Medical Social Work

What is Medical Social Work?

Medical Social Work (MSW) is a sub-discipline of social work, also known as Hospital Social Work and Healthcare Social Work. Medical social workers typically work in a hospital, outpatient clinic, community health agency, skilled nursing facility, long-term care facility or hospice. Social workers in this field have a graduate (post-graduate) degree or a bachelor's degree with a graduate/post-graduate diploma in healthcare specialization and work with patients and their families who face specific psycho-social barriers. Medical social workers assess patients' and families' psycho-social functioning, environmental and support needs and intervene. Interventions may include connecting patients and families to essential resources and support in the community, providing psychotherapy, supportive counselling, grief counselling, or helping patients expand and strengthen their network of social supports. Medical social workers typically work on an interdisciplinary team with professionals of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.)

{tocify} $title={Table of Contents} 

The prevalence of illness and premature death due to lack of awareness, access to good medical care or failure to take advantages of care mental or psycho-social disorder have long made medical care a topic of prime concern to the field of medical social work. We have come to realize that success of medical care or treatment is based as much on the adequacy of the delivery system as it is on the knowledge and skill of the medical personnel and social worker. Medical care is an important field of practice for social workers who play significant roles in facilitating the delivery in social services at the individual groups and community.

Scholarly definition of Medical Social Work

Medical or Hospital Social Work is defined as "Social work practice in a responsible relationship to medicine and public health within the structure of health care programs. Initially, this field of social work practice was concerned almost exclusively with the social needs of problems of ill persons under care in hospitals and civics.

Robert L. Barker defined Medical Social Work as “The social work practice that occurs in the hospitals and other health care settings to good health, prevent illness, and aid physically ill patients and their families to resolve the social and psychological problems related to illness. He also stated that medical social work also sensitizes other health care providers about the social-psychological aspect of illness (Barker, 1995).

$ads={2}

"The medical social worker seeks to remove those obstacles, either in the patient's surroundings or in their mental attitude, that interfere with successful treatment, thus freeing the patient to aid in his recovery as a whole person" - Ida Cannon, 1923.

In her book Medical Social work, Miss E.M.R Clarkson defined Medical social work as a specialized branch of social work practice in hospitals, clinics, community health centres, and sometimes general practice. Its method consists of understanding the sick person as a human being, temporarily or permanently incapacitated by illness, someone whose living habit may be disrupted, who may be away from home for long periods on end, who may be unemployed and consequently penniless, or who may react badly to illness or disfigurement, and working with doctors, nurses and others in trying to help them (Clarkson,1974).

$ads={2}

Characteristics of Medical Social Work 

By analyzing the previous discussion about medical social work, we can identify such criteria of medical social work.

1. Medical social work is a professional and specialized branch of social work.

2. Here, the social work method, skill, and philosophy are used to treat a patient.

3. Medical social work emphasizes treatment and attempts to provide training and rehabilitation facilities.

4. In medical social work, social casework and group therapy are appropriately used.

5. Hospital/medical social work help a patient or problematic person solve their problem next except the medical diseases. Ex: Drug addiction

6. Medical social work is an integrated attempt of spiritual, psycho-social, religious and educational therapy.

7. Here, poor patients get help and guideline to adjust to the hospital environment.

8. After all, the medical social worker provides counselling, follow up, treatment, home visits, psycho-social therapy by applying the social work method principle and code of ethics of social work discipline.

$ads={1}

Aims and Objectives of Hospital/Medical Social Work

The main goal of MSW in Bangladesh is to provide proper services for the patient, basically for the vulnarable patient with co-operation with the NGO or the donation of philanthropist or warm hearted people. According to Encyclopedia of Social Work purposes of hospital social work include:

1. Helping people facing illness, trauma-related crises, or disability to understand and manage the psychosocial impact on their lives and on significant relationships and to make decisions and plan for the future.

2. Facilitating adaptive coping patterns and adjustment to chronic illness or disability and assisting with reintegration or adaptation to new environments

3. Participating in multidisciplinary teams and providing insight and understanding of the psychosocial dimensions of the medical circumstances affecting particular patients and families

4. Identifying and arranging community supports and practical resources to facilitate discharge from hospital or transfer to alternative care facilities

5. Assisting with anticipatory grief and mourning, counseling people facing death, and providing other bereavement-related services to members of the family, including making practical arrangements

6. Assessing the needs of selected patient populations, networking with community organizations, and developing services to meet these needs, including support and psycho-educational groups, educational forums, socialization, and reintegration activities;

7. Identifying potential neglect, abuse, and exploitation in vulnerable populations and involving authorized agencies;

8. Supporting institutional goals and purposes and encouraging institutional responsiveness to patient needs(Ross, 1995)

$ads={2}

According to Minahan (1981) the objectives for social work in hospitals are consistent with following objectives:

1. Helping people enlarge problem solving and coping abilities;

2. Facilitating interaction between individuals and others in their environment;

3. Helping people obtain resources;

4. Making organizations responsive to people influencing interactions between organizations and institutions; and

5. Influencing social environment policy (Ross, 1995).

$ads={2}

Deputy Director (Treatment & Probation) of social services department Momotaz Begum, said that to emphasize psychological affairs for ensuring the full treatment of the patients.

1. To build up Report and collect social-economic and related information to assist the doctors to full cur the patients.

2. To identity the poor and vulnerable patients from outdoor and includes them within the medical social service.

3. To send the identified patients to the related department and doctor.

4. To admit the patients in the hospital by the basis of prescription of the doctors and assist in treatment process.

5. To build up relationship between the patient and doctor.

6. To assist poor patients by giving them medical, blood, artificial parts of the body, spectacles, and crèche etc.

7. To assist mental disorder type of patients using psycho therapy.

8. To keep the long periodical indoor patients from anxiety with proper communication with his/her family.

9. To motivate the patients for operation.

10. To counsel the illiterate patients for family planning, maternal and child health care and the way to prevent the transmitted diseases.

11. To send the patients to the home with financial help.

12. To admit abandoned child of the hospital in the baby home an child family (Shishu Paribar)

13. To rehabilitate the poor patients within social service department under the poverty alleviation program.

14. To follow-up the treatment and rehabilitation process of the patients.

$ads={1}

Functions of a Medical/Hospital Social Worker 

The primary function of a medical social worker is the practice of social case work to help the patients with social problems created by their illness. The other main functions of a medical social worker are:

1. Participation in program planning and policy formulation of the agency;

2. Participation in community organization;

3. Participation in educational programs;

4. Participation in social research;

5. Consultation (Pathak, 1961)

According to the Association’s Statement of Standards, social service departments in hospitals may appropriately engage:

1. Practice of medical social case work;

2. Development of the medical social program within the medical institution;

3. Participation in development of social and health programs in the community;

4. Participation in the educational program for professional personnel;

5. Medical social research (Goldstine, 1955).

$ads={2}

Some of the areas that the MSW will assist the patient and/or the family are: 

1. Multi-issue counseling 

2. Personal and family problems 

3. Needs for indigent medication programs 

4. Abuse, neglect, and exploitation issues 

5. Unsafe living conditions 

6. Coping with life threatening or life limiting diseases 

7. Inadequate housing 

8. Unemployment and disability issues 

9. Psychosocial support 

10. Referrals for services such as: meals on wheels, oxygen, medical equipment needs

$ads={2}

The following functions of the medical social worker have been spelled out the Joint committee of the American Hospital Association and the Medical Social Work Section of the National Association of Social Workers-

1. Aiding the health team in understanding the significance of social, economic and emotional factors in relation to the patient’s illness, treatment and recovery.

2. Helping the patient and his family in their understanding of these factors to enable them to make constructive use to medical care.

3. Promoting the well-being and morale of the patient and his family.

4. Participating in the educational programs of other members of the health team.

5. Assisting the hospital in giving better patient care through its various services.

6. Facilitating the productive utilization of community resources to meet the needs of patients and their families.

$ads={1}

It is estimated that about half of all patients who see doctors come with psychosomatic illness involving personal, emotional, and family problems. Thus, it is apparent that persons who are qualified to help with social factors are important members of the comprehensive treatment team. Their services are related to- (1) direct help to the patient, and (2) indirect aid through assistance to the family and /or others. Help to the patient is related to – 

(a) intake, 

(b) hospitalization, 

(c) release, and 

(d) aftercare (Skidmore & Thackery, 1964).

Dr. Alter Stated that medical social workers try to accomplish three things: Vorsorge, Fiirsorge, and Nachsorge- prevention, hospital treatment, later treatment. At the eleventh session of the Indian Conference of Social the Work held in Hyderabad in December, 1959, the following functions of Hospital Social Work have been suggested-

a) Dealing with social and emotional problems of patients and their families which come in the way of adequate treatment, care and rehabilitation of patients.

b) Acting as a liaison between the hospitals the patient, his family and the community and interpreting the treatment to patient and his family also the hospital to the community.

c) To bringing the information of the physical and psychological environment of the patient to the doctor for better of his care.

d) Mobilizing existing community resources and develop new services where they were lacking e. g. convalescent home, workshops for the physical and mentally handicap, clubs and hostels for mental patients, etc.(Cabot, 1928).

$ads={2}

After analyzing the above opinion functions of Hospital Social Workers can be explained as follows:

Screening and Case Finding

Access to social work service is determined through screening and case finding every patient cannot be sun by a social worker. Similarly not all health providers can anticipate or interpret patient needs or know when to request social work services. Screening and case including may be done through reviewing patient charts, reports or other automatic referral mechanism. Screening criteria usually include a combination of psychosocial factors, illness factors and outcome factors. The patient’s age economic and living circumstances, support systems, mental status, individual and family and skills in coping and adaptation, disease chronicity degree of disability and likelihood of death all are included in screening criteria. Sometimes brier interviews are necessary to clarity need and case finding. Screening may be of two types; preadmission screening and post admission screening (Ross, 1995).

$ads={1}

Crisis Intervention

Crisis intervention is needed when hospitalization is unplanned, emergent and experienced as a crisis. When recovery is uncertain hospital social workers needs to apply the skill of crisis intervention. Crisis intervention promotes coping ability to face adversity by supporting hope, offering relevant information, providing reassurance and emotional support, helping set attainable goals, rehearsing alternative outcome, and finding meaning social workers use crisis intervention for stabilizing crisis situation then proceeds to counseling and discharge planning (Ross, 1995).

Psychosocial Assessment and Formulation of Treatment Plan

Many Richmond in his book Social Diagnosis (1917) first urged on the importance of collection psychosocial data of the patient for understanding the patient and his environment. Psychosocial assessment is a compulsory duty for all medical social workers. The assessment including gathering demographic information, assessing patients mental and physical family history, citing patient mental problems each as digression or compulsion and evaluating patients for such risk as suicide and abuse. Medial social workers must be adept at communicating with people about sensitive issues and ailing to spend time getting to know patients and their families for successful completion of psychosocial assessment(Ross, 1995).

$ads={1}

Discharge Planning

When a patient is being released from a medical setting, a social worker is usually behind the scenes making sure that the patient receives the proper medical follow up a medical social worker might assist the family in scheduling physical therapy or post-hospital medical appointments. If a patient is depressed or anxious upon discharge, the social worker might provide a referral for counseling services 

Paper work and Record Keeping

Most medical social workers have piles of paper work to get through on a daily basis. They are required to document all services that are put into place for each patient. They may also be required to summarize counseling sessions and complete progress notes. Medical social workers fill out referrals for patients for necessary services. Each setting has a different way of maintaining its documentation, yet medical social worker are required to complete paper work in a timely manner. As a member of treatment team Hospital social workers activities are recorded in patient’s medical record. It reflects the skill and competence of Hospital social worker in dealing with patient. Most of the hospital social work departments require worker to keep record of every patient including demographic data, type of problem encounter, type of service provided, outcomes, follow up and referral data (Ross, 1995).

$ads={2}

Communication

Communication is priority when medical social workers team with medical professionals. They are required to follow up with doctors and nurses, and to discuss physical and mental complications or issues. In some settings, medical social workers advocate for patients with other medical professionals. Moreover, hospital social worker communicates with various agencies to utilize internal and external resources for the betterment of patients and their families

Therapy

Providing therapy or counseling is an important function of Hospital Social Worker. Medical social workers provide counseling to patients and their families. If a patient arrives at a nursing home and appears depressed, the social worker completes a psychosocial evaluation and provides counseling. Some settings required that social workers make referrals for patients to receive counseling services outside of their agencies because those social workers do not have the time to provide long term counseling. In other settings, however, social workers serve as therapists to patients and assist with mental health issues on a regular basis.

Others include:

Counselling for individuals, couples and families — for situations in which patients suffer from poor mental health states (e.g. depression, anxiety), and coping and adjustment difficulties. (e.g. due to loss of limb through amputation, loss of hearing, caring for family members suffering from dementia or grief and bereavement issues)

Risk assessment — assessing risk of self-harm (e.g. suicide) and to others (e.g. family violence, elder abuse, child abuse).

Financial assessment and fund management — identifying and referring cases for financial assistance.

$ads={1}

Role of Medical/Hospital Social Workers in Bangladesh

Medical social work application works by the medical social worker. Formally they are dedicated for the treatment of patient. In Bangladesh, there are little scope to work as a medical social worker. But some field they are playing a vital role in comprehensive medical treatment. According to Professor M. A. Momen, fundamentally the role medical social work are divided into three part such as-

a. Role of pre-treatment stage

b. Role of during treatment stage

c. Role of post treatment stage.

Overall role of medical social worker in these three parts identify in the showing way:

a) Admitting the patients in hospital: Many people don’t know the procedure of admitting in hospital, somebody even doesn’t know where he should admit. Social Worker helps them to admit in the necessary hospital.

b) Help to adjust hospital environment: When a patient comes to a hospital. He faces some problems to adjust with the hospital and medical social worker helps him/her to adjust with the new environment.

c) Helps to diagnosis the patient’s problems: Unlike physical problem a patient may social other problem (Mental, economic and family) which delays or inhabits his/her treatment. Medical social workers uncover these problems and their relation with physical problems.

d) Help to ensure patients participation in treatment process: Sometimes it’s happen that a patient cannot participate totally in the treatment procedure. It happens because of ignorance, superstition and other factors. Medical social worker removes these problems and ensures patients participation.

e) Materialistic help: To ensure patients treatment medical social worker provides medicine.

f) Case study: In the function of medical social worker, case study is being treated as a vital job. Because by taking case history a social worker can provide proper care and treatment for his client.

g) Home visit: Home visit represents an upgrade method of medical social work. So very much consciously medical social worker maintains the home visit application and process.

$ads={2}

Broadly the Roles of Hospital Social Workers are as follows

Role as an Effective Service Provider

Medical social worker plays an important role to ensure effectiveness of health services available in hospitals and clinics. Medical social worker directly takes part in diagnosis causes of illness, formulation of treatment plan, giving follow up helping the patient to get after care services.

In fulfilling the expectations and requirements of his professional role in the study diagnosis-treatment of patient problems, the medical social worker accepts responsibility for the following:

a) Authoritative definition of the social situation of the patient;

b) Identification of the social forces and factors which are exerting influence upon the etiology and treatment of the patient’s health problems;

c) Selection of appropriate measures of intervention directed toward the modification of factors which may have adverse consequences for the patient’s care and recovery;

d) Participation in joint treatment planning and evaluation of treatment out comes; and

e) The execution of social treatment within the goals and structure of a jointly developed treatment plan (Cockerill, 1960).

The study diagnosis-treatment procedure of the medical social worker is guided by the philosophy, goals, and ethics of the profession of social work and by a theoretical teamwork common to social work practice. Inasmuch as it is directed toward the social functioning needs and problems of ill and injured individuals and their families, it makes extensive use of knowledge about the structure, roles, and culture of health and medical institutions and about the requirements and expectations of the patient role. The medical social worker is continuously engaged in assessing the consequences of injury, illness, and hospitalization for the performance of the patients’ customary social roles and develops special expertness in defining these relationships (Cockerill, 1960).

$ads={1}

Role as a Policy Maker

The medical social worker from professional knowledge and practical experience gained from providing service to the patients is able to identify the gape in the services of the agency or the need of modification of policies and procedures that are needed for providing better and more effective service. This knowledge and experience is shared by the social worker with other members of the hospital staff. Medical social work administration of a hospital unit plays an important role in formulating service policy of a hospital or clinic. They can influence the management authority to formulate new policy and modify existing policy to ensure better care and effective service (Pathak, 1961).

Role as a Teacher /Trainer

Medial social works play a key role in providing health education and training to the patients as well as the social work training in medical social service sectors. Many health, medical care, and rehabilitation programs serve as field instruction centers for schools of social work. Students of social work school with a concentration in their educational program are placed in these programs. The field teacher is usually a member of the medical social work staff who are appointed to train the students. Medical social worker as a field teacher selects and arranges learning responsibility, participation in inter disciplinary case conference, word rounds, chart review and so on, designed to enhance the ability to perform the role of a social worker in medical settings. He also helps the students to extend and deepen his his knowledge of health and disease, of the culture and social structure of health institutions of the potential consequences of illness and injury for social functioning, of the concept of comprehensive patient care and so on(Cockerill, 1960).

$ads={2}

Role as a Coordinator

The Hospital social worker coordinates existing social work services to help the patients and their families to deal with social, economic and emotional crisis. He works with the team of physicians, nurses, psychologists and others therapist in medical settings. The physicians possess highest authority in the team and others must cooperate wholeheartedly under the doctor’s directions to success completion of treatment plan. The hospital social worker interprets and coordinates the patient’s and his family’s requests and recommendation of the physician. Moreover he coordinates the external and internal services to ensure better care and avoid duplications.

Role as a Consultant

As a consultant, Hospital social worker is involved in two type of consultation e. g. case consultation and program consultation. As a consultant he aims to increase the ability of the consulted to understand and to deal with the problem situation. In case consultation the medical social worker assist the consultee to identity the interrelationships between the biological and psychological problems of an individual and his psychological and social functioning. Moreover, he may suggest appropriate ways of intervening in order to present or modify adverse consequences of these relationships and develop social and psychological functioning. Similarly in program consultation the hospital social worker may assist the consultee in thinking through the possible consequences and efficacy of different polices programs, procedures and patterns of rendering health and medical care services for individual in need of them ( Cockerill, 1960 ).

$ads={2}

Role as a Researcher

Conducting research is must for the development of any profession on discipline Hospital Social Worker can study on subjects direct related to medical social work profession or can cooperate with other professional people in a multi-disciplinary study. For example, if the medical social worker identifies certain problems during working with the patients, he can decide to undertake study regarding their problems to investigate their nature, causes impact and find out necessary recommendations to solve these problems in order to help the agency or hospital to provide better medical case. He can also undertake or participate in studies of problems which are of interest and concern to medical social workers or to field of social work as a whole (Pathak, 1961).

$ads={1}

Constraints/Problems/Challenges of Medical Social Work in Bangladesh

Medical social work is a social work practice in a responsible relationship to medicine and public health within the health and medicine program structure. If we follow the world perspective, we will see that social work is a profession of developed countries. Still, social work does not get professional recognition in the least developing countries like Bangladesh. The per capita income of Bangladesh is just about 599 us dollars (UNDP report 2008). For the health sector, the present government of Bangladesh gave only 5.9 % in the national budget, which is so much tiny amount. Now the overall constraints of medical social work in Bangladesh are given below:

1.     Lack of financial constant and extreme poverty

2.     Insufficient knowledge of social service officer

3.     Lack of doctor's cooperation

4.     Without getting the professional recognition of social work discipline

5.     Lack of sufficient agency for exercising the fieldwork practice

6.     Lack of relevant literature

7.     Lack of efficient medical social worker.

8.     Dual administrative tangle of medical social service.

9.     Unawareness about the role of a medical social worker.

10. To pressure the medical social workers to do less important tasks like communications, sending the patients, and giving the patient's family information.

11.    Lack of after-care treatment.

12.   Lack of proper rehabilitation programme

13.   Inadequate budget.

14.   Lack of proper communication and co-ordination

15.   Finally, red-tapism is the extreme and giant problem of medical social work

$ads={1}

Recommendations of Medical Social Work in Bangladesh

To ensure transparent satisfactory, and good medical service, medical social work is must need part of hospital service. So our government should be aware of the medical social work sector immediately. To update the medical social work, some suggestions can be taken, such as

a) To provide sufficient financial support for medical social work;

b) Government should give concern towards medical services;

c) To remove the misunderstanding between hospital authority and social service department;

d) To ensure training for the social service officer and apprentice social workers;

e) To establish social work discipline as a profession to remove the red-tapism in the hospital social survival sector;

f) To provide more funding for the health sector; and

g) To create awareness about social work and social service department.

Finally, the ministry of social welfare, civil society, pioneer social worker and all work of life should update the health services and medical social work.