nasw standards for social work...ethical dilemmas for individuals, families, and health care...
TRANSCRIPT
N A S W S t a n d a r d s f o r
Social WorkPractice
i n H e a l t h C a r e S e t t i n g s
N A T I O N A L A S S O C I A T I O N O F S O C I A L W O R K E R S
2005
N A S W S t a n d a r d s f o r
Social WorkPractice
i n H e a l t h C a r e S e t t i n g s
National Association of Social Workers
Elvira Craig de Silva, DSW, ACSW
NASW President (2005-2008)
Elizabeth J. Clark, PhD, ACSW, MPH
Executive Director
Health Standards Working Group
Nancy Campbell, MSW, LISW
Nancy F. Cincotta, MSW
Lisa E. Cox, PhD, LCSW, MSW
Stuart Kaufer, ACSW, LMSW
Carol P. Marcusen, MSW, LCSW, BCD
Shirley Otis-Green, MSW, ACSW, LCSW
NASW Staff
Nancy Bateman, LCSW-C
Evelyn P. Tomaszewski, ACSW
Karyn Walsh, ACSW, LCSW
©2005 National Association of Social Workers.All Rights Reserved.
Contents
5 Introduction
6 Background
8 Social Work Guiding Principles
9 Definitions
14 Standards for Professional Practice
14 Standard 1. Ethics and Values
15 Standard 2. Health Disparities
17 Standard 3. Cultural Competence
18 Standard 4. Confidentiality
19 Standard 5. Knowledge
20 Standard 6. Assessment
21 Standard 7. Intervention and Treatment Planning
22 Standard 8. Case Management
24 Standard 9. Empowerment and Advocacy
24 Standard 10. Client and Community Education
25 Standard 11. Teamwork and Collaboration
26 Standard 12. Workload
27 Standard 13. Documentation
28 Standard 14. Research
29 Standard 15. Performance Improvement
30 Standard 16. Access to Information and Technology
31 Standards for Professional Development, Education
and Leadership
31 Standard 17. Qualifications
31 Standard18. Continuing Education
32 Standard 19. Supervision
33 Standard 20. Leadership
34 References
36 Acknowledgements
5
Introduction
The constant growth, demands, and changesin health care have had a serious impact on the viability and need for social workers in allareas and settings of health care. More than 15 percent of the population or 45 millionpeople in the United States were withouthealth insurance coverage during 2003 (U.S.Census Bureau, 2004). Access to timely,comprehensive, and equitable health care forindividuals in the United States variesconsiderably, with significant percentages of many populations having only limitedaccess to health care. The growth in medicaltechnology has offered hope and improvedquality of life to many people; yet, theadvances in technology have also raised healthcare costs and introduced social, legal, andethical dilemmas for individuals, families, and health care providers. These psychosocialimplications of health care are what socialworkers are trained to address.
Currently, health care social workers provideservices across the continuum of care and invarious settings. Social workers are present inpublic health, acute, and chronic care settingsproviding a range of services including healtheducation, crisis intervention, supportivecounseling, and case management. In responseto critical incidents that are both global andnational, health care social workers areincreasingly trained to provide interventions to prepare for and respond to traumatic eventsand disasters.
The health care system in the United States iscomplex and multidisciplinary in nature, and
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may include a network of services such asdiagnosis, treatment, rehabilitation, healthmaintenance, and prevention provided toindividuals of all ages and with a range ofneeds. Multiple sources of financing, rangingfrom Medicare and Medicaid to privateinsurance, provide further challenges. Manyconsumers lack health insurance or haveinadequate coverage, which causes financialstress on consumers and providers.
Professional social workers are well equippedto practice in the health care field, because of their broad perspective on the range ofphysical, emotional, and environmental factorsthat have an effect on the well-being ofindividuals and communities. These standardsare developed to meet the needs of socialworkers in multiple health care practicesettings and to help the public understand the role of the professional social worker. The National Association of Social Workers(NASW) recognizes that standards alonecannot improve the quality of practice unlessthey are disseminated and implemented at thepractice level. Client satisfaction and improvedquality of care result when social workers andadministrators recognize and use thesestandards.
Background
Social workers have been involved in thehealth care field since the turn of the 20thcentury. The profession’s earliest concernswere with making health care services availableto the poor and with improving socialconditions that bred infectious diseases such as
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tuberculosis. As the social work role expanded,social workers joined other health professionsin the delivery of high quality services. Today,social workers can be found in everycomponent of the health care system. In 1977,NASW published Standards for Hospital SocialServices. In 1980, the Standards for Social Workin Health Care Settings were developed andreplaced the hospital standards. Between 1981and 1982, the NASW Board of Directorsapproved the new standards, and threesubsections were developed, approved, andadded to the health care standards. Thesubsections included the Standards for SocialWork in Developmental Disabilities, Standards forSocial Work in End-Stage Renal DiseaseTreatment Settings, and Standards for SocialWork in Public Health Settings.
In the early 1980s, a capitated system forpayment of Medicare services in acute healthcare settings, known as diagnostic-relatedgroups (DRGs), was initiated by the federalgovernment. This initiative, generically knownas managed care, fundamentally altered healthcare financing for both public and privatehealth care systems. Managed care focused on reducing the length of stays in acute carefacilities, and this led to a fundamental shift in the role of social workers in acute healthcare. Social workers became more focused on planning for an individual’s transition tohome or to another level of care. Social workservices disappeared entirely from some healthcare settings due, in part, to a lack of datademonstrating the efficacy of social workservices and loss of funding for those services.Yet, in other settings, social workers haveprospered, gaining recognition through the
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provision of specialized services in multiplehealth care arenas such as palliative care,ethics, ambulatory care, rehabilitation, andgeriatric services.
The NASW Standards of Social Work Practice inHealth Care Settings are based on the consensusof expert health care social workers fromacross the country and are designed toenhance social workers’ knowledge, skills,values, and methods necessary to workeffectively with individuals, families (broadlydefined), health care providers, and thecommunity when practicing in health caresettings.
Social Work Guiding Principles
The basic values of social work, frompromoting an individual’s right to self-determination to having an attitude ofempathy for the individual, are the foundationof social work practice. When confrontingdilemmas or needs in health care, socialworkers can use the principle of client self-determination in matters where clients or their proxies are faced with such issues(NASW, 2004).
Social workers have skills in cultural awarenessand cultural competence, in which social workpractice respectfully responds to, and affirms,the worth and dignity of people of all cultures,languages, classes, ethnic backgrounds,abilities, religions, sexual orientation, andother diverse features found in individuals(NASW, 2001). Social workers look at theperson-in-environment, including all of the
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factors that influence the total health careexperience. Social workers practice at themacro and micro level of health care and thushave the ability to influence policy change and development at local, state, and federallevels and within systems of care. Social workresearch in health care benefits not onlyindividuals and families, but also the veryexistence, effectiveness, and validation of the profession. These standards offer a guide for social workers practicing in anyhealth care setting.
Definitions
Bioethics
Bioethics is the analysis and study of moral,legal, social, and ethical considerationsinvolving the biological and medical sciences.Many health care settings have organizedforums such as bioethics committees,institutional review boards, or consultationprocesses to address ethical dilemmas andquestions.
Biopsychosocial–spiritual Perspective
The biopsychosocial–spiritual perspectiverecognizes that health care services must takeinto account the physical or medical aspects of ourselves (bio); the emotional orpsychological aspects (psycho); thesociocultural, sociopolitical, andsocioeconomic issues in our lives (social); andhow people find meaning in their lives(spiritual). This approach draws from thestrengths perspective of social work practice.The strengths perspective recognizes anindividual’s strengths and abilities to cope
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with problems; and awareness and use of theclient’s strengths is part of the foundation ofsocial work theory and practice. The strengthsperspective is seen in social work practicethrough our role of enhancing personalstrengths and resources, helping clients solveboth interpersonal and environmentalproblems, and helping clients mobilize forchange. The strengths perspective helpsclients use their past successful choices andbehaviors, skills, and insights to resolve or“work through” a current crisis (Tomaszewski,E. P., 2004; Saleebey, 2003).
Case Management
Case management, sometimes usedinterchangeably with care management, is thecollaborative process of assessment, planning,and facilitation for options and services tomeet an individual’s complex needs. Whenappropriate, this would include arranging,coordinating, monitoring, evaluating, andadvocating on behalf of the client and/or hisor her family for the multiple services neededfrom a variety of social service and health careagencies. Case management addresses both theindividual client’s biopsychosocial-spiritualstatus (micro level) as well as the state of thesocial systems in which the services operate(macro level).
Client/Patient/Consumer
These terms refer to the person receiving careand treatment from physicians and alliedhealth care personnel. Social workers generallyuse the term client to identify the individual,group, family, or community who seeks or isprovided with professional services. The clientis often seen as both the individual and the
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client system or those in the client’senvironment. The term consumer is also used in settings that view the client as theconsumer, that is, one capable of decidingwhat is best for her or himself and encouragesself-advocacy and self-judgment in negotiatingthe social service and welfare system. Theterm patient is more commonly used by socialworkers employed in health care settings(Barker, 2003).
Continuum of Care
The care continuum includes the specializedhealth, social work services, rehabilitative, and home-based services that a seriously orchronically ill or injured person might need.This continuum addresses both the medicalcare and the other services that promote thepatients’ well-being (Barker, 2003).
Continuity of Care
Continuity of care ensures the coordination of care within an organization or acrossdifferent agencies or settings to reduceduplicate services, to address gaps in existingservices, and to ensure consistent andcontinuous services for the client as theytransition in care or are discharged.
Disabling Condition
A disabling condition is considered atemporary or permanent reduction in a client’scapacity or functioning based on the inabilityto perform some activities that most otherscan perform. A disabling condition can becongenital, can be the result of an accident ortrauma, or more frequently is the result ofchronic illness (that is, diabetes, hypertension).
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Health Care Settings
Health care settings are practice areas inwhich assessment, care, and treatment addressthe physical, mental, emotional, and socialwell-being of the person; and addressprevention, detection, and treatment ofphysical and mental disorders with the goal of enhancing the person’s biopsychosocial andspiritual well-being. The health care settingincludes personnel who provide the necessaryservices (for example, physicians, socialworkers, nurses, hospital attendants);appropriate service delivery facilities (forexample, hospitals, hospice, assisted living,medical centers, and outpatient clinics); andeducational and environmental facilities thatwork to help prevent disease (Barker, 2003).
Health Planning
Health planning is conducted in governmentorganizations, medical and researchorganizations, and educational institutions and in prevention, early intervention,treatment, and follow-up. Planning shouldinvolve determining and ensuring the numberof necessary health care personnel presentlyand in the future, and how to both finance and control costs. It includes where to locatefacilities, how to provide the most effectivemeans of service delivery, and how to provideservices in a cost effective manner (Barker,2003; NASW, 1987).
Managed Care
Managed care is a process designed to managehealth care costs primarily through the privatesector, although Medicaid’s or Medicare’scapitated systems are a form of managed care.It is a technique used by insurance carriers
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and characterized by preauthorization toqualify the patient for particular services;preauthorization for a given amount of care;review of treatment and patient response(s);utilization review; predischarge planning toensure the patient is ready to be released(having received the care required) and has an aftercare plan. Managed care plans includepreferred provider organizations (PPOs),health maintenance organizations (HMOs), or a combined version through a point-of-service (POS) plan.
Medicaid
Medicaid is a government-funded healthinsurance program that provides payment forhospital, nursing home, home care, dental, andmedical services to people who meet disabilityguidelines and income eligibility requirements.The Medicaid program is a shared federal/state/county program and although there arecertain federal standards, states have a choiceof benefits which they can choose to cover ornot. Medicaid, administered by the Centersfor Medicare and Medicaid Services (CMS), isthe largest source of funding for medical andhealth-related services for people with alimited income (Centers for Medicare andMedicaid Services, 2004b).
Medicare
Medicare is a national health care program,administered by CMS, for most people age 65 and older, people with a variety ofdisabilities who are under age 65, and peoplewith end-stage renal disease (ESRD), which ispermanent kidney failure requiring dialysis ora kidney transplant (CMS, 2004a). Medicare is funded through a combination of
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employer–employee contributions (as part ofthe person’s Social Security), from earmarkedtaxes, and general federal revenues. SinceMedicare is a federal program, benefits are the same in all 50 states.
Public Health Model
The Public Health Model of services focuseson the health of the individual, the family, andthe larger community or general public and isadministered by federal, state, and localagencies. The goal of programs, policies, andhealth care personnel is to prevent and treatdisease, identify and eliminate environmentalhazards, prolong life, and promote betterhealth (Barker, 2003; NASW, 1987).
Standards for Social Work Practice in Health Care Settings
Standard 1. Ethics and Values
Social workers shall have knowledge of and
practice according to the guidelines
established by the NASW Code of Ethics
(NASW, 1999).
Interpretation
The primary mission of the social workprofession is to enhance human well-being andhelp meet the basic human needs of all people,with particular attention to the needs ofpeople who are vulnerable, disenfranchised,oppressed, and living in poverty. The missionis rooted in a set of core values. These corevalues, embraced by social workers throughoutthe profession’s history, are the foundation ofsocial work’s unique purpose and perspective:
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n servicen social justicen dignity and worth of the personn importance of human relationshipsn integrityn competence
In a health care system increasingly driven bytechnological advances, the ethical and moralquestions and dilemmas raised for clients,families, and health care professionals arenumerous and complex. Health care settingshave designed a number of different systems toensure ethical behavior among health carepractitioners. Ethics committees are often usedto provide “objective” reviews to health careproviders and clients and families, when thereis conflict between providers or providers,clients, and families. Institutional reviewboards are used to protect clients from thepotential of experimentation in researchprojects. Social work supervision and peerconsultation can also be used to discuss ethicalissues facing practitioners.
Standard 2. Health Disparities
Social workers practicing in local, state,
national, and international health care settings
require knowledge and skills to help them
recognize and address inequalities and
injustices directed toward clients,
organizations, and communities related to
access to care and provision of health services.
Interpretation
Many social workers have historicallydelivered services as part of community-basedorganizations and public health programs toaddress health disparities among those who
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are least likely to be able to gain access toadequate care. Social workers have an ethicalobligation to address the health care needs ofthese groups and advocate for change toensure access to care. Training of health careprofessionals to achieve a level of culturalcompetence—an understanding of practicepatterns and attributes of diverse groups—isan essential part of basic and continuingeducation for all health care professionals,including social workers (Gilbert, 2003).
Health is a matter of both economics andsocial well-being. Both domestically andinternationally, health care social workersstrive to gain knowledge about health care:behavior, expenditures, reforms, systems,teams, insurance, health maintenanceorganizations, health protective behaviors, and more. Social workers also help clients togain access to health care as they navigatebetween and among complex service deliverysystems and entitlements.
Different entities shape public and globalpolicies in every country. Therefore, socialworkers must keep abreast of policies tocompetently help clients and to assess physical,environmental, historical, situational, cultural,and structural factors that affect health caresystems.
Accessibility to preventive, palliative, andcurative health care depends largely on theclient’s ability to pay, and often, people cannotafford existing fees. In many nonprofitcommunity-based clinics, services are providedon a “first come-first serve” basis (often with a long wait or long lines) and are limited by
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a shortage of supplies and equipment.Increasingly, private systems of care emergealongside public systems and other health care providers to care for the uninsured orunderinsured who need health services, yetprefer to care for those who can pay fee-for-services. When these realities exist, socialworkers shall act as brokers, advocates, andmediators for clients.
Standard 3. Cultural Competence
Social workers shall develop and maintain an
understanding of the history, traditions, values,
and family systems of client groups as they
relate to health care and decision-making. In
compliance with the NASW Standards for
Cultural Competence in Social Work Practice
(NASW, 2001), social workers shall have a
sensitivity to and awareness of the diversity
in cultural groups and integrate this
knowledge into their practice.
Interpretation
The importance of recognizing, respecting,and understanding other cultures and relatedhealth beliefs lays a foundation to buildtherapeutic alliances with clients and families.Social workers are responsible for self-reflection regarding the impact of their owncultural beliefs on their professional andpersonal life.
Social workers in health care shall approacheach client and family interaction from aperspective of cultural respect and awareness.This implies reluctance to stereotypeindividuals based on assumed groupsimilarities and seeks instead to ask individualswhat aspects of their cultural experience are
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meaningful in understanding a particularhealth care need. Social workers recognize that ethnic, cultural, spiritual, and religiousfactors can have an impact on health carechoices and adherence to regimens of care.
Appreciation of cultural influences is especiallyimportant for clients at critical healthjunctures, such as birth, diagnosis of a majorillness, and facing the end of life. Socialworkers have a responsibility to assist theclient and family system in observingculturally meaningful practices wheneverpossible. When delivering culturallycompetent services, social workers should beguided by the NASW Standards for CulturalCompetence in Social Work Practice (NASW,2001).
Standard 4. Confidentiality
Health care social workers shall maintain
appropriate safeguards for the privacy and
confidentiality of client information.
Interpretation
Social workers must be familiar and complywith local, state, and federal mandates relatedto confidentiality. Professional judgment in the use of confidential information shall bebased on best practice, ethical, and legalconsiderations (including the federal HealthInsurance Portability and Accountability Act[HIPPA] regulations). Clients, families, andother professionals should be informed of theconfidentiality limitations and requirementsbefore services are initiated and in all phases of the health care experience.
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Standard 5. Knowledge
Social workers in health care settings shall
demonstrate a working knowledge of current
theory and practice and integrate such
information into practice.
Interpretation
The social worker uses knowledge about, andpsychosocial implications of, illness, injury,and health conditions to provide social workservices to clients and families to help themmanage and cope with the impact of suchhealth matters. Social workers have expertisein communication; navigating systems of care,resources, client and family coping skills; andthe comprehensive impact of health conditionson the client. With the person-in-environmentperspective, social workers look at all of theinfluences and aspects of a person’s life tocomplete a thorough assessment and treatmentplan with the client, family, and other healthcare professionals.
Essential areas of knowledge andunderstanding about health care include:
n the roles and functions of social work inhealth care
n the biopsychosocial needs of clients andfamilies
n the physiological elements of illness andtheir impact on psychosocial functioning
n the psychological and spiritual needs ofclients and families and how to ensure thatthey can be addressed
n community resources to assist clients andfamilies
n the disparities across cultures and economicgroups in gaining access to and funding forhealth care
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n ethical and legal questions and dilemmasn laws, regulations, and policies affecting
clients, families, and social work practicen the accreditation and regulatory standards
governing settings providing health caren evidence-based practices and social work
research in health caren the needs of special populations.
Standard 6. Assessment
Social workers shall provide ongoing
assessment, including gathering
comprehensive information to use in
developing interventions and treatment
strategies.
Interpretation
Assessment is a fundamental process of socialwork practice. Treatment and interventionstrategies/plans require that social workersboth assess and reassess client needs andmodify plans accordingly. Social workassessments in health care settings includeconsidering relevant biomedical, psychosocial,and spiritual factors and the needs of theindividual client and the family (as defined bythe client) (NASW, 2004).
A comprehensive, culturally competentassessment includes:
n past and current health status includinggenetic history of family health
n the impact of health conditions ortreatments on cognitive, emotional, social,sexual, psychological, or physicalfunctioning
n the impact on body image, intimacy, andsexuality
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n social history, including current livingarrangement and household environment
n work, school, or vocational historyn stage in the life cycle and related and
relevant developmental issuesn cultural values and beliefs, including views
on illness, disability, and deathn family structure and the client’s role within
the family n social supports, including formal and
informal support systemsn behavioral and mental health status and
current level of functioning, includinghistory, suicide risk, and coping styles
n financial resources, including access to andtype of health insurance.
Comprehensive assessments shall addressunique needs relevant to special populations,including children, people with severe andpersistent mental illness, immigrants andrefugees, people with substance use disorders,victims of violence or trauma, homelesspeople, and people with physical or psychiatricdisabilities.
Standard 7. Intervention and Treatment
Planning
Social workers implement intervention and
treatment plans that promote client well-being
and ensure a continuum of care. Planning
shall be based on a comprehensive, culturally
competent assessment with interdisciplinary
input.
Interpretation
Intervention and treatment plans are stepsidentified by the health social worker, incollaboration with the client and with other
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members of the team, to achieve objectivesidentified during assessment. Social workersshall be able to adapt practice techniques tobest meet client needs within their health caresetting to work effectively with individualsacross the life-span, with different ethnicities,cultures, religions, socioeconomic andeducational backgrounds, and across the rangeof mental health and disability conditions(NASW, 2004).
Intervention or treatment plans may include:
n strategies to address needs identified in the assessment
n information, referral, and educationn individual, family, or group counseling n vocational, educational, and supportive
counselingn psychoeducational support groupsn financial counselingn case management n discharge planningn interdisciplinary care planning and
collaborationn client and systems advocacyn goals and objectives.
Standard 8. Case Management
Social work case management shall optimize
client functioning. Case management
facilitates collaboration among providers to
address the client’s biomedical and
psychosocial needs to better provide efficient,
appropriate, and beneficial health care services
to a client with (often) multiple needs.
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Interpretation
Social work case management requires theprofessional social worker to develop andmaintain a therapeutic relationship with theclient, which includes linking the client withresources that provide a range of services,resources, and opportunities to enhancesuccessful quality outcomes for the client.Culturally competent case management isboth micro and macro in nature and requiresinterdisciplinary care planning andcollaboration with other professionals tomaintain a team-oriented approach. Casemanagement may include having regularmeetings with the client and family andassisting the client to navigate systems.
The scope of services would include thefollowing:
n psychosocial assessment, includingdiagnoses, interventions, and treatmentplans
n financial assessment, planning, andintervention
n case facilitationn patient and family counselingn crisis interventionn quality improvementn resource brokering/referral/developmentn continuity of care planningn system integrationn outcome/practice evaluationn teamwork/collaborationn patient/family educationn patient/family advocacy
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Standard 9. Empowerment and Advocacy
Social workers have a responsibility to
advocate for the needs and interests of clients
and client systems in health care, including
advocating for larger system change to
improve access to care and improved delivery
of services.
Interpretation
Social workers have a special responsibility toadvocate for the needs of the disenfranchisedor the most vulnerable of the population atboth the micro and macro levels. Socialworkers will identify barriers to services andactively seek to resolve them. Theresponsibility to advocate for qualityimprovement also implies a responsibility for health social workers to act as advocates to expand the role of the profession, developleadership programs, and mentor newprofessionals.
Standard 10. Client and Community Education
Social workers act as educators for clients,
families, the community, and other
professionals regarding disease prevention,
impact of illness and disease progression,
advocacy for benefits, health maintenance,
and adherence to treatment regimens.
Interpretation
Social workers have a formal role as educators.Social workers gain knowledge and expertisein the health practice setting from otherprofessionals and from formal education,work, or teaching experience. They have theknowledge and skill to implement theprinciples of learning theories in educationprograms, activities, and resources. They
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communicate and collaborate withdepartments and other staff to foster clienteducation. They serve with other members ofthe health care team for program and resourcedevelopment, planning, implementation, andevaluation.
Social workers use a variety of methods todefine and identify learning needs ofindividuals and families. Assessment identifiesthe educational needs based on the expressedneeds of individuals, family members, andsignificant others. The social worker identifiesdeficiencies in the knowledge base of the clientand works with the client to obtain the neededinformation and resources. Social workerscollaborate with the health care team to designeducational activities to meet the client’sneeds, to deliver the activities in a method that facilitates the learning needed, and toevaluate the process in an integral, ongoing,and systematic manner.
Standard 11. Teamwork and Collaboration
Social workers shall participate in care teams,
and collaborate with other professionals,
volunteers, and groups in and outside of their
practice setting to enhance all aspects of the
client and family system’s care.
Interpretation
Social workers participate in multiple careteams, which are typically interdisciplinary.These teams often provide comprehensive care and information in a client’s home, inoutpatient or inpatient health, and mentalhealth care settings.
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As part of such teams and collaborations,social workers shall demonstrate the ability to:
n understand the mission and functions of theservice organization or group for which thesocial worker is employed
n understand the role of other relevantprofessions and organizations
n communicate and cooperate appropriatelywith other disciplines and agencies
n ensure that the social work role andresponsibilities are clearly delineated andcommunicated to other members of theteam
n ensure that the roles and responsibilities ofeach collaborating organization are clearlydelineated and communicated
n advocate for changes in care that reflect theinterests of the client and client system
n communicate the client’s information in arespectful and objective manner and protectthe client’s confidentiality and privacy
n share leadership and decision-makingfunctions
Standard 12. Workload
Health care social workers shall maintain a
workload that allows for efficient and quality
social work service delivery. The size of the
social work staff shall represent the scope and
the complexity of the organization and the
nature and numbers of the populations served.
Interpretation
Both the health care organization or settingand the social work leader and staff have jointresponsibility for establishing and maintaininga workload that allows for adequate andappropriate interventions and monitoring of
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services and outcomes. A workload consists ofany social work function performed for thepurpose of the social work position, includingdirect practice, administration, policy,research, or education. The workload alsoreflects the demands of the population servedand may include social work coverage outsideof regular office hours. It is the jointresponsibility of the organization and thesocial worker to resolve issues of workloadconcerns.
Standard 13. Documentation
Social workers shall maintain records or
documentation of social work services, which
reflect the client and client systems’ pertinent
information for assessment and treatment;
social work involvement and outcomes with
and for clients; and in accordance with care
goals and legislative and administrative
regulations and policies.
Interpretation
The importance of clear, concise, andorganized documentation reflects the hallmarkof quality social work services and often servesas the mode of communication between asocial worker and other professionals andclients. There are core elements that need tobe included and responsibilities to follow inrecord keeping. The elements andresponsibilities of thorough andcomprehensive documentation include thefollowing:
n comprehensive assessment and servicesdelivered to the client and client systems,including the development of a plan of care
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n ongoing assessments, interventions, andtreatment planning
n goals and planning that reflect an explicitstatement of agreement with client, clientsystems, and team input
n referral sources and collaborationsn dates, times, and descriptions of client and
client system contactsn documentation of outcomesn reason for case closure or transfern written permission to release and obtain
information, where appropriaten documentation of compliance with
confidentiality rights and responsibilitiesn documentation of receipts and
disbursements
Standard 14. Research
Health care social workers shall understand
research planning, methodology, evidence-
based outcomes, and program evaluation.
Interpretation
Social workers have a responsibility to befamiliar with the literature crucial to their areaof practice. As professionals, social workers inall settings have a mandate to improve theknowledge of the field, and this can best beaccomplished through participation inresearch activities.
Venues where health care social workers might help to develop, implement, or evaluateresearch include inpatient and outpatienthospital-based settings, community or homehealth agencies, and federally funded clinicaltrial research networks. Rich data sources thatpermit opportunities for quantitative andqualitative research exist within these entities.
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Clinical trials (methodological assessments ofthe safety and efficacy of new treatments ornew methods for administering existingtreatments) help answer scientific questionsand greatly depend on study participants’committed participation. Social workers mayhelp physicians, nurses, pharmacists, andothers recruit individuals and encourage studyparticipation and adherence to medicationregimens; they can also help clients manageproblems that may hinder adherence andretention, such as challenging lifecircumstances and demands from familymembers.
Standard 15. Performance Improvement
Health care social workers shall be a part of
ongoing, formal evaluation of their practice to
assess quality and appropriateness of services,
to improve practice, and to ensure
competence.
Interpretation
Social workers are trained to facilitateimprovements that alter the processes in whichhealth care is delivered. They are ethicallycharged to promote process improvementsthat will enhance patient or consumer safety,satisfaction, efficient and effective care, andidentify and promote best practices andequitable care on a multidisciplinary basis.
The evaluation of social work practice is a vital part of social work service delivery. Themethods to evaluate such practice include peerreview, self-evaluation, supervision, and otherresearch methods. Increasingly, social workoutcomes from evaluations are used forposition justification, performance review,
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social work standards for practice, goal setting,and research efforts. Evaluation practices mayinclude the following:
n using appropriate tools such as clinicalindicators, practice guidelines, consumersatisfaction surveys and measures, andstandardized performance assessments
n assessing both outcome and processobjectives
n involving the client and client system andcolleagues in the evaluation process
n protecting the privacy of the client andclient system and other professionals
n disseminating evaluative data to clients,payers, and other professionals on requestand adhering to privacy rights
n using external practice evaluators asappropriate
n participating in social work research.
Standard 16. Access to Information and
Technology
Health care social workers shall have access to
computer technology and the Internet, as the
need to communicate electronically and to
seek information on the Web for purposes of
education, networking, and resources is
essential for efficient and productive practice.
Interpretation
Health care professionals, including socialworkers, communicate, learn, educate, anddocument using computer technology on adaily basis. Social workers need initial andongoing training in technology applicationsrelevant to their practice, including clinicalcare, research, policy, education, resourcefinding, and administration. Social workers
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shall continue to follow guidelines for privacywith regard to confidential information of theclient, family, or health care providers.
Standards for Professional Development,Education, and Leadership
Standard 17. Qualifications
Health care social workers shall meet the
provisions set for practice by NASW.
A sufficient number of qualified social work
personnel shall be on staff to plan, provide,
and evaluate social work services.
Interpretation
Health care social workers shall have a socialwork degree from a school accredited by theCouncil on Social Work Education (CSWE).As a distinct specialty within the social workprofession, health care social work requiresspecialized knowledge as outlined in theseStandards. The social worker should receivethis knowledge and skill set from involvementor internship in a health care setting,preferably under social work supervision.
Social workers functioning in leadership roles,such as managers or directors, should belicensed at the advanced practice level and ableto provide supervision for licensure. Theirexperience shall show evidence of advancedpractice skills and judgment demonstratingprogressively more professional competenceand supervisory and management skills.
Standard 18. Continuing Education
Health care social workers shall assume
responsibility for their own continued
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professional development in accordance
with the NASW Standards for Continuing
Professional Education (NASW, 2002) and
state requirements.
Interpretation
Social workers shall remain knowledgeableabout medical diagnoses and advancements,and the psychosocial implications of illness,injury, disability, and treatment. To accomplishthis goal, social workers shall continually seekto improve their practice through educationand training, and to share this knowledge with other colleagues. Opportunities forprofessional education are available throughhealth care organizations; NASW Webcourses and chapters; participation andcontribution to professional conferences,training events, and other activities; ongoingpsychosocial research; current practice models;and professional publications.
Social workers shall assist in identifying healthcare and psychosocial topics for professionaldevelopment by participating in research; byencouraging organizations and institutions tocollaborate, advocate, and provide appropriateeducation for the field; and from clinicalpractice.
Standard 19. Supervision
A social work leader or supervisor shall be
available to supervise health care social work
staff on their responsibilities in practice,
research, policy, orientation, and education.
Interpretation
The purpose of supervision is to enhance theclinical social worker’s professional skills and
33
knowledge, to enhance competence inproviding quality patient care. Supervision aidsin professional growth and development andimproves clinical outcomes. Experienced socialworkers shall offer guidance and consultationto students, interns, and less experiencedpeers. Consultation and guidance are separatefrom supervision, and may be offered inmentoring opportunities.
Standard 20. Leadership
Social workers across all health care settings
have a responsibility to provide leadership to
ensure access to care and to improve and
maintain the quality of care provided by an
agency or institution. Leadership skills can be
demonstrated in teams and groups across
health care settings, and include mentoring
others within and outside the social work
profession.
Interpretation
Social work leaders typically demonstrateknowledge, skills, and abilities in the following areas:
n management/administration, which includessupervision, consultation, negotiation andmonitoring
n specialized knowledge of how to functionwithin care teams in which variousdisciplines are involved
n research and educationn legal, ethical, and professional standards
applicable to health social work practiceincluding standards of documentation(paper and computer) and qualityimprovement activities
34
n ability to prioritize needs for social workservices and to recommend adjustments tostaffing levels accordingly based on currentliterature and industry standards
n social work qualifications, productivity, andcontinuing education
n policies and regulations that affect socialwork practice, and patient and family care
n information on access to health care for theunderserved and marginalized populations
n consultation to social workers and alliedhealth professionals on relative health socialwork practice issues
n development of and adherence toorganizational policies, procedures, andregulations by staff.
Free information on the Standards is located onthe NASW Web site: www.socialworkers.org.
Purchase full document from NASW Press at1.800.227.3590.
References
Barker, R. L. (2003). The social work dictionary(4th ed.). Washington, DC: NASW Press.
Centers for Medicare and Medicaid Services.(2004a). Medicare information resource.[Online]. Retrieved fromhttp://www.cms.hhs.gov/medicare/ on April 15, 2005.
Centers for Medicare and Medicaid Services.(2004b). Welcome to Medicaid. [Online]. Retrieved from http://www.cms.hhs.gov/medicaid/ on April 15, 2005.
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Gilbert, J. (Ed.). (2003). Principles andrecommended standards for cultural competenceeducation of health care professionals. LosAngeles: California Endowment.
National Association of Social Workers.(1987). NASW standards for social work practice in health care settings. Washington, DC: Author.
National Association of Social Workers.(1999). Code of ethics of the National Associationof Social Workers. Washington, DC: Author.
National Association of Social Workers.(2002). NASW standards for continuingprofessional education. Washington, DC: Author.
National Association of Social Workers.(2001). NASW standards for cultural competencein social work practice. Washington, DC:Author.
National Association of Social Workers.(2004). NASW standards for social work practice in palliative and end of life care.Washington, DC: Author.
Saleebey, D. (2003). Strengths-based practice.In R.A.English (Ed.in Chief) Encyclopedia ofsocial work (19th ed. 2003 supplement, pp. 150-162). Washington, DC: NASW Press.
Tomaszewski, E. P. (Ed.). (2004).The role ofsocial work in medication treatment adherence.Washington, DC: National Association ofSocial Workers, HIV/AIDS Spectrum Project.
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U.S. Census Bureau. (2004) Health insurancecoverage: 2003/highlights. Retrieved April 15,2005, from http://www.census.gov/hhes/www/hlthins/hlthin03/hlth03asc.html
Acknowledgements
NASW would like to acknowledge the work of the Health Standards Workgroup for theircontributions to the NASW Standards of SocialWork Practice in Health Care Settings. Theworkgroup was comprised of social workersexperienced in all facets of health care. Thefollowing individuals comprised theworkgroup:
Nancy Campbell, MSW, LISWChief of Social Work ServicesCincinnati VA Medical Center
Nancy F. Cincotta, MSWMount Sinai Medical CenterNew York, New York
Lisa E. Cox, PhD, LCSW, MSWAssociate ProfessorThe Richard Stockton College of New Jersey
Stuart Kaufer, ACSW, LMSWRegional Resource Development SpecialistCenter for Independence of Disabled of NY
Carol P. Marcusen, MSW, LCSW, BCDDirector of Social Services, CaseManagement, Patient EducationUSC/Norris Cancer Hospital
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Shirley Otis-Green, MSW, ACSW, LCSW Senior Research Specialist Nursing Research and Education Department City of Hope National Medical Center
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