News and Commentary A Holistic Approach to Patient Care: Social Work

Charlotte Sanders, MSW, teaching associate and Northwest Leaders in Behavioral Health Program field lead for the University of Washington School of Social Work, has been working in social services for more than 22 years. With Macy Faculty Scholar Dr. Mayumi Willgerodt, Sanders helped build a social work learning module for the InterProfessional Education event, i-TEETH—a program that works to provide coordinated oral health care to children and families. We sat down with Sanders to learn more about the important role of social work in health care today.

How is social work connected to health?
At its core, social work is about looking at a patient—regardless of the health care setting—in a more holistic way. That means we look beyond diagnosis and physical health to assess a patient’s psychological, social, and spiritual health. We think about the impact a chronic health disorder has on a patient’s mental wellbeing, and how their emotional health impacts their physical health. We look to ensure that a patient has the social and emotional supports they need to follow through on treatment plans.

Why are social workers important members of the health care team?

It is the social worker on the health care team who is responsible for doing a biopsychosocial spiritual assessment to better understand what strengths a patient has to support whatever treatment plan is being made with them.

For example, in caring for a diabetes patient who is homeless or at risk of being homeless—which is where most of my experience lies—the social worker asks questions like: does that patient have family or friends who can help refrigerate their insulin? If not, can we help with mediation or reconciliation to help the patient regain their social network? As the social worker, we assess the whole person, not just the disease.

During our assessments we are asking different questions that the medical provider might not ask, either because they don’t know to ask the question or if they do, might not know how to ask it. This isn’t because the provider doesn’t care. I think a lot of it has to do with how we are trained. For social workers, a lot of our training is focused on social justice and how we can be an advocate and ally for our patients. Not every patient has a voice. We make sure they do.

But I think what’s also important to keep in mind is that even though everyone on the team has a different relationship with the patient—whether it’s the doctor, the nurse or the social worker—we all have the same goal of better patient care. It’s a team effort.

Is practice actually changing? Are you seeing social workers becoming more a core part of the health care team?
Yes, I believe so. I think we’ve always been there, it’s just becoming more and more visible. Now, more than ever before, health care providers are seeing how crucial it is to address the social determinants of health. A doctor knows that even with the best treatment plan, a patient suffering from heart disease or diabetes is not going to get better if they don’t have a roof over their heads or access to healthy, affordable food.

In the past, social workers were only seen as being part of the discharge or referral process. This has changed, and we are wearing many hats. We’re now directly involved in patient care from the beginning, and we help drive the treatment plan. With a social worker on board, the provider knows the treatment plan has a better chance of being carried out, the patient is more likely to improve, and the social workers are more fulfilled in their role. It’s great to see, and everyone wins.

What is the current landscape for how we educate social workers to work on health care teams? Has it changed at all?
In comparison to when I was in school over a decade ago, I see much more interprofessional education going on. Institutions across the country are bringing their health sciences students together not only to learn together, but practice alongside one another so that they learn about each other’s professions and what perspectives they are bringing to patient care. I am excited that students are now able to have these experiences.

We are also seeing this move well beyond health. At the University of Washington, I am starting to work with our law and nursing schools to find new ways to bring our students together to work on projects related to homelessness. In health care, there are many systems that need to work together to make sure patient care is of the highest quality. So, we are looking at every dimension of health, and challenging traditional curriculums. It’s a big shift, but it needs to happen and it is happening.

What are the challenges for expanding the role of social workers in a health care setting?

I tell all my social work students to be prepared that the other professions may not fully understand their role, at least at first. I tell them to be prepared to educate themselves about what their role can be in the health care setting, what role the other professions play, and how they can all support each other. It’s about breaking down silos, and that takes training and time.

I think another big challenge for social workers is that there can be a lot of intimidation when working with medical providers because of the hierarchal system we’ve created over the years. Other, more traditional health care providers hold a lot of power, so I teach my students how to build their own power and presence on the health care team. Social workers are used to being collaborative, but we have not always been trained to be leaders. I help my students think about the different ways they can be seen as a leader on the team. There is a seat for social workers at the table. We just need to find it, and take it.

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