What role for social work in the new health care practice paradigm?

Abstract

The hospital . . . must become part of primary care network of community-oriented delivery systems focused on chronic disease management. In this model, the social worker treats the patient throughout the continuum of care. Therefore, dynamic training that addresses the changing health care environment will be needed. (Berkman, 1996, p. 541) The rapidly changing organization and financing of health care delivery in the United States compels social to specify the elements of its health-related practice and to convincingly document its cost-effectiveness. (Ell, 1996, p. 583) Amid palpable anxiety over welfare reform, devolution, and multiculturalism, the Annual Program Meeting of he Council on Social Work Education (CSWE) held this March in Chicago offered more sessions than ever on aging, disability, health care, and managed care. Given the panoply of challenges facing social and higher education, perhaps it was remarkable that health care was on the agenda at all. The higher profile of bio amid the usual psychosocial fare at the meeting reflects how rapidly social is changing and how far it has to go to be player in the nation's lean-and-mean health care system. This terrain at the margins between social as profession and health care as system is not easy to traverse. Several challenges confront those eager to see health care higher priority in social education and social higher priority in health care. CHALLENGES TO SOCIAL WORK IN HEALTH CARE Articulating Social Work's Role The power of social work is not well understood in health care. Is social really health care Profession? Recent assessments of the nation's future health care staffing needs make no mention of social workers (Osterweis, McLaughlin, Manasse, & Hopper, 1996). Nor does the federal Bureau of Health Professions include social among the professions for which it advocates. Perhaps most telling, social workers rarely publish research findings in the journals most read by health care administrators, analysts, and policymakers. Social has peripheral presence at best in the larger arena of health policy and design of care delivery. And evidence abounds of tenuous relationships with colleagues in medicine and nursing in the largest medical research centers as well as in the most rural home health care programs. The term partnership overstates relationships often felt to be secondary and unnecessary to the enterprise of treating medical conditions and shaping medical outcomes. The research of Netting and Williams (1997) on physicians' and nurses' perceptions of social workers in the Hartford Foundation Generalist Physician Initiative identified vast misunderstandings among professional colleagues about what social workers do. Abramson and Mizrahi (1996, 1997), who also have studied physician-social relationships, noted similar problems. The value bases and missions of the various health professions differ markedly. Social work, for example, advocates a biopsychosocial model that encourages client empowerment and self-determination in medical environment that expects patient compliance (Netting & Williams, 1996, p. 217). Nurses, on the other hand, are socialized to during any 24 hours of the day. No wonder communication is difficult. Not the least among these problems is the difficulty social workers have effectively articulating what they do to other health care professionals and, presumably, to the public at large. Communication is also problematic in hospital and institutional settings where there has been an increase in nursing personnel in social and discharge planning departments and where shared responsibilities between social and other disciplines have increased (Berger et al., 1996). All hospital personnel are having to harder to ensure that patients and families are not affected by changes in hospital organization, placing all staff under pressure. …