Social work collective leadership in a large urban hospital during an era of unprecedented transformational change.

This Department of Social Work Services (the Department) is one of the largest hospital social work departments in the country, with almost 600 staff, in the largest of eight hospitals and one medical school of a major health system. The Department's senior directors (three current and one former) share its innovative and effective collective leadership model that was initially developed in response to a confluence of unprecedented complex events stemming from the Covid-19 pandemic. The experiences of these co-leaders, an evaluation of the model, future internal considerations as its applicability to other health care settings will be discussed.

Implicações da longa hospitalização às cuidadoras de crianças adoecidas cronicamente: atuação do serviço social / Implications of long hospitalization for the caregivers of chronically sick children: social service performance / Implicaciones de la hospitalización prolongada para los cuidadores de niños con enfermedades crónicas: desempeño en los servicios sociales

Objetivo: descrever as implicações do longo período de hospitalização às dimensões psicológica e social das cuidadoras de crianças com condições crônicas complexas de saúde. Método: pesquisa qualitativa realizada com cuidadoras de crianças adoecidas cronicamente em longa hospitalização em um hospital pediátrico na Bahia. A coleta de dados foi realizada no período entre 23 de fevereiro e 09 de março de 2021, remotamente, por meio de entrevista semiestruturada. Para sistematizar os dados utilizou-se análise de conteúdo. Resultados: participaram do estudo seis cuidadoras. E emergiram quatro categorias de análise: Afastamento da rede de suporte sociofamiliar; Dores psicossociais que permeiam a internação hospitalar; (Des) Humanização do Cuidado; e Importância da atuação do profissional de Serviço Social. Conclusão: identificou-se a necessidade de uma atuação profissional que atenda a família de forma integral, condizente com o enfrentamento qualificado à redução dos danos causados pela longa hospitalização infantil, no intuito de valorizar a humanização do cuidado.

Objective: to describe the implications of the long period of hospitalization for the psychological and social dimensions of caregivers of children with complex chronic health conditions. Methodo: qualitative research carried out with caregivers of chronically ill children in long hospitalization in a pediatric hospital in Bahia. Data collection was carried out in the period between February 23 and March 9, 2021, remotely, through a semi-structured interview. To systematize the data, content analysis was used. Results: six caregivers participated in the study. And four categories of analysis emerged: Withdrawal from the socio-family support network; Psychosocial pains that permeate hospital admission; (Des) Humanization of Care; and Importance of the performance of the Social Work professional. Conclusion: it was identified the need for a professional action that attends the family in an integral way, consistent with the qualified confrontation to the reduction of the damages caused by the long hospitalization of children, in order to value the humanization of care.

Objetivo: describir las implicaciones del largo período de hospitalización para las dimensiones psicológicas y sociales de los cuidadores de niños con condiciones crónicas complejas de salud. Metodo: investigación cualitativa realizada con cuidadores de niños con enfermedades crónicas en hospitalización prolongada en un hospital pediátrico de Bahia. La recolección de datos se realizó en el período comprendido entre el 23 de febrero y el 9 de marzo de 2021, de forma remota, a través de una entrevista semiestructurada. Para sistematizar los datos se utilizó el análisis de contenido. Resultados: seis cuidadores participaron del estudio. Y surgieron cuatro categorías de análisis: Retiro de la red de apoyo sociofamiliar; Dolores psicosociales que permean el ingreso hospitalario; (Des) Humanización del Cuidado; e Importancia de la actuación del profesional de Trabajo Social. Conclusión: se identificó la necesidad de una actuación profesional que atienda a la familia de forma integral, coherente con el enfrentamiento calificado a la reducción de los daños causados por la larga hospitalización de los niños, para valorizar la humanización del cuidado.

In the Global Epicenter: Social Work Leadership in a New York City Hospital.

The Mount Sinai Hospital in New York City was in the epicenter of the COVID-19 pandemic and had to transform from a tertiary to crisis care hospital and increase its bed capacity by 50 percent to care for COVID-19 patients. The size, scope, complexity and uncertainty of this crisis was unparalleled. This article describes the comprehensive response of the Department of Social Work Services, one of the largest hospital social work departments in the country. The response was informed by four Departmental principles, as well as crisis intervention strategies. This article describes organizational structures, practice models, policies, and protocols developed to respond quickly and effectively, given infection prevention mandates, to patient, population and workforce needs. Finally, it includes how social workers addressed COVID-19 related physical and psychosocial needs and applied and modified interprofessional communication and collaboration. Lessons learned and clinical and administrative changes that will assist in navigating "new normal" operations are discussed.

Análise de percepção da insulinoterapia em diabéticos tipo 1 no Serviço de Apoio e Assistência aos Diabéticos e seus Familiares / Analysis of type 1 diabetes patients' perception of insulin therapy at the service of care and support to diabetics and their family

Objetivo: Analisar a percepção dos diabéticos tipo 1 sobre a insulinoterapia. Métodos: Trata-se de estudo epidemiológico analítico de percepção, tendo sido realizado com pacientes de um Serviço de Apoio e Assistência aos Diabéticos e seus Familiares, no período de abril a agosto de 2018. Resultados: Os 33 diabéticos tipo 1 avaliados eram predominantemente do sexo feminino (60,6%) e a média de idade foi de 21±9 anos. A maioria afirmou portar o Cartão de Identificação do Diabético (78,8%). Mais de dois terços dos pacientes afirmaram saber quando aplicar a insulina de correção. A aferição da glicemia capilar foi relatada por 78,8%. Das insulinas utilizadas no esquema basal, a glargina e a NPH foram citadas como as mais utilizadas. Do total de pacientes, 97% referiram fazer autoaplicação, e 90,9% disseram posicionar a agulha corretamente sobre a pele. Quanto aos locais de aplicação, 84,8% realizavam rodízio. A maioria dos pacientes (78,8%) que aplicavam a insulina não referiu desconforto durante ou após a aplicação, e 69,7% mostraram conhecimento sobre o significado de distrofia. Conclusão: O serviço de educação continuada desenvolvido pelo Serviço de Apoio e Assistência aos Diabéticos e seus Familiares é efetivo na aquisição de bons hábitos e dos devidos cuidados para esses pacientes. A educação do indivíduo com diabetes tipo 1 e de sua família, bem como o acompanhamento por uma equipe multidisciplinar, é essencial para o bom controle da doença,

Objective: To analyze the perception of type 1 diabetes (DM 1) patients of insulin therapy. Methods: This is an epidemiological study of analysis of perception and was performed at the service for care and support of diabetes patients and their families from April to August 2018. Results: The 33 type 1 diabetes mellitus patients evaluated were predominantly female (60.6%) and the mean age was 21 years ± 9 years. Most reported having the diabetes medical ID card (78.8%). More than two thirds of the patients reported knowing when to apply the correction insulin. The capillary glycemia measurement was reported by 78.8%. Of the insulins used in the baseline regimen, Glargine and NPH were cited as the most used. Of the total patients, 97% reported self-application and 90.9% reported positioning the needle correctly on the skin. As for the application sites, 84.8% reported rotating sites. Most patients (78.8%) who applied insulin did not report discomfort during or after application, and 69.7% showed knowledge about the meaning of dystrophy. Conclusion: The continuing education service developed by the Service for Care and Support of Diabetics and their Families is effective in promoting good habits and the proper care of these patients for their disease.The education of the individual with type 1 diabetes and of his/her family, as well as follow-up by a multidisciplinary team, is essential for good disease control.

Prolonged treatment of COVID-19 pneumonia with high-flow nasal oxygen: A story of oxygen and resilience.

The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment.

Certificado de Entidade Beneficente de Assistência Social na Área de Saúde (CEBAS)

O Certificado de Entidade Beneficente de Assistência Social na Área de Saúde (CEBAS) é concedido pelo Ministério da Saúde a pessoas jurídicas de direito privado, sem fins lucrativos, reconhecidas como Entidade Beneficente de Assistência Social para a prestação de serviços na Área de Saúde. A obtenção do CEBAS possibilita a isenção das contribuições sociais e a celebração de convênios com o poder público, dentre outros. b

O acolhimento em saúde no espaço da rua: estratégias de cuidado do consultório na rua / The embracement in health in the space of the street: strategies of care of the clinic in the street

O objetivo deste artigo é apresentar alguns resultados, obtidos durante pesquisa de mestrado, sobre o processo de acolhimento em saúde no espaço da rua. Para tanto, nesta produção, daremos ênfase às concepções e percepções dos sujeitos entrevistados. A partir da análise de conteúdo, é possível afirmar que, para os(as) trabalhadores(as), o acolhimento é entrelaçado por estratégias, fundamentadas no Sistema Único de Saúde, que têm por uma das finalidades, contribuir com o acesso dessa população à rede de serviços intersetoriais. Já para os usuários, as concepções não perpassam tanto pelo processo de trabalho como para os(as) trabalhadores(as), mas sim pela percepção de quem é usuário do serviço, e de como essa equipe chega até eles. Nesse sentido, a Persistência Acolhedora se afirma como estratégia.

The aim of this paper is to present some results obtained during master's research on the health care process in street space. Therefore, in this production, we will emphasize the conceptions and perceptions of interviewees. From the content analysis, it is possible to affirm that, for the workers, the embracement is intertwined by strategies, based on the Unified Health System, whose purpose is to contribute with the access of this population to the intersectoral network services. As for the users, not the views pervade both the work process and the workers, but the perception of who is service user, and how this team reaches them. In this sense, the Welcoming Persistence is stated as a strategy.

Social workers, nurses, or both: Who is primarily responsible for hospital discharge planning with older adults?

This study examines the profession primarily responsible for discharge planning in all hospitals serving older adults in Minnesota. Quantitative analyses determined that the majority of hospitals in Minnesota serving older adults are small, rural hospitals with critical access designations, are private nonprofit, and are affiliated with a health care system. Social workers are primarily responsible for discharge planning in half of the hospitals, nurses in a quarter and either a nurse/social worker team or both nurse and social worker separately in the remaining quarter. Multinomial logistic regression determined that in critical access hospitals nurses are more likely than social workers to be the profession primarily responsible for discharge planning.

The role and the interventions of the Hospital Social Service (HSS) for the integration of the health and social activities: a comparative survey between 2008 and 2014 in the Social Service of the "Azienda Ospedaliera Universitaria Policlinico Umberto I" in Rome, Italy.

INTRODUCTION: In the Azienda Ospedaliera Universitaria Policlinico Umberto I in Rome, the Hospital Social Services (HSS) is located within the Directorate of Health, reporting directly to the Chief Medical Officer, providing counselling and supporting clinical services. The HSS is part of a network with its own technical, professional and assessment independence. It often serves as liaison between the hospital and the territory, facilitating the development of services and contributing to public health recovery and maintenance, therefore improving the citizens' standard of living thanks to aid projects and specific interventions. METHODS: The present Report is based on two different studies carried out in 2008 and 2014, both examining the work of the Hospital Social Service in the "Azienda Ospedaliera Universitaria Policlinico Umberto I" in Rome. The purpose is to compare these surveys and work out the results. The data collection is based on a number of social records from the HSS archives (814 records in 2008 and 790 in 2014). The research project followed subsequent stages: planning a draft of the research, where ethnomethodology was used as empirical evaluation technique; collecting data from the HSS's paper and file archives (biographical, clinical and social data); revising, analysing and elaborating the data which showed relevant changes leading to interesting conclusions. RESULTS AND CONCLUSIONS: The comparative analysis of data showed a higher demand of HSS healthcare services, despite a smaller number of beds and hospitalisations available in standard regime. Also, it indicated an increase of patients below 18 years and a decrease of the over-65s age group. As for the geographical origin of patients reported to the HSS, there was a decrease in the percentage of Italian citizens, while the percentage of irregular non-EU and EU patients increased by over 5%. Significant results were found comparing the days between the report to the HSS and patient discharge. Data concerning the 'more than 7 days' group was steady over the years, being more consistent for both the variables considered and increasing in 2014. In the comparative analysis, the interventions with more significant differences were those aimed at promoting homecare and entering sheltered housing. In the former cases, a considerable decrease was observed, if compared to the activation of the integrated health and social homecare services, while there were more requests for homecare assistance; in the latter ones the analysis highlighted a sharp decrease in the percentage of the variable called "assessment to enter Extended Care Units". The causes of these changes are remarkable and have to be found in the political, historical and cultural scenario: - a first factor is the increase in the more recent migratory flow from non-EU countries to Italy, which could explain the rising percentage of foreigners taken over by the HSS; - regional policies, economic cuts imposed on healthcare and higher income limits in order to calculate the patient's economic participation in the costs of institutionalisation have affected the above-mentioned changes; - the innovations in the regulatory field of Latium Region have brought structural changes in long-term care facilities and in the level of care in Extended Care Units (ECU).

A retrospective analysis of boarding times for adolescents in psychiatric crisis.

The boarding of children and adolescents with identified psychiatric conditions at medical facilities has numerous negative effects on the patients and the systems that treat them. Efforts to minimize boarding times serves to increase patients' access to appropriate levels of care, redirect medical resources to patients who need them most, and reduce safety risks to people and property. This study explores the role Clinical Social Workers can play in facilitation of care and highlights the advantages of a coordinated data collection process facilitated by the effective use of the Electronic Medical Record. A retrospective chart analysis of 100 patients admitted to the Emergency department at a pediatric hospital in Central Florida was conducted for patients seen between 1 January 2015 and 30 June 2016. The data suggest key correlates that may impact the boarding times of pediatric patients presenting in a psychiatric crisis and the average duration of boarding time in hours (M = 5.11, SD = 2.07) was found to be significantly lower than prior published studies in the adult and pediatric literature. Discussion of these data implications on behavioral health practice is discussed.

A History of Social Work in Public Health.

Social work is a core health profession with origins deeply connected to the development of contemporary public health in the United States. Today, many of the nation's 600 000 social workers practice broadly in public health and in other health settings, drawing on a century of experience in combining clinical, intermediate, and population approaches for greater health impact. Yet, the historic significance of this long-standing interdisciplinary collaboration-and its current implications-remains underexplored in the present era. This article builds on primary and contemporary sources to trace the historic arc of social work in public health, providing examples of successful collaborations. The scope and practices of public health social work practice are explored, and we articulate a rationale for an expanded place for social work in the public health enterprise.

Leading Practices in Alternate Level of Care (ALC) Avoidance: A Standardized Approach.

Providers across the healthcare system want to provide the right care, in the right place, in a timely manner. Patients listed as alternate level of care (ALC) are often not in the right place to receive the necessary care. In 2014, using a standardized approach, the Toronto Central Community Care Access Centre (CCAC), now Toronto Central Local Health Integration Network (LHIN), set out to reduce the number of ALC beds in hospitals to ensure that more people received the most appropriate level and type of care. Case studies cited in this article will highlight the successes that CCAC and its various partners have realized in developing and implementing strategies.

Social workers' experiences as the family support person during cardiopulmonary resuscitation attempts.

During inhospital cardiopulmonary resuscitation attempts, a designated family support person (FSP) may provide guidance and support to family members. Research on nurses and chaplains in this role has been published. Social workers also regularly fulfill this service, however, little is known about how they perceive and enact this role. To explore their experiences, qualitative interviews (n = 10) were conducted with FSP social workers. Critical realist thematic analysis identified five themes: walking in cold, promoting family presence, responding to the whole spectrum of grief, going beyond the family support role, and repercussions of bearing witness. Social workers perform a variety of tasks to promote family presence during resuscitation attempts and provide psychosocial support over the continuum of care. The FSP role impacts social workers emotionally and professionally. Implications for hospital policy, staffing, and clinical practice are discussed.

Who experiences seclusion? An examination of demographics and duration in a public acute inpatient mental health service.

Restrictive interventions such as seclusion may occur during an acute mental health crisis. Such interventions are experienced by people as traumatic and counter to recovery. The current study aimed to investigate the use of seclusion and who was secluded amongst patients presenting with psychotic symptomology. All acute inpatient admissions were examined across a 12-month period January-December 2013. Electronic and paper records were accessed and audited for all 655 admissions. There were 91 admissions that included a seclusion and 200 seclusion events. There were 79 unique patients who experienced seclusion. For those experiencing seclusion: two-thirds were male, 49% were either homeless or had no fixed abode, 32% received case management in the community prior to their inpatient stay, and 56% were unemployed or not in the workforce. The median and mode duration of seclusion was 4 h. By understanding seclusion interventions better, changes can be made to enhance practice. This descriptive research into seclusion has clarified the demographics of who is most likely to experience seclusion, for how long, and the implications for reducing restrictive interventions. How the social work role could contribute to reforms to protect and enhance the rights and well-being of marginalized members of our communities, at their most vulnerable, is considered.

Developing and sustaining a practice-based research infrastructure in a hospital social work department: Why is it important?

The future of hospital social work departments depends on their ability to demonstrate their effectiveness, efficiency, and consequently, their value to their host organizations. In order to demonstrate and enhance social work's contribution, research activities of various kinds must be encouraged. These include research consumption as well as production and utilization by clinicians, supervisors, managers, and administrators. The authors sought to develop a sustainable research environment in a large social work department of an academic health system. Continued work is needed to understand practice-research "best practices" within hospitals and how to ensure their sustainability within an ever changing health care environment.

A Hospital-based Patient Legal Clinic.

The HeLP Patient Legal Clinic has provided free legal advice to public hospital patients with health-related problems since March 2014. This article reports on the findings of a study of the first six months of HeLP's operation. The study adopted qualitative methods informed by grounded theory and sought to understand patient and social worker experiences of HeLP. Interviews were conducted with 13 patients and 10 next of kin. Focus group discussions were carried out with 19 social workers who referred patients to HeLP. Locating the legal service in the hospital's social work department enabled and expedited access to legal advice; a team-based approach to patient problems emerged that enhanced patient outcomes; and provision of legal advice relieved the anxiety experienced by patients, allowing them to focus better on their health concern.

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.