Cover Page

Praise for Handbook of Health Social Work, Second Edition

“The major strength is the organization and comprehensive content of the book. This is a book that can serve as a reference book in any social worker's library, regardless of whether they are practicing in a health-care setting. There are no other books on this topic that are as comprehensive in scope as the Handbook of Health Social Work, Second Edition.”

Deborah Collinsworth, LAPSW, NSW-C,
Director of Nephrology Social Work Services,
Dialysis Clinics, Inc., West Tennessee

“I’m quite impressed by the comprehensive nature of this revision. It's the enduring kind of text that serves an immediate purpose for social work instruction while also providing a reference for future practice. This is a book that you’ll want to keep on your shelf.”

Kevin Lindamood,
Vice President for External Affairs at Health Care for the Homeless,
Adjunct Professor of Health Policy at the University of Maryland SSW

“Sarah Gehlert and Teri Browne have thoughtfully covered the topics. The readers of this book will be empowered to deal with the daily challenges. It's simple but far reaching, a rich knowledge bank of social workers’ interventions, and will benefit even policy makers in planning strategies to improve patients’ quality of life.”

Sujata Mohan Rajapurkar,PhD,
Medical Social Worker and Transplant Coordinator,
Muljibhai Patel Urological Hospital, Gujarat, India

“The book's strengths include the high quality of writing and the expertise of its contributors. It covers the field of health social work in significant depth and is sure to leave readers well informed.”

Mary Sormanti, PhD, MSW,
Associate Professor of Professional Practice,
Columbia University School of Social Work

“Quite simply, this is the definitive volume for Health and Social Work. The first edition was well-executed, well-written, and comprehensive. In this second edition, Gehlert and Browne and their expert contributors have confidently managed to keep pace with current theory and empirical research across a wide range of subject matter that will be of interest to practitioners, educators, and researchers.”

Michael Vaughn, PhD,
Assistant Professor, School of Social Work,
School of Public Health,
and Department of Public Policy Studies, Saint Louis University

HANDBOOK OF HEALTH SOCIAL WORK

SECOND EDITION

Edited by

SARAH GEHLERT and TERI BROWNE

Title page

Foreword

It is both an exciting and a challenging time to be a social worker in the field of health. A diversity of roles is available for social workers. Areas of practice and opportunities for inter- and transdisciplinary collaborations are unprecedented in the history of the profession. Social workers along with other professionals are on the cutting edge of new health-relevant programs and practices, with social workers frequently in top leadership roles in these efforts. To note just a very few examples, social workers are providing genetic counseling and mental health treatment, coordinating hospice and palliative care, working with communities to develop better access to cancer care and clinical trials, advocating for and writing improved health-relevant policies, developing health programs and practices, and conducting research that provides an evidence base for effective practice in social work and other professions.

A number of events and trends have come to bear on this blossoming of social work in health. The Patient Protection and Affordable Care Act of 2010 (PPACA), itself the result of decades of advocacy and study on the part of many, including social workers, will radically change the context in which health care is delivered in the United States. This change will require profound and unsurpassed expertise in complex systems and their relationships to users of health care that is the domain of social workers. Effective implementation of the PPACA will require social work expertise at all levels, from front-line practitioner to policy maker and executive.

The evidence-based practice movement in social work and other health professions also has been integral to the rising importance of social work in health. From first-level, or T1, translation of research findings to cultural and community tailoring and dissemination and diffusion, social work has a principal role to play in getting health knowledge and knowledge-based practice to the populations that most can use it. Indeed, social work has been and will continue to be a key source of research producing such knowledge. As the profession is focused on improving people's well-being through practice that targets interrelationships among systems and people, social work research is of great consequence for knowledge production on which to base health-care reform and other efforts to improve health care in the United States. Thanks to the concerted and strategic efforts of academic social work and professional social work organizations, health social work research is growing and beginning to flourish.

The growth of the social determinants perspective on health has fostered a crucial place for social work in health. As a profession, social work has long understood the importance of multiple life dimensions and experiences as they affect human well-being across the life cycle and has built its practice on such a perspective. As other health professions catch up in this area, social work's contributions can be very influential in helping to prevent reinvention of the wheel in both health care and disease prevention.

I have noted just a few of the phenomena leading to social work's rich contributions to health and great potential for even more. As a postdoctoral fellow in applied anthropology, I once worked in a hospital setting on a geriatric consult team. Repeatedly I went to social work staff for information and advice. Indeed, my team (which included physicians, a nurse, and a pharmacologist) held to the mantra of “go ask a social worker, they know everything!” The breadth and depth of social work expertise in health is reflected in and supported by the material in the current work.

This volume is a crucial addition to the libraries of seasoned practitioners as well as an essential foundation for fledgling social workers ready to enter health as a practice and research area. Both editors are respected leaders in the field of health and social work with an abundance of experience, knowledge, and passion for their work. They have brought together a multiplicity of impressive contributors, all authorities in their respective areas, who share their knowledge and wisdom. The Handbook's contributors address multiple theoretical foundations, models, issues, and dilemmas for the social worker in health. Included are descriptions of skill sets and other expertise needed for direct practice clinicians, community workers, planners, policy makers, researchers, advocates, and administrators. The volume covers practice and research areas ranging from chronic disorders to infectious disease, from physical to mental disorders, and all the gray areas in between.

However, the book is not simply a how-to manual. Rather, it assesses the current state of the field while suggesting important new directions and developments for the future of social work in health. The ideas in this volume suggest that, perhaps, there is some truth to the sentiment that “social workers know everything.” Certainly they know a great deal about working to improve health and about what will be needed in the future to improve the nation's health. At a time of great change in the United States in regard to facilitating the production of better health for populations and individuals, any social worker engaged in this area would be well advised to have this outstanding resource at hand.

Suzanne Heurtin-Roberts
Bethesda, Maryland

Acknowledgments

The preparation of the second edition of this Handbook involved the efforts of a number of people. First and foremost was Jerrod Liveoak, a very talented young man who again helped us organize and edit the Handbook. We could not have done it without his assistance. Rachel Livsey and Kara Borbely of John Wiley & Sons’ behavioral science division were supportive throughout the process. We join them in mourning the loss of Lisa Gebo, a gifted member of the John Wiley & Sons team who worked with us on the first edition and lost her life to breast cancer on June 14, 2010. We also would like to thank these colleagues who reviewed the book and provided valuable feedback: Gary Rosenberg, Mount Sinai School of Medicine; Mary Sormanti, Columbia University; Judy Howe, Mount Sinai School of Medicine; Kevin Lindamood, University of Maryland; Deborah Collinsworth, Union University; and Michael Vaughn, St. Louis University. The 36 contributors to the Handbook, some of whom were friends and others known to us only by reputation prior to the collaboration, worked hard and were patient with this revision. Finally, we would like to thank our spouses, Roy Wilson and Lyle Browne, who were always willing to listen to our ideas and to provide feedback and support.

List of Contributors

Terry Altilio, MSW, ACSW
Beth Israel Medical Center
New York, New York

Wendy Auslander, PhD
Washington University
St. Louis, Missouri

Shantha Balaswamy, PhD
Ohio State University
Columbus, Ohio

Rose A. Bartone, MSW, LCSW-R
New York Medical College
Valhalla, New York

Candyce S. Berger, PhD
Stony Brook University
Stony Brook, New York

David S. Bimbi, PhD
LaGuardia Community College
Long Island City, New York

Penny B. Block, PhD
Block Center for Integrative Cancer Care
Evanston, Illinois

Sarah E. Bollinger, MSW, LCSW
Washington University
St. Louis, Missouri

Rebecca Brashler, MSW, LCSW
Rehabilitation Institute of Chicago
Chicago, Illinois

Teri Browne, PhD
University of South Carolina
Columbia, South Carolina

Yvette Colón, PhD, ACSW, BCD
American Pain Foundation
Baltimore, Maryland

Julie S. Darnell, PhD
University of Illinois at Chicago
Chicago, Illinois

Sadhna Diwan, PhD
San Jose State University
San Jose, California

Malitta Engstrom, PhD
University of Chicago
Chicago, Illinois

Iris Cohen Fineberg, PhD
Lancaster University
Lancaster, United Kingdom

Stacey Freedenthal, PhD
University of Denver
Denver, Colorado

Les Gallo-Silver, MSW, ACSW, CSW-R
LaGuardia Community College
Long Island City, New York

Daniel S. Gardner, PhD
New York University
New York, New York

Sarah Gehlert, PhD
Washington University
St. Louis, Missouri

Susan Hedlund, MSW, LCSW
Hospice of Washington County
Portland, Oregon

Suzanne Heurtin-Roberts, PhD, MSW
United States Department of Health and Human Services
Bethesda, Maryland

J. Aaron Hipp, PhD
Washington University
St. Louis, Missouri

Edward F. Lawlor, PhD
Washington University
St. Louis, Missouri

Sang E. Lee, PhD
San Jose State University
San Jose, California

Colleen A. Mahoney, PhD
University of Wisconsin
Madison, Wisconsin

Jeanne C. Marsh, PhD
University of Chicago
Chicago, Illinois

Christopher Masi, MD, PhD
University of Chicago
Chicago, Illinois

Shirley Otis-Green, MSW, ACSW, LCSW
City of Hope National Medical Center
Duarte, California

Kate Reed, MPH, ScM
National Coalition for Health Professional Education in Genetics
Lutherville, Maryland

John S. Rolland, MD
Chicago Center for Family Health
Chicago, Illinois

Marjorie R. Sable, DrPH
University of Missouri
Columbia, Missouri

Deborah R. Schild, PhD
Public Health Social Worker
Ann Arbor, Michigan

Jared Sparks, PhD
Ozark Guidance
Springdale, Arkansas

Nancy Boyd Webb, DSW, LICSW, RPT-S
Fordham University (retired)
New York, New York

Allison Werner-Lin, PhD
New York University
New York, New York

Terry A. Wolfer, PhD
University of South Carolina
Columbia, South Carolina

Introduction

In a faculty meeting a few years ago, a colleague from another profession referred to the “lower-level skills” of social workers in health care. She distinguished these skills from the “higher-level skills” of social workers in mental health settings. I addressed her comment by citing the broad array of information that social workers in health care must possess and be able to access quickly in order to assess client situations and devise optimal plans in the limited time available to them in health-care settings. I characterized the process as highly challenging, requiring skills at least as well developed as those of social workers in other arenas. This exchange between my colleague and me made me realize two things. First of all, health social work is not well understood by those working in other subfields of social work and other disciplines. Second, it would behoove health social work scholars to better define and represent the subfield.

As health care becomes increasingly more complex, social workers have much to know. We have yet to fully understand what the Patient Protection and Affordable Care Act that was enacted in March 2010 means for the health of the nation or what it means for social work practice and research. We do know that current federal approaches to addressing complicated health conditions like HIV/AIDS and cancer argue strongly for simultaneous attention to factors operating at the social, psychological, and biological levels (see, e.g., Warnecke et al., 2008). As members of health-care teams that take these approaches, social workers must possess sufficient knowledge at the social, psychological, and biological levels to converse productively with other team members and to work in concert with them constructively. In addition, to be effective, social workers must be aware of how these factors operate with individuals, families, groups, communities, and societies. This awareness is best accomplished by engaging community stakeholders at many levels in research.

The Handbook of Health Social Work was developed to prepare students to work in the current health-care environment in which providers from a number of disciplines work more closely together than was ever the case in the past. Health care in the United States has moved from being multidisciplinary to being interdisciplinary, with the ultimate goal of being transdisciplinary. In multidisciplinary environments, professionals from different disciplines work on the same projects but speak their own languages, view health care through their own disciplinary lens, and often share knowledge with one another after the fact. Interdisciplinary teams interact more closely, but each discipline continues to operate within its own boundaries. Because an interdisciplinary approach almost never provides a broad enough view of health-care conditions to capture their inherent complexities, transdisciplinary teamwork has become the exemplar. Here health-care professionals work so closely together that they must develop a shared language and pool the best of their separate disciplinary theories. Absent this new, more interdependent approach, the team is reminiscent of the old cartoon of a roomful of blindfolded people touching different parts of an elephant, with each describing the beast based only on the part that she is touching. One might base his description on the trunk, another on the ears, and a third on the tail. To address complex health conditions like HIV/AIDS effectively, we must recognize the elephant in the room.

In 2009, my coeditor, Teri Browne, and I were asked by John Wiley & Sons if we would be interested in revising the Handbook. A good deal has changed on both the national and international fronts in the 4 years since the first edition was published. The mapping of the human genome in 2004 continues to change how we view and approach the treatment of disease. Our ability to treat some disorders has increased markedly. Over the four years between the first and second editions, increasing numbers of people lost their health-care coverage. Although health-care reform holds the potential to ensure that citizens have coverage, this is not true for those who are undocumented immigrants, and exactly how reform will impact the nation's steadily increasing health disparities remains a question.

These changes will continue, and require a great deal of flexibility on the part of health social workers. As was the case with the first edition of the Handbook of Health Social Work, the second edition considers social workers in health care to be active problem solvers who must draw from a variety of germane bodies of information to address the issues and problems faced by individuals, families, groups, communities, and societies. We believe that this approach allows flexibility and thus positions health social workers to deal optimally with a changing health-care environment. The authors and layout of the second edition reflect this approach. Learning exercises at the end of each chapter are designed to stimulate discussion and help readers process the information provided and consider it analytically. The book's chapters are sandwiched between a foreword by Suzanne Heurtin-Roberts and an afterword by Candyce Berger, both of whom have broken ground as social work leaders in health-care practice and research and done much to raise the profile of the profession.

The book is divided into three sections. Part I, Foundations of Social Work in Health Care, provides information that we consider basic and central to the operations of social workers in health care. In Chapter 1, “Conceptual Underpinnings of Social Work in Health Care,” Sarah Gehlert again discusses the principles that underlie the development of social work in health care and follows its course through time to discover any changes in principles and activities that may have occurred. Chapter 2, “Social Work Roles and Health-Care Settings,” by Teri Browne, carefully outlines the wide array of roles performed by social workers in health-care settings today. After providing a framework for ethical decision making, Chapter 3, “Ethics and Social Work in Health Care,” by Jared Sparks, again considers some key issues confronting social workers in health care in a variety of arenas, from practice with individuals to policy development. All three chapters take into account the unique challenges facing health care in the United States.

Public health social work recently was named as one of the top 50 professions by U.S. News & World Report, and training programs that combine the two continue to grow. Because of this, and because social work has for a long time played an integral role in the public health of the United States and other parts of the world, Chapter 4, titled “Public Health and Social Work,” is an essential component of the Handbook, to orient readers to the public health perspective. J. Aaron Hipp, a community psychologist who works in a school of public health, joined health social workers Marjorie R. Sable and Deborah R. Schild in revising the chapter. The chapter introduces readers to the concepts of primary, secondary, and tertiary health care and considers health from a wider lens than is often used, including global patterns of health and disease. Chapter 5, “Health Policy and Social Work,” written by Julie S. Darnell and Edward F. Lawlor, is almost totally revised from the first edition. It presents basic information on the interplay
among clinical, administrative, and policy issues in health care. Although it is beyond the scope of this book to cover all possible health policies and considerations, an overview of the most pertinent policies and issues is provided. The authors address the likely sequelae of health care reform. Chapter 6, “Theories of Health Behavior,” by Sarah Gehlert and Sarah E. Bollinger, outlines five key theories and methods that can help guide social work practice and research in health care. Empirical evidence for their use in certain situations is provided.

Part II is titled Health Social Work Practice: A Spectrum of Critical Considerations. Although cases and questions confronted by social workers in health care vary widely, certain critical issues should always be considered. The eight chapters in this part represent critical issues that should be considered in approaching cases or pursuing the answers to health-care questions, even though in time they may not prove to be germane to those cases or questions. Failing to consider issues such as religion, sexuality, or substance use may lead to incomplete understandings of cases or consideration of health-care questions. It was only after considering health beliefs, for instance, that Matsunaga and colleagues (1996) were able to understand why native Hawaiian women did not participate in breast cancer screening despite their high rates of breast cancer.

Because individuals and families do not operate independently but rather as parts of communities, an overview of the relationships between health and community factors is included in Part II. In Chapter 7, “Community and Health,” Christopher Masi again reviews significant evidence-based data and provides information about how knowledge about community factors can be accessed and included in social work activities in health care. The complex interplay of physical and mental health is addressed in Chapter 8, “Physical and Mental Health: Interactions, Assessment, and
Interventions.” The chapter, again prepared
by Malitta Engstrom, carefully outlines how to assess for mental health concerns and reviews a variety of interventions. In Chapter 9, “Social Work Practice and Disability Issues,” Rebecca Brashler again carefully frames social work practice with individuals and groups with disabilities and provides suggestions for practice. Because communication is central to the effective provision of heath care as it changes through time, the revised chapter titled “Communication in Health Care” is included as Chapter 10 in Part II of this Handbook. The chapter provides a basic framework for understanding the dynamics of health-care communication; reviews interventions for improving communication; considers the effect of culture, gender, race, and other salient factors on patient and provider communication; and provides guidelines for the use of interpreters. It also addresses the dynamics of health-care teams and social workers’ positions on teams.

In Chapter 11, “Religion, Spirituality, Health, and Social Work,” author Terry A. Wolfer, who is new to the Handbook, reviews the ways in which religion and spirituality affect health and individual and group responses to health care. Ways of incorporating religious and spiritual considerations into practice and policy are reviewed. Complementary and alternative treatments are reviewed in Chapter 12, “Developing a Shared Understanding: When Medical Patients Use Complementary and Alternative Approaches.” Author Penny B. Block provides information on the extent of alternative and complementary treatments in the United States and reasons for their use. She reviews a number of treatments and their histories and addresses the importance for social workers of being familiar with complementary and alternative techniques. Chapter 13, “Families, Health, and Illness,” again written by John S. Rolland, presents a framework for understanding the interplay between family structure and dynamics and health and addresses its implications for social work practice and policy in health care. Chapter 14, “Human Sexual Health,” addresses the relationship between sexuality and health and discusses ways to incorporate sexual and other intimate considerations into practice and policy. Authors Les Gallo-Silver and David S. Bimbi make the point that sexual and other intimate issues are more likely to be faced by social workers in health care than in other areas of practice.

Part III, Health Social Work: Selected Areas of Practice, contains nine chapters by social workers with extensive practice and academic experience. Selecting the areas to include was difficult, and the list is not meant to be exhaustive. Our aim was to present a range of examples of good social work practice in sufficient detail to provide a reasonable overview of social work practice in health care. The second edition of the Handbook includes a new chapter devoted to health social work practice with young patients: Chapter 15, “Social Work With Children and Adolescents With Medical Conditions,” by seasoned authors Nancy Boyd Webb and Rose A. Bartone. Chapter 16, “Social Work With Older Adults in Health-Care Settings,” outlines the issues central to practice with older adults and the challenges faced by social workers. Sang E. Lee joins Sadhna Diwan and Shantha Balaswamy as an author of the revised chapter. Because substance use is widespread today and can negatively affect health and response to treatment, it is important that social workers consider the topic in practice and policy. The revised Chapter 17, titled “Substance Use Problems in Health Social Work Practice,” again written by Malitta Engstrom, Colleen A. Mahoney, and Jeanne C. Marsh, carefully outlines the importance of considering substance use and abuse and provides guidelines for incorporation into practice and policy.

After providing background on end-stage renal disease and its psychosocial sequelae, in Chapter 18, “Nephrology Social Work,” Teri Browne reviews evidence-based social work interventions, policies and programs, and resources and organizations available to nephrology social workers. In Chapter 19, “Oncology Social Work,” Daniel S. Gardner joins Allison Werner-Lin as an author in the revised chapter. The chapter reviews psychosocial issues faced by patients with cancer and their families. Practice considerations are outlined and suggestions for interventions provided.

Issues of chronic illness are addressed by Wendy Auslander and Stacey Freedenthal in the revised and retitled Chapter 20, “Adherence and Mental Health Issues in Chronic Disease: Diabetes, Heart Disease, and HIV/AIDS.” Chronic conditions present a number of unique challenges to social workers, such as how to improve adherence to treatment recommendations. The authors outline these challenges and make suggestions for practice. Chapter 21, “Social Work and Genetics,” has been revised in light of myriad advances in our understanding of genetics and health that have occurred in the last several years. Kate Reed, from the National Coalition for Health Professional Education in Genetics, joins Allison Werner-Lin as an author of the chapter, which considers the role of social workers in helping patients and families learn and make decisions about genetic testing and cope with its results.

The management of pain in acute and chronic illness increasingly has become the domain of social workers in health care. Chapter 22, “Pain Management and Palliative Care,” orients readers to the effect of pain on behavior and functioning and reviews roles for social workers in pain management and palliative care teams. Terry Altilio, Shirley Otis-Green, Susan Hedlund, and Iris Cohen Fineberg are authors of the chapter. Finally, Chapter 23, “End-of-Life Care,” again by Yvette Colón, discusses how social workers can assist patients and families in dealing with these end-of-life issues effectively.

Our aim in preparing the Handbook of Health Social Work has been to provide a source of information that would help social workers to be active problem solvers rather than followers of routines and existing protocols. The book enables social work students to learn the foundations of practice and policy in health care (Part I), critical considerations in implementing practice and policy (Part II), and the ways in which social work is practiced in a number of arenas and with a number of health conditions (Part III).

We hope that the book will continue to be useful in professional education, allowing those already in practice to learn about issues such as pain management and alternative and complementary medicine that they might not have been exposed to while in school or had the opportunity to learn after graduation. It also is a valuable source of information on evidence-based practice in a variety of areas of health care.

Social workers in health care today face a number of challenges, some new and some that have always been with the profession. We hope that readers will use the 23 chapters of the Handbook of Health Social Work as a set of tools to help them better address the health-care needs of the individuals, families, groups, communities, and societies with whom they work.

Sarah Gehlert
St. Louis, Missouri

Teri Browne
Columbia, South Carolina

REFERENCES

Matsunaga, D. S., Enos, R., Gotay, C. C., Banner, R. O., DeCambra, H., Hammond, O. W., … Tsark, J. (1996). Participatory research in a native Hawaiian community: The Wai’anae Cancer Research Project. Cancer, 78, 1582–1586.

Warnecke, R. B., Oh, A., Breen, N., Gehlert, S., Lurie, N., Rebbeck, T., … Patmios, G. (2008). Approaching health disparities from a population perspective: The NIH Centers for Population Health and Health Disparities. American Journal of Public Health, 98, 1608–1615.

PART I
Foundations of Social Work in Health Care