• Podsoc #65

Hospital social work:

In conversation with Shelley Craig and Barbara Muskat

[Transcript of this podcast is found in the tab below]

Brokers, bouncers and glue are some of the self-described social work roles that Shelley Craig and Barbara Muskat identified in their research. Healthcare is changing rapidly and social workers are vital to this system. But what do social workers actually do in hospital settings?

Shelly Craig’s practice-based research focuses on the social determinants of health and mental health and the impact of the health care system on vulnerable populations. She is particularly quizzical about the roles and interventions used by health social workers to impact on the social determinants of health and has written several papers on the topic. She is currently Principal Investigator on multiple studies, including an investigation of social networks within interprofessional teams in urban hospitals, a qualitative analysis of the value-added of social work in health care settings and testing a coping skills training for sexual and gender minority youth.

Barbara Muskat is the Director of Social Work at the Hospital for Sick Children. In this position she supports and oversees the staff of the department as well as acts as a champion for the role of social work throughout the institution. Barbara is a lead researcher on a number of projects, including examination of the hospital experiences of children and youth with Autism Spectrum Disorders and their families; coping strategies of hospital staff working with dying children; hospital-based group work approaches; and the role of social workers in hospital settings. Barbara has over 30 years experience in direct clinical work, clinical supervision, community consultation and organizational management. She is well-known for her consultation to the children’s mental health community and her role as a social work educator in the areas of direct clinical practice and group work, with a focus on children with neuro-developmental needs. Barbara’s areas of expertise include: group facilitation, neuro-developmental disorders in children and adolescents, and clinical practice.

Recommended citation – APA6th

Fronek, P. (Host). (2014, February 18). Hospital social work: In conversation with Shelley Craig and Barbara Muskat [Episode 65]. Podsocs. Podcast retrieved Month Day, Year, from http://www.podsocs.com/podcast/hospital-social-work/.

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Transcription Podsocs 65: Hospital Social Work: In Conversation with Shelley Craig and Barbara Muskat

Thank you to the Social Work Programme at Open Polytechnic of New Zealand for this transcription

Hello, and welcome to Podsocs, the podcast for social workers on the run. Brought to you by a bunch of social workers from Griffith University in Australia.
I’m Tricia Fronek, one of that bunch, and we’re just basically really glad you found us. So, happy listening.

Patricia: This morning on Podsocs we’re speaking with Shelley Craig and Barbara Muskat from Toronto, Canada. Welcome to Podsocs.

Participant: Thank you Patricia.

Patricia: Now, we’re going to be talking about hospital social work today, which I think is a really interesting topic and very much on the agenda in many countries. Perhaps we might start and ask you to introduce yourselves.

Shelley: Sure. This is Shelley. I am an Assistant Professor at the Factor-Inwentash Faculty of Social Work here at the University of Toronto.

Barbara: And I’m Barbara Muskat, I'm the Director of Social Work at the Hospital for Sick Children in Toronto and also Assistant Professor (status only) at the Factor-Inwentash Faculty of Social Work, the University of Toronto.

Patricia: So what led you to doing this research?

Shelley: This actually has been a labour of love for several years now and it came from some conversations that Barb and I had had about the state of social work in healthcare settings specifically.

I was for many years an Emergency Room social worker, before I went in social work education, and now I am teaching students that end up being placed in and then becoming employed at hospitals. What I found is that the thing that I was struggling with many years ago still continue to be problems for students, including a lack of awareness or knowledge about exactly what it is that they're supposed to do in the healthcare setting, what our role is – those kind of challenges. So that initially for me was part of our conversation.

Barbara: I worked as a hospital social worker years ago, then worked in children's mental health and then later came back as the Director of Social Work to the hospital.

I found that the landscape had changed so much that we were having costly medical interventions. It's wonderful that we're saving lots of lives. We have a completely new patient population that is impacted by poverty, location, non-English speaking – all of those with restricted budgets were pulling on the staff. And what I saw was a kind of panicked staff trying to do everything without being able to articulate what it was they did. So Shelley and I would have many a conversation about it, and we decided we wanted to dig into this a little more deeply.

When Shelley talks about this being a labour of love, this study was done, I think, for no cost. I think we supplied cookies and the rest we did completely without a budget. Correct?

Shelley: Right. Zero budget.

Patricia: Just so I understand properly. So from what you could see, the patient’s circumstances were getting more complex, there was less money, the social workers had more to do?

Shelley: They weren’t really sure what direction to run in, so they were running in all directions.

Patricia: Right.

Barbara: Yeah, and I think the difficulty was they didn't have time to articulate what it is they did and they were very determined to do what needed to be done. They were seen as the problem solvers - and pretty much for everything. Everything. Yep.

Shelley: It’s true, and I think that we have a somewhat easier time articulating what the needs of our clients and patient populations are, but we wanted to look at, if we don't understand how to articulate what we need as a profession and what our value-add is in a healthcare setting…. Which is a setting that sometimes has a little bit of a difficult fit with social work, I think, because there's definitely the hierarchy in healthcare that we might not experience if we're working in a community-based organisation or a mental health organisation. So within the context of that hierarchy, what is it that we are doing and what is it that we're expected to do that really fits within the mandate of social work. So there is some challenge with regard to that.

Patricia: We're probably the only profession that isn't biomedical, yet on the other hand look at the social determinants of health. Who’s better equipped to deal with some of the social factors?

Shelley: Absolutely. That was part of our conversation and we also wrote a paper to look at which social determinants of health some of the healthcare social workers were looking at. We completely agree with that. The problem is we have not, as a profession, made that case that we are seen the perfect fit to address those social determinants of health that are leading to more complex medical and mental health issues with patients that are being seen in healthcare settings really across the world. But we haven't made that case, because we don't completely understand what it is that we’re doing on a daily basis, often, from a professional standpoint.

Patricia: So is that what this research has led you to do? To actually look at how social workers saw what they were doing?

Barbara: Yeah, we were curious to hear whether we had a phenomenon at one location or at various sites. So we wanted to engage social workers from as many locations as we could in our broad area. We actually went across Canada to do this research and to find out how they talk about their work, how they understand their work and describe their work.

Shelley: Our bigger question has been, what's the value-add of social work in healthcare settings? And as we sat and we saw it and talked about that, we felt because of our community-based approach, it doesn't make sense for some ‘academic’, even with a great deal of experience, to determine what those answers are. We really need to go back to the people who are doing the work, and those are the social workers that are currently in direct practice in healthcare settings. And as we moved into this, what is the value-added, we realised that one of the particular challenges is we can't even articulate what we do at the moment - let alone collectively - let alone when our value add is to the setting. So that's why we went to a description and trying to understand what the roles were.

Patricia: In your findings, you had a number of themes or categories of jobs that social workers identified as doing. The bouncer. Who’s the bouncer?

Shelley: We interviewed a large number of social workers in a variety of healthcare settings here. So both healthcare settings that were focused on particular patient populations, maybe with chronic illnesses, for example, cancer, as well as emergency rooms in a variety of other settings. What that means is that the findings are a little more robust because they hold across different, I think…

Patricia: Areas of work, yeah, where the work’s quite different.

Shelley: Exactly. So within that we found that in many cases - and we used the language that the participants gave us, which was very rich – and bouncer was this idea that whenever there was a particularly challenging family or patients - so maybe one that was acting out or was exhibiting some sort of behavioural health issues or there was some conflict within the family or they weren’t adhering exactly to what the doctor was saying to them – social work was immediately called in. And in many cases, the social work practitioners had to act as almost bouncers to figure out what was happening with the family, to use the family example, to almost break up fights – there were many examples of those that were given – and calm down and escort out particularly ‘troublesome’ family members that were either causing some trouble to the staff and/or the patient. So that was interesting, in terms of needing to be quite assertive within those contexts. But those were often the patients that we were called to assist.

Patricia: I’ve spent a lot of my career working in hospitals and I’ve seen that time and time again, where families, whether it’s miscommunication, whether they’ve repeatedly sought help and not got that – so many reasons why people get upset and frustrated in hospital systems, even just worried about their family member. And that is just so common. Obviously it happens right around the world – the social worker gets called.

Shelley: Exactly, and it's normative. We’re not gonna be on our best behaviour - even for those of us who work in social work – if our family member’s been going through some sort of physical health crisis and we're all showing up there. It is going to be a time - it's not gonna to be a holiday.

Patricia: No.

Shelley: Another part maybe comes out of coping mechanisms are going to come out and I think that's completely normative. But it’s not clear that the biomedical system always understands that. I know when I was working in the Emergency Room, often the physician would say, well they're not listening to my instructions or sometimes when they were just asking questions, it would fluster the healthcare professional and they would need to bring me in, because they would label this patient and family as difficult.

Patricia: Difficult, mm.

Shelley: It’s normative. Those are normative coping responses and they haven’t been labelled as such, so we get called in. Sometimes that initially requires a lot of conflict resolution.

Patricia: So did social workers recognise that this took a particular set of skills and expertise, to be able to manage these situations, or was it just like, ho hum, that’s what we do?

Barbara: Well, I think those who have time to think about it might discuss conflict management and crisis intervention skills, both of which would apply understand the person and their situation and being able to empathise with that situation, but I don’t know how much they fit. I feel like in these situations we’re brought in and we do it. We do it. And we don’t probably sit back and discuss it with our teams in terms of what we’re doing or helping them to do it. That’s been my experience.

Patricia: Because I imagine, if we could articulate that, that’s a pretty big asset in a hospital. It’s almost in that risk management category, isn’t it?

Shelley: Absolutely. And I think it was sometimes hard for the social workers in this study to break down what… They would say, well this was just a Tuesday. These are all the things that we had to do on a Tuesday. And the skills that were required, as evident in this article, run the gamut. There’s almost a continuum of skills that are required that we try to touch on in generalist practice, particularly at the MSW level – but we’re not really able to get to that often and we don’t do a great job in social work education. So I think that that is something that’s required. Often they just learn that on the job; they don’t even think of those as discrete skill sets that really could benefit the healthcare setting.

Patricia: Who are the janitors?

Barbara: Oh the janitor, I get to speak about this, because this is one of my favourite areas. The janitors are the people who clean up the messes. They clean up and do the job that nobody else wants to do. I think across hospitals everywhere, social workers get called in to do those kinds of things. Our favourite quote has to do with a social worker who described a patient coming in having their clothes thrown away and then the social worker had to go get the pants. I know that my staff occasionally now come and see me, ‘You’ll never believe this, but today I actually had to get pants.’ It seems to happen quite a bit: when somebody says, ‘oh this patient needs this, ‘but there’s no money for it, you go figure out how to find that money and when you say, ‘Well it’s your piece of equipment – why aren’t you finding that money?’ – the staff will say, ‘Well, that’s not our job.’ So [indistinct 14.34] we figure out how to solve those problems.

I don’t know that we train that in social workers, but that’s what you have to become pretty quickly, is a problem-solver. And we’ve become very good at it and adept at it. It majorly helps our fellow practitioners in the hospital because it means they don’t do it – we do it. We often help get patients out quicker that way, because we can’t find funds to cover certain things or we can buy them a pair of pants or find them a pair of pants. But we don’t articulate it that way either.

Shelley: Mm.

Barbara: I think there’s a dilemma that in some ways it’s a little demeaning and we seem to not be able to share that with other people. It’s easier for us to do it than to help other people learn to do it. So I see this as a double edged sword for social workers. We certainly are value-add, because we do those jobs, but I don’t know if you need an MSW to buy a pair of pants. I’ll leave it there.

Patricia: I have to laugh, when I read that, because except for maybe the last hospital, at any hospital I’ve worked at, there’s always been a wardrobe of clothes. But really, it’s about client-centered practice, because it’s about the dignity and the needs of the client, isn’t it?

Shelley: Yeah, very much.

Patricia: Rather than sending someone home without pants.

Shelley: Very much. Right. And we’re not going to send the patient home, certainly, or the client home, without pants. But in healthcare systems that does client-centered care and patient-centered care all the way through, really as key, core hospital value, are we the only ones that have to address those? Like is everybody else also equally as client-centered?

Patricia: Especially in areas like rehab, I would have thought, rehabilitation, there would have been a broader responsibility for those sort of roles.

Shelley: Mm-hm, yep, agreed. We’ve still found that within the rehab hospitals, because they were part of our study, that it did seem more often than not – not in every case, but more often than not – it seems to still fall to the social worker.

Patricia: To the social worker, mm.

Shelley: Yep.

Barbara: Yep.

Patricia: How did social workers view that role?

Barbara: Mm. They live with it. I would say that some of them embrace it and some of them are resentful. I think there’s a real split in here, that some people feel like, I can feel good that I did something and I helped that family and I did give them dignity and help them go home, but on the other hand, there’s a sense of, how did this fall to us? I do think there’s some of that feeling. Why would you think?

Shelley: When we discuss even all of the roles at the end of many of the focus groups, the social workers said, and they often referred specifically to the issue of being a janitor, that my social work education didn’t train me for this. If I thought about this when I was in school, I didn’t realise that this is what I would be doing. Now they were generally reflecting on the entire job as a whole. They stayed at those positions for a really long time, so that’s something else to factor into the equation, but it’s a very interesting…

I think for many of them, it was almost like a necessary evil, that they felt like they had to be the janitors in these healthcare settings, also because there’s quite a fear – and in some cases, it’s a not unfounded fear – that if they don’t take on some of these tasks that may not necessarily require a MSW, that they will be moved out and then other professions will come in and take those jobs. So I would say there’s a lack of an understanding of, again, exactly that what we do requires MSW-level education or BSW-level education and many other professions think that they can do it just as well. So there is a fear of losing their jobs, if they don’t embrace all of these different role that they are being asked to take on.

Barbara: However, the thing is I think the role creep that’s coming in is more about running groups or helping people cope. I feel like those social work roles – that we’re seeing role creep from other professions wanting to do that. We don’t see role creep for anybody wanting to be the janitors.

Patricia: Yes, it’s a bit like form filling.

Barbara: Mm-hm.

Shelley: Right, exactly. They’re more…

Patricia: Just thinking about my own experience a little bit, perhaps it’s about, if you identify a need when you’re doing an assessment and that’s part of your professional intervention, that’s probably very different to someone, say, ringing up the social worker and saying, ‘can you do this task.’

Shelley: Exactly.

Patricia: Does that make sense?

**Shelley: ** Yes, exactly. So if it’s part of the needs assessment and then perhaps the treatment plan and the discharge plan, then I think social workers feel much more comfortable about it than if they hadn’t been involved in the process at all. And then when the physicians or the nurses or the other allied health professionals hit a wall, then they call social workers in. That’s a very different context. I completely agree with you.

Barbara: Yeah, just recently one of my social workers in our Neonatal Intensive Care Unit was told by a nurse, ‘I want you to help this family get a breast pump. They look like they need one. They look like they can’t pay.’ And part of me says …

Patricia: Oh my goodness.

Barbara: How does that look? It wasn’t from the social worker’s assessment – it was from somebody looking and judging and that sort of thing. That’s what I think our reactions sometimes develop [indistinct 21.01].

Patricia: I’m sure, I’m sure. The glue. “Social workers are the glue.” What do you mean by that?

Shelley: With this, we had to ask them questions to drill down to what exactly they meant by that term. So what they meant is that particularly within the context of working in maybe an interprofessional team, which is the model that’s used quite a bit here in Canada, the social workers were the folks who held both the interprofessional team, so the other professionals and the family together separately, and then pulling them all together often to ensure that the patients’ needs were met and represented.

So sometimes if there was conflict, what they needed was a professional team having nothing to do with the patient. The social worker was expected to be the glue to hold everybody together, to ensure that the patient’s needs were met and also often had to be glue that held the team to the patient and family, with regard to communicating and discussing some of the important issues relevant to the family and particularly the medical care.

Patricia: Again, that’s a very particular set of skills and a set of high level skills.

Barbara: I think it comes sometimes from some of our training in group work and understanding how group work and understanding the importance of communication and flow of communication. I think it’s our facilitator abilities that we can develop. And the fact that we’re good at listening, which in the healthcare teams, many people are [indistinct 23.06].

Patricia: It makes us unusual perhaps. It’s also about keeping the team very gently, often, on the issue at hand – on the mission, on the patient. Being focused on what we’re there for.

Shelley: Exactly. It ties to those skills that we talked about, in terms of patient advocacy, but also layering that with the facilitation skills that Barb was talking about. So I completely agree, it’s a set of very high level, very integrated skills. Within this too, as I was talking about before, it’s interesting that we’re required to be the glue or maybe the facilitators within the context of the professionals themselves.

One of the things that, again, we’ve all experienced, but when I was an emergency social worker, I didn’t know that other people also experience being the ‘therapist’ for the members of the team. That’s not in our job description and we really shouldn’t be, in many cases, being doing that. But there would be a physician who would be having a problem maybe with his adolescent daughter and would drop by my office when I was trying to catch up on the 14 hours of paperwork, and would try to informally, obviously, get my advice about what to do with his own relationship with his daughter, for example. So it’s almost like a secondary role that takes a lot of time, but isn’t captured in job descriptions or in any sort of discussions of what it is that we’re required to do within the profession.

Again, because our role within the interprofessional teams is often based on relationships and it’s not based on a clear role definition about what exactly we do or don’t do, that it’s important for us in terms of job preservation, often, to continue and support these conversations, even if we feel like it might not be the best use of our time because our job is really to serve the patients and families.

Patricia: One of the most common questions in hospitals, I think, is, ‘what do social workers do anyway,’ Does that happen in Canada?

Shelley: Well, here’s an interesting little experience recently. I’m taking my department through a re-visioning stage, to really be able to help them articulate what they do. Our HR department, whom I’m working with on this, said, ‘Why don’t you ask other people in the hospital what social workers do and see how they describe it?’ And I thought to myself, what other profession would go out to other people to ask them what their role is?

Barbara: Yeah, yeah.

Shelley: Do speech and language pathologists go out and say, ‘What do you think the role of a speech and language pathologist is?’ So I find it fascinating to think that why would we ask others to define our role? We teach our clients about agency and identity and empowerment, but we haven’t applied those to ourselves sufficiently. So yeah, I don’t know. I think that’s what gets us. I don’t know if we don’t have that clear articulation or we just don’t say it. I think in our quest to be maybe patient and family centred, which is important, we’ve also given our power away. I think we were talking about this before, but there aren’t actually a lot of articles, practice research anything, that really talk about the role of social work in healthcare settings. The few that we found – so that was motivation for us to do this research – the few that we found were articles written by nurses or doctors about what social workers do in a healthcare setting and maybe that they’re important. So that, to me, was like oh my God, what is happening here? We need to use our own knowledge and our own power to be able to understand and craft some of these messages. But it needs to come from us. I think that’s in Canada and across North America.

Barbara: Yeah.

Patricia: Is it because we can’t say no or set limits? That we see the need and we’re so busy running around, being busy, responding to need, that research goes right down to the bottom; self-promotion for the profession comes right down to the bottom of the list. Are those some of the factors?

Shelley: It could be the nature of who goes into social work. I think people who wanna help others. I think that’s what you would hear – very altruistic people. People with humanistic values. Very few people go into social work who are self-promotional.

Patricia: Mm, it doesn’t fit, does it?

Shelley: Yeah, it doesn’t, which is why perhaps then it makes more sense to not… I don’t think that we should leave that to individual social workers or even social work departments – although we mostly have the programme management model here with the interprofessional teams. We shouldn’t leave that to them. The educators should really maybe be helping support - with the insight and the wisdom of the social workers really doing the work, really support the crafting of a larger vision and understanding of what social workers do, really honestly certainly across the country, but across the world. Because I think it’s quite similar. So maybe that’s our responsibility, to help craft that, so that there are tools available for the social workers to advocate for themselves in the profession within their own hospitals.

Patricia: We’re going to move on, but the broker. I really loved reading about the broker, because I think that’s so important. And I loved your term “durable discharges”.

Barbara: What they talked about is being the ones to help link patients and families to services outside the hospital. They’re the ones who are asked to do some of that – helping people get home in a safe, secure way. I think often times, when social workers are involved, you don’t have the repeat visits, because people went home too soon or without what they needed. We actually had somebody in one of our focus groups who did a study in terms of discharge from emergency rooms and when a social worker was involved, there were fewer repeat visits, which is a real economic argument for having social workers involved. Those durable discharges – discharges that stick – so that you’re not repeatedly coming back, should be something that we could use as a self-promoting value-add kind of description of our work.

Shelley: Absolutely.

Patricia: So it’s putting those things in place. It’s that professional assessment. It’s knowing what a person needs to actually stop them coming back, where possible.

Shelley: It is. As we talked about earlier, social workers have larger caseloads with more complex patients and families that could be potentially discharged to more vulnerable situations and a lot of challenges, let’s say, in terms of social determinants of health. So considering all of those in this assessment and then planning for all of those, which requires again a very high level of assessment and I think almost critical analysis and communication with the patient and family to ensure that you’re able to elicit all of that and factoring all of that in, into the discharge plan and working in partnership with the patient and family, I think can really help ensure that the patients and families don’t come back in this revolving door. Now that will still happen, but we found that it’s less likely to happen. So again, it is that really economic argument like Barb was talking about before, that I think is probably an important part of our value-add discussion.

Patricia: And firefighters. We would call that “putting out bush fires” here.

Barbara: Yeah, I think our expertise and with assessment being able to figure out what needs to be done and being able to go in quickly and put out some of the crises is a skill that we oughta be more proud of. I think it’s a skill that does get taught and it’s something that I feel that social workers become more and more adept at, the longer they stay in healthcare. Because so much is done on the fly quickly. You jump into a difficult situation and set down. I do think that’s what we heard from the social workers we interviewed, and those were people who weren’t working in crisis positions. Cos there’s certainly social workers that emerge there trained at that, but I think across the health system, it's something that we can do pretty quickly.

Shelley: And in Canada they’re identified, because many of these social workers had been working in healthcare settings for well over 10, sometimes 20, years at the same job. They said that back in the day they were doing more counselling in the way that we might traditionally think about counselling. And now they did very little ‘counselling’ in the way that we would consider it. A lot of their work had shifted to this firefighter crisis intervention approach where you see someone for a short period of time, deal with the immediate problem, and then keep it moving so that they can continue to be discharged and you can move on to the next crisis and the next eight crises that have emerged in the 10 minutes you've been with the patient.

So that's an interesting share that the social workers here are articulating. Which means for social work education we have to continue to focus on those skill sets to ensure that our graduates that are going to healthcare settings are really able to deal with crises and really able to act as folks who can put out those bush fires.

Barbara: But I also think it fits in the way medicine is carried out in healthcare settings as well. Because there's a real push here in Canada to get people out of the hospital. That people [indistinct 34.15].

Patricia: Shorter lengths of stay

Barbara: Yeah. I heard some doctors speaking yesterday. “Why would you want to stay in a place that has the most germs, infectious diseases…” “You’re better off at home.”

Patricia: Provided you’ve got the help you need at home.

Barbara: Right….

Patricia: Mm.

Barbara: …which is an important part of that set-up. This is some place that I think we have needed to adapt to the change in acute care healthcare. Because certainly back in the day when I started, people were kept in hospital for as long as they needed. We had these things called social admissions, where if a family didn't have a place to live, so they’d bring their child into the hospital and they’d stay there until you found them a place to live. None of that anymore. So I think it really our skills too have had to change with the change in delivery of healthcare here.

Patricia: The last two are the juggler and the challenger.

Barbara: Well, the juggler’s kind of obvious.

Patricia: Yeah, I think we can all see it.

Barbara: And really jack of all trades way of doing work is quite needed because you do move from crisis to crisis, situation to situation, sometimes needing a mental health intervention, if you’re dealing with the bad, ‘the challenging’ patient or family - running from that to buying pants.

Patricia: And sweeps really quickly.

Shelley: Exactly. The challenger is just an articulation of that importance of challenging or being the advocate, let’s say. Both advocate for the patient and family within the hospital setting – so with the other members of the interprofessional team as well as in the community, when we’re thinking about putting together the durable discharge plan. In some cases also being a challenger of the larger healthcare system and the ways that the larger healthcare system really can contribute to poor social determinants of health for patients and family.

There are a lot of battles being fought and certainly on behalf of the patient and family, you’re often challenging the healthcare system specifically. So you’re fighting from within the system that could be perceived as oppressive and could be oppressive. So that's an interesting issue as well.
Some of our participants talked about the issues in terms of utilising or using up their social capital. So from all of this work you generate some social capital with the physicians, particularly, but also members of the interprofessional team, and they would have to think about what patients and families they would utilise that social capital on. Because they couldn’t necessarily advocate for all the patients and families that needed it, because then they would be shut out of the decision making process in some cases.

So that was a really interesting, enlightening point too with regard to the challenger. There's quite a bit required to try to improve the communication and make the system better.

Patricia: I think we could do a Podsocs on each of these. There is so much here. But what it's really saying to me is social workers are so valuable and do so much in a hospital setting, but we really need it to get with it and start articulating these things in a way that other professionals and hospital hierarchies and bureaucracies and funders understand.

Shelley: Exactly. I know that we haven’t done that in the past, I think, as a profession, but increasingly understanding that that will be something that is important. It doesn't take away in any way from our focus on patient and families.

Patricia: No.

Shelley: I think it could really enhance it, because we could be very clear about what it is that we bring to the table and really be able to focus on those skill sets and really continue to improve the lives of patients and families. So working on our own sort of professional image, let's say, I think could only enhance patient and family-centered care. It doesn't take away from that, which I think is something that we're learning. After the focus group, it was certainly something that many of the participants seemed to think was an important next step.

Patricia: I think other professionals who work with social workers value them tremendously, but I think it’s the money holders that don’t always understand.

Shelley: It's true. In Barb’s discussion of the conversation that was had about what social workers bring to the table at the Hospital for Sick Children, what was interesting is the other professions seemed to value social work more highly than we valued ourselves, which was really enlightening as well. There are many professions who don't value possibly because they don't understand, but in thinking about this from a strengths-based approach, maybe we need to continue to value ourselves, which will then improve our relationship with some of these other professions.

Patricia: Mm-hm. Final comments, Shelley and Barbara. Anything really important that we’ve left out?

Barbara: I think when we’re teaching about social work, we have to be articulating right from the get go to our students what it is that we do and the value of it. I think we do have a bit of the ‘rob Peter to pay Paul’ – that’s what I find in the actual setting. The staff will say, ‘What should we focus on?’ If we’re trying to help people cope, we often don't have time, because what they want us to do is get them out of here quickly with all the resources. It doesn't allow us to do a little bit more that would maybe help them cope better in a psychosocial way.

I think from the profession as a whole that it’s split between, we’re trying to change the environment around people or helping people in their situation. People can get polarised that way. I think there's a lot of discussion that still needs to happen as a profession not just for social workers in healthcare for social workers altogether to be able to better articulate what we do and our value. I don't know. That’s my closing remark.

Shelley: I would completely agree. I think it’s important for social workers within healthcare settings to really start to think about what it is that they're doing as they're running through the very busy day and trying to articulate those maybe at the department level or within the interprofessional team. I think there's some personal responsibility and personal action that can happen. Because if you're very cognitively aware of what it is that you're doing, often you can do that better. So I think that that's important, is to be aware.

I also think that social work education, speaking to myself here, we really need to think about the ways that we can really support and effect change for the social workers in the healthcare setting. How can we support, in our research and in our other practice effort, the work of the folks really on the ground doing the work to think about these larger issues of value-add, maybe branding if you will, thinking about the economic impact of the work that we do. Because we can both teach that to our students, who will then go out into the field and be more aware of what they're bringing to the table, but also work with current healthcare professionals to help them understand their importance in the role of social work in their healthcare settings too. So I think it’s really a multi-tiered effort, and I think social work education bears a great responsibility in starting to continue to have these conversations.

Patricia: I think the experience of hospital social workers could be universal everywhere. So Shelley and Barbara, thank you so much for being on Podsocs.

Barbara: Thank you so much Patricia.

Shelley: Thank you.

[Musical outro 43.01 to END]

Recording ENDS: 43.23