Wednesday, January 22, 2014

Models of Social Work Practice in a Hospital

Social Work Practice in a HospitalIn my short career, I've been fortunate enough to work at various hospitals as a medical social worker.  Doing so has helped me hone my social work skills and learn about the various community resources in different locales.  Additionally, I've been able to see first-hand the true versatility of this profession, as demonstrated by how the social work role differs at each hospital.

I've practiced two main models of hospital social work practice: pure social work and social work/discharge planning.  In this post I will elaborate on these two practice models and discuss the pros and cons of each.

Pure Social Work
Pure social work focuses exclusively on the psychological and social barriers that affect a patient's well-being and hinder a safe discharge home.  Social workers practicing this model focus on completing comprehensive psychosocial assessments, providing brief counseling/crisis intervention services, assisting with end-of-life situations, finding shelters for homeless individuals, placing individuals who cannot return home for social reasons (i.e. no family support), and evaluating patient safety (i.e. abuse assessments, domestic violence intervention).

Social Work/Discharge Planning
This model takes pure social work and incorporates elements of discharge planning.  Social workers who practice this model take on the medical barriers that interfere with a safe discharge home.  Tasks include placing patients in skilled nursing homes, ordering durable medical equipment, arranging home health care, making transportation arrangements to other facilities, and addressing any other post-hospitalization needs (i.e. medication, follow-up appointments) in order to reduce the likelihood of patient readmission.

Pure Social Work Pros
-A slightly smaller caseload means more time to interact with patients, develop rapport, and go above and beyond to address their needs.  When I have the time to get to know my patients, I can better anticipate their future needs and provide resources/interventions as necessary.
 -Hospitals with a pure social work focus usually have a dedicated social work department headed by a social worker.
-I find myself having more autonomy on the job than when I'm at hospitals that use the social work/discharge planning model.
-The bulk of my time is spent practicing social work, which is what I went to school to do.

Social Work/Discharge Planning Pros
-Compared to pure social work, discharge planning requires a more expansive knowledge of insurance requirements and medicine/nursing.  I feel that this helps me better address patient needs and makes me a more effective clinician overall.
-I interact a lot more with other disciplines, such as nurse case managers, nurses, discharge planners, physical therapists, occupational therapists, etc.
-I get a sense of fulfillment and closure from coordinating patients' discharge plans from the moment of admission to discharge.

Pure Social Work Cons
-Social work cases are usually extremely emotionally draining.  Sometimes I like having the occasional straightforward home health or skilled nursing referral to get a mental break.
-Social work cases also tend to be the most complex, with no simple solutions.  There have been many instances where I've had absolutely no idea how to fix a patient's problems.  Anyone who has ever said that social work doesn't involve advanced problem solving skills has never worked a day in our shoes!
-With regard to the interdisciplinary team approach, I feel more like a consultant since I typically only get involved in more challenging situations.

Social Work/Discharge Planning Cons
-Social workers who function as discharge planners have job duties that overlap with nurse case managers. This often results in situations where staff members confuse us as nurse case managers and vice-versa.  Because of this confusion, social workers are often asked to do things outside their scope of practice, such as analyze test results, predict discharge date, and provide updates on medical status.  I've definitely felt stupid more than once for not knowing things that are basic to nurses/doctors.  Not my training!
-Having higher case loads mean less time spent with patients.  Patients who have discharge orders have first priority, meaning patients with mental health problems needing support sadly may not be seen.
-Case management departments tend to be focused more on metrics and the bottom line.  The goal of discharge planning is to discharge patients in a quick, safe manner and prevent readmission. This is not always compatible with social work practice.

Honestly, I am not sure which model of hospital social work practice I like the best.  I suppose this is part of the reason why I continue to split my time between various hospitals.

What do other medical social workers think of how social work is practiced in a hospital?  Comment away!

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