Social workers play a key role in the delivery of interdisciplinary health care. However, in the past decade, concerns have been raised about social work’s sustainability and contributions in a changing health care sector. Due to multiple factors, including spending cuts and the expansion of the roles of nurses, social work’s role in frontline health care situations has experienced a decline, or at least altered in a way that social workers usually perform administrative tasks. But do social workers bring unique training and values that are indispensable to frontline health care and patient navigation?
In a recent issue of the journal Health and Social Work, Joanie Sims-Gould, PhD, Kerry Byrne, PhD, Elisabeth Hicks, Thea Franke , and Paul Stolee, PhD, published their findings from a study of social workers dealing with patients with hip fractures (PHFs). PHFs experience a mortality rate seven times that of other older adults, and are among the most vulnerable and complex patients, from a biophysical and psychosocial perspective. Research shows that the depression, anxiety, social isolation, and socioeconomic hardship that accompany hip fracture recovery in older adults can affect outcomes such as mobility and social activity.
Using a strengths-based approach, the authors examined the key contributions made by social workers working with older patients with hip fracture as they strive to achieve successful care transitions. Twenty-five interviews with health care professionals (HCPs) were conducted and then analyzed using an analytical coding framework. Although social workers are vital, they are often underused and overlooked in the care of hip fracture patients. Based on the interviews, the authors sketched the important contributions that social workers make to care transitions after hip fracture, specifically:
- informational continuity;
- patient–HCP relational continuity;
- conflict resolution;
- mediation among family, patient, and HCP (for example, doctors and nurses);
- collaboration with family caregivers and community supports;
- relocation counseling.
The authors point out that:
[t]he findings demonstrate that social workers’ supportive services are both necessary and effective and go beyond just “medically” helping the patient. Not only is it necessary to ensure that patients are medically stable, but an awareness of their psychosocial (for example, substance abuse, fear, anxiety), environmental, and socioeconomic characteristics is also vital to properly support their transitions. Social workers bring a specific skill set and viewpoint to identify and address these concerns.
Of course, further research is needed in studying not only how social workers can and do help PHFs, but also other older patients with health care issues, and patients of all ages.
My experience in the VA is that social work has grown exponentially because the factors Sims-Gould et al notes in their article has been the experience of the VA system, that every time a medical social work challenge is given it
overcome and then a new standard for achievement is set by that solution. At Hines VA Hospital our social Work executive actually felt he had to decline offers by the Surgeon Chief of Staff for new job roles for social workers out of concern that even though social work meet and exceed expectation that there might be an issue of going beyond the boundaries of scope of practice and LCSW licensure and his belief that perhaps another profession might serve the veteran better in that role
Sadly while simultaneously working part time in the a Tertiary Care Medical School Teaching Hospital Level One Trauma Center I have seen the number of social workers cut by 2/3 and replaced by nurse case managers in
med / surg, psychologist in opt mental health and BA level employees working off scripts and algorithms for
community outreach and followup. The only area of growth was in Emergency Department Social Work where that hospital went 24/7/365 MSW coverage by primarily full time staff working twelves with vacation/sick time/
spot coverage by their long-term service group of parttime and on call MSW’s.
There is a lot of case data and “war stories ” about how profession med-surg LCSW /BCD/ NASW specialty
boarded/ACSW social workers and some of our long term and experienced BSW health care social workers create a lot better outcomes than various types of case managers but the research data is not out there, the cost benefit analysis in terms of shortening length of stay, pt satisfaction, decreased lawsuits and better outcomes. We really do need that data so that our managers can have the ammunition that they need to
keep social work in Med-surg Social Work. Luckily within the VA systems, managers have been able to do just that and been able to increase the numbers of social workers and not incidentally the pay grades of many clinical service social workers.
Just a thought
Frank, you are “Spot On”! We don’t have the data to give to our Health Administrators who always view Social Work as “fluff”. Do you know the history of how the VA System embraced Soial Work? Maybe we should take a look at their experience. Thank you
Thank you for advocating for the social work profession.highly appreciated
As a medical social worker of 13 years I would be happy to participate in any study that advances he social workers ability to provide medical services to the comminity
Thank you to the academicians who authored this study! It’s a great start toward evaluating the value of professional social work. I hope this study may be replicated to develop a stronger database of results. These factors then can be measured against quantitative outcomes for the PHFs, leading to a better quality of life for older adults and their loved ones.