Maryann Amodeo and Luz Marilis López
This entry focuses on practice interventions for working with families and individuals including behavioral marital therapy, transitional family therapy, and the developmental model of recovery, as well as motivational interviewing, cognitive-behavioral therapy, relapse prevention training, and harm reduction therapy. A commonality in these intervention frameworks is their view of the therapeutic work in stages—from active drinking and drug use, to deciding on change, to movement toward change and recovery. We also identify skills that equip social work practitioners to make a special contribution to alcohol and other drug (AOD) interventions and highlight factors to consider in choosing interventions.
There are a range of practice interventions for clients with AOD problems based on well-controlled research.
June Simmons, Sandy Atkins, Janice Lynch Schuster, and Melissa Jones
Transitions in care occur when a patient moves from an institutional setting, such as a hospital or nursing home, to home or community, often with the hope or expectation of improving health status. At the very least, patients, clinicians, and caregivers aim to achieve stability and avoid complications that would precipitate a return to the emergency department (ED) or hospital. For some groups of vulnerable people, especially the very old and frail, such transitions often require specific, targeted coaching and supports that enable them to make the change successfully. Too often, as research indicates, these transitions are poorly executed and trigger a cycle of hospital readmissions and worsening health, even death. In recognizing these perils, organizations have begun to see that by improving the care transition process, they can improve health outcomes and reduce costs while ensuring safety, consistency, and continuity. While some of this improvement relies on medical care, coaching, social services and supports are often also essential. Lack of timely medical follow-up, transportation, inadequate nutrition, medication issues, low health literacy, and poverty present barriers to optimal health outcomes. By addressing social and environmental determinants of health and chronic disease self-management, social workers who make home visits or other proven timely interventions to assess and coach patients and their caregivers are demonstrating real results. This article describes care transitions interventions, research into barriers and opportunities, and specific programs aimed at improvement.
Patricia A. Fennell and Sara Rieder Bennett
There is a paradigm shift occurring in medicine, from models focused on treating acute illnesses to those concerned with managing chronic conditions. This shift coincides with the higher prevalence of chronic illnesses resulting from factors such as lower mortality from formerly fatal illnesses and an aging population. The chronically ill do not fare well in an acute care model, and as a result, it has become imperative to develop new models effective for these chronic conditions. These new care models will require comprehensive, coordinated case management, an activity in which social workers can play a significant role.
Elizabeth C. Pomeroy and Polly Y. Browning
Eating disorders involve maladaptive eating patterns accompanied by a wide range of physical complications likely to require extensive treatment. In addition, “eating disorders” frequently occur with other mental disorders, such as depression, substance abuse, and anxiety disorders. The earlier these disorders are diagnosed and treated, the better the chances are for full recovery” (NIMH, 2011). As of 2013, lifetime prevalence rates for anorexia nervosa, bulimia nervosa, and binge eating disorder are 0.9%, 1.5%, and 3.5% among females, and 0.3%, 0.5%, and 2.0% among males respectively (Hudson, Hiripi, Pope, & Kessler, 2007). Early diagnosis is imperative; the National Institute of Mental Health estimates that the mortality rate for anorexia is 0.56% per year, one of the highest mortality rates of any mental illness, including depression (NIMH, 2006). More recent research (Crow et al., 2009) indicates mortality rates as high as 4.0% for anorexia nervosa, 3.9% for bulimia nervosa and 5.2% for eating disorders not otherwise specified. Current research and treatment options are discussed.
Eye movement desensitization and reprocessing (EMDR) is one of the two most empirically supported treatments for adult populations with noncombat, single-episode posttraumatic stress disorder (PTSD), with the other being exposure therapy. This entry describes the unconventional origin, theoretical underpinnings, and treatment protocol of EMDR, including its distinctive use of bilateral stimulation (that is, dual-attention stimulation). Also discussed are possible contraindications, unresolved issues, and the need for more research regarding the effectiveness of EMDR with other populations with PTSD, such as children and individuals with combat PTSD and complex trauma.
This entry provides an overview of the state of health care in the United States. Service delivery problems such as access and affordability issues are examined, and health care disparities and the populations affected are identified. A discussion of two primary government-sponsored health care programs—Title XVIII (Medicare) and Title XIX (Medicaid), and the Patient Protection and Affordable Health Care Act—are reviewed along with various health care programs and major existing service delivery systems. Ethical conflicts in providing health care, and new directions and challenges are discussed, along with future roles for social workers.
Lois F. Cowles
Social work in health care emerged with immigration and urbanization associated with industrialization, and the resultant shift from physician visits to the patient's home and workplace to hospital-centered care. This change is alleged to have resulted in a loss of the doctor's perspective of the psychosocial influences on physical health. Originally, some nurses were assigned the function of addressing this loss. But eventually, the function became recognized as that of a social worker. From its beginnings in the general hospital setting in the late 1800s, social work in health care, that is, medical social work, has expanded into multiple settings of health care, and the role of the social worker from being a nurse to requiring a Master's Degree in Social Work (MSW) from a university. However, the broad function of social work in health care remains much the same, that is, “to remove the obstacles in the patient's surroundings or in his mental attitude that interfere with successful treatment, thus freeing him to aid in his own recovery” (Cannon, 1923. p 15). Health care social workers are trained to work across the range of “methods,” that is, work with individuals, small groups, and communities (social work “methods” are called “casework”, “group work” and “community organization”). They work to assist the patient, using a broad range of interventions, including, when indicated, speaking on behalf of the client (advocacy), helping clients to assert themselves, to modify undesirable behaviors, to link with needed resources, to face their challenges, to cope with crises, to develop improved understanding of their health-related thought processes and habits, to build needed self confidence to do what is required to help themselves deal with their health problem, to gain insight and support from others who are in a similar situation, to gain strength from humor, or from a supportive environment, and through spiritual experience, and from practicing tasks that are needed to deal with their health-related problems or from joining forces with others in the community to modify it in the interest of improved health status for all, or to gradually restore a sense of stability and normalcy after a traumatic experience. Most important of all, perhaps, is the “helping relationship” between client and social worker, which needs to be one of total understanding and acceptance of the client as a person. A sizable portion of the U.S. population lacks financial access to health care, where health care is regarded as a privilege rather than a right, as it is seen in all other industrial nations (except South Africa). Current trends in the U.S. health care system reflect efforts to control rising health care costs without dealing with the “real problems,” which are: (1) the lack of a single-payer health care system and: (2) the lack of focus on “public health.”
Health social work is a subspecialization of social work concerned with a person's adjustment to changes in one's health and the impact this has on that person's social network. Social workers in every setting must be ready to assist individuals and families adjusting to illness and coping with medical crises. This entry provides a brief overview and history of health social work and describes the settings and roles where this work is practiced. Significant challenges and opportunities in clinical care, research, education, and policy are discussed. Standards and guidelines for quality practice are then noted.
Kosta N. Kalogerogiannis, Richard Hibbert, Lydia M. Franco, Taiwanna Messam, and Mary M. McKay
For over 20 years, social workers have been involved in service delivery for HIV and AIDS infected and affected individuals. It is estimated that more than 1 million people are living with HIV or AIDS in the United States. The rates of HIV infections continue to rise, with more than 40,000 individuals being diagnosed each year in the United States. This entry explores the current trends in HIV primary prevention, secondary prevention, and counseling and psychotherapy services for people living with or affected by HIV/AIDS.
Larry D. Icard, Jacqueline J. Lloyd, and Gisoo Barnes
HIV/AIDS has introduced an array of issues and needs for children, youth, and their families. Family-focused interventions have emerged as a viable strategy for researchers and practitioners seeking effective and appropriate responses for the prevention, treatment, and care of children, youth, and families affected by HIV/AIDS. This discussion provides an overview of the epidemiology of HIV infection among children and youth, and highlights common elements and trends in the development, implementation, and testing of family-focused interventions. The discussion concludes with a commentary on areas for future attention.
Home health care is professional medical and non-medical care delivered in the home (home refers to a private residence, an assisted living facility, or a group home) to assist ill, injured, or disabled seniors or adults remain safely at home for as long as possible. As the population ages, and the numbers of Baby Boomers age 85 and older increases, it is likely that there will be a growing need for long-term care, including home health care. In this article, the role of social work in home health care is reviewed as it is impacted by sources of payment and demographic characteristics of home care users. Social work assessment and intervention in home health care is also discussed with a focus on effective referral practices.
Mary Raymer and Dona J. Reese
Hospice social workers are essential members of the interdisciplinary team that provide biopsychosocial and spiritual care to terminally ill patients and their significant others during the last 6 months of life. Hospice philosophy emphasizes symptom control, quality of life, patient self-determination, and death with dignity. Hospice social workers must be skilled in providing evidence-based interventions including direct client services; collaboration with the interdisciplinary team; community outreach; developing culturally competent services; and advocating for policy change on the organizational, local, and national levels.
Vikki L. Vandiver
Since the mid-1980s, managed care has been one approach used to address the economic crisis in the American health-care system. This entry overviews managed care from the perspective of policy, procedure, practice, and system. Specifically, emphasis is given to understanding the emergence and history of managed care, multiple definitions, how it works, and examples of managed care plans, key legislation, existing research, its future, and implications for social-work practitioners.
Charles L. Robbins
The distribution of illness and its impact are not random occurrences. Social workers can prevent illness through education and behavioral change as well as mitigate its impact once it does occur, and social workers should be knowledgeable about illness and the health status of the people with whom they work. As advocates for our clients, it is important that we pursue policies and programs that address the inadequacies and injustices in health care. To accomplish this, we must be prepared with the necessary knowledge.
Shaun M. Eack
Mental health research is the study of the causes and correlates of mental health and illness, approaches to improve mental well-being, and the delivery of effective mental health services to those in need. Social workers have been leading researchers in each of these areas of inquiry, and this article provides an overview of the broad field of mental health research, with particular emphasis on the contributions of social work. A biopsychosocial review of research on the correlates of mental health and illness is provided, followed by a synthesis of studies examining pharmacological and psychosocial approaches to improving mental health. Research on mental health services is then presented, with a focus on studies seeking to improve access to quality care and reduce service disparities. Key directions for future mental health research include identifying specific causal predictors of mental illness, improving existing treatments, and disseminating advances to the community.
Marie M. Lauria
Oncology social work is a specialization of social work in health care. Its practitioners provide supportive services and programs, patient navigation, education, research, administration, policy development, and advocacy to address the social, psychological, practical, and spiritual concerns of cancer patients, their families, and caregivers from pre-diagnosis through treatment, survivorship, and end of life care or bereavement. The coming decades will present many challenges and opportunities for oncology social workers in helping patients, families, and caregivers overcome barriers to quality of life and care.
Jennifer L. Magnabosco
Throughout history, measuring outcomes has been a goal and priority in the human services. This entry chronicles the history of outcomes measurement in the human services in the United States and discusses present-day outcome measurement activities as well as trends and some of the key areas for outcomes measurement in several human service domains.
Terry Altilio and Maris Pasquale Doran
Pain is a multidimensional, subjective experience that embodies the complex relationship of body, mind, emotions, and spirit. Assessment begins with the patient’s report and is enhanced by diagnostic tools, skilled inquiry and observation of behavioral, physical, cognitive and emotional responses. Pain may be acute, chronic, intermittent, or persistent and can be related to a chronic condition or progressive life-threatening illness—all of which may lead to significant psychological, spiritual, functional, and socioeconomic consequences. The undertreatment of pain is well documented and ubiquitous, especially in vulnerable populations, including the elderly, infants and children, and ethnic minorities. Inadequate management of pain has been the focus of national and international research and policy and relates to many variables, including the controversy and concerns about the use of opioids which are classified as controlled substances. This classification creates a unique environment of legislative, regulatory, and law enforcement scrutiny most recently exacerbated by the public health focus on the abuse of prescription medications. Pain is a clinical, ethical, policy, and advocacy issue. Advocating for state of the art pain management is a shared responsibility of professionals whose ethical codes include social justice, beneficence, and commitment to vulnerable populations.
Terry Altilio and Dana Ribeiro
Palliative care is a burgeoning specialty in medicine, nursing, social work and chaplaincy which privileges patient-centered, family-focused care provided across settings. Rather than a singular focus on a disease or an organ of the body, clinicians serve persons with serious illness with an approach that honors the whole person, their priorities, values and goals. In contrast to hospice care, palliative care is accessible at any point along the continuum of illness and is often provided concurrently with disease-modifying or potentially curative therapies as in the treatment of many persons with various cancers. Palliative care clinicians often work in interdisciplinary teams who collaborate with primary teams such as oncology or cardiology to identify and respond to the physical, psychological, social and spiritual needs of patients and their families. Palliative care programs are extending beyond the confines of acute care settings to venues such as outpatient clinics, home and extended care facilities. Signal events have contributed to the history, evolving role and presence of social work in this specialty. Palliative social work brings values and skills that reflect a whole person in environment perspective that is elegantly congruous with the palliative approach to care.
Enola Proctor and J. Curtis McMillen
Assessing and improving the quality of social services is one of the most pressing concerns for social work practice and research. Practice in nearly every setting is affected by stakeholder expectations that agencies monitor and improve quality. This entry addresses the meaning of the phrase “quality of care” with respect to social work services, considers this topic in relation to quality improvement, quality assurance, and evaluation of services, and points to the research that is needed in order to assess and improve quality.