Medical social workers assume various distinct roles in their practice. These roles range from educator and advocate to counselor, liaison, and mediator. The generalist intervention model (GIM) informs medical social work practice, with these roles reaching across each stage of the model. Medical social workers view patients and their problems in context, combine practice skills and techniques that meet the individual situation, and implement interventions across the multiple systems present in the patient’s life. The interventions are implemented on a continuum ranging from micro to mezzo to macro levels.It is important to be mindful of the fact that patients are not the only people with whom medical social workers practice. It is not uncommon for medical social workers to intervene with family members and support caregivers, cooperate with members of the community, and collaborate with other health care professionals as well.To prepare for this Discussion, think about the wide array of services provided by a medical social worker. Consider the roles, responsibilities, and scope of practice of the medical social work profession. Examine the medical social work practice skill within the GIM.By Day 3Post a description of three primary roles of medical social workers that you consider to be inspiring and rewarding. Explain why. Explain how these roles directly support patients and their families. Explain how these roles might directly address three issues related to patient care (e.g., noncompliance with treatment regimen). Then, describe specific interventions (e.g., patient education to improve treatment compliance) you might implement when performing your primary roles to resolve the three specific issues you selected. Illustrate these issues and interventions with examples (e.g., patient education or health literacy to reinforce treatment regimen).Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style.Gehlert, S., & Browne, T. (Eds). (2012). Handbook of health social work (2nd ed.). Hoboken, NJ: Wiley.Chapter 2, “Social Work Roles and Health-Care Settings” (pp. 20–40)
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Social Work
in Health Care Settings
Social Work
in Health Care Settings
National Association of Social Workers
Darrell P. Wheeler, PhD, ACSW, MPH
Angelo McClain, PhD, LICSW
Chief Executive Officer
Health Care Standards Expert Panel
Lisa E. Cox, PhD, LCSW, MSW
Terrie Fritz, LCSW
Virna Little, PsyD, LCSW-R
Shirley Otis-Green, MSW, ACSW, LCSW
Anthony Yamamoto, LCSW
NASW Staff
Stacy Collins, MSW
©2016 National Association of Social Workers.
All Rights Reserved.
Guiding Principles
Standard 1. Ethics and Values
Standard 2. Qualifications
Standard 3. Knowledge
Standard 4. Cultural and Linguistic Competence
Standard 5. Screening and Assessment
Standard 6. Care Planning and Intervention
Standard 7. Advocacy
Standard 8. Interdisciplinary and Interorganizational
Standard 9. Practice Evaluation and Quality
Standard 10. Record Keeping and Confidentiality
Standard 11. Workload Sustainability
Standard 12. Professional Development
Standard 13. Supervision and Leadership
Since the early 20th century, social work has
been an integral component of the U.S. health
care system, and the profession continues to
play a leadership role in the psychosocial
aspects of health care. Today, social workers
are present in settings across the health care
continuum, including prevention and public
health, primary and acute care, specialty care,
rehabilitation, home health, long-term care,
and hospice. Professional social workers
provide services to individuals and families
throughout the life span, addressing the full
range of biopsychosocial–spiritual and
environmental issues that affect well-being.
Social work’s strengths-based, person-inenvironment perspective provides the
contextual focus necessary for client- and
family-centered care and is unique among
the health professions.
A hallmark of social work’s commitment to
health and well-being is the profession’s
continued focus on the issue of health care
inequality in the United States. People living
in poverty and communities of color continue
to experience disproportionately higher rates
of acute and chronic illness, due to unequal
access to health care services, lack of health
insurance coverage, poverty, discrimination,
and other social determinants of health. Social
workers recognize that reducing health
disparities can only be accomplished by
addressing the biopsychosocial–spiritual needs
of individuals and families, as well as the
systemic issues that contribute to poor
health outcomes.
The Evolving U.S. Health Care System
The U.S. health care system is in an era of
unprecedented change. In recent years, the
nation has witnessed continuing high rates of
uninsurance (13 percent of the U.S.
population, or 42 million people, were
uninsured in 2013 [U.S. Census Bureau,
2014]), inadequate coverage, escalating health
care costs, erosion of employer-based health
insurance, and increasing demand for health
care services as the baby boom generation
enters retirement. The Patient Protection and
Affordable Care Act (ACA) (2010) was
designed to address these issues. The goal of
the ACA is to expand access to affordable and
comprehensive health coverage, improve
patient outcomes, and increase the efficiency
and cost-effectiveness of the health care
delivery system. The ACA invests heavily in
care delivery models that promote
coordination of acute and postacute care and
greater integration of primary and behavioral
health services.
Challenges for the Profession
Their long-standing role in the health system
notwithstanding, social workers practicing in
health care settings today face significant
challenges. Ongoing changes in the financing
and delivery of health care and a shortage of
social work effectiveness data have contributed
to the reduction of social work services in
certain health care settings. Increasingly,
health care social workers are supervised by
individuals without social work degrees, and
tasks previously performed by social workers
are often assigned to other personnel,
including nurses, paraprofessionals, and
volunteers, in an effort to reduce costs.
Opportunities for Social Work in the ACA Era
Despite these challenges, health care social
work is poised to experience a resurgence in
the ACA era. With its emphasis on the “triple
aim”—improving the patient experience of
care (including quality and satisfaction),
improving the health of populations, and
reducing the per capita cost of health care
(Institute for Healthcare Improvement,
2014)—the ACA strengthens social work’s
traditional role in health care and offers new
opportunities for the profession.
The ACA promotes care delivery models, such
as the patient-centered medical home
(PCMH) and accountable care organization
(ACO), which are designed to improve health
outcomes and control health care costs. To
succeed, these models will rely on social
workers skilled and competent in health care
navigation, behavioral and mental health
integration, chronic care management, and
care coordination, among other skills. The
aging of the population will necessitate a need
for social workers skilled in transitioning
patients between different settings and levels
of care and managing complex discharges.
The anticipated influx of patients into the
health care system resulting from the ACA
insurance coverage expansion will increase the
need for social workers who are educated and
trained in working with diverse populations
and with clients who have challenging
physical, behavioral, and mental health needs.
Greater emphasis on community-based care
will require social workers skilled in reducing
nonmedical barriers to health care access. As
important, expanded social work involvement
in these roles and settings presents an
opportunity to advance the evidence base for
the profession.
Prevention and public health, traditional social
work roles, have gained renewed importance
under the ACA. With its ecological viewpoint,
the social work profession is well-positioned to
take a leadership role in new ACA prevention
initiatives, including workplace wellness, home
visiting, and smoking cessation programs. Social
workers are also well positioned to participate
in macro-level prevention efforts, such as policy
change to reduce obesity, which can improve
population outcomes more efficiently than
individual-actions at the clinical care level.
Furthermore, new research fields, particularly
patient-centered outcomes research and
community-based participatory research, offer an
opportunity for social workers to contribute to
the prevention and public health research base.
Purpose of the Standards for Social Work
Practice in Health Care Settings
These standards articulate the necessary
knowledge and skills health care social workers
should possess to deliver competent and ethical
services in today’s health care environment;
provide benchmarks for quality social work
practice for use by health care employers; and
assist policymakers, other health professionals,
and the public in understanding the role of
professional social workers in health care
settings. These standards are intended to
guide social work practice and may be applied
differently, as appropriate, to different health
care settings.
The specific goals of the standards are to

Ensure that social work practice in health
care settings is guided by the NASW Code
of Ethics (NASW, 2008)

Enhance the quality of social work services
provided to clients and families in health
care settings

Advocate for clients’ rights to selfdetermination, confidentiality, access to
supportive services and resources, and
appropriate inclusion in decision making
that affects their health and well-being

Encourage social work participation in the
development, refinement, and integration of
best practices in health care and health care
social work

Promote social work participation in
systemwide quality improvement and
research efforts within health care

Provide a basis for the development of
continuing education materials and
programs related to social work in health
care settings

Promote social work participation in the
development and refinement of public
policy at the local, state, federal, and tribal
levels to support the well-being of clients,
families, and communities served by the
rapidly evolving U.S. health care system

Inform policymakers, employers, and the
public about the essential role of social
workers across the health care continuum.
Social Worker
Within the United States, a social worker is an
individual who possesses a baccalaureate or
master’s degree in social work from a school or
program accredited by the Council on Social
Work Education. Although all 50 states and
the District of Columbia license or certify
social workers, licensure and certification laws
vary by state. Each social worker should be
licensed or certified, as applicable and required,
at the level appropriate to her or his scope of
practice in the practitioner’s jurisdiction(s).
Client refers to the “individual, group, family,
or community that seeks or is provided with
professional services” (Barker, 2013, p. 73).
For purposes of these standards, the term
“client” refers to an individual. The term
“patient” is more commonly used by social
workers employed in health care settings.
Biopsychosocial–Spiritual Perspective
A biopsychosocial–spiritual perspective
recognizes the importance of whole person
care and takes into account a client’s physical
or medical condition; emotional or
psychological state; socioeconomic,
sociocultural, and sociopolitical status; and
spiritual needs and concerns.
Bioethics is “the analysis and study of legal,
moral, social, and ethical considerations
involving the biological and medical sciences”
(Barker, 2013, p. 41).
Case Management
Case management is a collaborative process to
plan, seek, advocate for, and monitor services,
resources, and supports on behalf of a client.
Case management enables a health care social
worker to serve clients who may require the
services of various health care providers and
facilities, community-based organizations,
social services agencies, and other programs.
Case management limits problems arising
from fragmentation of services, staff turnover,
and inadequate coordination among providers.
“Care coordination,” “care management,” and
“patient navigation” are sometimes used
interchangeably with “case management”
(Barker, 2013).
Cultural Competence
Cultural competence is “the process by which
individuals and systems respond respectfully and
effectively to people of all cultures, languages,
classes, races, ethnic backgrounds, religions,
and other diversity factors [including, but not
limited to, sexual orientation; gender, gender
expression, and gender identity; and family
status] in a manner that recognizes, affirms,
and values the worth of individuals, families,
and communities and protects and preserves
the dignity of each” (NASW, 2007, pp. 12–13).
Health Disparities
Health disparities are preventable differences
in the incidence, prevalence, mortality, and
disease burden that are closely linked with
social, economic, and environmental
disadvantage. Health disparities adversely affect
groups of people who have systematically
experienced greater obstacles to health based
on their race or ethnicity; religion;
socioeconomic status; sexual orientation;
gender, gender expression, and gender
identity; age; mental health; cognitive, sensory,
or physical disability; geographic location; or
other characteristics historically linked to
discrimination or exclusion (Centers for
Disease Control and Prevention, n.d.).
Social Determinants of Health
The social determinants of health are factors
that affect a wide range of health and qualityof-life outcomes and are responsible for most
health disparities. These factors include income,
housing, education, employment, and access to
health services, among others. Social determinants
of health are shaped by the distribution of
money, power, and resources (Centers for
Disease Control and Prevention, n.d.).
National Standards for Culturally and
Linguistically Appropriate Services in Health
Care (CLAS Standards)
The National Standards for Culturally and
Linguistically Appropriate Services in Health
and Health Care (the CLAS Standards),
developed by the U.S. Department of Health
and Human Services (HHS), are intended to
advance health equity, improve quality, and
help eliminate health care disparities by
providing guidance to health care
organizations for implementing culturally and
linguistically appropriate services (HHS,
Office of Minority Health, 2013).
Patient Protection and Affordable Care Act
(ACA) (2010)
The ACA is a broad-based federal law that
seeks to reform the U.S. health care delivery
system by expanding health insurance
coverage, enhancing quality of care, improving
health outcomes, regulating the health insurance
industry, and reducing health care spending.
Patient-Centered Medical Home (PCMH)
The PCMH is a health care delivery model
accountable for meeting the large majority of a
person’s physical and mental health care needs,
including primary, acute, and chronic care.
Within a PCMH, an individual has an
ongoing relationship with a primary care
provider who directs and coordinates his or
her care across all elements of the broader
health care system, including physician
specialty services, hospitals, home health care,
and community services and supports (Agency
for Healthcare Research and Quality, n.d.-a).
Integrated Care
Integrated care is a health care delivery
approach in which primary care, mental
health, and behavioral health care services are
systematically coordinated and available in one
location (Substance Abuse and Mental Health
Services Administration & HHS, Health
Resources and Services Administration, Center
for Integrated Health Solutions, n.d.).
Chronic Care Model
The chronic care model is a widely used
approach to chronic illness management that
adapts the acute care delivery system to more
appropriately meet the needs of individuals
with chronic illness (Agency for Healthcare
Research and Quality, n.d.-b).
Accountable Care Organization (ACO)
An ACO is a group of physicians, hospitals,
and other health care providers who share
responsibility for providing coordinated care
to patients. Within an ACO, providers are
financially incentivized for meeting specific
quality and utilization benchmarks for a
defined patient population (Centers for
Medicare & Medicaid Services, n.d.).
Evidence-Informed Practice
Evidence-informed practice is practice based
on the best available research, practice
expertise, and available resources.
Guiding Principles
The NASW Standards for Social Work Practice
in Health Care Settings reflect the following
guiding principles of the social work profession:

Self-determination: Social workers respect
and promote the right of clients to selfdetermination and assist clients in their
efforts to identify and clarify their goals.

Cultural competency and affirmation of the
dignity and worth of all people: Social
workers treat each person in a caring and
respectful fashion. With skills in cultural
awareness and cultural competence, social
workers affirm the worth and dignity of
people of all cultures.

Person-in-environment framework: Social
workers understand that each individual
experiences a mutually influential
relationship with her or his physical and
social environment and cannot be
understood outside of that context. This
ecological perspective recognizes that
systemic injustice and oppression underlie
many challenges faced by clients.

Strengths perspective: Rather than focus on
pathology, social workers elicit, support, and
build on the resilience and potential for
growth and development inherent in each

Primacy of the client–social worker
relationship: The therapeutic relationship
between the social worker and the client is
integral to helping the client achieve her or
his goals.

Social justice: At all levels, from local to
global, social workers promote and advocate
for social, economic, political, and cultural
values and institutions that are compatible
with the realization of social justice.

Importance of social work research: Social
workers promote the value of research as a
means of improving the well-being of
individuals, families, and society;
strengthening the current workforce; and
maintaining the social work profession’s role
in health care settings.
Standard 1. Ethics and Values
Social workers practicing in health care
settings shall adhere to and promote the ethics
and values of the social work profession, using
the NASW Code of Ethics as a guide to ethical
decision making (NASW, 2015a).
The primary mission of the social work
profession is to enhance human well-being and
help meet the basic human needs, with special
attention to the needs of people and
communities who are vulnerable, oppressed,
or living in poverty. Social workers have an
ethical obligation to address the health care
needs of these groups and advocate for change
to ensure access to quality care.
The profession’s mission is rooted in core
values that have been embraced by social
workers throughout the profession’s history
and highlight social work’s distinct purpose
and perspective. These values—service, social
justice, dignity and worth of the person,
importance of human relationships, compassion,
integrity and competence—constitute the
foundation of social work and underlie the
practice of social work in health care settings.
The NASW Code of Ethics establishes the
ethical responsibilities of all social workers
with respect to their own practice, clients,
colleagues, employees and employing
organizations, the social work profession, and
society. Acceptance of these responsibilities—
which include upholding a client’s right to
privacy and confidentiality and promoting
client self-determination—fosters competent
social work practice in health care settings.
In a health care system characterized by
technological advancement and rapid change
in care delivery and financing of health care
services, ethical dilemmas among and between
clients, families, health care professionals, and
organizations are potentially numerous and
complex. The NASW Code of Ethics and
prevailing clinical bioethics provide a
foundation for social workers to manage such
dilemmas. Health care social workers have the
responsibility to know and comply with local,
state, federal, and tribal legislation,
regulations, and policies, addressing topics
such as guardianship; parental rights; advance
directives; and reporting requirements for
abuse, neglect, exploitation, suicide, and threat
of harm to others.
When an ethical dilemma or conflict occurs,
the health care social worker is expected to
employ available mechanisms, including social
work supervision, peer review, institutional
ethics committees, and external consultation,
to resolve the dilemma.
Standard 2. Qualifications
Social workers practicing in health care
settings shall possess a baccalaureate or
master’s degree in social work from a school or
program accredited by the Council on Social
Work Education, shall comply with the
licensing and certification requirements of the
state(s) or jurisdiction(s) in which she or he
practices, and shall possess the skills and
professional experience necessary to practice
social work in health care settings.
Social …
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