When patients seek care because they are struggling with health challenges, they encounter a complex system that’s often difficult to navigate. How will they access, pay for, and continue care in the face of insurance approvals, financial challenges, and the everyday pressures of life? And for those patients who are also facing socioeconomic challenges, these difficulties are compounded by additional serious health issues including disproportionate levels of diabetes, heart disease, obesity, untreated mental health problems, and maternal health complications. As a health care system, it’s time to redouble our efforts to fight health care disparities, and social workers need to play a more critical role. We need more social workers on the front lines to address these disparities and help make the health care system work better for all people.
Despite the profession’s long-standing commitment to clients’ health and wellness, social workers remain an often discounted component of health care teams. However, social workers play an indispensable role in helping patients navigate insurance, in-home care, community resources, economic assistance, and mental health services at the conclusion of a hospitalization. One misconception is that the role of counselor, coordinator, and advocate is needed only as an acute medical intervention draws to an end, when the reality is that a social worker can be beneficial throughout a patient’s entire medical journey.
First and foremost, social workers are trusted guides in a complex health care system that can’t always meet patients where they are. Social workers can advise on important decisions, improve communication between provider and patient, and dig more deeply to identify root causes and concerns a physician may not have time to unearth. Patients can turn to social workers with questions and concerns they may be too intimidated to discuss with their health care provider. With the time to more closely work with patients, social workers can increase compliance with care instructions, ensure proper follow-ups, and ultimately improve patient health outcomes.
Social workers can also be patients’ best advocates in a care setting, making sure their voices are heard and their needs are fully met. This is especially true when it comes to counteracting bias in the provision of care. For example, studies have shown that African American patients’ pain is often undertreated relative to that of Caucasian patients. Faced with these challenges, social workers in a care setting can help resolve communication issues, encourage patients to persist in making their needs known, and provide insights into how best to pursue proper care when a pathway doesn’t always seem open. By working to confront bias, social workers can even help correct damaging assumptions that can lower the quality of care received.
Social work is a calling, and we need more practitioners to meet the increasing demands placed on the health care system, including those caused by the opioid crisis and aging Baby Boomers. The Bureau of Labor Statistics has predicted 16% growth in the need for health care social workers through 2026, and meeting that demand with skilled, compassionate men and women is critical. If we have any hope of meaningfully reducing health disparities and better caring for disadvantaged populations, it’s time to get more serious about health care social work.
That begins with raising social workers’ profiles within the health care system. Patients and their families should know that a social work team is available to support them throughout their treatment and follow-up. Next, health care educators must do more to connect students interested in health professions to this field. When we talk to students about careers in the health care industry, health care social work should be included with other clinical disciplines. Finally, social work support should be expanded in high-need communities. With smaller caseloads, social workers can best do their jobs, which, by improving patient outcomes, provides long-term savings to our health care system.
In the media and in discussions with students, we often stress the need for the next generation of doctors and nurses, and that is undoubtedly important. However, even without a stethoscope or a prescription pad, health care social work is an essential career option in making a difference in patients’ lives and improving health care for our communities.
education: Master of Social Work, Loyola University, Chicago; Bachelor of Science in Sociology, Creighton University, Omaha, Neb.
title: Director of social services workplace: Brightview Care Center location: Chicago, Ill
The role of a social worker varies depending on what type of setting you work in—hospitals, schools, non-profit agencies and nursing homes are just a few of the possibilities. Prior to my current position as director of social services at Brightview Care Center in Chicago, I worked with mentally retarded adults in a vocational setting, pregnant and sexually active adolescents in a hospital clinic, elderly patients in the Chicago community, and dialysis patients in a hospital and outpatient clinic. Despite the diversity of these settings, there was one common theme: I always enjoyed helping patients cope with their medical problems in a health care setting. Brightview Care Center has allowed me to continue this vocation; I currently work with individuals who are facing medical setbacks or require end-of-life care.
Brightview has a diverse population of residents, and the goal of the center is to increase the quality of life of the residents and to help them maximize their level of independence. Some residents are at the center for a short-term stay while they recover from a stroke, amputation, surgery or infection. These patients might receive physical therapy, occupational therapy, speech therapy, amputation adaptation therapy, post-stroke care, bone fracture recuperation, IV antibiotic therapy or wound care treatment in order to gain the strength and skills they need to ensure a safe and successful return home.
My role with this patient group is to provide counseling to help them adjust and cope with their limitations. Many of these individuals will experience a wide range of emotions during their adjustment process such as grief, anger, depression, denial, fear or concern until they come to terms with their situation. When residents are ready to return home, I assist them with the discharge process. I make any necessary arrangements for home services, such as home physical or occupational therapy, home nursing, meals on wheels, home health care or homemaker services.
For those residents at the center for a long-term stay, my role is to help them with the adjustment process as well. Adapting to a new environment takes time. Careful consideration is taken when making room assignments at Brightview. I work closely with the director of nursing to take into consideration the resident’s medical condition and personality to make a compatible roommate match. We always consult the resident and the family during this process as well.
When any new resident arrives, I meet with him or her to begin the orientation process. I usually start by taking the resident on a tour in order to familiarize them with their new surroundings. During our initial meeting, I also get an extensive social history so that I have an understanding the resident, and I find out who is part of their support system. We discuss in detail their rights as a resident of Brightview and the various policies at the center. New residents often have questions about obtaining personal belongings or financial considerations. The maintenance department retrieves any desired belongings to be transferred and Brightview has a bookkeeper on staff to answer any questions pertaining to insurance coverage or finances. Despite the question or need, I make sure to connect residents to the appropriate service or department.
Over the course of the next few weeks, I conduct a thorough psychosocial assessment on the patient. I look closely at their thought processes, communication abilities, mood, behavior, interpersonal relationships (including family, friends and other individuals), spirituality, interests and hobbies. I bring all this information to the care plan meeting, and the care plan coordinator (RN), rehab director (ADON), activity director, dietary supervisor, social service director and social service case manager also bring their assessments of the resident to the meeting. Involved family or friends and the resident also attend this meeting, which takes place within 14 days of admission and then every 90 days thereafter.
The purpose of the care plan meeting is to determine the residents’ goals and what the staff can do to assist him or her. Typical resident goals are increasing independence and quality of life or achieving a better level of comfort. Department representatives have a specific area to focus on to help the resident achieve their desired goal. My role varies; for some residents I focus on discharge planning while for others I may help with a vocational program. I also do one-on-one counseling to address a particular problem or refer a resident to a specific group that may help them.
Generally my daily activities vary but each day usually includes pursuing guardianship or surrogacy for residents as needed; handling resident or family complaints, grievances and suggestions; coordinating and supervising the Social Service Department, which includes four case managers; and preparing quality assurance and safety committee reports.
I enjoy my position at Brightview; I find it both challenging and rewarding. Each resident is different and finds a way to touch me in their own special way, which brings me opportunities for personal and professional growth.
7:20 a.m. I arrive at work and check if there are any new admissions. There is one new patient and one readmission. My first order of business is to check on the resident that returned from the hospital last night. She is 40 years old and was sent to the hospital for complications related to lung cancer, which required surgery. She indicates that she is happy to be back and is feeling better. She has received all of her belongings from storage and has no immediate concerns.
I then visit with a newly admitted resident and welcome him to Brightview. He is in his mid 60s and was living alone when he suffered a stroke. He is paralyzed on the left side and has come to Brightview to receive physical and occupational therapy; he hopes to eventually return to his apartment. The resident is in his room eating breakfast when I meet him. He says that his first night went smoothly; he feels comfortable in his room and says that his roommates have not caused him any problems. “They’re cool. He’s my bud (pointing to the gentleman in front of him); he reminds me of George Burns.” We make a plan to meet later in the morning, and I leave him to finish his breakfast.
8:10 a.m.
I head back to my office and take care of some charting before the day gets away from me. I also get my handouts ready for general orientation, which is later in the morning. I get interrupted a few times, once by a resident with a question and twice by the phone.
8:59 a.m.
I head downstairs to the care plan office for our daily “house report” meeting. This is a daily meeting with all department heads. It starts at 9:00 a.m. Monday through Friday. Those in attendance include the administrator, director of nursing, rehab director, care plan coordinator, dietary supervisor, activity director, bookkeeper, maintenance/housekeeper supervisor, medical records director, human resources supervisor and the social services director (myself). This is an opportunity to discuss any issues that may be pertinent to the various departments, potential admissions or discharges and other resident issues. The meeting ends at 9:40 a.m., and I meet with the director of nursing to briefly discuss a possible room change.
10:00 a.m.
Now I meet with the new resident again, as promised. He says that he was not able to tour the facility when he arrived the night before, so we start off by taking a tour of the home. We end up in my office where we discuss his rights as a resident, and I orient him to Brightview’s programs, services and policies. I then conduct an extensive social history assessment. The new resident would like to retrieve some of his personal belongings from his apartment and also go to the bank to take of some financial business. The meeting concludes at 11:15 a.m. I make arrangements with the maintenance department to retrieve his belongings from his apartment the following morning. I then arrange with a rehab aide to accompany him in a cab to the bank because he cannot get in and out of a cab by himself due to paralysis. Next I call the bookkeeper and see if she can stop by and see him. The resident signs a consent form with a list of all the items he would like moved from his apartment to Brightview.
11:30 a.m.
I head to the conference room for a new employee orientation. Each department head orientates new employees in their area of expertise. We discuss resident rights and patient privacy, abuse/neglect prevention, employment policies and procedures, communicating with residents and managing difficult behaviors. When I am done, I call the next person to let them know it is their turn to present.
12:50 p.m.
I grab a quick bite to eat and enter reports. (I try to eat with co-workers several times per month and not always eat at my desk!) My lunch is over faster than planned, although, when I receive a call from a resident’s guardian. Then a case manager comes to me with a concern over a patient who refuses to take his IV-antibiotics. We discuss strategies as to how we can gain the cooperation of the resident.
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1:30 p.m.
I head to the care plan office. We have five residents to review today—one new resident and four current residents who are scheduled for quarterly meetings to review their current situation with their care providers and family members. Goals for residents are established. The goals of these residents include, rehabilitation to gain more mobility, personal hygiene (taking more frequent showers and changing their clothes regularly), medication compliance and wound care (allowing the treatment nurse to do dressing changes). One resident has progressed to the point where discharge is in sight and another is working on increasing their socialization by getting involved in facility groups and activities.
3:00 p.m.
The care plan meeting is not quite over, but I need to attend a resident council meeting. These meetings take place every month, and they are an opportunity for the residents to get together with an elected board of officers to discuss issues and ideas for the center.
4:25 p.m.
I gather my things and get ready to head home for the day. I am on call on evenings and weekends for emergencies, but typically I do not get paged more than once or twice a week. Usually these calls pertain to resident or family issues or guardianship/power of attorney questions, but they can be about any issue that comes up. I say goodnight to residents and staff as I leave and let the receptionist know that I am leaving for the day.
One fall morning at approximately 10 a.m., a woman claiming to be a university student conducting research entered the hospital room of a patient who had recently given birth. The woman stayed with the patient all day, leading staff to believe she was related to or a friend of the new mother. When the mother went to the bathroom around 5 p.m., the “researcher” removed the baby from the bassinet and exited the room. The image of the abductor arm-carrying the baby from the room, as well as that of a nurse approaching the abductor and telling her to return to the room, was captured by video surveillance cameras.
The National Center for Missing & Exploited Children also offers child safety brochures and other resources for parents.
Upon returning to the victim mother’s room, the abductor located a tote bag, placed the infant inside and left the room, cradling the tote bag in her arms. This image was also captured by the strategically placed surveillance cameras.
These taped images of the abductor were immediately provided to the local media. When aired on television stations that day, viewers called with information that helped identify the abductor. As a result, law enforcement officials were at the home of a member of the abductor’s family when she arrived with the infant later that day.
Helping health care providers and families prevent infant abductions is a priority for the National Center for Missing & Exploited Children® (NCMEC). The successful resolution of the case cited above demonstrates how this health care facility utilized a combination of well-trained staff, technology and guidelines recommended by NCMEC when responding to this incident.
Created in 1984 as a national resource center for child protection, NCMEC is a private non-profit organization operating under a Congressional mandate. We work in cooperation with the U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention. NCMEC’s mission is to help prevent the abduction and sexual exploitation of children, help find missing children and assist victims of child abduction and sexual exploitation, their families and the professionals who serve them. As of December 2004, NCMEC has worked on more than 104,000 missing-child cases and played a role in the recovery of more than 89,000 children.
Profiling the “Typical Abductor”
For more than 15 years, NCMEC has been providing assistance to health care facilities, including nursing and security staff, to help them prevent infant abductions by nonfamily members. Since 1983, we have documented 232 infant abduction cases nationwide. An examination of the data shows that the majority of abductions (116) occurred in a health care facility (primarily the mother’s room), compared to 87 abductions from homes and 29 from other locations, such as malls, offices and parking lots. This averages to between 12 and 18 incidents each year. Of the 232 infant abductions documented, all but 11 children have been recovered.
Further assessment of the data shows that 69% of the infants abducted are children of color and the majority of the abductors are also persons of color. Of the 232 abductors, 92 were African American, 44 were Hispanic and 86 were Caucasian. (The race/ethnicity of 10 abductors is unknown.)
Our research has also enabled us to build a profile of the “typical infant abductor.” She is a female between the ages of 12 and 50, usually lives in the community where the abduction takes place, frequently indicates she has lost a baby or is incapable of having one, and is in a relationship (either married or cohabitating) that is on the verge of collapse. She is most likely compulsive and most often relies on manipulation, lying and deception in her everyday life.
Analysis of the cases yields some interesting information. The abductor will take an infant whose skin color “matches” her significant other’s to ensure he will accept the infant presented to him as “his baby.” We have also found that many non-English- speaking mothers are victimized by bilingual abductors who are able to portray themselves as different things to different people. To a victim mother, the abductor may present herself as a member of the hospital staff, while at the same time presenting herself to the hospital staff as a member of the mother’s family.
Prevention Through Education
Education is critical to preventing infant abductions from health care facilities, and that means educating both staff and patients. NCMEC’s publication For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions contains detailed information for health care staff, including nursing guidelines and security guidelines. It also has information for patients, including a chapter titled “What Parents Need to Know.”
NCMEC encourages health care facilities to share this important information with patients who will be giving birth in their hospital. These guidelines, available in English and Spanish, combined with specific information about security measures in your facility, will provide new parents with information on what to be aware of while they are patients, as well as precautions they should take after discharge. Health care facilities can obtain 10 free copies of these guidelines by calling our toll-free hotline 1-800-THE-LOST (800-843-5678) or by visiting our Web site, www.missingkids.com.
Mead Johnson Nutritionals, working in conjunction with NCMEC, has developed a free training video for health care professionals called Safeguard Their Tomorrows, which has been distributed to hospitals nationwide since 1991. NCMEC attributes the decline of infant abductions from health care facilities in recent years to this preventive education program. In 1991, there were a total of 17 infant abductions nationwide, 11 of them from health care facilities. By December 2004, there were a total of six infant abductions nationwide, with only two abductions from health care facilities.
Project ALERT: A Valuable Resource
During its 20-year history, the National Center for Missing & Exploited Children has expanded the depth and breadth of services it provides to those who are in need of assistance. In addition to helping health care providers reduce the number of infant abductions, NCMEC also provides services to law enforcement professionals and to parents of missing children at no cost. The Jimmy Ryce Law Enforcement Training Center provides training for law enforcement officers and prosecutors, and the Exploited Child Unit assists law enforcement in the investigation of child pornography and child sexual exploitation on the Internet via the CyberTipline® (www.cybertipline.com).
Our International Division assists the U.S. Department of State in certain cases of international child abduction in accordance with the Hague Convention on the Civil Aspects of International Child Abduction. The Missing Children’s Division provides crucial support to investigators and parents, and the www.missingkids.com Web site provides access to booklets, brochures and online resources about child safety, as well as a more complete listing of NCMEC services.
Project ALERT (America’s Law Enforcement Retiree Team) is a program within the Missing Children’s Division that uses the skills and experience of more than 150 retired law enforcement professionals nationwide to help investigate missing-children cases. Each candidate, all of whom have an average length of service of more than 20 years, is certified by NCMEC through a background check and completion of an additional comprehensive training program.
The Project ALERT representatives provide assistance to relatively smaller law enforcement agencies across the nation whose access to available resources such as technology, personnel and logistical support is diminished due to budgetary constraints. Larger agencies that have access to substantial resources but have an overwhelming caseload also benefit from the skills of these retired veterans who are able to review older “cold” cases in search of new leads.
Project ALERT representatives respond only when requested by law enforcement agencies to help investigate missing-children cases or to provide community child safety awareness presentations and exhibits. This concept is not new, but rather has been a practice NCMEC has implemented and successfully administered for the benefit of law enforcement agencies and families across the nation for more than 12 years. The Project ALERT program is endorsed by 17 nationally recognized law enforcement associations, including the International Association of Chiefs of Police (IACP), the National Sheriffs’ Association (NSA) and the National Organization of Black Law Enforcement Executives (NOBLE).
This is the nation’s challenge: that all agencies with the philosophy of creating a safer environment for children unite their resources in the common quest to make our communities a safer place. And, of course, health care facilities and nurses can play a crucially important role in this effort as well.
For more information about infant abductions, please contact Cathy Nahirny at (703) 837-6243 or [email protected]. For more information about Project ALERT, contact Ann Scofield at (703) 837-6219 or [email protected].
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