Lorie Shekter-Wolfson, Dan Stapleton, Linda Prentice, Ted McNeill, Ann Bergman, Leota Embleton, Sharon Abbey, Anne Huot, Marion Bogo, Sorele Urman, Lilian M. Wells, Verna Chandler, and Samira Guirgis
Research into patient recovery and relapse indicates that many high-risk patients and families do not receive the services they need both in health care settings and in the community (Coulton, 1985). Health care professionals have become increasingly cognizant of the psychosocial risks of illness for patients and their families, and of the impact of family structure and support systems on patient compliance and rehabilitation. The identification of factors that predicate differential responses to illness and the modification of the underlying risks are effective ways to prevent psychosocial breakdown. A review of the recent empirical literature reveals a growing interest in efforts to improve the identification of patients and families in need of social work services and to develop screening mechanisms for use on hospital admission. Although the focus on the individual patient remains paramount, the role of the family is receiving increasing attention. The research to date has been performed primarily by hospital social work departments in collaboration with health care professionals and hospital administrators. Social Work in Health Care Social work practice in health care settings has been recorded since the early 1900s. However, changes in disease definition and treatment, in social and organizational concerns, and in service and professional orientation have created new and different demands for social work services (Bailis, 1985; Bergman, Contro, & Zivet, 1984; Hatfield, 1983; Rehr, 1984; Shevlin, 1983). Traditionally, social workers in health care settings have depended on referrals, primarily from physicians, to provide direct services to patients and their families (Shevlin, 1983). Until the mid-1900s, the major health concerns included infectious and contagious diseases, which often resulted in death. Today, chronic illnesses and their consequences, as well as a variety of psychological ailments including emotional disorders, social diseases, and stress, appear as the major personal and social-health problems encountered by health care professionals (Rehr, 1984). Although the physician maintains the traditional image as the key professional in the health care system, the treatment needs of patients often require the services of a variety of professionals. In addition to shifts in health concerns, such issues as fiscal restraints, technological advances, moves to community-based care, and demands for accountability have created severe tensions in modern health care settings (Rehr, 1984). The rapidly escalating costs of health care have created demands for restraint and have resulted in concerns about service access and equity and continuity of care. Technological advances have created changes and uncertainties leading to ethical questions for which professionals, patients, and families have not yet found answers. Increasing emphasis on community-based family care has sparked changing roles for hospitals and a necessity for not only fiscal, but also need-based criteria for admission, discharge, and linkage with family members and community services. Finally, as uncertainty and costs increase, the public, the government, and private interests have begun to demand proof of quality, rationale for decisions, and clear guidelines for practice. The crisis in health care--the new demands, and the need for answers--clearly points to the need for a redefinition of services. The impact on social work will be great. There has often been a lack of understanding of what social workers do as well as a lack of acceptance of the profession. Today, it is possible to predict the need for more, rather than less, social services in large medical institutions and community hospitals (Bergman et al., 1984; Rehr, 1984; Shevlin, 1983). Social workers must document their service effectiveness to gain more acceptance. They must objectify services, define expectations, clarify "what" and "for whom," and demonstrate that interventions are cost-effective. …