Essential - The Rising Role of Palliative Social Work
by Abigail Latimer, LCSW, AHPSW-C
There have been many moments in my clinical experience that have reminded me how fortunate I am to be present in some of the most intimate and difficult moments of peoples’ lives. Sitting cross-legged on the hospital bathroom floor with a 15-year-old, witnessing her intense grief was one such moment. I was able to be present in part because I had excellent and meritorious mentorship and direct leadership that respected and supported my unique role as the palliative care team clinical social worker (PCSW).
Often conflated with hospice care, which is dedicated to the last six months of life, palliative care (PC) is an extra layer of support for any patient of any age who is facing a serious illness (CAPC, n.d.). Social workers in medical settings have existed for decades, and with the promotion of integrated behavioral health (IBH) in primary care centers, the essential skill sets of social workers in these settings are necessary and valued (Ruth & Marshall, 2017). However, as IBH program developers are learning, there are barriers to facilitating quality integrated care (Acri et al., 2016). Healthcare professionals and social workers struggle with knowing their role and scope (Ashcroft, McMillan, Ambrose-Miller, McKee, & Brown, 2018). PCSWs have also contended with these issues, which are inherent to medical interdisciplinary teamwork (Head, Peters, Middleton, Friedman, & Guman, 2019). However, professional advancements have enabled PCSWs to be utilized to the best of their abilities and skill levels.
Arguably, the most helpful professional advancement has been the establishment of the first evidence-based certification exam for hospice and PCSWs, the Advanced Palliative and Hospice Social Work-Certification (APHSW-C) (Leff & Shukraft, 2019). This has elevated the professional standard of quality palliative and hospice social work and equals the expectation of other team members (i.e., nurses and physicians). Exam development required careful evaluation of existing hospice and palliative social work tasks, job descriptions, and training (Head et al., 2019). Job analysis combined with expert opinion of competency standards have implications for quality care, reimbursement, and training curricula (Glajchen et al., 2018).
Additionally, hospice and palliative social work are recognized as necessary components to quality of care on national levels. The National Consensus Project for the National Coalition for Hospice and Palliative Care released the Clinical Practice Guidelines (4th edition), which establish the standard of hospice and palliative care. Social workers are mentioned as essential to the structure and process of care; the psychological, psychiatric, and social aspects of care; as well as the well-being of the team itself (Altilio, Dahlin, Remke, Tucker, & Weissman, n.d.; NCP, 2018). PCSWs sit at the table in organizational leadership and team development.
These advancements have helped create a culture of interprofessional inclusion and recognition. They do not mitigate all sources of potential conflict and tension, and hospice and palliative social workers continue to contend with scope and practice confusion. However, they offer an exemplary model of interprofessional care. I am truly grateful for the experiences I have been able to have as a PCSW.
References
Acri, M., Bornheimer, L., O’Brien, K., Sezer S., Little, V., Cleek, A., & McKay, M. (2016). A model of integrated health care in a poverty impacted community in New York City: Importance of early detection and addressing potential barriers to intervention implementation. Social Work in Health Care, 55:4, 314-327, DOI: 10.1080/00981389.2015.1137256
Altilio, T., Dahlin, C., Remke, S., Tucker, R., & Weissman, D. (n.d.). Strategies for maximizing the health/ function of palliative care teams (Resource Monograph from the Center to Advance Palliative Care). Retrieved from https://www.capc.org/documents/download/98/
Ashcroft, R., McMillan, C., Ambrose-Miller, W., McKee, R., & Brown, J.B. (2018). The emerging role of social work in primary health care: A survey of social workers in Ontario family health teams. Journal of Health and Social Work, 43(2), 109-117.
CAPC. (n.d). About palliative care. Retrieved January 28, 2018. https://www.capc.org/about/palliative-care/
Glajchen, M., Berkman, C., Otis-Green, S., Stein, G., Sedgwick, T., Bern-Klug, M…Portenoy, R. (2018). Defining core competencies for generalist-level palliative social work. Journal of Pain and Symptom Management, 56(6), 886-892. Doi: https://doi.org/10.1016/j.jpainsymman.2018.09.002
Head, B., Peters, B., Middleton, A., Friedman, C., & Guman, N. (2019). Results of a nationwide hospice and palliative care social work job analysis. Journal of Social Work in End-of-life Care, 15(1), 16-33. Doi: https://doi.org/10.1080/15524256.2019.1577326
Leff, V. & Shukraft, A. (2019, March). Palliative care social work: A year of leadership. [Web Blog Post]. https://www.pallimed.org/2019/03/palliative-care-social-work-year-of.html
National Consensus Project [NCP]. Clinical Practice Guidelines for Quality Palliative Care. 4th edition. (2018). [Last accessed on 2019 January 22]. http//www.nationalcoalitionhpc.org/ncp.
Ruth, B., & Marshall, J. W. (2017). A history of social work in public health. American Journal of Public Health, 107 (Suppl 3), S236-S242.
Abigail Latimer earned her bachelor’s degree in psychology and master’s degree in social work from the University of Kentucky and is currently a doctoral candidate at University of Kentucky’s College of Social Work. Her research interests include advanced heart failure, gerontology, moral distress, palliative care, and grief.