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(Reprinted permission Rose Dobrof,
Editor, Journal Gerontological Social Work Journal
of Gerontological Social Work, Vol. 30 (3/4) 1998.)
The
Distinctive Role of Gerontological Social Work
Gerontological
social work is concerned with maintaining and
enhancing the quality of life of older adults
and their families.
Gerontological social work is particularly
concerned with ameliorating those physical, psychosocial,
familial, cultural, ethnic and racial, organizational,
and societal factors which serve as barriers to
physical and emotional well-being in later life.
Gerontological social work interventions
are directed at enhancing dignity, self-determination,
personal fulfillment, quality of life, optimal
functioning, and ensuring the least restrictive
living environment possible.
Interventions that enhance older adults'
coping and problem-solving capabilities are perhaps
the most basic and crucial aspect of gerontological
social work.
Because services are typically sought at
times of crisis, gerontological social workers
give special attention to the psychosocial meanings
of change and loss, as well as to underlying biological,
psychological, cognitive and social factors experienced
by the older adult and family.
Gerontological
social workers are trained to conduct holistic
bio-psycho-social geriatric assessments which
attempt to untangle interconnected physical, psychological,
and social factors that affect health and well-being. Geriatric social work, as many of the health professions, is
increasingly focused on prevention and wellness
in late life as well as problems of aging.
Gerontological social workers are also
skilled in crisis intervention as well as other
forms of brief and/or short-term treatment modalities
and working with family systems in order to strengthen
older adults coping capabilities and their informal
support system.
Resolving barriers to service utilization
is another distinctive area of gerontological
social work.
Similarly, gerontological social workers
emphasize monitoring the effectiveness and appropriateness
of services to ensure that needs are being met
in the most effective and cost efficient manner
for both the consumer and the service organization. Besides working directly with individuals and groups, social
workers seek to promote the responsiveness of
organizations, communities, and other social institutions
to individuals' needs and social problems.
This is done through a variety of management,
administrative, and community-organizing roles
including policy and program development, program
management and evaluation, resource development,
and strategic planning.
Such roles are especially essential to
the development and operation of service delivery
systems which are effective and efficient (Scharlach
& Robinson, 1997).
Interdisciplinary Teams and Social Work
Social workers with their training in interpersonal
relationships, group work and (often) interdisciplinary
team skills play a vital role in the development
and functioning of the interdisciplinary team
unit and in all major phases of its work, including
assessment, goal setting and care planning, and
monitoring/evaluation.
The social worker provides key leadership
in identifying psychosocial issues.
The social worker's roles within teams
include convener, facilitator, and expert in group
work skills which contributes to their ability
to foster team collaboration.
Interdisciplinary teamwork recognizes that
the complexities of older people's problems necessitate
a comprehensive and planned approach to their
resolution.
As with other members of the interdisciplinary
team, the social worker benefits the elderly person
in terms of providing coordinated service, information,
skilled services, avoidance of duplication of
services, and the introduction of preventive services
(HRSA, 1995). The social worker acts as liaison as needed between client
and family and the health care system. The social
work profession's emphasis on advocacy, and its
knowledge about service delivery systems in both
public and private sectors, enables social workers
to take a lead role in promoting interdisciplinary
practice and facilitating the coordination of
services, reducing duplication and potentially
providing preventive approaches (CSWE, 1994).
Knowledge and skills contributed by the
social worker to the team may, and often do, overlap
with other disciplines contributions.
In a team environment it is common for
some knowledge areas to be "shared"
with others.
Field
Work Requirements for the Master of Social Work
Degree
Accredited schools of social work must
comply with requirements and guidelines for academic
course work and field practica established by
the Council for Social Work Education (CSWE, 1994).
Academic curricula must
include course work in human behavior and social
environment, social policy, methods for working
with client populations, cultural diversity and
cultural competence, and methods and practice
of social work research.
Generally, all students take required “foundation”
courses in theses subjects in their first year,
and elective courses in the same subject areas
in their second year.
Students must also complete 900 hours in
field practica (or approximately 40% of
students’ time in the overall program) which is
designed to provide students with opportunities
to apply foundation, knowledge, skills, values
and ethics to practice.
Typically these practica take place in
governmental or private sector social service
agencies.
CSWE requires each school to establish
clear guidelines for selecting agencies and field
instructors as well as for types of appropriate
learning activities and outcomes.
Social Work’s Multiple Roles on Interdisciplinary
TeamThe role of the social worker on an interdisciplinary
team includes but is not limited to the following
(West, Mellor, & Robinson, 1998):
1. Diagnosis/Assessment
- The goal of a bio-psycho-social assessment is
to identify the strengths and limitations of the
patient and family and to assist them in creating
a treatment plan with clearly defined goals.
It provides a holistic view of the patient/family.
The social worker can identify barriers
to medical compliance and assist others on the
team in the management of an acute or chronic
illness.
The social worker can also help to assess
whether the presenting medical problem is compounded
by mental health problems.
The social work assessment takes into consideration
how well the patient (and the family or caregiver)
is functioning in six areas:
Physical - a brief medical history,
functional abilities, appearance and observed
behavior. Psychological - Affect, mood, outlook,
attitude, personality characteristics, cognitive
functioning, self-image. Social - Vocation, social roles,
support networks, education and financial status.
Cultural - Values, general rules
of behavior, definition of the "sick role",
beliefs about the root causes of illness and prescribed
treatments, communication patterns that encompass
varied language and speech patterns as well as
bilingual issues. Environmental - Living conditions
and home surroundings with focus on safety and maintaining
functional independence. Spiritual - Beliefs about people's
roles and responsibilities, rules for living,
belief system, diet, and acceptable medical treatments.
2. Care
Management - Equally referred to as case management,
this social work role includes problem identification
(e.g., lack of financial resources, need for help
with ADL's or mental health intervention) as well
as linkages to and coordination of community resources
to facilitate the highest practical level of functioning
for the patient and family.
It requires a knowledge of community resources
and knowledge of entitlements, and skills in matching
patient/family with resources, linking resources
and serving as an interpreter and advocate for
the patient/family.
3. Individual Counseling
- Psycho-social counseling includes treatment
of mental health problems such as depression and
anxiety through various techniques including family
therapy, relaxation and stress management training
for the patient and/or caregiver.
This is intended to assist patients and
families to adjust to major life stressors and
transitions such as illness, disability, institutionalization,
and loss as well as to empower the client.
A patient's ability to adapt to an illness
has a profound impact on quality of life as well
as upon the patient's willingness/ability to comply
with the prescribed treatment and are paramount
to recovery, physical and emotional healing, timely
discharge from the hospital, risk management,
and effective decision-making.
The social worker brings skills in listening,
problem resolution and negotiation with attention
to community and environmental factors.
4. Group Work - Group
psychotherapy and supportive psychoeducational
groups are designed to help patients/families
and/or caregivers cope with a specific illness,
e.g., depression, Alzheimer's disease, cancer
or diabetes.
The social worker brings skills in group
development and facilitation.
5. Liaison
- The social worker can also serve as a liaison
between the patient/family and the professional
community forming a vital link.
This is particularly pertinent when the
family lives out of the area and their input must
be obtained via long-distance communication.
6. Advocacy
- Social workers' training, including a working
knowledge of ethics, confidentiality, advance
directives, cultural/ethnic factors and patient/family
rights, serves to help teams face the challenge
of balancing patient needs with the system demands.
Often the most important service provided
by a geriatric/gerontological social worker to
patients is simply to assist in negotiating an
overwhelmingly bureaucratic system, such as Medicaid,
Social Security disability, funeral arrangements,
or dealing with insurance and hospital paperwork
by acting on their behalf and/or teaching them
to help themselves.
7. Community
Resource Expertise - Knowledge of community
resources and how to access them is an invaluable
piece of the social work profession.
This involves a high level skill in negotiation
and bargaining in order to become a broker for
appropriate resource allocation.
A working knowledge of financial systems,
including federal, state and county programs is
part of this expertise.
Serving as a resource referral coordinator
requires negotiation and collaboration in order
to assist patients and families in setting priorities,
care goals, balancing issues.
Developed by the GITT - Social
Work Interest Group of the John A. Hartford Foundation
Geriatric Interdisciplinary Team Training Program
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