Hospital Social Services in Bangladesh (Fieldwork: Part-03)

Functions of Hospital Social Workers

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:

Participation in program planning and policy formulation of the agency;
Participation in community organization;
Participation in educational programs;
Participation in social research;
Consultation (Pathak, 1961)

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

Practice of medical social case work;
Development of the medical social program within the medical institution;
Participation in development of social and health programs in the community;
Participation in the educational program for professional personnel;
Medical social research (Goldstine, 1955).

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

Multi-issue counseling
Personal and family problems
Needs for indigent medication programs
Abuse, neglect, and exploitation issues
Unsafe living conditions
Coping with life threatening or life limiting diseases
Inadequate housing
Unemployment and disability issues
Psychosocial support
Referrals for services such as: meals on wheels, oxygen, medical equipment needs

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-

Aiding the health team in understanding the significance of social, economic and emotional factors in relation to the patient’s illness, treatment and recovery.
Helping the patient and his family in their understanding of these factors to enable them to make constructive use to medical care.
Promoting the well-being and morale of the patient and his family.
Participating in the educational programs of other members of the health team.
Assisting the hospital in giving better patient care through its various services.
Facilitating the productive utilization of community resources to meet the needs of patients and their families.

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,

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

Dr. Alter (loc. cit.) 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-

Dealing with social and emotional problems of patients and their families which come in the way of adequate treatment, care and rehabilitation of patients.
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.
To bringing the information of the physical and psychological environment of the patient to the doctor for better of his care.
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).

Some of the areas that the Medical Social Workers will assist the patient and/or the family are:

Multi-issue counseling
Personal and family problems
Abuse, neglect, and exploitation issues
Unsafe living conditions
Coping with life threatening or life limiting diseases
Inadequate housing
Needs for indigent medication programs
Unemployment and disability issues
Psychosocial support
Referrals for services such as: meals on wheels, oxygen, medical equipment needs

The functions of social workers includes- helping people become more self-sufficient;strengthening family relationships;preventing dependency; and restoring individuals, families, and groups to successful social functioning. Social services include helping people obtain adequate financial resources for their needs, evaluating the capabilities of people to care for themselves, for children, or other dependents, referral and channeling, counseling and psychotherapy, mediation, advocating for social causes, informing organizations of their obligations to individuals, facilitating health care provisions, and linking patients to resources.

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

a) 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).

b) 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).

c) 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).

d) 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

e) 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).

f) 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

g) 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.

Part Three