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.

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).

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.

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.

Interventions targeting absences increase adherence and reduce abandonment of childhood cancer treatment in El Salvador.

BACKGROUND: In El Salvador, about 200 new cases of pediatric cancer are diagnosed each year, and survival rates approach 70%. Although treatment is available at no cost, abandonment of therapy has remained at a steady yearly rate of 13% during the past decade. A time sensitive adherence tracking procedure (TS-ATP) was recently implemented to detect missed appointments, identify their causes, and intervene promptly. Procedure The study team was informed daily of patient/family failure to attend medical appointments in the pediatric oncology unit; the families were contacted and interviewed to ascertain and address the reasons. Patients who did not return after this initial contact were contacted again through local health clinics and municipalities. Law enforcement was a last resort for patients undergoing frontline treatment with a good prognosis., The system was adapted to clinical urgency: families of patients undergoing induction therapy were contacted within 24 hr, those in other therapy phases, within 48 hr, and those who had completed treatment, within one week. Reasons for absence were obtained by telephone or in person. RESULTS: The annual rate of abandonment was reduced from 13-3% during the 2 years period. There were 1,111 absences reported and 1,472 contacts with caregivers and institutions. The three main reasons for absences were financial needs (165, 23%), unforeseen barriers (116, 16%), and domestic needs (86, 12%). CONCLUSIONS: Use of the treatment adherence tracking system to locate and communicate with patients/families after missed appointments and the allocated aid stemming from these interviews substantially reduced abandonment and non-adherence.

Hospital social workers in Saudi Arabia: characteristics and functions.

Social work practitioners are important members of the health care team and the hospital sector has been a traditional employer of social workers. Social work practitioners have become increasingly involved in hospital work as a result of the growing recognition of the important link between the biophysical aspects of health and the surrounding psychosocial circumstances, which require multidisciplinary interventions and demand the involvement of specialized social work personnel to deal with such issues. The article has been carried out in order to contribute to the literature by exploring to see if the characteristics and functions of contemporary professional social workers (who practice in the health sector in western Saudi Arabia) are achieving best practice.

The why of practice: utilizing PIE to analyze social work practice in Australian hospitals.

This research used a collaborative approach to gain a comprehensive, quantitative understanding of the breadth and depth of the social work role in health care. Data was collected from individual interviews with all employed hospital social workers (N = 120) across five Melbourne, Australia health networks about their most recently completed case. This data was coded using a revised version of the Karls and Wandrei (1994) Person-in-Environment (PIE) tool to retrospectively analyze the reasons for social work involvement over the course of the case. The findings demonstrate that the hospital social work role is multidimensional across a number of domains but centers predominantly on assisting clients and their significant others with issues of altered social roles and functioning; particularly in relation to role responsibility, dependency, and managing associated role-change losses. The findings of this study will assist hospital social workers, managers, and academics to better describe and effectively undertake this complex work. These findings will also assist in the development of professional training and education to up-skill social workers who operate within this complex setting.

Everyone's business: developing an integrated model of care to respond to child abuse in a pediatric hospital setting.

In pediatric hospitals, social work plays a central role in the prevention, identification, and management of child abuse. Children who are suspected of having been abused or neglected require an evaluation of their psychosocial situation. As an integral member of the health care team, the social worker is well placed to undertake comprehensive psychosocial assessments including information on the child's development, parental capacity, family, and community supports. Current practice approaches have seen a shift away from a narrow, "expert" approach to child protection. This article describes the development of an integrated model of social work service delivery to better respond to vulnerable and at-risk children in a pediatric hospital setting. Developing a new model of service required strategic planning, consultation, and endorsement from senior hospital management. The new model aimed to ensure a high quality, responsive social work service to children at risk of physical abuse, neglect, or cumulative harm. The change necessitated understanding of current research evidence, development of best practice guidelines, and effective communication with staff and external stakeholders. Policy development, implementation of practice guidelines, staff training, data collection, and service evaluation are described. The role of social work management and leadership were central in creating change. Visionary leadership is widely regarded as key to successful organizational change. The management approach included consultation with staff, building commitment to the need for change, addressing staff concerns, and providing a vision of enhanced client outcomes as a result of the change process. This article provides a candid overview of challenges and barriers to change. Change strategies described are easily transferable to other social work settings.

The challenges of health care reform for hospital social work in the United States.

This article examines the potential impact of the Patient Protection and Affordable Care Act (ACA) of 2010 on the practice of hospital social work in the United States and its implications for social work education and training. It briefly traces the history of hospital social work, outlines some contemporary issues in the health care field, particularly those that create persistent health disparities, summarizes the major provisions of the Act that have implications for social work practice, and discusses how social workers in hospital settings might respond effectively to the changes produced by the legislation.

An evidence-based case for the value of social workers in efficient hospital discharge.

A study was undertaken to make an evidence-based case for the value of social workers in efficient discharge of patients from acute care hospitals and to assist hospital managers in making informed staffing decisions. Hospital administrative databases from March 1 to November 30, 2008, were used for the analysis of inpatient discharges on days when social workers were on vacation compared with days fully staffed with social workers. Two performance measures, daily discharge rate and average length of stay, were evaluated. During the study period, 1825 patients were discharged from the General Internal Medicine inpatient service. Team discharge rates were significantly lower on social work vacation Fridays versus regular Fridays. In contrast, the average length of stay for patients discharged on social work vacation Fridays was significantly shorter than that for patients discharged on regular Fridays. It was concluded that daily discharge rate better quantified the role of social work in patient discharge. More generally, these results provide preliminary support for the need for adequate social work staffing in timely and efficient patient discharge.

Care management redesign: increasing care manager time with patients and providers while improving metrics.

In many hospitals, addressing increasing financial and regulatory requirements has resulted in a decline in care managers' time spent communicating directly with patients, families, and healthcare providers. The authors discuss the redesign of a hospital care management model that increased the time care managers spend with patients, families, and other care professionals, while patient satisfaction increased, labor cost remained neutral, length of stay decreased, and the payment denial rate remained among the country's lowest.

Single contacts with hospital social workers: the clients' experiences.

Decreasing lengths of stay in acute hospitals result in social workers often being unable to engage in planned interventions with clients over a number of sessions. Single session work is a reality for much social work practice. This article reports on a qualitative study of clients' experiences of a single contact with a social worker in a hospital setting. Building on prior research on hospital social workers' experiences of single session work, the study found that rapport building, empathy, non-judgmentalism, practical assistance, and advocacy are important features of the social work role in the intense and time limited context of single session hospital social work.

Practical innovations: technology-assisted referrals.

Patients in the acute care setting often require referrals for post-hospital care. Before 2003, charts were copied manually and faxed to each nursing home separately, which was labor intensive, created delays, depended on legible notes, and did not ensure patient confidentiality. Social workers at our institution, in collaboration with 21 area nursing homes, successfully developed a program to streamline this process by using the electronic medical record and computer-assisted faxing. The patient's medical record (history/physical, nursing notes, pharmacy record, and therapy notes) was able to be transmitted quickly. This technology-assisted referral system had positive and successful outcomes, such as decreased length of stay, which resulted in an estimated cost savings of $2,008,512 per year.

Developing an in-house resource for clinical social work services in the dialysis setting: a pilot program.

In 2005, the Renal Care Group's social work department in Arizona launched a pilot program to show the viability of an in-house resource for clinical social work services to address depression and treatment adherence among hemodialysis patients. Sixty-three participants were divided into an intervention group that was counseled by a licensed clinical social worker over a span of 3 months and a comparison group that received no additional services. Quantitative data were collected by using the Center for Epidemiological Studies-Depression scale, the short form of the Kidney Disease Quality of Life survey, and attendance records. Qualitative data were collected as narrative descriptions of patients' reasons for missing treatment time, their readiness for change, and the benefits they observed with improved adherence. Although no significant differences in outcomes were found between the intervention and comparison groups, women and patients with catheters were significantly more depressed than men and patients with fistulas. The qualitative data indicated that loss of confidence in the healthcare team undermined adherence even though patients described the potential benefits of dialysis in terms of increased energy, emotional well-being, and the ability to resume familiar activities. The findings supported the feasibility of establishing a clinical role within the social work department that would be dedicated to clinical social work practice in the dialysis setting.

[Not Available]. / Retombées de l'initiative Main dans la main auprès des futures et nouvelles mères consommatrices de substances psychoactives en période périnatale.

OBJECTIVES: The Main dans la main initiative relies on collaboration between child protection and hospital-based social workers to help substance-abusing expectant mothers maximize their chances of caring for their newborn. The article describes the positive outcomes of this initiative for the women, based on the experiences and perception of the participants and social workers involved. METHOD: A case study was conducted with 21 participants using three data sources: 1) a semi-structured interview with the mothers at two points in time; 2) a semi-structured interview with social workers; and 3) the tools of the initiative. The data were analyzed based on content condensation and data presentation. RESULTS: A majority of participants experienced changes in their various spheres of life: personal (positive changes in substance-abuse habits), parental (improved self-confidence as a parent, reduced stress due to the fear of losing custody of their newborn), and social/relational (improved relationships with social support network and support services). CONCLUSION: The results confirm the relevance and potential for change of a short intervention model during the perinatal period based on inter-professional collaboration with substance-abusing expectant mothers. Further research is needed to validate the hypothesis on the effectiveness of this initiative.

Toward the integration of psychosocial services in the general hospital. The human services department.

This article describes an innovative administrative organization for the delivery of psychologic care in the contemporary teaching hospital that, by combining services under medical leadership, takes an evolutionary beyond multidisciplinary team approaches. The long-range goal of this organization is to provide cost-effective psychosocial services in the general hospital while maintaining the unique role contributions of the participating disciplines. To allow for informed decision making in this process, the initial step has been to establish a collaborative data base for patient and staff tracking, program planning, and evaluation.

Health service delivery and research outcomes of a common departmental structure for psychiatric consultation-liaison and social work services at a university hospital.

Convincing evidence exists that psychosocial factors have a major impact on both outcome and costs in the medical/surgical services in general hospitals. This paper describes the Human Services Department's impact on social work and consultation-liaison psychiatry, using a data-based management system across five specialties: 1) social work; 2) consultation-liaison psychiatry; 3) supportive care (hospice); 4) home care (home health discharge planning); and 5) pastoral care, which offers opportunities for research and quality assurance monitoring. Time spent in service delivery was used to estimate the cost per hour: 1) pastoral care $96; 2) social work $36; 3) consultation-liaison psychiatry $59; 4) home care $49. Referral to social work was preferred for a range of family and discharge planning services. Consultation-liaison services were preferred for depression, paranoid behavior, and management problems. Referral overlap was noted for "coping with diagnosis" for social work and consultation-liaison psychiatry. Using a computerized data base format for documenting the referral process, work accomplished, and time spent among those services providing mental health care in the general hospital permits the observation of redundancy of services delivered and their costs.