Primary Health Care Workers' Views about Social Work

Summary SUMMARY A comparison of the views about social work held by 188 primaryhealth care workers—118 GPs, 31 health visitors and 39district nurses—working in the same teams is presentedhere.^* The study focussed particularly on their perceptionsof social workers, their role and performance. The data indicatea general acceptance of the social work role, but a lack ofknowledge of or extensive criticism about, social work performance.Significant differences of view emerged about social work training,role and clients, indicating occupation is a significant factorin perceptions held. In particular, the client group predominantlydealt with appears to have had an impact on perceptions. However,views about social work performance did not differ greatly,suggesting the influence of occupation on perceptions shouldnot be overstated.     

Towards Accountability in Social Work: Long Term Social Work in an Area Office

Summary This article reports the results of monitoring the social workof two long term teams in an area office throughout one yearwith the help of a computerized Case Review System. It describesthe characteristics of some 1,400 long-term cases of whom 61%were disabled, visually handicapped and/or elderly and 22% presentedproblems related to children and families. One of the outstanding features was the concentration on surveillanceand review visiting which was reported for nearly three quartersof these cases and was considered the most important socialworker activity in two fifths of them. In over half of theselong term situations no change was expected and nearly threequarters of the cases were to remain open indefinitely. Another striking feature was the somewhat uneven distributionof social work resources among the different problem groups.Although the physically disabled and/or elderly outnumberedthe child/family problems by two to one, they made up only 20%of the cases allocated to individual social workers, while almostall the child and family problems were allocated amounting to35% of all individual caseloads. But the disabled and elderlyreceived far more domiciliary services and aids to daily living. This exercise has brought into sharp focus the question of howto ensure continuous support and surveillance for the very frailelderly, as the occasional social work visit did not appearto be the appropriate means of support, rarely anticipatingor averting crises. The data highlight the challenge which chronically disorganizedand disturbed families present to social work skills. The outcomescast doubt on the wisdom of closing, within the intake stageas low priority, relatively early family problems, and on thesharp division into intake and long term teams. The general issue emerging is the need to formulate more precisesocial service strategies for those who require long term careby others to some extent—the very old and frail, the chronicallyphysically and mentally disabled and children in long term care—andwhat specific contributions social workers can usefully maketo this enterprise.     

Social Work as an Aspect of Primary Health Care: The Social Workers' View

Summary This study is based on an analysis of social workers' viewsof their work with 168 clients referred over a six month periodin 1977 in a health centre setting. A wide range of referralswas made and there was close collaboration with other primaryhealth care professionals as well as outside agencies. Far morepsycho-social problems were encountered by the social workersin the course of their intervention than were apparent on referral,although most of the work was short term. Social work with theindividual predominated and a variety of traditional socialwork skills were employed, although the elderly received relativelylittle help with emotional problems and were offered mainlypractical help. Social workers' perceptions of their clientsare discussed in relation to their choice of methods of interventionand feelings of efficacy. The attachment scheme emerges as generallyfruitful both in terms of social workers' job satisfaction andclients benefitting from a multi-disciplinary approach; howeverthe need for closer inter-professional collaboration in meetingthe needs of the elderly is highlighted.     

Community-Based Long Term Care

Through the Living at Home Program (LAHP) 20 communities across the United States have developed cooperative networks involving multiple health and social services providers. The LAHP networks have sought to increase access to care, reduce duplication of services, and identify and fill service gaps. The LAHP national evaluation is examining the inter-organizational linkages that have been implemented by the networks and the characteristics of 1500 clients enrolled for care. Preliminary findings at the midpoint of the evaluation indicate that the networks have moved from a reliance on informal communication and coordination mechanisms at baseline to the use of more formal structural mechanisms over time. Despite the lack of formal targeting criteria, the networks have enrolled a quite frail elderly population. Future analyses will examine variability across the networks in client targeting and service utilization, In order to shed light on the need for utilization review of community based long term care.     

Graduate Social Work Training in Geriatrics in an Acute Care Setting

An enriched clinical placement in an acute care academic training institution was developed for graduate social work students in aging. The teaching context of the team approach is noted, and specific goals of social work training are discussed. Demographic changes and anticipated demand on VA facilities are highlighted, along with specific VA responses and opportunities for training.     

Setting an Agenda for Social Work in End-of-Life and Palliative Care

Abstract

This article describes leadership efforts within social work to promote, enhance, and shape the future of social work practice, education, and research in end-of-life and palliative care. The background and outcomes of the Project on Death in America, Open Society Institute's Social Work Leadership Development Award Program, and the 2002 Social Work Leadership Summit on End-of-Life and Palliative Care are reviewed.     

Theory and Practice in Long Term Social Work: a Case-Study of Practice with Social Services Department Clients

Summary This study is based on empirical research into the practiceof 14 social services department social workers with 42 of theirlong term clients. The findings suggest that, contrary to expectation,this type of social work practice is not characterised by aproblem solving approach, but rather by a concern for the containmentof problems and the maintenance of stability. This leads toa restricted form of social work practice which is not linkedto any particular method of intervention. Reasons for this theory-practicehiatus are suggested along with a discussion of the issues surroundingtraining for long term social work of this kind in the future.     

Social Work in a Managed Care Environment

Managed care has created a new service environment, eliminating distinctions that have sustained social work ideology and the profession throughout its history. This paper reviews important features of managed care, considers changes it has brought to practice ideology, the practitioner/client relationship, and the practice environment, including social work employment. The paper discusses the new opportunities, challenges and problems that have emerged with this approach.
While social workers should not embrace managed care, they should not run from it or blindly oppose it. They need to aggressively pursue it, fighting its major drawbacks, while adapting to a competitive market place. Given the current managed care market, the social work profession is now in the right place, at the right time, with the right skills, and available at the right price. It must now take on a leadership role to maintain its competitive position, protect its clients and insure quality practice.     

Welfare Rights Advocacy in a Specialist Health and Social Care Setting: A Service Audit

Is a specialized welfare rights service, thought important insocial services departments, a valid element of social careservices in multi-professional settings in which social workis increasingly incorporated, where social workers often helpservice users with benefits? An audit of a specialized welfarerights advocacy service, part of social work provision in alarge UK hospice, demonstrated inconsistent referral by nursingstaff, the main referrers, a large workload including frequentcomplex cases and achievement of benefits and grants for patients,carers and families substantially in excess of the cost of theservice. Annual workload for a forty-eight-bed hospice with1,600 home care patients was estimated at 976 typical caseswith nearly 2,928 contacts; about sixty complex cases annuallygenerated a similar workload in themselves. Provision of specializedwelfare benefits advocacy for palliative care patients is foundlikely to meet a substantial need and to require specialistprovision. This may be true of other multi-professional servicesincorporating social workers.     

城市老年人长期照护社会支持体系的构建

为了满足城市老年人的长期照护需求,需要根据老年人的活动能力缺失状况和特点,建立一个社会支持体系,以老年人自助互助为中心,以家庭和邻里支助为基础,以社区居家养老和机构养老为依托,以社会团体和组织资助为补充,以国家和政府政策为保障,以志愿者服务为纽带。     

Development of a Level 1 Geriatric Outpatient Social Work Screen in a Veterans Primary Care Clinic

Patient Aligned Care Teams (PACT) provide primary care to veterans. We describe our experience in a PACT (average age 66, 98% men, 8 medications, 16% yearly hospitalization rate) using a nurse-administered screen to identify patients in need of intervention by a Masters-level Social Worker. Our screening results—98% Positive predictive value (included social work concerns) and 73% negative predictive value (excluded social work concerns)—suggest that the nurse accurately identified patients. Another 15% of patients were identified by the social worker. Similar screens used in interprofessional clinics could help target patients in need of further social work care.     

Long Term Care for the Elderly: the Community Care Scheme

Summary The article describes the full evaluation of the Community CareScheme for the elderly in Kent. The evaluation compared therelative cost-effectiveness of the scheme for clients and carerswith the range of services which would otherwise have been received.It is argued that effective case-management by a key workeris an essential feature of more effective home care for thevery frail elderly and that the case-management role is an appropriatemodel of social work for other long term care groups. The newscheme appeared particularly appropriate for the extremely mentallyand physically frail who were living with others and for theless frail, socially isolated elderly person prone to minorpsychiatric disorder.     

Overcoming Obstacles to Cooperation in Interdisciplinary Long Term Care Teams

This paper outlines several common problem areas in long term care interdisciplinary teams: the team's institutional context, leadership, goals, communications, and relationships within the teams. Suggestions made for circumventing or overcoming identified obstacles include: assessing organizational support, adopting a more constructive conceptualization of leadership, exercises for reaching goal consensus, and several team development activities addressing communication and relationships among team members.     

Social Work and End-of-Life Care

Abstract

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.     

Lesbian Health Care: Women's Experiences and the Role for Social Work

ABSTRACT

Lesbian patients and their families may be exposed to discriminatory practices in the health care system. This qualitative study of 57 Midwestern lesbian parents used open- and closed-ended questions to examine the experiences the respondents had with their primary and secondary health care providers. Four themes emerged from the data: systemic barriers to health care, coming out to providers, seeking lesbian, gay, bisexual, and transgender-friendly health care providers, and concern about mistreatment and prejudice within the health care system. Implications for service delivery, health care education, and directions in policy and research are explored.     

Professional Social Work Education in End-of-Life Care

Abstract

Social work education in both BSW and MSW level courses is missing vital content about end-of-life care, palliative care, and bereavement. End-of-life care training opportunities through continuing education programs have also been limited. This deficit is significant because a vast number of social workers are already confronted with end-of-life issues on a daily basis in a variety of practice settings. Through the Project on Death in America, Social Work Leadership Development Awards initiative, many programs and models for professional social work education and training in end-of-life care have been developed and are presented in this article. These include: end-of-life care courses, symposia, training manuals, certificate programs and fellowships. Although the curricula continue to be refined, many of these programs are available to practitioners to advance their knowledge and skills and their curricular models are available to social work educators for possible replication.     

End-of-Life Care and Social Work Education

Summary

Social workers are major service providers to people who are facing end-of-life issues including the terminally ill and their families. Yet, exemplary models for social work education and intervention methods are limited in rural states. A statewide survey conducted in Kentucky found only two social work courses dedicated to end-of-life care currently being offered by accredited undergraduate and graduate institutions. Another statewide survey found that many hospice social workers are relatively inexperienced and have a need and desire for more education on death, dying and loss. Also, unique cultural, economic and geographic areas, such as Appalachia are enigmas when it comes to the provision of end-of-life care. This partnership provides a varied perspective on delivery of end-of-life care services with an emphasis on social work interventions and education.     

Hypothesis Testing of CNA Perceptions of Organizational Culture in Long Term Care

This commentary for the special issue on research that went wrong describes a study that explored factors that contribute to variability within Certified Nursing Assistants (CNAs) on organizational safety culture. We know from previous research that CNAs provide most direct care in nursing homes and that direct care workers often experience agency culture differently from agency management (Wolf et al., 2014). We were looking for factors that nursing homes could alter to improve the culture for CNAs, and thus, residents. We conducted a secondary analysis of data collected via a multi-component paper survey of CNAs employed in long term care. We used results from the Nursing Home Survey on Patient Safety Culture and primary shift, type of unit, and years as a CNA to identify modifiable characteristics that would explain variability in the perceptions of patient safety culture. The final sample included n = 106 from three nursing homes. Dimension scores were compared using bivariate tests appropriate to the scale and ordinal logistic regression. Despite support in the literature for the hypothesis, we found few significant differences on the total scale within groups. Differences in perceptions have implications for quality of care and the experiences of residents within nursing homes.     

Preparing Social Work Students to Work with Grandparents in Kinship Care

Summary

Grandparents in kinship care represent an expanding population of older adults assuming primary parenting responsibilities for their grandchildren at a time when many grandparents may also be experiencing developmental changes accompanying their own aging process. Research documents a lack of social workers prepared to respond to the needs of an aging population in general, and grandparents in kinship care in particular, as curricular content on this population has been limited in undergraduate and graduate social work programs. This article describes an infusion model proposed for an undergraduate social work program's GeroRich Project designed to introduce content on an aging population in four foundation courses to expand students' knowledge of older adults and grandparents as kinship care providers.