3. Overview
▪ Origins of social work practice in health
▪ Objectives and methods of social work in health care settings
▪ The medical model
▪ Chronic care / bio-psycho-social model
▪ Shift to primary care approach
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4. Hospital social work
This brief YouTube provides an overview of contemporary social work in a
hospital setting.
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5. General Background
First known hospitals were places of rest, care and prayer, rather
than places of treatment and cure
Nursing profession emerges from this
tradition, the medical profession emerged
later and gained power as medical
knowledge advanced
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6. Origins of Social Work in Health in the UK
▪ Origins of SW in health in UK
- Alms houses – providing aid to the poor / forerunners of free hospitals
- 1891 – UK - House of Lords submission – almoners in hospitals to determine
those eligible for free treatment
- 1895 - Miss Mary Stewart appointed the first hospital almoner at Royal Free
Hospital, London
- Almoners – the gatekeepers for free treatment at charitable hospitals
- By 1906 – Charity Organisation Society (CSO) practice standards, training
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7. USA- Early Development
- Similar to the UK
- 1889 – 1903 – increased use of SWs in
hospitals, visiting service to lone mothers
established, stronger links between community
and hospital
- 1928 – minimum practice standards developed
by Social Workers
- Post WW2 – increase use of sociological
concepts
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8. Almoner’s Duties
- To prevent the abuse of free treatment
- To make referrals to the Poor Law authorities (CSO)
Almoners also –
- Mobilised other resources to help
the poor
- Aimed to increase the effectiveness
of treatment
- Interviewed patients
- Encouraged thrift
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9. Australian context
▪ Training of almoners (hospital social workers) varied from state to state.
▪ Earliest training started in Melbourne and Sydney, late 1920s.
▪ Based on UK model of almoner practice.
(Miller & Nilsson 2009)
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10. Further Developments in Social Work in Health
1950s-60s
- More emphasis on group work, especially in USA psych. Wards
- Increased recognition of social control issues
- More SW input to social policy, more social activism and proactivity
- Less dependence on referrals from medical staff to SW
- Increase focus on prevention, community, advocacy
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11. Practice Models
Acute care model / Medical Model
- Medical hierarchy – medical doctor as expert, diagnosis/treatment/outcome
- ‘Patient’ as passive, compliant with medical doctor’s orders
- Focus on the mechanics of the body
- Individualised treatment of symptoms of biomedical disease –
pathologised, individualised response to symptoms
- Doctor as expert in diagnosis / prescription / treatment
- Hierarchical organisation of hospitals
- Outcomes; measurable/ scientific
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12. Social Work role in Medical Model
Respond to referrals – reactive rather than proactive
Discharge planning
Practical assistance
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13. Social work finds itself at odds with medicine in its central belief
in respect for the client’s self knowledge and right to choice, and
in its growing recognition of the value of mutual support and
exchange.
Medical expectations of patient passivity fit uneasily with social
work objectives of a self-directed and empowered clientele.
(Babawi & Biamonti 1990).
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14. Changing Context and Paradigms in Health
▪ Increased use of technology, pharmaceuticals and demographic change (ageing
population)
▪ Escalating costs of health care provision > need to decrease government
spending on health but maintain quality
▪ More emphasis on;
- Early detection
- Prevention / screening
- Primary health care models (ie. Community Health)
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15. Health Care Reform
Key health care reform objectives from the Council of Australian Governments (COAG) meeting in
1995 – foundations for current health funding/sector
- Move away from institution-based funding in health
- Encourage health promotion, prevention & recognition of multidimensional nature of
health
- Changing view of ‘patients’ to ‘consumers’
- Decreased reliance on medical services & more reliance on allied health professions
- Increase service integration – multidisciplinary teams
- Increased recognition of the bio-psycho-social nature of health
- Need for a team approach
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16. Australian Health Care Reform Alliance (AHCRA)
▪ Formed in 2003
▪ AHCRA has played a significant role in advocating for health care reform in Australia and has actively worked
to influence the development and implementation of the health reform agenda. AHCRA undertakes this role
through a number of activities including;
- Meeting regularly with key federal politicians to advocate for health system reform
- Providing input into relevant inquiries and reviews;
- Making public comments and media statements on key health reform issues;
- Holding bi-annual Summits which bring together ACHRA members with other health experts and stakeholders
to discuss the current state of health reform;
- Developing policy and discussion papers on specific issues relevant to the health reform agenda; and
- Partnering with other key groups on specific health reform issues supported by AHCRA, such as improving
access to oral health care (AHCRA 2017)
17. Emergence of the Chronic Care Model
▪ Based on bio-psycho-social approach
▪ Recognises multidimensional nature of health, need for multidisciplinary approach
- More community / context oriented
- SW moves away from individual casework focus to a case management model
‘patients’ become participants
- Consolidation of community health care approach and roles for SWs in community
health centres
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18. Objectives of Social Work in health
‘Social workers … provide a framework for practice that is unique;
their skills provide psychological support to clients and families
creating a facilitative climate in which they can adjust to the
psychological impact of the physical/mental condition on
themselves and their families as well as guiding them on practical
issues’ (Connolly 1997, p. 299).
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19. Social Workers in Health
Social workers in health today provide services within hospital settings and in
community (primary) health settings-
- SW assessment of service users’ circumstances
- Support for carers
- Locating relevant sources of support in the
community, formal and informal
- Advocacy
- Health promotion
- Research, policy, evaluation
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22. ▪ Job description for Hospital social worker
[for a SW Grade 2 at a major hospital in Melbourne]
- Need to demonstrate highly developed skills in undertaking complex assessments
and discharge planning
- Ability to work collaboratively with a range of professionals
- Capacity to manage multiple tasks of varying priority levels
- Excellent communication skills (written and verbal)
- Ability to work autonomously
- Eligibility for AASW membership
Think about the range of skills required to successfully undertake this role
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23. YouTube Videos on Hospital Social Work
▪ Hospital Social Work- UK ▪ Hospital Social Work- US
24. References
Australian Health Care Reform Alliance (2017). History of AHCRA. Retrieved from
http://www.healthreform.org.au/history-of-ahcra/
Berger, C. 1996. The changing role of social work in hospitals: A report on a national study by the society for social
work administrators in health care and NASW, Health & Social Work 21(3):167-177
Berkman, B. 1996. The emerging health care world: Implications for social work practice and education, Health and
Social Work 41(5):541-551
Browne, E. 2005. Social work in health care settings. In Alston, M. & McKinnon, J. (Eds.) Social work fields of
practice. Sydney, OUP.
Connolly, J. 1997. The Hospital. In Davies, M. (Ed.) Blackwell Companion to Social Work London, Blackwell.
Giles, R. 2013. Contemporary issues in health social work. In Connolly, M. & Harms, L. (Eds.) Social work contexts
and practice. Melbourne, OUP, chapter 14.
Miller, J. & Nilsson, D. 2009. Contemporary issues in health social work. In Connolly, M. & Harms, L. (eds) 2009.
Social work contexts and practice. Melbourne, OUP, chapter 13.
Patford, J. 1999. What’s happening in health: Progress and prospects for social work, Australian Social Work
52(1):3-7
Studdy, L. & Duffy, A. 1999 Beyond 2000: Where is hospital social work going?, AASW, NSW Branch Newsletter:
Social Work in the Health System 4:21-24
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