The Distinctive Role of Gerontological Social Work

Gerontological social work is concerned with maintaining and enhancing the quality of life of older adults and their families. Gerontological social work is particularly concerned with ameliorating those physical, psychosocial, familial, cultural, ethnic and racial, organizational, and societal factors which serve as barriers to physical and emotional well-being in later life. Gerontological social work interventions are directed at enhancing dignity, self-determination, personal fulfillment, quality of life, optimal functioning, and ensuring the least restrictive living environment possible. Interventions that enhance older adults' coping and problem-solving capabilities are perhaps the most basic and crucial aspect of gerontological social work. Because services are typically sought at times of crisis, gerontological social workers give special attention to the psychosocial meanings of change and loss, as well as to underlying biological, psychological, cognitive and social factors experienced by the older adult and family. Gerontological social workers are trained to conduct holistic bio-psycho-social geriatric assessments which attempt to untangle interconnected physical, psychological, and social factors that affect health and well-being. Geriatric social work, as many of the health professions, is increasingly focused on prevention and wellness in late life as well as problems of aging. Gerontological social workers are also skilled in crisis intervention as well as other forms of brief and/or short-term treatment modalities and working with family systems in order to strengthen older adults coping capabilities and their informal support system. Resolving barriers to service utilization is another distinctive area of gerontological social work. Similarly, gerontological social workers emphasize monitoring the effectiveness and appropriateness of services to ensure that needs are being met in the most effective and cost efficient manner for both the consumer and the service organization. Besides working directly with individuals and groups, social workers seek to promote the responsiveness of organizations, communities, and other social institutions to individuals' needs and social problems. This is done through a variety of management, administrative, and community-organizing roles including policy and program development, program management and evaluation, resource development, and strategic planning. Such roles are especially essential to the development and operation of service delivery systems which are effective and efficient (Scharlach & Robinson, 1997).

Interdisciplinary Teams and Social Work

Social workers with their training in interpersonal relationships, group work and (often) interdisciplinary team skills play a vital role in the development and functioning of the interdisciplinary team unit and in all major phases of its work, including assessment, goal setting and care planning, and monitoring/evaluation. The social worker provides key leadership in identifying psychosocial issues. The social worker's roles within teams include convener, facilitator, and expert in group work skills which contributes to their ability to foster team collaboration. Interdisciplinary teamwork recognizes that the complexities of older people's problems necessitate a comprehensive and planned approach to their resolution. As with other members of the interdisciplinary team, the social worker benefits the elderly person in terms of providing coordinated service, information, skilled services, avoidance of duplication of services, and the introduction of preventive services (HRSA, 1995). The social worker acts as liaison as

needed between client and family and the health care system. The social work profession's emphasis on advocacy, and its knowledge about service delivery systems in both public and private sectors, enables social workers to take a lead role in promoting interdisciplinary practice and facilitating the coordination of services, reducing duplication and potentially providing preventive approaches (CSWE, 1994). Knowledge and skills contributed by the social worker to the team may, and often do, overlap with other disciplines contributions. In a team environment it is common for some knowledge areas to be "shared" with others.

Field Work Requirements for the Master of Social Work Degree

Accredited schools of social work must comply with requirements and guidelines for academic course work and field practica established by the Council for Social Work Education (CSWE, 1994). Academic curricula must include course work in human behavior and social environment, social policy, methods for working with client populations, cultural diversity and cultural competence, and methods and practice of social work research. Generally, all students take required ? foundation? courses in theses subjects in their first year, and elective courses in the same subject areas in their second year. Students must also complete 900 hours in field practica (or approximately 40% of students? time in the overall program) which is designed to provide students with opportunities to apply foundation, knowledge, skills, values and ethics to practice. Typically these practica take place in governmental or private sector social service agencies. CSWE requires each school to establish clear guidelines for selecting agencies and field instructors as well as for types of appropriate learning activities and outcomes. Social Work?s Multiple Roles on Interdisciplinary TeamThe role of the social worker on an interdisciplinary team includes but is not limited to the following (West, Mellor, & Robinson, 1998): 1. Diagnosis/Assessment - The goal of a bio-psycho-social assessment is to identify the strengths and limitations of the patient and family and to assist them in creating a treatment plan with clearly defined goals. It provides a holistic view of the patient/family. The social worker can identify barriers to medical compliance and assist others on the team in the management of an acute or chronic illness. The social worker can also help to assess whether the presenting medical problem is compounded by mental health problems. The social work assessment takes into consideration how well the patient (and the family or caregiver) is functioning in six areas:

Physical - a brief medical history, functional abilities, appearance and observed behavior.

Psychological - Affect, mood, outlook, attitude, personality characteristics, cognitive

functioning, self-image.

Social - Vocation, social roles, support networks, education and financial status. Cultural - Values, general rules of behavior, definition of the "sick role", beliefs about the
root causes of illness and prescribed treatments, communication patterns that encompass varied language and speech patterns as well as bilingual issues.

Environmental - Living conditions and home surroundings with focus on safety and
maintaining functional independence.

Spiritual - Beliefs about people's roles and responsibilities, rules for living, belief system,
diet, and acceptable medical treatments. 2. Care Management - Equally referred to as case management, this social work role includes problem identification (e.g., lack of financial resources, need for help with ADL's or mental health intervention) as well as linkages to and coordination of community resources to facilitate the highest practical level of functioning for the patient and family. It requires a knowledge of community resources and knowledge of entitlements, and skills in matching patient/family with resources, linking resources and serving as an interpreter and advocate for the patient/family. 3. Individual Counseling - Psycho-social counseling includes treatment of mental health problems such as depression and anxiety through various techniques including family therapy, relaxation and stress management training for the patient and/or caregiver. This is intended to assist patients and families to adjust to major life stressors and transitions such as illness, disability, institutionalization, and loss as well as to empower the client. A patient's ability to adapt to an illness has a profound impact on quality of life as well as upon the patient's willingness/ability to comply with the prescribed treatment and are paramount to recovery, physical and emotional healing, timely discharge from the hospital, risk management, and effective decision-making. The social worker brings skills in listening, problem resolution and negotiation with attention to community and environmental factors. 4. Group Work - Group psychotherapy and supportive psychoeducational groups are designed to help patients/families and/or caregivers cope with a specific illness, e.g., depression, Alzheimer's disease, cancer or diabetes. The social worker brings skills in group development and facilitation. 5. Liaison - The social worker can also serve as a liaison between the patient/family and the professional community forming a vital link. This is particularly pertinent when the family lives out of the area and their input must be obtained via long-distance communication. 6. Advocacy - Social workers' training, including a working knowledge of ethics, confidentiality, advance directives, cultural/ethnic factors and patient/family rights, serves to

help teams face the challenge of balancing patient needs with the system demands. Often the most important service provided by a geriatric/gerontological social worker to patients is simply to assist in negotiating an overwhelmingly bureaucratic system, such as Medicaid, Social Security disability, funeral arrangements, or dealing with insurance and hospital paperwork by acting on their behalf and/or teaching them to help themselves. 7. Community Resource Expertise - Knowledge of community resources and how to access them is an invaluable piece of the social work profession. This involves a high level skill in negotiation and bargaining in order to become a broker for appropriate resource allocation. A working knowledge of financial systems, including federal, state and county programs is part of this expertise. Serving as a resource referral coordinator requires negotiation and collaboration in order to assist patients and families in setting priorities, care goals, balancing issues. Developed by the GITT - Social Work Interest Group of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training Program