Social Work and Health Care

Social Work Generalist PracticeGeneralist Practice is the application of an

eclectic knowledge base, professional values and ethics, and a wide range of skills to target any size system for change within the context of three primary principles, and four major processes.

Three Primary PrinciplesEmphasis on empowerment, strengths, and

resiliency.

Importance of understanding how human diversity characterizes and shapes the human experience and is critical to the formation of “identity.”

Advocacy for human rights, and the pursuit of social and economic justice

Four Primary ProcessesAssumption of a wide range of roles

Application of critical thinking skills throughout the intervention process

Incorporates research-informed practice to determine most effective/best practice principles

Follow a planned change process.

Social Work Generalist PracticeEclectic Knowledge BaseStrengths PerspectiveSystems TheoryEcological TheoryCommon Generalist SkillsPlanned Change Model

Holistic AssessmentMicro ConcernsMezzo ConcernsMacro ConcernsStrengthsIssues related to Diversity that must be

accounted for in planning/intervention: - Gender - Ethnicity - Sexual Orientation - Age - Culture - Disability - Social/Economic Status - Religion

Social Work and Health CareMental Health – 60 % of mental health

professionals are social workers (NASW)In PatientOut PatientPartial HospitalizationEmergency Services

SuicideIn 2010 Idaho had the 6th highest suicide rate

in the nation – 49% higher than the national average (latest data available according to the Suicide Prevention Action Network of Idaho)

In 2011 – 284 people committed suicide in Idaho

There is a significant increase in the suicide rate among farmers; higher than the suicide rate among the general male population. (Idaho Suicide Prevention Research Report)

Social Work and Health CareDischarge PlanningHospice/Palliative CareEmergency Room Care

Suicide Substance AbuseTraumaTriage

Oncology

Social Work and Health CareObstetricsSurgical Intensive CareRehabilitation ProgramsHealth LiteracyCommunity Health ClinicsNursing Homes

Social Work and Health CareHome Health CareVeterans Service Networks

Discharge Planning

AssessmentCoordinationDocumentationCounselingLinkage

AssessmentAssessment: >Bio/Psycho/Social/Spiritual/Financial

resources for discharge planning > Interviews with patient and family

members/caregivers and engages family in decision-making process

> Assists medical team’s understanding of patient’s bio/psycho/social/spiritual/financial needs

CoordinationCoordination > Activities concerned with

exchanging information with hospital personnel or the patient and the family to facilitate discharge planning.

Coordination > The availability, willingness, and ability of

family/caregivers to provide care. > Advise patients and family/caregivers

about appropriate discharge options addressed in bio/psycho/social/spiritual/financial assessment

DocumentationActivities concerned with producing

a written record of discharge planning process.

Checklists, Narratives, Forms, Summaries, etc.

Record of required information provided patient or individual acting in patient’s behalf

CounselingProvision of information and

intervention to bring about change in client’s feelings, behaviors, attitudes, activities

Assist family with adjustment/adaptation to changes

ReferralFollow-up

LinkageActivities focused on obtaining

services for patients and families after discharge

Include patient and family wishes wherever possible

Hospice/Palliative CareCounseling for individuals, couples, and

familiesPsychosocial education to patents and

families/caregivers about coping skills and adjustment to anxiety relative to death, suffering and related stressors.

Crisis InterventionMediating conflicts within families, between

clients and the interdisciplinary team, and between service organizations

Hospice/Palliative CareAdvocacyFacilitating psycho/educational support

groupsFacilitating advance planningWork closely with interdisciplinary teamsAccess needed equipment, services, etc. for

patients and families

Emergency Room CareConnecting patients to services they need at home

and in the community avoids unnecessary hospital admissions and reduces insurance costs.

Over 80% of patients seen by social workers in emergency departments were not admitted; rather, they were referred to community services (2007)

Crisis InterventionPatients with a mental disorderCounseling victims of violence, sexual assaultChild ProtectionCounseling with patients and families

Emergency Room CareSuicidal Ideology – or attempted suicideSubstance Abuse

“One in eight adults in Emergency Departments present with a mental disorder, substance abuse, or both.” (Agency for Health Care Research and Quality, 2007)

Address acute grief reactions for family members and mobilize support systems.

Health LiteracyHealth Literacy is the degree to which an

individual has the capacity to obtain, process, and understand basic health information an services needed to make appropriate health decisions (Ratzan & Parker, 2000)

More than 1/3 of adults in the U.S. do not have adequate health literacy to manage their own health care needs (Kutner, Greenberg, Jin, & Paulsen, 2006)

Low health literacy coexists with other social disadvantages such as low levels of education, lack of medical insurance, and poverty, often exacerbating its effect on vulnerable populations.

Health LiteracyLow health literacy is associated with

increased emergency department visits, higher rates of hospitalization, longer stays (by an average of two days) (Nelson-Bohlman et al, 2004) and poorer self-reported health. (Kutner et al, 2006).

The estimated cost of low health literacy ranges from $106 to $238 billion each year (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007).

ReferencesAccordino, M.P., Porter, D.F., & Morse, T. (2001).

Deinstitutionalization of persons with severe mental illness: Context and consequences. Journal of Rehabilitation, Vol. 67, No.2.

Allen, H. (2012). Is there a social worker in the house? Health care reform and the future of medical social work. Health & Social Work, vol.38, No. 3, 183-186.

Druss, B., Bornemann, T., Fry-Johnson, Y., McCombs, H., Politzer, R., & Rust, G. (2006). Trends in mental health substance abuse services at the nation’s community health care centers: 1998-2003. American journal of public health, 96, 1779-1784.

Hollman, D., Dzieglewski, S.F., & Teare, R. (2003). Differences and similarities between social work and nurse discharge planners. Health and Social Work, Vol. 28, Number 3, 224-231.

References Johansen, S., Kaasa, S., Lorge, J.H. & Materstvedt, L.J. (2005).

Attitudes towards and wishes for, enthusiasm in advanced cancer patients at a palliative medicine unit. Palliative Medicine, 19, 454-460.

Kirst-Ashman, K.K,. & Hull, Jr., (2012). G.H. Understanding generalist practice. Sixth Edition. Brooks/Cole, Cengage Learning.

Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education, National Center for Education.

Liechty, J.M. (2011). Health literacy: Critical opportunities for social work leadership in health care and research. Health and Social Work, Vol. 16, No. 2, 99-107.

References Mcoyd, J.L.M. (2010). The implicit contract: Implications for health

social work. Health and Social Work. Vol. 35, No. 10, 99-106. Nielsen-Bohlman, L., Panzer, A.M., & Kindig, D.A. (Eds.). (2004).

Health literacy: A prescription to end confusion. Washington, DC: National Academics Press.

Robertson, M. (2008). Suicidal ideation in the palliative care patient: Considerations for health care practice. Australian social work. Vol. 61, No. 2, 150-167.

VanPelt, J. (2010). Making caring connections, cutting costs – Social work in the emergency department. Social work today. Vol. 10, No. 6, 12-15.

Vernon, J.A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national health policy. Retrieved from http:/www.npsf.org/askme3/pdfs/Case_Report_10_07_pdf.