The Role of Social Work in Pediatric Pulmonary Susan Horky, LCSW Pediatric Pulmonary Division University of Florida

Which of these is a social worker? What does a social worker do? What comes to mind when you think “Social Work” or “social worker”?

Overview What does a Social Worker do?? What does a Social Worker do?? Social Work in pediatric healthcare Social Work in pediatric healthcare CasesCases

What does a Social Worker do? concrete services resource information case management discharge planning advocacy/policy social welfare/child protection BSW, MSW MSW,LCSW PhD psychotherapy research medical social work administration MSWs may do some or all of these

Medical Social Work Early 1900s 2007 History of Social Work 1920s Child Guidance/Psychiatric Social Work Child Welfare/Social Policy 1890s

History of Social Work- Child Welfare Providing food/shelter Job training Child labor laws Public health Federal programs for the poor

History of Social Work - Medical “to make medical care effective” Financial needs/resources Psychosocial support Adherence

History of Social Work- Child Guidance/Psychiatric Social Work Child Guidance Model: Psychiatrist sees child Social work works with family 1930s WWII- Social Workers do more therapy: Psychiatrists at war Psychiatrists doing meds 1940s Some Social Workers trained in psychoanalysis 1950s

Health

Top Ten Social Work Rules 1.Start where the patient is 2.The relationship is everything 3.Don’t judge a book by its cover 4.There is no big book in the sky 5.Concrete help may lead to counseling

Top Ten Social Work Rules 6.It takes two to tango 7.People are doing the best the know how 8.People bring their solutions, we figure out what the problem is 9.Emotions always underlie behavior 10.Don’t just do something, sit there!

Social Work in Pediatric Pulmonary Setting: Primarily Clinic Roles: –Psychosocial Assessment Child and family functioning Concrete needs Emotional needs –May depend on roles of other team members

Social Work in Pediatric Pulmonary (cont’d) Interventions: Support to child and/or family members Ongoing psychotherapy or referral for same (child or family members) Behavioral interventions Child behavior Parenting Adherence Groups

Social Work in Pediatric Pulmonary (cont’d) Assistance with concrete issues Community resources: WIC, Food Stamps, SSI Case Management: Agencies involved with child: school, after-school, outside therapist Conveying families’ views to team Discharge planning (has varied over time) Child protection

PPC Adjustment to illness Parenting issues Support Life stresses Relationships School Work SSI Insurance/Housing Transition/Voc Rehab

Goal is for Adaptation: Adaptation is achieved when the family’s POWER > LOAD

LOAD: Chronicity Unpredictability High Costs Extensive Daily Care Pain/embarrassment (physical appearance) Multiple providers Isolation

POWER: Healthy family dynamics: –Open communication –Mutual respect and support –Good differentiation –Shared problem solving and decision making –Role flexibility –Enhancement of personal growth

More Power: Knowledge of disease process and health care system Finding meaning in the illness Financial Security Sharing the Burden

Case taken from: Gropper, RC. Culture and the Clinical Encounter. Yarmouth, Maine: Intercultural Press, 1996

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