Discussion 6205 : Psychosocial Aspects Of Cancer Cancer is often synonymous with fear, uncertainty, and death. A diagnosis of cancer begins a long journey

Cancer is often synonymous with fear, uncertainty, and death. A diagnosis of cancer begins a long journey that affects physical health, mental well-being, and relationships with loved ones. Although cancer care today often provides advanced medical treatment, psychosocial issues may not be adequately addressed (Artherholt & Fann, 2012). This failure may compromise the effectiveness of overall cancer management.

Oncology social workers play an integral role in cancer care in multiple settings. It is common for oncology social workers to engage in individual, family, and group intervention. In addition to providing direct patient care, oncology social workers provide valuable public health interventions, such as health education programs and policymaking.

To prepare for this Discussion:

Review this week’s resources. Select one of the many different types of cancer and think about the overall impact of the disease. Consider the psychosocial effects of cancer. How might cancer affect the health and well-being of an individual and caregivers?

Post an explanation of how this type of cancer might affect the health and well-being of the patient and caregivers. Explain the psychosocial effects of cancer on the patient and caregivers. Explain how psychosocial factors might impact a treatment care plan and the management of the disease. Finally, explain how you might address the psychosocial needs of a cancer patient and caregiver.

Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style.

Read a selection of your colleagues’ postings.

  • Expand on your post regarding the psychosocial effects of cancer on patients and caregivers by providing a different perspective.
  • Suggest different ways you might address the psychosocial needs of a cancer patient.

N A S W S t a n d a r d s f o r

Social Work
Practice

i n H e a l t h C a r e S e t t i n g s

N A T I O N A L A S S O C I A T I O N O F S O C I A L W O R K E R S

N A S W S t a n d a r d s f o r

Social Work
Practice

i n H e a l t h C a r e S e t t i n g s

National Association of Social Workers

Darrell P. Wheeler, PhD, ACSW, MPH

President

Angelo McClain, PhD, LICSW

Chief Executive Officer

Health Care Standards Expert Panel

Lisa E. Cox, PhD, LCSW, MSW

Terrie Fritz, LCSW

Virna Little, PsyD, LCSW-R

Shirley Otis-Green, MSW, ACSW, LCSW

Anthony Yamamoto, LCSW

NASW Staff

Stacy Collins, MSW

©2016 National Association of Social Workers.
All Rights Reserved.

Contents

5 Introduction

9 Goals

10 Definitions

14 Guiding Principles

16 Standard 1. Ethics and Values

17 Standard 2. Qualifications

18 Standard 3. Knowledge

22 Standard 4. Cultural and Linguistic Competence

24 Standard 5. Screening and Assessment

27 Standard 6. Care Planning and Intervention

29 Standard 7. Advocacy

31 Standard 8. Interdisciplinary and Interorganizational

Collaboration

33 Standard 9. Practice Evaluation and Quality

Improvement

34 Standard 10. Record Keeping and Confidentiality

37 Standard 11. Workload Sustainability

39 Standard 12. Professional Development

40 Standard 13. Supervision and Leadership

42 References

45 Acknowledgments

5

Introduction

Since the early 20th century, social work has
been an integral component of the U.S. health
care system, and the profession continues to
play a leadership role in the psychosocial
aspects of health care. Today, social workers
are present in settings across the health care
continuum, including prevention and public
health, primary and acute care, specialty care,
rehabilitation, home health, long-term care,
and hospice. Professional social workers
provide services to individuals and families
throughout the life span, addressing the full
range of biopsychosocial–spiritual and
environmental issues that affect well-being.
Social work’s strengths-based, person-in-
environment perspective provides the
contextual focus necessary for client- and
family-centered care and is unique among
the health professions.

A hallmark of social work’s commitment to
health and well-being is the profession’s
continued focus on the issue of health care
inequality in the United States. People living
in poverty and communities of color continue
to experience disproportionately higher rates
of acute and chronic illness, due to unequal
access to health care services, lack of health
insurance coverage, poverty, discrimination,
and other social determinants of health. Social
workers recognize that reducing health
disparities can only be accomplished by
addressing the biopsychosocial–spiritual needs
of individuals and families, as well as the
systemic issues that contribute to poor
health outcomes.

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The Evolving U.S. Health Care System

The U.S. health care system is in an era of
unprecedented change. In recent years, the
nation has witnessed continuing high rates of
uninsurance (13 percent of the U.S.
population, or 42 million people, were
uninsured in 2013 [U.S. Census Bureau,
2014]), inadequate coverage, escalating health
care costs, erosion of employer-based health
insurance, and increasing demand for health
care services as the baby boom generation
enters retirement. The Patient Protection and
Affordable Care Act (ACA) (2010) was
designed to address these issues. The goal of
the ACA is to expand access to affordable and
comprehensive health coverage, improve
patient outcomes, and increase the efficiency
and cost-effectiveness of the health care
delivery system. The ACA invests heavily in
care delivery models that promote
coordination of acute and postacute care and
greater integration of primary and behavioral
health services.

Challenges for the Profession

Their long-standing role in the health system
notwithstanding, social workers practicing in
health care settings today face significant
challenges. Ongoing changes in the financing
and delivery of health care and a shortage of
social work effectiveness data have contributed
to the reduction of social work services in
certain health care settings. Increasingly,
health care social workers are supervised by
individuals without social work degrees, and
tasks previously performed by social workers
are often assigned to other personnel,
including nurses, paraprofessionals, and
volunteers, in an effort to reduce costs.

7

Opportunities for Social Work in the ACA Era

Despite these challenges, health care social
work is poised to experience a resurgence in
the ACA era. With its emphasis on the “triple
aim”—improving the patient experience of
care (including quality and satisfaction),
improving the health of populations, and
reducing the per capita cost of health care
(Institute for Healthcare Improvement,
2014)—the ACA strengthens social work’s
traditional role in health care and offers new
opportunities for the profession.

The ACA promotes care delivery models, such
as the patient-centered medical home
(PCMH) and accountable care organization
(ACO), which are designed to improve health
outcomes and control health care costs. To
succeed, these models will rely on social
workers skilled and competent in health care
navigation, behavioral and mental health
integration, chronic care management, and
care coordination, among other skills. The
aging of the population will necessitate a need
for social workers skilled in transitioning
patients between different settings and levels
of care and managing complex discharges.

The anticipated influx of patients into the
health care system resulting from the ACA
insurance coverage expansion will increase the
need for social workers who are educated and
trained in working with diverse populations
and with clients who have challenging
physical, behavioral, and mental health needs.
Greater emphasis on community-based care
will require social workers skilled in reducing
nonmedical barriers to health care access. As
important, expanded social work involvement

8

in these roles and settings presents an
opportunity to advance the evidence base for
the profession.

Prevention and public health, traditional social
work roles, have gained renewed importance
under the ACA. With its ecological viewpoint,
the social work profession is well-positioned to
take a leadership role in new ACA prevention
initiatives, including workplace wellness, home
visiting, and smoking cessation programs. Social
workers are also well positioned to participate
in macro-level prevention efforts, such as policy
change to reduce obesity, which can improve
population outcomes more efficiently than
individual-actions at the clinical care level.
Furthermore, new research fields, particularly
patient-centered outcomes research and
community-based participatory research, offer an
opportunity for social workers to contribute to
the prevention and public health research base.

Purpose of the Standards for Social Work
Practice in Health Care Settings

These standards articulate the necessary
knowledge and skills health care social workers
should possess to deliver competent and ethical
services in today’s health care environment;
provide benchmarks for quality social work
practice for use by health care employers; and
assist policymakers, other health professionals,
and the public in understanding the role of
professional social workers in health care
settings. These standards are intended to
guide social work practice and may be applied
differently, as appropriate, to different health
care settings.

9

Goals

The specific goals of the standards are to

� Ensure that social work practice in health
care settings is guided by the NASW Code
of Ethics (NASW, 2008)

� Enhance the quality of social work services
provided to clients and families in health
care settings

� Advocate for clients’ rights to self-
determination, confidentiality, access to
supportive services and resources, and
appropriate inclusion in decision making
that affects their health and well-being

� Encourage social work participation in the
development, refinement, and integration of
best practices in health care and health care
social work

� Promote social work participation in
systemwide quality improvement and
research efforts within health care
organizations

� 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 tribal
levels to support the well-being of clients,
families, and communities served by the
rapidly evolving U.S. health care system

� Inform policymakers, employers, and the
public about the essential role of social
workers across the health care continuum.

10

Definitions

Social Worker

Within the United States, a social worker is an
individual who possesses a baccalaureate or
master’s degree in social work from a school or
program accredited by the Council on Social
Work Education. Although all 50 states and
the District of Columbia license or certify
social workers, licensure and certification laws
vary by state. Each social worker should be
licensed or certified, as applicable and required,
at the level appropriate to her or his scope of
practice in the practitioner’s jurisdiction(s).

Client

Client refers to the “individual, group, family,
or community that seeks or is provided with
professional services” (Barker, 2013, p. 73).
For purposes of these standards, the term
“client” refers to an individual. The term
“patient” is more commonly used by social
workers employed in health care settings.

Biopsychosocial–Spiritual Perspective

A biopsychosocial–spiritual perspective
recognizes the importance of whole person
care and takes into account a client’s physical
or medical condition; emotional or
psychological state; socioeconomic,
sociocultural, and sociopolitical status; and
spiritual needs and concerns.

Bioethics

Bioethics is “the analysis and study of legal,
moral, social, and ethical considerations
involving the biological and medical sciences”
(Barker, 2013, p. 41).

11

Case Management

Case management is a collaborative process to
plan, seek, advocate for, and monitor services,
resources, and supports on behalf of a client.
Case management enables a health care social
worker to serve clients who may require the
services of various health care providers and
facilities, community-based organizations,
social services agencies, and other programs.
Case management limits problems arising
from fragmentation of services, staff turnover,
and inadequate coordination among providers.
“Care coordination,” “care management,” and
“patient navigation” are sometimes used
interchangeably with “case management”
(Barker, 2013).

Cultural Competence

Cultural competence is “the process by which
individuals and systems respond respectfully and
effectively to people of all cultures, languages,
classes, races, ethnic backgrounds, religions,
and other diversity factors [including, but not
limited to, sexual orientation; gender, gender
expression, and gender identity; and family
status] in a manner that recognizes, affirms,
and values the worth of individuals, families,
and communities and protects and preserves
the dignity of each” (NASW, 2007, pp. 12–13).

Health Disparities

Health disparities are preventable differences
in the incidence, prevalence, mortality, and
disease burden that are closely linked with
social, economic, and environmental
disadvantage. Health disparities adversely affect
groups of people who have systematically
experienced greater obstacles to health based
on their race or ethnicity; religion;

12

socioeconomic status; sexual orientation;
gender, gender expression, and gender
identity; age; mental health; cognitive, sensory,
or physical disability; geographic location; or
other characteristics historically linked to
discrimination or exclusion (Centers for
Disease Control and Prevention, n.d.).

Social Determinants of Health

The social determinants of health are factors
that affect a wide range of health and quality-
of-life outcomes and are responsible for most
health disparities. These factors include income,
housing, education, employment, and access to
health services, among others. Social determinants
of health are shaped by the distribution of
money, power, and resources (Centers for
Disease Control and Prevention, n.d.).

National Standards for Culturally and

Linguistically Appropriate Services in Health

Care (CLAS Standards)

The National Standards for Culturally and
Linguistically Appropriate Services in Health
and Health Care (the CLAS Standards),
developed by the U.S. Department of Health
and Human Services (HHS), are intended to
advance health equity, improve quality, and
help eliminate health care disparities by
providing guidance to health care
organizations for implementing culturally and
linguistically appropriate services (HHS,
Office of Minority Health, 2013).

Patient Protection and Affordable Care Act

(ACA) (2010)

The ACA is a broad-based federal law that
seeks to reform the U.S. health care delivery
system by expanding health insurance

13

coverage, enhancing quality of care, improving
health outcomes, regulating the health insurance
industry, and reducing health care spending.

Patient-Centered Medical Home (PCMH)

The PCMH is a health care delivery model
accountable for meeting the large majority of a
person’s physical and mental health care needs,
including primary, acute, and chronic care.
Within a PCMH, an individual has an
ongoing relationship with a primary care
provider who directs and coordinates his or
her care across all elements of the broader
health care system, including physician
specialty services, hospitals, home health care,
and community services and supports (Agency
for Healthcare Research and Quality, n.d.-a).

Integrated Care

Integrated care is a health care delivery
approach in which primary care, mental
health, and behavioral health care services are
systematically coordinated and available in one
location (Substance Abuse and Mental Health
Services Administration & HHS, Health
Resources and Services Administration, Center
for Integrated Health Solutions, n.d.).

Chronic Care Model

The chronic care model is a widely used
approach to chronic illness management that
adapts the acute care delivery system to more
appropriately meet the needs of individuals
with chronic illness (Agency for Healthcare
Research and Quality, n.d.-b).

Accountable Care Organization (ACO)

An ACO is a group of physicians, hospitals,
and other health care providers who share

14

responsibility for providing coordinated care
to patients. Within an ACO, providers are
financially incentivized for meeting specific
quality and utilization benchmarks for a
defined patient population (Centers for
Medicare & Medicaid Services, n.d.).

Evidence-Informed Practice

Evidence-informed practice is practice based
on the best available research, practice
expertise, and available resources.

Guiding Principles

The NASW Standards for Social Work Practice
in Health Care Settings reflect the following
guiding principles of the social work profession:

� Self-determination: Social workers respect
and promote the right of clients to self-
determination and assist clients in their
efforts to identify and clarify their goals.

� Cultural competency and affirmation of the
dignity and worth of all people: Social
workers treat each person in a caring and
respectful fashion. With skills in cultural
awareness and cultural competence, social
workers affirm the worth and dignity of
people of all cultures.

� Person-in-environment framework: Social
workers understand that each individual
experiences a mutually influential
relationship with her or his physical and
social environment and cannot be
understood outside of that context. This
ecological perspective recognizes that
systemic injustice and oppression underlie
many challenges faced by clients.

15

� Strengths perspective: Rather than focus on
pathology, social workers elicit, support, and
build on the resilience and potential for
growth and development inherent in each
individual.

� Primacy of the client–social worker
relationship: The therapeutic relationship
between the social worker and the client is
integral to helping the client achieve her or
his goals.

� Social justice: At all levels, from local to
global, social workers promote and advocate
for social, economic, political, and cultural
values and institutions that are compatible
with the realization of social justice.

� Importance of social work research: Social
workers promote the value of research as a
means of improving the well-being of
individuals, families, and society;
strengthening the current workforce; and
maintaining the social work profession’s role
in health care settings.

16

Standards

Standard 1. Ethics and Values

Social workers practicing in health care
settings shall adhere to and promote the ethics
and values of the social work profession, using
the NASW Code of Ethics as a guide to ethical
decision making (NASW, 2015a).

Interpretation

The primary mission of the social work
profession is to enhance human well-being and
help meet the basic human needs, with special
attention to the needs of people and
communities who are vulnerable, oppressed,
or living in poverty. Social workers have an
ethical obligation to address the health care
needs of these groups and advocate for change
to ensure access to quality care.

The profession’s mission is rooted in core
values that have been embraced by social
workers throughout the profession’s history
and highlight social work’s distinct purpose
and perspective. These values—service, social
justice, dignity and worth of the person,
importance of human relationships, compassion,
integrity and competence—constitute the
foundation of social work and underlie the
practice of social work in health care settings.

The NASW Code of Ethics establishes the
ethical responsibilities of all social workers
with respect to their own practice, clients,
colleagues, employees and employing
organizations, the social work profession, and
society. Acceptance of these responsibilities—
which include upholding a client’s right to
privacy and confidentiality and promoting

17

client self-determination—fosters competent
social work practice in health care settings.

In a health care system characterized by
technological advancement and rapid change
in care delivery and financing of health care
services, ethical dilemmas among and between
clients, families, health care professionals, and
organizations are potentially numerous and
complex. The NASW Code of Ethics and
prevailing clinical bioethics provide a
foundation for social workers to manage such
dilemmas. Health care social workers have the
responsibility to know and comply with local,
state, federal, and tribal legislation,
regulations, and policies, addressing topics
such as guardianship; parental rights; advance
directives; and reporting requirements for
abuse, neglect, exploitation, suicide, and threat
of harm to others.

When an ethical dilemma or conflict occurs,
the health care social worker is expected to
employ available mechanisms, including social
work supervision, peer review, institutional
ethics committees, and external consultation,
to resolve the dilemma.

Standard 2. Qualifications

Social workers practicing in health care
settings shall possess a baccalaureate or
master’s degree in social work from a school or
program accredited by the Council on Social
Work Education, shall comply with the
licensing and certification requirements of the
state(s) or jurisdiction(s) in which she or he
practices, and shall possess the skills and
professional experience necessary to practice
social work in health care settings.

18

Interpretation

Social work degree programs provide the
fundamental education and training required
for all social work practice specialties. As an
area of specialization within the social work
profession, health care social work requires a
distinct skill set and knowledge base, as
outlined in these standards. Ideally,
prospective health care social workers should
have prior health care–related educational or
employment experience. At a minimum, it is a
health care social worker’s responsibility to

� Acquire and maintain social work licensure
or certification, as available, for the social
worker’s educational level and professional
experience

� Abide by a defined scope of practice, as
required by state law or regulation

� Adhere to supervision requirements
� Pursue ongoing professional development

activities, to acquire the competence
necessary to perform job responsibilities.

A health care social worker whose responsibilities
include the diagnosis of mental and behavioral
health conditions and/or the provision of
psychotherapy must have a master’s degree in
social work and should either be licensed at
the clinical level or, if the licensing jurisdiction
allows, perform clinical tasks under supervision.

Standard 3. Knowledge

Social workers practicing in health care
settings shall acquire and maintain a working
knowledge of current theory and evidence-
informed practice, and shall use such
information to ensure the quality of social
work practice.

19

Interpretation

As health care professionals, social workers
require specialized knowledge and skills. This
knowledge and skill base can be obtained
through multiple approaches, including
coursework and field practice in a social work
degree program, specialty practice credentials
earned after graduation, health care–related
employment experience, and ongoing
continuing education. Developing a knowledge
and skill base is a cumulative process that
requires a commitment to career-long learning.

Given the growing complexity of services
delivery systems and client needs, even
experienced health care social workers may
encounter situations requiring knowledge and
skills beyond the scope of their usual practice
setting. In such situations, the health care
social worker seeks supervision, consultation,
and continuing professional development, as
described elsewhere in these standards, to ensure
she or he has both the requisite knowledge of
health care delivery systems and the skills to
serve clients effectively. In addition, the social
worker may need to collaborate with health
care and other services providers on behalf of a
client, or refer a client to other social workers
whose expertise is more suitable to the client’s
needs and circumstances.

Knowledge and skills that are essential to social
work practice in health care settings include,
but are not limited to, the following areas:

Physical and mental/behavioral health

� The interplay between the physiological
elements of acute, chronic, and life-limiting
illness and biopsychosocial–spiritual health
and well-being

20

� Concepts and theories associated with life-
span development, neurobiology, and
behavioral change

� Grief, loss, and bereavement
� Depression, anxiety, and other mental

health conditions
� Addiction and other behavioral health

conditions
� Sexual health
� Concerns related to sexual orientation, gender

identity and expression, and gender roles
� Basic medical terminology
� Knowledge of common health conditions
� Counseling and behavioral change

intervention

Health care delivery system issues

� The health care continuum
� The unique needs of marginalized,

oppressed, and diverse populations
� Health disparities and the social

determinants of health
� Evidence-informed approaches to health

care, including the PCMH, integrated
primary and behavioral health care, ACOs,
and the chronic care model

� New health care policies and delivery
system changes resulting from the ACA

� Basics of health insurance coverage,
including Medicare, Medicaid, the
Children’s Health Insurance Program, and
commercial insurance plans

� Health care system trends, including
ongoing health care infrastructure changes

� Accreditation and regulatory standards
governing health care settings

� Thorough knowledge of community resources
� Micro-, mezzo-, and macro-level preventive

health care

21

Roles and responsibilities of social workers in

health care settings

� Understanding of common ethical and legal
issues in social work practice in health care
settings

� Biopsychosocial–spiritual assessment
� Use of the strengths perspective
� Client and family engagement in all aspects

of social work intervention
� Case management/care management/care

coordination/health care navigation
� Discharge and transition planning
� Client concordance with and adherence to

the plan of care
� Advance care planning
� Palliative care, including pain and symptom

management
� Hospice and end-of-life care
� Identification of child/elder/vulnerable adult

abuse, trauma, neglect, and exploitation
� Crisis intervention
� Facilitation of benefits and resource

acquisition to assist clients and families,
including an understanding of related
policies, eligibility requirements, and
financial and legal issues

� Advocacy with other members of the
interdisciplinary team and within the health
care institution to promote clients’ and
families’ decision making and quality of life

� Client, family, interdisciplinary, and
community education

� Family systems issues, including the impact
of health care concerns, illness, and disease
on family relationships; life cycles; and
caregiving roles and support needs

Research and evaluation

� Research and evaluation methodology

22

� Social work outcome/practice evaluation
approaches

� Opportunities for social work participation
in institutional quality improvement
programs and research projects

� Client and family education regarding
opportunities for clinical trial participation

� Ability to analyze research results and
incorporate findings into practice,
organizational quality improvement
initiatives, and advancement of the social
work profession

Standard 4. Cultural and Linguistic Competence

Social workers practicing in health care
settings shall provide and facilitate access to
culturally and linguistically appropriate
services, consistent with the NASW Standards
and Indicators for Cultural Competence in Social
Work Practice (NASW, 2015b).

Interpretation

The increasing racial, ethnic, and linguistic
diversity of the United States requires health
care social workers to strive continuously for
cultural competence. Recognition and
affirmation of cultural and linguistic diversity
are critical to both therapeutic alliances with
clients and cooperative working relationships
with colleagues. Given the many facets of
culture, every interaction between a health
care social worker and a client is potentially a
cross-cultural exchange, as two individuals are
unlikely to be identical in every aspect of
cultural identity.

The practice of health care social work requires
an understanding of the broad scope of
diversity in the United States. Client diversity

23

is expressed in many ways, including race,
ethnicity, socioeconomic class, sexual
orientation; gender, gender expression, and
gender identity; religion, age, health and
family status; cognitive, physical, or psychiatric
ability; and sensory differences, preferred
language, immigration status, degree of
acculturation, level of formal education, and
literacy, among others. Health care social
workers must also recognize that cultural self-
awareness is an integral component of cultural
competence. Such awareness entails
understanding how one’s own cultural values,
beliefs, biases, experiences, and perceptions
affect interactions with clients and colleagues.

Health care social workers must acquire a
cross-cultural knowledge base to provide
effective, culturally competent practice. In
particular, social workers must develop and
maintain an understanding of the history,
traditions, rituals, values, family systems, and
communication patterns of major client
groups served, as well as an understanding of
the influence of culture on help-seeking
behaviors and perceptions of health, illness,
health care treatments, disability, caregiving
roles, and death and dying among client/patient
groups served. So

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