement this emphasis in their particular programs. Furthermore, collaborating with experienced medical social
57 workers in exploring models/theories and concepts they currently use in their field can provide insight on effective practice which should be considered when implementing courses that are tailored to teach students pursing a career in medical social work.
Limitations
The researchers found that a portion of the quantitative questions in the survey were not applicable to the study. For the final findings of the study the researchers used the qualitative and a minimal portion of quantitative questions asked. Due to the lack of information received about inquired quantitative questions, the findings were limited to specific data therefore restricting our findings. The sample size was unrepresentative of the general population due to the researchers limited time and funding. The sample size was also unrepresentative because all of the respondents were employed at Sutter General
Hospital and Sutter Memorial Hospital in Sacramento, California. Lastly, a final discrepancy in the research was the amount of research regarding effectiveness of interventions in a medical setting. Because the researchers were unable to locate specific findings about the effectiveness of the profession in medical settings, the study cannot determine whether skills, methods, and theories described by respondents were effective in the field.
Conclusion
In conclusion, the purpose of the study was to highlight the importance of an emphasis in health in a master of social work program. The study focused on findings that portrayed skills and competence a medical social worker should entail. The study also discussed how the role of the social worker in the medical setting collaborates with
58 the interdisciplinary team in reducing lengths of stay and recidivism while additionally providing care that is cost effective to the organization. When addressing psychosocial barriers patients are treated with a better quality of care and issues are addressed before becoming complex. Inversely, this demonstrates the value of a properly educated and knowledgeable medical social worker, which delineates the significance of a healthcare foundation in a program of Master of Social Work. Although limitations to the study are unrepresentative of the general population, the findings further depicted that current medical social workers, which attended a school with an emphasis in medical social work, found their experience more cultivating towards their current career in the healthcare field.
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APPENDICES
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Appendix A
California State University, Sacramento Master of Social Work Program (MSW) Guidelines for a Concentration in Health Care Setting
The MSW program at CSUS is comprised of a two-year curriculum. During the first year, students will be exposed to core social work professional foundation. During their second year, students will have the opportunity to engage in a health concentration. While completing both years, students will be able to enroll in elective courses that provide education in population-specific knowledge.
As health care in the United States continues to change, develop and become increasingly complex, people with acute and chronic illness must navigate this system with little support. This brings about new and exciting opportunities for social workers that are working in the healthcare field. During their second year, courses in this concentration will place an emphasis on social work role of the delivery of healthcare to diverse populations, more specifically the vulnerable and oppressed populations who are at risk for biological, psychological, social, spiritual and environmental challenges.
This concentration in healthcare will allow for social work graduates to work in various healthcare field including:
. Adult day healthcare programs . Alternative treatment centers . Assisted living facilities . Community health centers . Hospitals and hospices . Mobile clinics . Non-profit and for-profit organizations . Rehabilitation centers . Residential settings . Specialized health clinics (oncology, HIV/AIDS, multiple sclerosis)
Year One: Social Work Foundation
Goals and Objectives: . To introduce core values and ethics of the social work profession as defined by the National Association of Social Work (NASW). . Understand a common based knowledge of social work values and skills through education on theories, practice methods and issues that deal with individuals and their environment. . Develop a culturally competent understanding of diverse populations. . Understand social work’s role in micro, mezzo and macro level settings.
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. Explore past and present policy and gain knowledge of its effect on vulnerable populations. . Introduce principles and methods of social work research and its contribution to the future of the profession.
Course Requirements:
For course requirements during the first year of the Master of Social Work program, students will follow the curriculum already implemented by the Department of social work at CSU, Sacramento.
These courses include:
. SWRK 202 (3 units) Social Work with Diverse Populations . SWRK 204A (3 units) Social Work Practice I (Co requisite: SWRK 295A) . SWRK 204B (3 units) Social Work Practice II (Prerequisite: SWRK 204A & SWRK 295A; Co requisite: SWRK 295B) . SWRK 210 (3 units) Methods of Social Research (Prerequisite: Undergraduate Social Statistics) . SWRK 235A (3 units) Theoretical Bases of Social Behavior . SWRK 235B (3 units) Theoretical Bases of Social Behavior (Prerequisite: SWRK 235A) . SWRK 250 (3 units) Social Welfare Policy & Services . SWRK 295A (3 units) First Year Field Instruction (Prerequisite: Classified Social Work graduate; Co-requisite: SWRK 204A) S . SWRK 295B (4 units) First Year Field Instruction (Prerequisite: SWRK 295A, classified Social Work graduate; Co-requisite: SWRK 204B) . SWRK Electives (6 units)
Recommendations: Students who are interested in entering their second year with a concentration in healthcare will be advised to enroll during their first year in 6 of the 9 units of population-specific electives that will benefit their advanced education in the healthcare field during their second year. This may include: Older Adults, Veterans, Substance Abuse, Mental Health, Child Welfare, Grief and Loss, etc. Students will also be advised to intern at an agency that can provide a foundation of experience for entry into a 2nd year medical social work placement. This may include: Mental Health clinics, Hospice programs, Home Health agencies, Case Management roles, etc.
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Year Two: Heath Concentration
Goals and Objectives: . Ability to offer culturally competent social work interventions in the healthcare setting. . Ability to apply relevant theories for effective care in the health care setting. . Understand the complex and unique situations, experiences and challenges of clients who have both acute and chronic illnesses. . Understand a basic knowledge of epidemiology of disease, medical terminology and healthcare systems and their policies. . Ability to contribute an advanced knowledge of the psychosocial challenges of clients and families to an interdisciplinary team.
Course Requirements
Year Two, Fall Semester
SWRK 204C Clinical Practice in the Health Care Setting This course provides advanced knowledge of evaluation of theory, best practices, emerging issues and skill development in healthcare settings, including interaction among cultural, socioeconomic and organizational factors.
Objectives: . Explore in more depth the role of the social work in the health care field. . Provide education on areas such as health care systems, the epidemiology of the disease, the impact of illness on the patient and family functioning. . Explore challenges of transference and counter- transference in the professional setting. . Understand and use basic medical terminology. . Explore effective communication skills as to prepare for collaboration with interdisciplinary members.
SWRK 211 Introduction to Research in Health Services This course provides an introduction of principles and methods in healthcare research for social work students entering the field. This course will build upon methods learned in SWRK 210, while relating it to methods of effective research in health care.
Objectives: . Provide a conceptual understanding of the research process in the healthcare setting as it relates to social work. . Understand the scientific approach, definition and concept formation, measurement and research design, modes of observation and inferential methods to effectively conduct social research in the healthcare setting.
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. Engagement in discussion of current research regarding cost of healthcare, quality of care and competition and its affect on vulnerable client populations.
SWRK 251 Healthcare Policy This course examines health policies with attention to vulnerable and oppressed population. Current health policies will be discussed, as well as their past, current and future impact on client populations.
Objectives: . Understand the biopsychosocial aspects of political factors as it pertains to health status and access to healthcare. . Understand and have awareness of assumptions that impact policy formation, development, implementation and effectiveness. . Understand current and changing policies and programs, and the gaps in these policies and programs that target vulnerable and oppressed populations. . Ability to critically analyze health policy and the policymaking process.
SWRK 295A Field Instruction This independent course requires students to obtain an internship (paid or unpaid) with a social service agency that provides a position as a social worker in the healthcare field. This position must be supervised by a Master level social worker with 2+ years experience in the field. Field instruction will require 24 hours of internship per week, with one hour of individual or group supervision.
Year 2, Spring Semester
SWRK 204D Advanced Clinical Practice in the Health Care Setting This course includes further advanced education of theory, best practices, emerging issues and skill development in healthcare settings, including interaction among cultural, socioeconomic and organizational factors.
Objectives: . Critically analyze complexities that exist in the client’s experience of illness. . Advanced knowledge of theoretical models of social work practice in healthcare settings. . Ability to critically analyze theories and application to implement clinical interventions in various healthcare setting and systems. . Advanced understanding and application of communication skills to provide effective contribution to an interdisciplinary team.
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SWRK 295A Field Instruction This independent course requires students to obtain an internship (paid or unpaid) with a social service agency that provides a position as a social worker in the healthcare field. This position must be supervised by a Master level social worker with 2+ years experience in the field. Field instruction will require 24 hours of internship per week, with one hour of individual or group supervision.
*Elective Courses in recommended areas for advanced knowledge of population- specific intervention. (3 units)
Project/Thesis (SWRK 500 or 295A &B) Along with completion of course work, students must produce a Project/Thesis that is related to or intended to benefit social work in the health care field. An advisor who is a professor within the health concentration must approve this Project/Thesis to ensure its relevancy to social work in the health care field.
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Appendix B
Human Subjects Approval Letter
CALIFORNIA STATE UNIVERSITY, SACRAMENTO DIVISION OF SOCIAL WORK
To: Kassy Merino & Jocelyn Mason Date: 12/12/2012
From: Committee for the Protection of Human Subjects
RE: YOUR RECENT HUMAN SUBJECTS APPLICATION
We are writing on behalf of the Committee for the Protection of Human Subjects from the Division of Social Work. Your proposed study, “Does the Curriculum in MSW Programs Prepare Students for Practice in the Field of Medical Social Work.”
__X_ approved as _ _ X _EXEMPT ____ MINIMAL RISK
Your human subjects approval number is: 12-13-039. Please use this number in all official correspondence and written materials relative to your study. Your approval expires one year from this date. Approval carries with it that you will inform the Committee promptly should an adverse reaction occur, and that you will make no modification in the protocol without prior approval of the Committee.
Approved with the expectation that the data collection will not be done through internet as indicated in the consent form. As a result the reference of “survey via internet.”
The committee wishes you the best in your research.
Professors: Maria Dinis, Jude Antonyappan, Teiahsha Bankhead, Serge Lee, Kisun Nam, Maura O’Keefe, Dale Russell, Francis Yuen
Cc: Russell
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Appendix C
Letter of Consent
This study’s purpose is to develop a curriculum of best practices for a student in the Mater’s of Social Work program who is pursuing medical social work. You are being asked to participate in research which will be conducted by Jocelyn Merino and Kassy Mason, students of the Division of Social Work at California State University, Sacramento.
The study will determine what courses and practices are conducive with pursing a medical social work career. You will be asked to complete a questionnaire about your academic experience, current career description, and your personal opinion about the relatedness of the two. The questionnaire may require up to 15 minutes of your time.
If at any point the questions become uncomfortable please do not hesitate to skip that item. At any moment you may chose to withdraw from the survey.
Our intention is that your feedback will give us an insight as to what education will most benefit a student pursuing medical social work. However, this survey may also encourage personal reflection on helpful courses, which enhanced your current career.
Contact information will be retrieved from the Social Work Department listing at Sutter General Hospital. Your questionnaires will remain anonymous. You may chose to send the surveys back via mail without writing a return address or you have the option of taking the survey via internet.
Your survey will be marked with a number that corresponds with your consent letter. All results will be kept confidential to all other participants and will only be seen by the researchers. Results will only be used for the purpose of this study and will automatically be destroyed after the findings have been interpreted.
You will not receive any compensation for participating in this survey.
If you have any questions about this research, you may contact Jocelyn Merino at (xxx) xxx-xxxx or by email at [email protected] or Kassy Mason at (xxx) xxx-xxxx or by email at [email protected] You may also contact our advisor Dale Russell at (916) 278-7170 or by email at [email protected].
Your participation is completely voluntary and is appreciated. Please sign below to indicate that you have read what is stated above and agree to take part of this survey.
______Signature of Participant Date
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Appendix D
Survey
Thank you for volunteering to complete this survey. This questionnaire is anonymous and is intended for the use of enhancing the emphasis of Medical Social Work in the Master’s of Social Work Program at CSU, Sacramento. Answer the following questions by explaining your experience or opinion. Remember to be confidential in your answers. Please do not name specific professors, students or colleagues. Please make sure to print clearly.
What is your age in years? With which gender do you identify? _____ 20-30 ______Male _____ 31-40 ______Female _____ 41-50 ______Other _____ 51-60 _____ 60 +
From which university did you receive your MSW? ______
Which year did you graduate from the MSW Program? ______
How many years and months have you worked as a Medical Social Worker? ______Years ______Months
What field (s), if any, did you work in prior to Medical Social Work? (Mental Health, CPS, Substance Abuse etc.)
1) 4) 2) 5) 3) 6)
Did your MSW program have an emphasis on Medical Social Work? ______Yes ______No
If yes, please list all of the courses that you remember taking within this emphasis.
1) 4) 2) 5) 3) 6)
If no, please list any classes that you can remember which you felt were beneficial specifically for your career in Medical Social work.
1) 4) 2) 5) 3) 6)
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What did you enjoy or find helpful within your MSW program as it relates to your experience as a Medical Social Worker?
What did you dislike or have concerns about within your MSW program as it relates to your experience as a Medical Social Worker?
What would you have changed or would have liked to be different about your MSW program as it relates to your experience as a Medical Social Worker?
Please list some of the theories and/ or models you currently use or find relevant in your practice. Please specify if they were taught during your MSW program or if they were learned through experience in the field.
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Please rate each of the following statements about the Masters of Social Work Program you attended based on the degree of agreement with the statement. If the statement does not apply to you, check the box marked “Not Applicable.” If you are unsure, check the box marked “Unsure.”
Professors and Completely Partially Neutral Partially Completely Unsure Not Courses Agree Agree Disagree Disagree Appli- cable My professors had experience in the field of medical social work. My professors provided assignments that were appropriate to critically explore medical social work. My practice course addressed medical social work in some way. My courses exposed me to some of the positions possible within the medical field. My courses taught relevant theories/models I currently use in the medical social work field. The reading materials assigned in my courses were relevant. I still have the reading materials I used while attending courses. Internship Completely Partially Neutral Partially Completely Unsure Not Experience Agree Agree Disagree Disagree Applic able I was able to intern at a hospital-based placement during my program.
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I had exposure to various aspects of the medical social work such as: (Mark in boxes areas that apply) Crisis Intervention: Substance Abuse: Case Management: Hospice: Palliative Care: I worked one on one with patients. I worked with groups. I was able to be involved in seminars/ Presentations that provided education about various topics to patient’s and/ or hospital staff. Completely Partially Neutral Partially Completely Unsure Not Overall Agree Agree Disagree Disagree Appli- Satisfaction cable I was satisfied with the medical emphasis in the MSW program that I attended. I would recommend social workers that want to receive their masters with an emphasis in Medical Social Work to the MSW program that I attended.
Do you have any recommendations that would be helpful in guiding an MSW curriculum as it relates to Medical Social Work?
Thank you for completing this questionnaire!
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