2015-PPTs for Hospital Social Work [Aut].pdf

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1. Historical Perspectives about the Origins of
Hospitals
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In the Western Context
The history and development of medicine, medical
practices and hospitals were connected with religion.
In the ancient times, hospitals did not exist as they
are today.
Illnesses were often considered to be connected with
the mind and sprit.
Treatments were more spiritual than physical.
Egyptian “sleeping temples” dated back to 2000 years
BC were used as treating places of patients.
In these temples, patients had been treated by priests
through methods of hypnosis and chanting.

2. Historical Perspectives about the Origins of
Hospitals
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After Egyptians, during the Greeks, Romans, Byzantine
empires hospitals and patient services were also
connected with religion and charity services.
Ancient Geeks are considered as the founder of
“rational medicine”.
Healing and treatment practices were connected to
the Greek god-Asclepius.
Modern symbols of the medical profession including
the universal pharmaceutical symbols and the
Hippocrates oath, developed by a Hippocrates are
connected to the Greek god-Asclepius.
The Hippocrates oath is a universal oath that all
doctors must do it at the day of their graduation today.
Originally it was a devotee of Asclepius.

3. Historical Perspectives about the Origins of
Hospitals
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Gradually, hospital care became secular in 1500s with
the advent of Protestantism.
St. Bartholomew's, St. Thomas & St. Mary hospitals
were the earliest hospitals that became secular
hospitals following the dissolution of churches and
monasteries by King Henry 8
th
of England.
Protestantism beliefs influenced for the advent of
scientific medical intervention instead of religious
aspects of patient care.

4. Historical Perspectives about the Origins of
Hospitals
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The 1700s, the Age of Enlightenment, helped for
establishment and development modern hospitals,
which are familiar today.
Hospitals became centers that served only medical
needs with professionally trained doctors, nurses and
health professionals.
Medical services become specialized and
emphasized the use of modern treatment methods to
cure patients and become centers of medical
innovation.
In the western world, through time, hospitals evolved
from charitable guesthouses to center of medical
excellence.

5. Historical Perspectives about the Origins of
Hospitals
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History of Modern Hospitals in Africa and Ethiopia
It is difficult to find a well documented history of
modern hospitals in developing nations and in Africa
Documents indicated that Ethiopia adopted modern
medicine in the 16
th
century.
1886 western medicine was introduced by Swedish
medical staff and more western countries started
investing time and resources in Ethiopia.
In 1909, the first Ethiopian hospital was built by the
Russian Red Cross.
By 1936, Ethiopia had 11 hospitals, two leprosaria
and serological for vaccine production.

6. Historical Perspectives about the Origins of
Hospitals
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1946 the Ethiopian Public Health Laboratory and
Research Institute was established.
1948, The Ministry of Public was established- now
Ministry of Health
1954, the Gondar Public Health College and Training
Center was established.
1965, the first Faculty of Medicine was opened at AAU.
Currently, there are lots of modern hospitals in every
region but still they are not proportional to the number
of Ethiopian population.
There are a lot of challenges and problems in terms of
quality standards.
There is a significant progressive in terms access to
health care centers from time to time

7. Historical Perspectives about the Origins of
Hospitals
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Hospitals, hospital structures and functions
Hospitals are institutions that provide medical and
surgical treatments and nursing care for sick or
injured people.
Typically, hospitals are structured with a hierarchical
and divisional structures.
This structures are arranged in line with various levels
of staff ranging from lower to high positions.
Hospitals require precision in their execution of job
responsibilities and multiple layer of accountability in
order to function effectively and efficiently.
Hospitals often use a functional organizational
structure.
Specific hospital structures and functions greatly vary
depending on the status of hospitals.

8.

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Hospitals, Hospital Structures and Hospital Functions
Based on the status of the service, hospitals can be
categorized into:
Primary,
Secondary,
Tertiary and above).
However, the typical organizational structure of hospitals
include:
Board (regulatory body that helps in strategic decisions and
directions),
Executives (hospital top leaders who are responsible for the
overall functioning )
Department administrators (responsible for the day-to-day
operations of departments and report to hospital executives.
Patient care managers (nurse managers and supervising
physicians provide supervision of services and professionals)
Service providers (vast majority of hospital workers including
non-medical service providers).

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Hospitals, hospital structures and functions
Hospital is an integral part of social and medical
organization established to provide complete
health care services for the intended population
These generally include preventive, curative and
rehabilitative services.
Hospital is also a center for training of health
workers.
In addition to training of health professionals, it is
also a center for research, community outreach
services and innovation
Skilled man power production, research,
innovation and community outreach services are
among the core missions of university teaching
hospitals but not for all general hospitals.

10. Overview of historical origin of Hospital Social Work
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Hospital Social Work is just a branch of Health Social
Work
It is focused on providing mainly psychosocial support in
hospitals and other clinical health settings.
Like the history of modern hospitals, HSW started in UK &
USA in the late 19
th and early 20
th C.
Through time, it becomes more prominent in USA.
Eventually, it disseminated to other western countries and
in other parts of the globe.
Three factors led to the emergence of the field of social
work in health care in U.S. These are:
The demographics of the U.S. population during the 19th
and early 20th centuries
Attitudes about how the sick should be treated, including
where treatment should be given
Attitudes toward the role of psychological factors in health-
Increasingly beloved as preventable, treatable or curable

11. Overview of historical…
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In the 1800s, there was massive immigration to USA from
different parts of Europe.
35-40 million people migrated form different European
countries for economic and political reasons.
As a result, new health care challenges emerged.
Cultural and language barriers to health care raised.
Before the mass immigration, almshouse were the centers
to care for the needy people started in 17
th century.
These almshouse eventually changed into public
hospitals.
Health is not only a physical issue (anatomy & physiology)
it is also involves other dimensions including social,
mental, emotional, spiritual, environmental.
It should be addressed from holistic & multi-dimensional
views.

12.
Overview of historical…Hospital Social Work
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The situation required for highly committed professionals who
could address all the social, emotional, financial aspects of health.
Like the social work profession itself, medical social work is also
problem or demand-driven.
Dr. Elizabeth Blackwell, a woman, unable to find employment in
hospitals because of her gender, established a dispensary for women
and children in New York’s East Side in 1853.
The dispensary, which later became the New York Infirmary for Women
and Children, provided home visits.
The New York Infirmary for Women and Children employed a full-time
home visitor.
The home visitor kept records of family size, income, and living
expenses in the manner of social workers of the time.
Gradually, home visit social work services expanded and this led to the
emergence of social work services in hospitals (in public and private
hospitals to address the psychosocial aspects of health).

13. Overview…Hospital Social Work
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Four people were instrumental to the establishment of formal social
work services in hospitals.
These were:
Mary Richmond,
Mary Wilcox Glenn,
Jeffrey Brackett, and
Dr. John Glenn (please read about these people and further know
what they did)
The first social worker working in hospitals called a hospital almoner .
The first hospital almoner was hired by the Royal Free Hospital in
London in 1895.
This was in collaboration with the London Charity Organization
through its Chief Officer, Charles Loch.
Charles Loch was appointed secretary of the London Charity
Organization in 1875 and brought with him a strong interest in the
social aspects of health.

14. Overview of historical…Hospital Social Work
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Loch thought that individuals requesting care (free health
care) should be screened by “a competent person of
education and refinement who could consider the position
and circumstances of the patients.
Loch fought for many years to have an almoner appointed.
In 1895, Mary Stewart was hired to be the first social
almoner at the Royal Free Hospital.
She was stationed at its entrance because her principal
function at the hospital.
Her major tasks were to review applications for
admission to the hospital’s dispensary and accept
those that were deemed suitable for care.
Her secondary duties were to refer patients for services
and determine who should be served at dispensaries.

15. Overview of historical…Hospital Social Work
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By 1905, seven other hospitals had hired almoners.
Gradually, it became part of the hospital systems
and many hospitals in USA started hiring social
workers.
In 1905, the first social worker was hired in
Massachusetts General Hospital in USA.
Dr. Richard Cabot a Harvard educated physician
who had a great deal to do with the establishment
of social work and other helping professions in U.S.
hospitals.

16. Overview of historical…
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Cabot viewed social workers as translators of medical
information to patients and families in a way that they could
understand.
He defined social work’s expertise as diagnosis and
“treatment of character in difficulties,” which he saw as
encompassing expertise in mental health.
Garnet Pelton & Ida Cannon were professionally hired social
workers at Massachusetts General Hospital in 1905.
Inspired by the lecture of Jan Adams, Ida Cannon who was
originally a nurse and later studied MSW.
She was the first chief of social work at Massachusetts
General Hospital in 1914.
She shared status with the chief of surgery and the chief of
medicine.

17. Overview of historical…Hospital Social Work
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This was due to the strong advocacy of Dr. Richard
Cabot about the importance of social workers
intervention to patients.
To convince the medical management team, he did a
cost benefit analysis of hospital costs for patients
repeated visit of medical center due to misuse of
drugs and preventable issues compared to the salary
cost paid to a professional social worker.
Before the social service department became part of
the permanent hospital programs in1919, Dr. Cabot
paid the salary of 13 social workers from his
personal funds.
The first training course in medical social work was
held in 1912.

18. Conceptualization…
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Health Care System/Structure
Health care system is a formal structure for a
defined population, whose finance, management,
scope, and content is defined by law and
regulations.
A health care system consists of all organizations,
people, and actions whose primary intent is to
prevent, promote, restore, or maintain health.
HCS/S incudes both private and public health care
systems.
Within the broader health system, there are various
levels or domains of health care systems/practices.
Hierarchies/levels or admin structures or domains
of health can be national-regional-zonal-lowest level
Domains/types- Primary, secondary, tertiary &
above

19. Different health care levels and
settings
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Health Care System/Structure
It is a pyramidal structure, with three or more tiers of
health care systems representing increasing degrees
of specialization and technical sophistication, generally
with increasing costs of care.
These structures often categorized into primary,
secondary, tertiary and quaternary care systems or
structures
This categorization indicates the complexity and
severity of health challenges that are addressed, as
well as the nature of the patient-provider relationship.

20. Health care system/structure
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Primary health care
Is a people-centered rather than disease-centered
service that addresses the majority of a person’s health
needs
Primary care is generally the first level of care that
patients receive when they have medical concerns or
needs.
Takes a whole-of-society approach includes health
promotion, disease prevention, treatment, rehabilitation
and palliative care.
A primary care practitioner must possess a wide breadth
of knowledge in many areas given that primary care
involves the widest scope of health care, including
patients of all ages, all socioeconomic and geographic
origins.

21. Health care system/structure
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Secondary Health Care
Is the specialist treatment, provided by doctors
and other health professionals.
Most often provided in hospitals & some
services may be community-based.
More specialized and focuses on helping
patients who are struggling with more severe or
complex health conditions requiring the support
of a specialist.
Depending on the policies of the national health
system, patients may be required a referral
system from a primary care.

22.
Health Care System/Structure
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Tertiary care
Is a level above secondary health care.
Highly specialized medical care, usually provided
over an extended period of time.
Involves advanced and complex diagnostics,
procedures and treatments performed by medical
specialists in state-of-the-art facilities.
Tertiary care can be available either at a Regional
or National level, dependent on the size and
resources available in the country.
Examples of tertiary care services include
specialist cancer management, neurosurgery,
cardiac surgery, transplant services etc.

23. Health Care System/Structure
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Quaternary care
An extension of tertiary care in reference to
advanced levels of medical treatment.
Highly specialized and not widely accessed
services.
Usually only offered in a very limited number of
national or international centers.
Tends to have large catchment areas, often
catering for individuals, not only countrywide but
worldwide.
Providing care for very rare health conditions with
small numbers of patients globally.
Do you think that the roles and responsibilities of
health social workers is the same in primary,
secondary, tertiary and quaternary care systems?
Discuss in groups and reflect back

24. Basic medical terminologies to social workers
practice at Hospitals
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It is difficult get a standard list of basic terminologies but some are the following
Acute- an illness having a sudden onset, sharp rise, and short course & can be
lethal if no immediate intervention.
Adverse effects- is a medical term used in clinical investigations of research
that connotes negative effect.
Comorbidity- the presence of more than one distinct condition in an individual.
Efficacy- is the ability of an intervention to produce the desired beneficial effect.
Psychosocial- an approach that views individuals in the context of a combined
influence of emotional, social, physical and environmental issues of health.
Metastasis- the spread of cancer cells from the place where they first formed to
other parts of the body
Myopathy- a clinical disorder of skeletal muscles or abnormalities of muscle
structures that could lead to dysfunctions.
Pharmacokinetics- a study of drug interactions within a patient. It is the study of
the body absorption, distribution, metabolism or excursion of drugs.
Remission- A decrease in or disappearance of signs and symptoms of cancer.
Triage- is sorting of patients according to the urgency of their needs for care.
Natality- birth
Morbidity- illness or sickness
Mortality or Fatality- death etc.

25.  
Nexus between health policies, health care
systems, medical settings/hospitals
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Health Care Policy
Healthcare policy refers the rules and regulations set forth by
lawmakers on a local, state, and national level.
Healthcare policy also refers to the decisions, goals, and actions
that determine how care is administered and accessed.
Healthcare policy is important on a macro and micro level.
It affects the whole society, each community, each individual, each
health care institution, and each facility where care is administered.
Hospitals/health care settings are implementers of health care
policies.
Health care policy impacts fundamental healthcare issues
including:
Access and coverage
Quality of care
Cost of services
Delivery methods, and
Ethics and standards of care

26. Nexus between health policies, health care
systems, medical settings/hospitals
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Though they vary greatly form one nation to another depending on
socio-economic and socio-cultural factors, there are various
subcategories of health policy include:
Within the general health care policy there are subcategories:
Public health policies- more of non clinical care services
Healthcare services policy- more about the clinical care services
Health insurance policy- e.g. Community Based Health Insurance (CBHI)
policy in Ethiopia
Patient care policy
Global health policy
Mental health, and pharmaceuticals policies etc.
Written policies and procedures help healthcare facilities to provide:
Safe, high-quality patient care,
Efficiently use resources, and facilities
Reduce risks, keep standards and medical ethics
Healthcare policy is important because it helps to establish guidelines
that benefit patients, healthcare systems and healthcare
organizations and health care professionals.
Having protocols in place can help prevent human error and poor
communication around medical decisions.

27. Nexus between health policies, health care
systems, medical settings/hospitals
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To create and sustain high-quality patient care, healthcare

results-driven, health-related policies and procedures.
These policies provide a framework for employees by
outlining expected standards for day-to-day operations.
Health care policies help facilities to meet many health
safety standards and legal regulatory requirements in a
high-risk industry.
They help to improve compliance to standards by requiring
healthcare organizations to meet complex accreditation
requirements, and international, federal, regional, and local
laws and regulations.
They also help to improve internal communication by

need to do their jobs well, which makes operations run
smoothly and fosters better patient care.


facilitiesrelyoneffectiveguidancefromavarietyof
ensuringthatstaffmembershavetheinformationthey

28. 

Class group discussion
Discuss in groups and explain further the
interrelationship between health policies, health
care systems and hospitals/medical settings?

29. Chapter 2: Fundamentals of Hospital Social Work
Practice
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Clinical practice and standards in healthcare
setting/hospital
A clinical standard is a nationally agreed
statements on the care patients should be offered
by health professionals, social workers and health
services for a specific clinical condition in line
with the current best evidence.
Standards are explicit statements of expected
quality in the performance of a health care activity.
Standards communicate expectations for how a
particular health care activity will be performed to
achieve the desired results.
Standards define for both health workers and
clients, what is needed to produce quality
services.

30. Clinical practice and standards in healthcare
setting/hospital

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Clinical care standards play an important role in guiding
the delivery of appropriate care and in reducing un
warranted variations to provide health care services.
They help to prevent, minimize and avoid overuse,
underuse or misuse of medical care services and protect
professionals from malpractices and the subsequent
accountabilities.
Clinical standards include:
Clinical practice guidelines,
Treatment protocols,
Critical paths,
Algorithms,
Standard operating procedures,
Statements of expected health care outcomes, among
other formats.

31. Clinical practice and Standards in health care
settings…
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Performance in accordance with standards is the
cornerstone of quality assurance in health care services.
At the end, a wide range of quality assurance activities
lead to accreditation of health facilities, external quality
evaluation, and performance improvement.
Like health professionals, medical social workers
should know and critically follow/apply the clinical
standards in their social work practice whenever they
are applicable.
Some clinical standards are common to be followed by
all professionals working in hospitals or clinical health
settings
Some are different standards for different types of
health care issues.
Social workers should be aware and apply these
common and different clinical standards accordingly.

32. Chapter 2: Fundamentals of Hospital Social Work
Practice
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Major Roles and Functions of Social Workers in
Hospitals/Clinical Care Settings
The American Association of Medical Social Workers
defined hospital/medical social work as:
A specific form of social case work that focuses on the
relationship between disease and social maladjustment.
Different polices and regulations have been enacted about
hospital social workers roles in health care settings in the
western context especially in US.
Some expanded and some narrowed the roles of social
workers in hospitals at different times due to so many
emerging factors.
Despite the challenges, health social workers still play a
crucial role in connecting patients to appropriate services
and resources.

33. Fundamentals of Hospital Social Work
Practice
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With the advent of psychotherapy other professionals such
as psychologists and other social scientists began to work
in hospitals.
Thus, social workers had to compete with these for roles
in hospitals.
It has weathered seemingly insurmountable challenges
through time.
It has weathered seemingly insurmountable challenges
through time.
Despite the challenges, social work in health care has
been through a great deal for more than 100 years.
Medical social workers primarily use bio-psychosocial-
spiritual model that addresses the biological, social,
environmental, psychological, spiritual and behavioral
aspects of illness.

34. Fundamentals of Hospital Social Work Practice
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The bio-psychosocial model considers the medical & non-
medical determinants of disease
Major Roles and Functions of Social Workers in Hospitals
Hospitals are the most common primary employment
settings for social workers.
Social workers in hospitals and medical centers provide
frontline services to patients with conditions spanning the
entire health care continuum.
Medical professionals tend to use the medical model of
health care, which focuses on the physical aspect of
health
It means they often take medical history, test results,
scrutiny of the symptoms, treatment the ill person and
eventually led to clinical measures.

35. Fundamentals of Hospital Social Work
Practice
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This approach provide a paternalistic relationship
between the doctor and the patient.
Social worker in a medical team helps to solve psych0-
social problems in individual patients and their families.
The interaction between the patient and the family is the
main role of social workers in health care for patients in
order to obtain their health.
Hospital social workers help patients and their families
understand a particular illness.
They do diagnosis of emotions about the health
concerns and related issues, and provide counseling
about the decisions that need to be made.
Social workers are also essential members of
interdisciplinary hospital teams.

36. 
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Working in collaboration with doctors, nurses, and other health
professionals, social workers sensitize health care providers to the
social and emotional aspects of a patient’s illness.
Hospital social workers use case management skills to help patients
and their families address and resolve:
Social,
Financial and
Psychological problems related to their health condition.
Hospital social workers practice in increasingly specialized
environments, and are frequently assigned to specific medical units.
Social work specialization within a hospital include:
Pediatrics,
Oncology,
Nephrology,
Emergency/trauma and many other clinical setting etc.


Hospital Social Work

37. Hospital Social Work
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Social workers are also employed in hospital leadership roles.
They may serve as mangers or administrators for specific hospital
programs such as mental health, aging or community outreach.
Roles of Hospital &Leadership and administration
Medical Center Social Workers ranged from individual (micro) to
system (macro) levels. These include:
Case management,
Includes all interventions like counseling and other psychosocial support
using social work planned change interventions strategies and methods
Professional collaboration with the health team & others
Discharge planning,
Resource mobilization and networking
Linkage and referral
Educating and organizing patients
Practice and policy advocacy and activism
Leadership and administration

38. 
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Specific Job Descriptions of Social Workers in Hospital &
Medical Centers:
Initial screening and evaluation of patient and families;
Comprehensive psychosocial assessment of patients?
Helping patients and families understand the illness and
treatment options, as well as consequences of various
treatments or treatment refusal;
Helping patients/families adjust to hospital admission;
exploring emotional/social responses to illness and
treatment;
Educating patients on the roles of health care team
members;
Assisting patients and families in communicating with
one another and to members of health care team;
Interpreting information and medical jargons and
concepts.

39. Hospital Social Workers
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Educating patients on the levels/types of health care (i.e.
acute, sub-acute, home care, chronic illness and the
appropriate care for each illness)- teach how to respond
Educating patients and their families about entitlements &
rights, community resources; and advance directives;
Facilitating decision making on behalf of patients and
families;
Employing crisis intervention.
Crisis intervention focuses on the immediate problem
situation, not on long-standing disorders or well-established
character patterns. 
In the crisis intervention model, the caseworker involves in
enhancing the ability of the person to cope with the current
problem of living.
Diagnosing underlying mental illness; providing or making
referrals for individual, family, and group psychotherapy;

40. Hospital Social Work
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Job Description of Social Workers…
Educating hospital staff on patient psychosocial
issues;
Promoting communication and collaboration among
health care team members;
Coordinating patient discharge and continuity of care
planning;
Promoting patient navigation of hospital services.
Arranging for resources/funds to finance medications,
durable medical equipment, and other needed
services;
Ensuring communication and understanding about
post-hospital care among patient, family and health
care team
members;

41. Job Descriptions of Social Workers…
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Advocating for patient and family needs in different
settings: inpatient, outpatient, home, and in the
community; and
Championing the health care rights of patients through
advocacy at the institutional and policy level.
These are the common roles of social workers in
hospital and clinical care settings.
However, there are also more specific and unique roles
of medical social workers at each medical department
or unit they are placed.
Hospital departments- emergency, inpatient, outpatient,
Hospital units/wards- Internal medicine, pediatric, Gyn.
&Obs., Surgery, etc.,

42. Communication and professional
collaboration or interdisciplinary practice
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Interdisciplinary collaboration is becoming
increasingly important as the current complexity and
cost of health care require an efficient and well-
coordinated service delivery system.
Interdisciplinary collaboration is an effective and
satisfying way to provide health care services and
learning across professions.
Working using multidisciplinary teams in-hospitals
limits adverse events,
improves outcomes, and
adds to patient and employee satisfaction and learning.
Team collaboration is essential for effective and
efficient health care practice.

43. Communication and…interdisciplinary practice
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On the other hand, when health care professionals
teams are not communicating effectively, patient
safety is at risk for several reasons:
Lack of critical information,
Misinterpretation of information,
Unclear orders
Overlooked changes in status
Lack of communication creates situations where medical
errors can occur.
These errors have the potential to cause severe injury or
unexpected patient death.
Medical errors, especially those caused by a failure to
communicate, are a pervasive problem in today’s health
care organizations.

44. Communication and…interdisciplinary
practice
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To ensure optimum functioning of the team and
effective patient outcomes, the roles of the
multidisciplinary team members in care planning and
delivery must be clearly negotiated and defined.
This requires:
Agreed-upon clinical governance structures
Agreed-upon systems and protocols for
communication and interaction among team members.
Respect and trust among team members
Best use of the skill mix within the team- use diversity
as an asset/opportunity.
Work to minimize and avoid both team and individual
barriers for collaborative work

45. Communication and…interdisciplinary
practice
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Some of the Barriers at the Team Level
Lack of a clearly stated, shared, and measurable
purpose/s
Lack of training in inter-professional collaboration
Role and leadership ambiguity
Team too large or too small
Team not composed of appropriate professionals
Lack of appropriate mechanism for timely exchange of
information
Need for orientation for new members
Lack of framework for problem discovery and resolution
Difference in levels of authority, power, expertise,
income
Traditions/professional cultures, particularly medicine’s
history of hierarchy
Lack of commitment of team members

46. Communication and…interdisciplinary
practice
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Different goals of individual team members
Apathy of team members
Inadequate decision making
Conflict regarding individual relationships to the
patient/client
Barriers Faced by Individual Team Members
Split loyalties between team and own discipline
Multiple responsibilities and job titles
Competition instead of cooperation among team
members
Gender, race, or class-based prejudice
Persistence of a defensive attitude
Reluctance to accept suggestions from team members
representing other professions
Lack of trust in the collaborative process etc.,

47. Improving Multidisciplinary Healthcare
Teams
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Coaching Healthcare Teams, Physician and Other Team Leaders
and come up with:
Agree on a unifying philosophy centered on primary care of
the patient/client and the community.
Develop a commitment to the common goal of collaboration.
Learn about basic nature of medical and other professions.
Respect others’ skills and knowledge.
Establish positive attitudes about own profession.
Develop trust among members.
Be willing to share responsibility for patient/client care.
Establish a mechanism for negotiation and renegotiation of
goals and roles over time.
Establish a method for resolving conflicts among team
members.
Be willing to work continuously on overcoming barriers.
Keep personal and professional integrity and be committed

48. Knowledge requirements and theoretical
perspectives for hospital social work
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1.
2.
3.
4.
5.
6.
Contemporary health promotion and disease
prevention theories/models.
There are still various but the most common ones
are:
The Bio-psychosocial perspective
The Ecological Model
The Health Belief Model
The Stages of Change Model (Transtheoretical
Model)
The Social Cognitive Model
The Theory of Reasoned Action/Planed
Behavior

49.
The Bio-psychosocial perspective

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A bio-psychosocial-spiritual model is a holistic
approach that acknowledges the interaction between:
Physical,
Psychological,
Socio-cultural, and
Spiritual aspects to patient care and patient well-being. 
Model is a holistic perspective grounded in general
systems theory and works to address health-related
issues.
It is based on the idea that suffering, disease, and
illness are all affected by multiple levels of
organization, from the societal to the molecular.

50. The Bio-psychosocial perspective

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In acknowledging how biological, psychological,
social, and spiritual factors present in a person’s  life.
It helps medical doctors, psychiatrists, social
workers and other professionals to conceptualize
patient problems holistically.
This help them to come with greater understanding,
and effectively develop a treatment plan.
E.g. During the pandemic of COVID-19, evidences
shows that a lot of people were suffering and dying
due to social isolations and lack of spiritual support

52. Health Theories and Models
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1. The Ecological Model
Illustrates the interaction between, and
interdependence of, factors within and across all
levels of a health problem.
It highlights people’s interactions with their
physical and sociocultural environments.
It recognizes multiple levels of influence on health
behaviors form micro-to macro levels
It also recognizes the synergic or intersectionality
effects of these multilevel factors

53. Health Theories and Models
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The Ecological Model…
Intrapersonal/individual factors, 
Which influence behavior such as knowledge,
attitudes, beliefs, personality, personal habits and
behavioral practices.
E.g. if your are sensitive, aggressive, calm etc.
Their influence is both towards the negative and
positive side
Interpersonal factors:
Interactions with other people, which can provide
social support or create barriers to interpersonal
growth that promotes healthy behavior
They could be supportive, empowering or
discriminatory, oppressive, exploitative.
As a result stress, conflict, hate, love, peace,
cooperation etc.

54.
The Ecological Model
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Institutional and organizational factors: 
Including the rules, regulations, policies, and informal
structures that constrain or promote healthy behaviors.
Negative interaction with co-workers, boss, workload &
stress, dangerous working conditions etc.
Community factors: 
Such as formal or informal social norms that exist
among individuals, groups, or organizations,
They can limit or enhance healthy behaviors
E.g. slum areas with gambling groups, robbery groups,
alcoholic groups, etc.
Healthy neighborhoods with GYM groups, volunteer
humanitarian support groups, etc.
Community traditional practices (HTPs) such as child
marriage, FGM, ovulations, milk teeth extraction,
abdominal massage of pregnant women etc.

55. The Ecological Model…
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Traditionally prohibited food items pregnant women
and children like:
Cabbage, egg, portage, mike and milk products etc.
Unfortunately they are key diets for development
Malnutrition is not only occurring due to absence of
food supplies but inappropriate utilization (i.e. lack of
awareness)
Public policy factors, 
Including local, state, and federal policies and laws
that regulate or support health actions and practices
for disease prevention including early detection,
control, and management.
E.g. Quarantine centers for COVID-19, health
extension workers, community health insurance
Availability of free medical services like ART, TB,
MCH etc.

56. Ecological Influencing Factors of Health

57. Ecological Intervention Strategies

58. Health Theories and Models
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2. The Health Belief Model (HBM)
The HBM is a theoretical model that can be
used to guide health promotion and disease
prevention programs.
It is used to explain and predict individual
changes in health behaviors.
It is one of the most widely used models for
understanding health behaviors.
Key elements of the Health Belief Model focus
on individual beliefs about health conditions,
which predict individual health-related
behaviors.

59. Health Theories and Models
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1.
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2.
3.
4.
5.
The HBM…
Underlines that individuals’ perceptions are key factors
that influence their health behaviors.
There are 5 key elements of perception:
Perceived threat to sickness or disease (perceived
susceptibility to diseases ),
E.g. The COVID-19 study 84% vs. 26 % (seriousness vs.
susceptibility) respectively.
Belief of consequence (perceived severity of the
disease),
Potential positive benefits of action (perceived
benefits of actions),
Perceived barriers to action, exposure to factors that
prompt action (cues to action)
Confidence in ability to succeed (self-efficacy).

60. Intervention Activities-HBM

61. Health Theories and Models
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3. Stages of Change Model (Transtheoretical
Model)
The Stages of Change Model also called the
Transtheoretical Model, explains an
individual's readiness to change their behavior.
It describes the process of behavior change as
occurring in stages.
It describes how an individual or organization
integrates new behaviors, goals, and programs
at various levels.

62. Health Theories and Models
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The Stages of Change Model…
At each stage, different intervention strategies
will help individuals progress to the next stage.
Individuals within a population will likely vary in
their readiness to change.
It is important to recognize that movement
through this model is cyclical
i.e. individuals may progress to the next stage
or regress to a previous stage.
Progress is not always in one direction it
might goes back and forth.

63. The Stages of Change Model

64. Interventions in Stage Change
Model

65. Health Theories and Models
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4. The Social Cognitive Theory
Social Cognitive Theory (SCT) describes the influence
of individual experiences, the actions of others, and
environmental factors on individual health behaviors.
The theory provides a framework for understanding
how people actively shape and are shaped by their
environment.
Describes a dynamic, ongoing process in which the
personal, interpersonal, environmental factors, and
human behavior exert influence upon each other.
SCT provides opportunities for social support through
instilling expectations, self-efficacy, and using
observational learning and other reinforcements to
achieve behavior change.

66. Health Theories and models

67. Health Theories and Models
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The Social Cognitive Theory….
Key components of the SCT related to individual behavior change
factors include:
Reciprocal Determinism - This is the central concept of SCT.
RD is a model composed of three factors that influence behavior: the
individual (including how they think and feel), their environment, and the
behavior itself.
A person’s behavior is the result of the mutual interactions of personal
factors and environment.
Self-efficacy: This refers to the level of a person's confidence in his or
her ability to successfully perform a behavior.
Self-control: Regulating and monitoring individual behavior.
Behavioral capability: Understanding and having the skill to perform a
behavior.
Expectations - This refers to the anticipated consequences of a
person's behavior. Outcome expectations can be health-related or not
health-related
Observational learning: Watching and observing outcomes of others
performing or modeling the desired behavior.
Reinforcements: Promoting incentives and rewards that encourage
behavior change.

68. Health Theories and Models

69. Health Theories and Models
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5. Theory of Reasoned Action/Planned Behavior
Two closely associated theories –
The Theory of Reasoned Action & the Theory of
Planned Behavior
Suggest that a person's health behavior is
determined by their intention to perform a
behavior.
A person's intention to perform a behavior
(behavioral intention) is predicted by:
(1) a person's attitude toward the behavior, and
(2) subjective norms regarding the behavior.

70. Health Theories and Models
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Theory of Reasoned Action/Planned Behavior…
Subjective norms are the result of social and
environmental surroundings and a person's perceived
control over the behavior.
Generally, positive attitude and positive subjective
norms result in greater perceived control and increase
the likelihood of intentions governing changes in
behavior.
Subjective norms can be also used to describe the
behaviors of healthcare providers, patients, care
providers, and others in the community.
These theories have been used to guide health
promotion and disease prevention such as:
Asthma counseling and treatment compliant,
Tobacco use interventions,
Anti-drug media campaigns, and others.

71. Health Theories and Models
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Summary points
Theory and practice are part of a continuum for understanding
the determinants of behaviors, testing strategies for change,
and disseminating effective interventions.
Theories/ models help to guide or intervention/practice
The adequacy of a theory/model most often is assessed in
terms of three criteria:
Its logic, or internal consistency in not yielding mutually
contradictory derivations,
The extent to which it is parsimonious, or broadly relevant while
using a manageable number of concepts, and
Its plausibility in fitting with prevailing theories in the field
The strongest interventions may be built from multiple theories.

72. Health Theories and Models

73. Values and Ethical
Considerations
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The NASW Code of Ethics is a guide for the day-to-day conduct
of a social worker.
The code of ethics clearly defines laws, regulations and policies
for people in the field to follow, and to hold them accountable if
the rules are broken.
Provides core values and ethical principles or standards upon
which the social work occupation is based.
These values and ethical standards guide social workers in their
professional considerations and obligations when ethical
uncertainties occur.
The code of ethics establishes the profession’s mission, values
and ethical principles and standards for new social workers.
Ethical codes describe the responsibility to the Social Work
profession to maintain the dignity and integrity of the profession.
This is extended up to taking action appropriately against
unethical conduct by any other member of the profession.

74. Values and Ethical
Considerations
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Core Values in Social Work
Professional ethics are rooted in the heart of social
work.
Core values have ethical requirements each social
worker should strive to follow.
These legal provisions help social workers identify
professional obligations and legal conflicts of interest.
The 6 Values of Social Work
Service
Social justice
Dignity and worth of the individual
Importance of human relationships
Integrity
Competence

75. Values and Ethical
Considerations
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Medical Social workers perform their professional practice in an
integrated health care settings.
Integrated health care settings include deliberate and sustained
coordination of care among health care practitioners (physicians,
nurses, nurse practitioners, and physician assistants, among
others) and behavioral health professionals (social workers,
psychiatrists, psychologists, mental health counselors, and
addiction specialists, among others).
Social workers in integrated health care settings face ethical
challenges especially related to:
Informed consent,
Privacy,
Confidentiality,
Professional boundaries,
Dual relationships, and
Conflicts of interest

76. Values and Ethical Considerations
1.
2.
3.
4.
5.
6.
7.
8.
Eight Standards of Practice for Health Care Social Workers by NSAW,
All medical social workers in the healthcare arena must practice in
accordance with the social work code of ethics.
Advocate for client’s right to self-determination, confidentiality,
access to supportive services and resources, and appropriate
inclusion in decision making that affects their overall health and well-
being.
Encourage social work participation in the development, refinement,
and integration of best practices in health care.
Enhance the quality of social work services provided to clients and
families in health care settings.
Promote social work participation in system wide quality
improvement and research efforts within health care settings.
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 local levels
to support the well-being of clients, families, and communities
served by the rapidly evolving health care system in every nation.
Inform policymakers, employers, and the public about the essential
role of social workers across the health care continuum.

77. Skill requirements and interventions for hospital social workers
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Social work is a dynamic and demanding profession that
requires a variety of skills and qualities.
Social workers should have fundamental skills that could be
applied in a variety of intervention settings.
Skills are foundation to build successful professional and
helping relationships between social workers, clients,
families and the working teams.
These skills include but not all:
Empathy
Empathy is the ability to identify with and understand
another person’s experience and point of view.
It is the act of perceiving, understanding, experiencing
and responding to the emotional state and ideas of
another person.
It is the act of stepping into someone else’s shoes” and
recognizing that experiences, perceptions and worldviews
are unique to each individual.
This enables social workers to better understand and
build stronger relationships with clients.

78. Skill requirements and interventions
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Communication
Communication – both verbal and non-verbal – is a vital skill for
social workers.
The ability to communicate clearly with a wide range of people is
essential.
Being cognizant of body language and other non-verbal cues.
This means communicating appropriately and effectively with
clients regardless of cultural background, age, gender, literacy skill
level or disability.
Social workers must also communicate with care providers,
colleagues, and agencies, and must document and report
information in a clear and professional manner.
Organization
Social workers have busy schedules and a wide range of
responsibilities in addition to managing and supporting multiple
clients, including documentation, reporting, networking and
collaborating.
This requires social workers to be very organized and able to
prioritize clients’ needs in order to effectively manage cases.
Disorganization and poor time management could cause a social
worker to overlook a client’s needs and result in negative outcomes.

79. Skill requirements and interventions for hospital social
workers
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Critical thinking
Critical thinking is the ability to analyze information
gathered from unbiased observation and communication.
Social workers must be able to objectively evaluate each
case by collecting information through observation,
interviews and research.
Thinking critically and without prejudice enables social
workers to make informed decisions, identify the best
resources and formulate the best plan to help clients.
Active and emphatic listening
Active listening is necessary for social workers to
understand and identify a client’s needs.
Listening carefully, concentrating, asking the right
questions, and utilizing techniques such as paraphrasing
and summarizing also helps social workers to engage
and establish trust with clients.
Emphatic listening is like listening the client's concerns
putting ourselves in the place of the client

80. Skill requirements and interventions for hospital social
workers
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Self-care
Social work can be demanding and emotionally stressful,
so it is important to engage in activities that help you to
maintain a healthy work-life balance.
Self-care refers to practices that help to reduce stress and
improve health and well-being.
Engaging in these practices helps to prevent burnout and
fatigue and is crucial to having a sustainable career.
Cultural competence
Working effectively with clients from diverse backgrounds
requires social workers to be respectful and responsive to
cultural beliefs and practices.
Social workers must be knowledgeable and respectful of
their clients’ cultural backgrounds.
Possessing a non-judgmental attitude and an appreciation
for diversity and the value of individual differences
enables social worker to provide clients with what they
need.

81. Skill requirements and interventions for hospital social
workers
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Patience
Social workers encounter an array of circumstances and individuals in
their work.
It is important to have patience to work through complex cases and
with clients who need longer periods of time to make progress.
This empowers social workers to understand the client’s situation and
avoid hasty decision-making and frustration that can lead to inflated
errors and poor outcomes for the client.
Professional commitment
Being successful in social work requires lifelong learning.
Social workers must have a professional commitment to social work
values and ethics, and to continuously developing professional
competence through formal, informal learning, and practice based
learning .
Advocacy
Social workers promote social justice and empower clients and
communities through advocacy. 
Advocacy skills enable social workers to represent and argue for their
clients and to connect them with needed resources and opportunities,
especially when clients are vulnerable or unable to advocate for
themselves.

82. Skill requirements and interventions for hospital social
workers
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Clinical/medical/hospital social workers require additional
skills including
Technical knowledge
Clinical social workers must have a certain level of
multidisciplinary technical knowledge in order to perform their
roles as mental health and social service professionals.
Note-taking
Documentation and record-keeping are all an essential part of
working as a clinical social worker.
As they listen to their clients, these professionals must write
effective notes to keep track of the conversation and
important details that may inform the treatment plans they
propose.
Having a thorough set of notes that outline a patients'
treatment over time can be especially useful in monitoring
their progress and evaluating the treatment's success.

83. Skill requirements and interventions for hospital social
workers
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Collaboration
While clinical social workers often work in an independent
capacity when treating their clients, they must be able to
collaborate with other healthcare providers and practitioners
when necessary.
This often occurs when they encounter clients who need
medical or psychiatric interventions that clinical social
workers aren't qualified to offer.
Boundary setting
Even though clinical social workers need to serve their clients
empathetically and compassionately, it's also important for
these professionals to be able to set boundaries in their
careers.
These boundaries may be of a professional or ethical nature.
Clinical social workers must abide by a high code of ethics to
protect their clients and maintain confidentiality over their
treatment period.

84. Skill requirements and interventions for hospital social
workers
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Knowledge of interventions
Clinical social workers must have knowledge of the
various intervention strategies available to them when
treating clients.
These interventions may include resources related to
coping mechanisms, clinical services, community
services, informational materials and social welfare
programs
Evaluation
Clinical social workers must be able to evaluate their
treatment plans and success in helping clients achieve
wellbeing through their practice.
This reflective process can allow clinical social workers
to identify areas of improvement, understand what's
working within their treatment offerings and make shifts
to enhance client care in the long term.

85. Skill requirements and interventions for hospital social
workers
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Self-awareness
Self-awareness can enable clinical social workers to be
mindful of how their actions, perceptions and potential
biases may affect client outcomes.
With greater self-awareness, these professionals can
better navigate client treatment and offset any effect
their body language, tone of voice or reactions may
have on a client's progress.
Self-compassion
While it can be challenging to practice self-compassion,
clinical social workers must develop the ability to act
with kindness toward themselves.
The social work profession can be emotionally
demanding and implementing self-compassion
purposefully can allow clinical social workers to build
resilience and understanding in their personal lives.
This may help them serve their clients more
compassionately as well.

86. Skill requirements and interventions for hospital social
workers
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Technical skills such as:
Case finding,
It involves actively searching systematically for at risk people, rather
than waiting for them to present with symptoms or signs of active
disease.
It is a form of screening of which the main object is to detect disease
and bring patients to treatment.
It is a strategy for targeting resources at individuals or groups who are
suspected to be at risk for a particular disease . 
Case finding is a system for locating every patient, either inpatient or
outpatient, who is diagnosed and/or treated with a reportable
diagnosis. 
Engagement,
The engagement process refers to the initial interactions between the
social worker and the client.
A successful engagement process sets in place a strong foundation
for the work that the client and social worker will do together.
The social worker’s most fundamental goal at this stage is to
establish a relationship with the client in which the client feels
respected and secure in discussing personal matters.
This is achieved by developing rapport with the client, demonstrating
empathy, and clarifying expectations of the helping process. 

87. Skill requirements and interventions for hospital social
workers
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Assessment,
Gather information
Problems, strengths, resources from in and out of the client
Study the concern or situation
Identification
Decide what needs to be changed.
Prioritize the most pressing problems to be addressed first
Decide what and how it can be changed.
Planning
Identifying Objectives- SMART objectives
Identifying Intervention Strategies
Identify Strengths
Intervention Plan
Who, What and When
Intervention
Carry out the plan
Monitor progress toward plan
Revise if needed

88. Skill requirements and interventions for hospital social
workers
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Evaluation and Termination
Evaluate overall progress
Give feedback
Get feedback
Determine what work the client will continue
End working relationship
Follow-up
Assess the intervention and identify whether the client
maintains the change or not, and act accordingly
Case management
The practice of case management varies greatly across
social work settings and is even more diverse as applied
by other professionals.
It is a process of planning, seeking, advocating for, and
monitoring services from different social services or
health care organizations and staff on behalf of a client.

89. Skill requirements and
interventions…
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Social work case management is a method assessing
the needs of the client and the client’s family, when
appropriate, and arranging, coordinating, monitoring,
evaluating, and advocating for a package of multiple
services to meet the specific client’s complex needs.
A professional social worker is the primary provider of
social work case management.
Distinct from other forms of case management, social
work case management addresses both the individual
client’s bio-psychosocial status as well as the state of
the social system in which case management operates.
Social work case management is both micro and
macro in nature: intervention occurs at both the client
and system levels.

90. Skill requirements and
interventions…
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It requires the social worker to develop and maintain a
therapeutic relationship with the client.
This may include linking the client with systems that
provide him or her with needed services, resources,
and opportunities.
Three principles for effective social work case
management:
Evidence-based practice
Trusting relationships
Client empowerment
Case management is the overall intervention
processes provided for an individual or a group using
the planed change strategies of social work.

91. Settings in Hospitals
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clinical social workers also have specific/unique roles at
different departments/units of a hospital.
Some of the most common units are the following:
Social Workers at the Emergency Room
Social workers’ roles in the emergency department (ED)
revolves around a patient-centered approach to care that
considers psychosocial aspects that impact the patient's
health and behavior . 
These interventions are commonly referred to as:
Case management,
Care management, or
Care coordination.

Despitethecross-cuttingrolesinallhospitalsettingss
3.SocialWorkPracticeatSelectedMedical

92. Social Work Practice at Selected…
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Social Work at the Emergency Room
The role and scope of social workers in the ED includes:
Avoiding unnecessary hospitalizations, including “social
admissions”
Responsibilities include psychosocial assessment; a full range
of psychosocial interventions for patients/families.
This include transitional care; and, when appropriate, follow-up
phone calls; and post-discharge intervention
Addressing social determinants that may lead to subsequent
hospitalizations:
Like poor medical literacy contributing to inadequate compliance or
adherence to prescribed treatment
Patient education: disease or medication-driven, importance
of follow up.
Identifying appropriate community resources to bridge gaps:
peer groups, arranging transportation, visiting nurse, home
health aide referrals, medication delivery services.
The social worker in this position will also facilitate the
discharge of patients in the ED.

93. Social Work Practice at
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The role and scope of social work in the ED…
Arranging appropriate follow up: future primary care
physician (PCP) or specialist referrals, appointments,
reminder phone calls, post-visit calls.
Providing appropriate alternatives to inpatient setting
such as;
referrals to long term care facilities,
visiting nurse or provider house calls, prompt
outpatient follow-up arrangements etc.,
Crisis intervention: family counseling after a death,
substance use leading to trauma or critical illness.

94. Social Work Practice at
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Nephrology/Renal Social Work
Nephrology social work services support and maximize the
psychosocial functioning and adjustment of patients
experiencing:
Chronic Kidney Disease (CKD),
End-Stage Renal Disease (ESRD) and
Those receiving renal replacement therapies.
Psychosocial issues are identified and addressed in order
to resolve problems, promote healthy adaptation to kidney
disease and renal replacement therapies and to help
improve quality of life.
These services are provided to ameliorate social and
emotional stresses resulting from the interacting physical,
social, and psychological concomitants of ESRD, including;
shortened life expectancy; altered lifestyle with changes in
social, financial, vocational, and sexual functioning; and the
demands of a rigorous, time-consuming, and complex
treatment regimen.

95. Social Work Practice at
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Nephrology/Renal Social Work…
Nephrology social workers function as part of the
interdisciplinary team.
They advocate for positive treatment environments,
policies, and care approaches that respect diversity
including individual, cultural, gender, religious and
ethnic differences.
Social work services are also extended to families,
caregivers, and support networks.
Overall wellness is promoted through all stages of
care: prevention, diagnosis, chronic illness
management, treatment, and end-of-life care.

96. 
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Major Functions and Services Provided By Renal
Social Workers can be summarized:
Psychosocial evaluation (assessment for treatment
plan)
Ongoing bio-psychosocial Assessment (including
quality of life measurement)
Pre-dialysis education and assessment
Casework (counseling with patients, families, and
support networks; crisis intervention; goal-directed
counseling; discharge planning, home-visit, meditation)
Group work (education, emotional support, self-help)
Information and referral
Facilitation of community agency referrals
Team care planning and collaboration
Patient and family education
Interdisciplinary care planning and collaboration.
Advocacy on patients’ behalf within the setting and with
appropriate local, state, and federal agencies and
programs and programming.

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Major Categories of Problems Addressed include;
Adjustment to chronic illness and treatment as they
relate to quality of life
Physical, sexual, and emotional relationship problems
Educational, vocational, and activity of daily living
problems
Crisis and chronic problem solving
Problems related to treatment options and setting
transfers
Resource needs, including finances, living
arrangements, transportation, and legal issues
Decision making regarding advance directives

98. Social Work Practice at Selected…
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Oncology Social Work- Supporting Patients who are diagnosed with
Cancer
Oncology Social Workers provide support in the following areas:
Counseling. 
Feeling stressed or anxious while coping with cancer is common.
You may also experience your body reacting differently to certain foods or
feel tired more often.
Counseling provides a safe space to voice any concerns to better cope with
these changes
Guiding parents in talking with their children about cancer
Helping to navigate the health care systems available.
Addressing domestic violence, substance abuse and mental health issues
Assisting in accessing transportation, governments benefits, and
community resources
Counseling and helping to cope living through loss and grief.
Building or networking with Support groups: 
Building a support network can lessen the isolation that often comes with a
cancer diagnosis.
A support group is a unique opportunity to connect with others impact by
cancer.

99. Social Work Practice at Selected…
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Social Work in the Pediatric Unit
Pediatric social workers integrate a child’s social and
psychological needs into a medical care plan by:
Providing education and information to the child, families and
care givers.
Providing counseling and support to adjust to illness and grief.
Providing counseling to the child, their siblings, parents and
grandparents around a variety of issues.
These might include adjustment to diagnosis/prognosis,
anticipatory grief or bereavement.
Providing crisis intervention- helping to cope with the problem
Assisting with communication between family and medical
team.
Connecting to community resources and trauma services.
Providing group counseling programs for common cases.
Participating in discharge planning.
Advocating on behalf of the child and family on medical
treatment and other services.

100. Social Work Practice at Selected…
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Social Work in the Psychiatric Unit
Social workers provide an array of services within a
psychiatric hospital.
Clinical social workers provide insight-oriented, behavior
modifying and supportive psychotherapy.
Psychiatric social workers are among the core staff of the
unit
A psychiatric social worker helps the mental health
professionals-psychiatrists and families of patients in a
similar way as counselors and psychologists do.
Their main job is to assess patients and develop patients’
specific plans of care.
They also provide therapy or counseling services to
patients, as well as help family members to deal with
patients with mental illness in the family.

101. 
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Psychiatric social workers do interviews with
admitted patients, members of their families, agency
staff and others.
This is through collateral investigations to identify
range of services needed by patients & their families.
They develop a plan of care for each patient and
his/her family which may include:
Direct counseling, treatment provided by other agency
support services and/or referral to other agencies;
Conduct individual and group therapy sessions;
Instruct and direct other agency support staff in
therapeutic techniques;
Arrange for services from referral agencies;

102. 
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Review patient and family social situations as necessary
and modifies social plan of care as necessary
Explain the scope of services to the patient and family as
is appropriate;
Provide direct crisis intervention services when required;
Maintain case records and prepares reports;
Participate in development of multidisciplinary plans of
care and their reviews;
Facilitate development of interdisciplinary active
treatment plans,
Write monthly summaries of progress toward active
treatment goals,
Arrange interdisciplinary reviews of active treatment plan
periodically.

103. Social Work Practice at Selected…
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Social work with chronic illnesses
Chronic illnesses are diseases that persist on a person
for along time and typically can’t be cured.
However, there are some which are manageable or
treatable e.g. obesity
These diseases usually last for 3 months and above.
Examples of such diseases include:
Heart diseases, lung cancer, arthritis, asthma,
depression, chronic kidney disease,
HIV, diabetes, high blood pressure, stroke, colorectal
cancer, epilepsy, chronic obstructive pulmonary disease,
Bronchitis, thyroid disease, mental illness, sickle-cell-
anemia, cerebral palsy,

104. Social Work Practice at Selected…
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Social work with chronic illnesses
Social workers provide a range of interventions and
supports in relation to chronic diseases including:
Psychosocial assessments and case management
Counseling and self-management support for patients in
managing their own care.
Forming and supporting self-help groups of common cases.
Community and multidisciplinary work for public education and
rehabilitation
Decision support for the health care providers that is based on
evidence-based practice.
Helping to clinical information systems that allow patients to
have access to population data.
E.g. how many people living with diabetes, HIV, cancer & other CDs
What is the importance of having access to such information?
Linkages to community resources to facilitate care beyond the
scope of the clinical environment (i.e. housing, social services)
Advocacy for policy and practice improvement and change for
chronic illness patients.

105. Social Work Practice at Selected…
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Cardiac care social work
The unprecedented industrialization and urbanization with
consequent changes in the life styles are leading to enhanced
stress and strain.
This have resulted in a dramatic increase in the number of heart
attacks.
Now a days cardiovascular disease (CVD) is one of the leading
cause of death and disability in both developed and many
developing countries.
There are lots of contributing factors including:
Excess use of fats and cholesterol in the blood, high blood
pressure,
Overweight, diabetes, smoking.
Depression, anxiety, anger, emotional stress and physical
inactivity
Social workers in cardiac unit can improve quality of patients' life
in many ways and they can take lots of roles including:

106. Social Work Practice at Selected…
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Cardiac care social workers do several activities in:
Addressing social service needs,
Providing mental health treatment
Assisting in the completion of standard cardiac rehabilitation
assessment
Preparing patients for life after leaving a residential setting
Providing support to clients and family members in the forms
of discharge planning
Case management and referrals
Support management of catastrophic disabilities
Looking for resources and support networks
Support medication adherence
Management and protect patients from committing suicide.
Support terminal illness management
Support end of life decisions
Psychosocial and grief counseling

107. Hospice and Palliative Care Social Work
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Hospice and palliative care social workers provide critical
support to individuals facing chronic pain, a terminal
illness, or both.
Hospice is a medical care for people with an anticipated
life expectancy of 6 months or less & cure is not an option.
The purpose of support services is symptom & pain
management to improve the quality of life in the remaining
short span 
Palliative care is medical treatment that does not seek to
cure disease, but helps patients manage the pain &
symptoms of their condition.
Hospice care includes palliative care, but palliative care
also applies to patients who are not suffering from
terminal illnesses and who require non-curative remedies.

108. Hospice and Palliative Care Social Work
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The simultaneous distinction and overlap between
hospice and palliative care means that social workers who
work in hospice care by necessity work in palliative care,
While palliative care social workers may not work in
hospice settings.
Hospice social workers help clients and their families:
Support to plan and create readiness for end-of-life care;
Help to understand their treatment plan and speak
about their needs;
Help to manage the stresses of debilitating physical
illnesses, emotional, familial, financial and other
stresses
Empower to overcome crisis situations
Connect patients and families to other support services.

109. Hospice VS. Palliative Care
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Hospice is comfort care without curative intent
The patient no longer has curative options
No choice not to pursue treatment because the side
effects outweigh the benefits. 
Palliative care is comfort care with or without curative
intent.
Both hospice and palliative provides psychosocial
support
When it hospice- to make the end of life process
smooth
While palliative to smoothen the end of life or to cure
through psychosocial support

111. 
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Role and duties of hospice and palliative care social
workers
Hospice and palliative care social work is challenging
work, as it involves helping people through difficult and
stressful times of their lives.
However, the rewards may include making strong
connections with people, learning and celebrating their life
stories, and having a positive impact on clients and their
families.
As in other social work specialty areas, bio-psychosocial
assessment guides practice and is repeated throughout
the episode of care.
Assessments focus on the goals, needs, and strengths of
both the patient and family caregiver(s).

112. Social Work Practice at Selected…
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Palliative care is an approach that improves quality of life
for patients and their families facing the problems
associated with life-limiting illness.
This is accomplished through the prevention and relief of
suffering by means of early identification and
comprehensive assessment and treatment of pain and
other physical, psychosocial, and spiritual problems.
Palliative care provides relief from pain and other
distressing symptoms;
Affirms life and regards dying as a normal process;
Intends neither to hasten nor to postpone death;
Integrates the psychological and spiritual aspects of
patient care;
Offers a support system to help patients live as actively
as possible until death;
Offers a support system to help the family cope during the
patient’s illness and in their own bereavement;

113. 
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Summary of Roles of social workers in hospice and palliative
Counseling and psychotherapy for individuals, couples, and families;
Providing psychosocial education to patients and family caregivers about
coping skills, hospice and palliative care philosophy, and non-
pharmacological symptom management strategies;
Leading community education workshops;
Planning for discharge, coordinating care, and helping clients navigate
systems;
Facilitating advance care planning and lifespan planning; Intervening in
crises;
Mediating conflicts within families, between clients and the interdisciplinary
team, and between service organizations;
Participating in interdisciplinary team meetings, care planning, and ethics
consultations;
Advocating on behalf of the patient and family;
Identifying and linking clients with resources;
Facilitating psycho-educational support groups; and documenting social
work activities.

114.
Social Workers working People with HIV/AIDS
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On an individual level, social workers provide a range of
services and supports to people living with HIV/AIDS . 
They can help individuals to navigate:
Community resources,
Government support,
Legal services and other systems,
All the services should be based on empowering their
clients to make informed decisions about their health.
Role and responsibilities of SWs
Depending on the role and the organization, social
workers working in the HIV/AIDS field provide supports:
Holding individual counseling and psychotherapy
sessions for individuals, couples and families

115. Social Workers working People with
HIV/AIDS
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Conduct support groups for people living with HIV/AIDS and their
partners, children and friends
Work as part of an interdisciplinary team to develop individualized
treatment plans
Liaise with agencies, organizations and service providers to offer
additional support or augment what already exists
Make referrals to community resources
Advocate on behalf of people living with HIV/AIDS, families,
groups and communities, as needed. E.g. free ART the result of
advocacy
Develop and deliver education to individuals, families and
communities- for PLWHA and also for the public
Perform community health needs assessments and participate in
community health planning
Plan, develop and evaluate community programs
ART adherence counseling and follow up
Establish support groups and follow up- stigma & discriminations
were so intense in the previous times

116. Social Workers at Burn Unit
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Social workers responsibilities in burn centers and out of
burn centers include:
Community education about prevention, treatment
and other duties.
Patient counseling & family counseling- how to cope
& thrive with the new image
Provide initial trauma and grief and bereavement
counseling as required.
Support group facilitation & discharge planning,
Supporting for school reentry/back to work programs,
Provide immediate crisis intervention and support to
patients, families and care givers.
Assess and attend to the immediate practical needs of
patients, families and care givers.

117. Social Workers at Burn Unit
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Provide information regarding:
Trauma responses,
Burn injury and the recovery process,
Children’s and adolescents’ responses to trauma and
loss,
Information regarding available local services.
Assist with accommodation, financial assistance and
access to legal assistance and information
Provide support to patients, families and patients
throughout official interviews with police or other
agencies
Liaise with relevant hospital staff and government and
non-government agencies as required.

118. Social Work in the Rehabilitation Units of
health
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This unit deals with problems include:
Breast cancer,
Pregnancy,
Breastfeeding,
Menopause,
Mental health, aging etc.
Rehabilitation is a complex, multidimensional approach within
health care that uses an interdisciplinary model of specialized
services.
Team work is one of the most fundamental factors in
rehabilitation medicine.
Different professionals, assessments, and evaluations are
brought together to obtain a holistic view of the patients
problems.
This allows realistic rehabilitation measurements to be taken.

119. Social Work in the Rehabilitation Units of
health
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Professionals in the multidisciplinary model usually work
independently to accomplish discipline specific goals and they
share information for decisions.
Social workers play a number key roles in the treatment team
including:
Initial screening and evaluation of patients and families needs.
Helping patients and family members to deal with many
aspects of the patients conditions-social, financial, emotional
etc.,
Helping patients and families to understand their illness and
treatment options
Aid and expenditure decision making on behalf of patients and
their families.
Educating patients on the roles of members of their recovery
team including physicians, nurses, etc.

120. Social Work in the Rehabilitation Units of health…
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Crisis intervention
Providing compressive psychosocial assessment of
patients.
Educating patients and families about post hospital
care
Helping patients adjust to their inpatient rehabilitation
setting.
Care coordination, discharge planning, continuity of
care following discharge, and community reintegration. 
Acting as an advocate for patients and families
including as an advocate for the patients health care
rights
Rehabilitation counseling to adjust with the new
situation or to regain careers etc.
Rehabilitation counseling focuses on patients’ families
and community strengths, resources, abilities, skills and
empower them to solve or adjust with the new health
condition

121. Hospital Social Workers in Rural Health
Institutions and Communities
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Many social problems continue to affect rural
communities more severely than urban ones.
As a result, rural social work practitioners face different
obstacles when serving in those areas.
In order to offer the most effective support, rural social
workers need to understand those unique challenges
and think creatively about how to solve them.
E.g. Across the United States, there are close to 650,000
social workers, of which 80 percent are located in cities.
In Ethiopian social workers are rare even in urban
settings
Existing social workers majority are in NGOs, the others
are in gov’t offices

122. Hospital Social Workers in Rural
Communities
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Even in the western context, there is high
concentration of social work professionals in urban
areas.
This leaves individuals and families in geographically
less-populated areas inadequately covered by critical
social support systems.
In USA, rural and frontier communities have nearly
140 percent more Health Professional Shortage
Areas than their urban counterparts.

123. Hospital Social Workers in Rural
Communities
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No medical/rural social workers in Ethiopia but there
are generalist, short term-trained para-social workers.
They are known as community social workers like
health extension workers
Most of them hired by NGOs & there is no gov’t
structure in Amhara region particularly
Addis Ababa City Administration has formal structure
up to kebele level,
Oromia and other regions they are in progress
It is a hot point of advocacy since long times and still
not solved nationally

124. Chapter 4. Hospital Social Work Practice in Ethiopia
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Healthcare policies and medical care in Ethiopia
This chapter deals about policies, programs,
guidelines, standards related to healthcare at
hospitals and other medical centers.
Ethiopia's health service is structured mainly into a
three-tier system: primary, secondary and tertiary
levels of care . 
Recent initiatives & processes are started to establish
quaternary care services
Each level of services has its own specific minimum
requirements standard guidelines.
The primary level of care includes primary hospitals,
health centers and health posts.
There are around 15,000 health posts and about
30,000 women trained to run them.

125.
Hospital Social Work Practice in Ethiopia
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Tertiary and advanced care systems are growing fast
both in private and public as compared to the previous
but the gap between the demand and supply is very
huge.
Affordability for the majority is also questionable
The secondary level of care consists of general
hospitals that serve 1 to 1.5 million people. 
The tertiary level of health care specialized hospitals
and serves 3.5 to 5.0 million people.
 
Only major cities have hospitals with full-time
physicians, most of which are in Addis Ababa.
 Access to modern advanced healthcare is very limited,
and in many rural areas it is virtually nonexistent.
The government has public health as a national priority
and they have implemented initiatives.

126. Hospital Social Work Practice in
Ethiopia
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Major health concerns include:
Malaria, TB, HIV, malnutrition, car accident, maternal
and child health, hepatitis B &C, respiratory infection,
leprosy, and diarrhea are among the serious health
problems of Ethiopia
Ethiopia has also seen an increase in non-
communicable diseases including
Cancer, diabetes, heart diseases, and high blood
pressure.
Mental health and eye problems are also becoming
major issues in Ethiopia.   
Gov’t is working towards feasible solutions to
address these chronic, acute & emerging diseases

127.
Chapter 4. Hospital Social Work Practice in Ethiopia
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According to the World Health Organization, Ethiopia’s
healthcare sector is financed by multiple sources.
These include loans and donations from all over the
world (46.8%), the Ethiopian Government (16.5%), out-
of-pocket payments (35.8%), and others (0.9%).
There are lots of actors in the health system including
multilateral, bilateral, international NGOs, private,
Social workers are included formally in the recently
revised tertiary hospital policy in Ethiopia
See the CH requirements guideline
A gap for policy advocacy and activism to enhance the
health care system

128. Thank you!!!