Medical Social Work is a sub-discipline of
social workSocial Work is both a profession and social science. It involves the application of social theory and research methods to study and improve the lives of people, groups, and societies...
, also known as Hospital social work. Medical social workers typically work in a hospital, skilled nursing facility or hospice, have a graduate degree in the field, and work with patients and their families in need of psychosocial help. Medical social workers assess the psychosocial functioning of patients and families and intervene as necessary. Interventions may include connecting patients and families to necessary resources and supports in the community; providing psychotherapy, supportive counseling, or grief counseling; or helping a patient to expand and strengthen their network of social supports.
Medical social workers typically work on an interdisciplinary team with
professionalA professional is a member of a vocation founded upon specialised educational training.The word professional traditionally means a person who has obtained a degree in a professional field...
s of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.).
Medical social workers in Britain and Ireland were previously known as
AlmonerAn almoner is a chaplain or church officer who originally was in charge of distributing charity.Historically, almoners were Christian religious functionaries whose duty was to distribute alms to the poor. Monasteries were required to spend one tenth of their income in charity to the poor...
s, or Hospital Almoners.
Medical Social Work is a sub-discipline of
social workSocial Work is both a profession and social science. It involves the application of social theory and research methods to study and improve the lives of people, groups, and societies...
, also known as Hospital social work. Medical social workers typically work in a hospital, skilled nursing facility or hospice, have a graduate degree in the field, and work with patients and their families in need of psychosocial help. Medical social workers assess the psychosocial functioning of patients and families and intervene as necessary. Interventions may include connecting patients and families to necessary resources and supports in the community; providing psychotherapy, supportive counseling, or grief counseling; or helping a patient to expand and strengthen their network of social supports.
Medical social workers typically work on an interdisciplinary team with
professionalA professional is a member of a vocation founded upon specialised educational training.The word professional traditionally means a person who has obtained a degree in a professional field...
s of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.).
Britain and Ireland
Medical social workers in Britain and Ireland were previously known as
AlmonerAn almoner is a chaplain or church officer who originally was in charge of distributing charity.Historically, almoners were Christian religious functionaries whose duty was to distribute alms to the poor. Monasteries were required to spend one tenth of their income in charity to the poor...
s, or Hospital Almoners. In Ireland, the origins of medical social workers go back to Dr. Ella Webb who in 1918 established a dispensary for sick children in the Adelaide Hospital in Dublin, and to Winifred Alcock who had trained as an Almoner and worked with Dr. Webb in her dispensary.
In 1945 Institute of Almoners in Britain was formed, which in 1964 renamed as the Institute of Medical Social Workers. The amalgamation with social work was complete in 1970 with the merger into the
British Association of Social WorkersThe British Association of Social Workers is the largest professional association of social workers in the United Kingdom. It has created a code of ethics that outlines good social work practice and works to support social workers through education and resources...
.
United States
The
Massachusetts General HospitalMassachusetts General Hospital is a teaching hospital of Harvard Medical School and a biomedical research facility in Boston, Massachusetts....
was the first American hospital to have professional social workers on site in the early 1900s. The position was created by
Richard Clarke CabotRichard Clarke Cabot was an influential American physician who was intricately involved in the creation of social work.-Family History:...
to help patients to deal with areas of their life that made treatment difficult. This was important from an
epidemiologicalEpidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine...
point of view, as it made it easier to control and prevent outbreaks of syphillis and
tuberculosisTuberculosis is a common and often deadly infectious disease caused by mycobacteria...
.
Role and required skills
The medical social worker has a critical role in the area of discharge planning. It is the medical social worker's responsibility to ensure that the services the patient requires are in place in order to facilitate a timely discharge and prevent delays in discharge that can cost the hospital thousands of dollars per day.
For example, the medical doctor may inform the medical social worker that a patient will soon be cleared for discharge (a term that means that the patient no longer requires hospitalization) and will need home care services. It is the medical social worker's job to then arrange for the home care service to be in place so that the patient can be discharged. If the medical social worker fails to arrange for the home care service, the patient may not leave the hospital resulting in a delay in discharge. In such situations the treating physician is ultimately held responsible for the delay. Nevertheless the medical social worker often bears the brunt of the blame for the delay in discharge and his or her failure to perform often attracts the attention of management.
Other skills required of the medical social worker is an ability to work cooperatively with other health care staff as part of a multidisciplinary treatment team. They need to have good analytical and assessment skills, an ability to communicate clearly with both patients and staff, and an ability to quickly engage the patient in a therapeutic relationship. The Medical Social Worker will inevitably have to be able to process almost a never-ending flow of paperwork, whilst retaining a willingness to advocate for the patient, especially in situations where the medical social worker has identified a problem that may compromise the discharge and put the patient at risk in the community.
For example, the medical doctor reports that a frail elderly patient is medically cleared for discharge and plans to discharge the patient home with home care services. However, after assessing the patient's psychosocial needs, the medical social worker determines that the patient does not have the requisite ability to direct a home care worker and recommends that the discharge be deferred pending further assessment of this problem. In such a case, it is the medical social worker's ethical duty to inform the medical doctor that the discharge may place the patient at risk and advocate for another, more appropriate discharge even if it means that the patient's discharge has to be postponed. It is precisely in such cases that the medical social worker proves his or her worth - by placing the needs of the patient above all other considerations.
Challenges
As medical social workers often have large case-loads and have to meet tight deadlines to arrange for necessary services, medical social work is a highly demanding job and as a result the turnover rate is high. In addition, medical social worker often confront highly complex cases involving patients with multiple psycho-social issues, all of which requiring intervention and leading to delays in discharge. For instance, in a major urban acute care medical center, it is not uncommon for the medical social worker to assess patients who are simultaneously homeless, without health insurance coverage, have multiple chronic medical and psychiatric conditions, are unemployed, have just been released from incarceration, and have substance abuse problems. Any of these, separately and together, can impede timely discharge. Sometimes situations as mundane as the patient needing carfare or shoes can lead to delays in discharge, especially if these needs are not identified early. This is why a complete and timely assessment of the patient's psychosocial needs is critical.
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