This article was downloaded by: [McGill University Library] On: 08 February 2015, At: 18:27 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
LETTER TO THE EDITOR a
b
Abraham Lurie PhD , Laurence Shulman ACSW & Leonard Tuzman ACSW
b
a
Department of Social Work Services, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York b
Department of Social Work Services, Long Island Jewish-Hillside Medical Center, New Hyde Park, NY Published online: 26 Oct 2008.
To cite this article: Abraham Lurie PhD , Laurence Shulman ACSW & Leonard Tuzman ACSW (1979) LETTER TO THE EDITOR, Social Work in Health Care, 4:2, 233-234, DOI: 10.1300/J010v04n02_09 To link to this article: http://dx.doi.org/10.1300/J010v04n02_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Downloaded by [McGill University Library] at 18:27 08 February 2015
LETTER TO THE EDITOR
The three articles on discharge planning by Davidson, Foster and Brown, and Schrager et al. in the Fall 1978 issue of Social Work in Health Care evoked these thoughts which we want to share with other readers. In the early years of this century, when hospital social work first began in general and psychiatric hospitals, helping techniques were elementary, and support systems were natural ones or those created by the worker. The principal activities of that time were to help patients with their adjustments to their illness, emotional or physical, and to help them move into the community with appropriate supports. Over the years many social workers moved away from their original realityfocused beginnings and pursued more actively treatment of interpersonal and intrapsychic systems. New expectations were placed on us by outside forces as well as bv new roles and functions that evolved out of our own orofessional growth &d development. We sought out more "highly skilled and hofessional" roles. In this process, what has occurred? Some social workers in the health field have come toiook with disdainupon and resist those functions havingto do with the "concrete matters" which often are related to discharge planning. We note with concern that many social workers have tended to abdicate their responsibility in this area. They have been active in splitting-off discharge planning from other functions in health care social work, considering this activity nonclinical and, therefore, not warranting the investment and involvement of professional social work skills. Therapeutic counseling in interpersonal relationships is presumed to have much greater validity. But for whom? The patient and the patient's family? Are some of their needs more "worthy" than others? We raise these issues: 1. Since patient service is our focus, then discharge planning becomes a vital social work function. Much may be technical, but the process of working with the patient and the family in weighing alternatives, hel~iingto set goals, and in enhancing ego capacity to cope with altered circumstances is clearly the core of good social work practice in the health field. Discharge planning offers an opportunity for social workers to use all of their skills, not only those interpersonal counseling skills but also those used in work with planning and community groups to develop needed support systems for persons who require such resources as they leave the institution. The hospitalization of an individual usually creates a social crisis both for the patient and the family. When the skilled social work professional moves in to help them a t this point, he or she has the opportunity to use the full range of diagnostic skills and treatment modalities including the creative utilization of family and community resources. As professional social workers we clearly 8ocial WorkinHealthCare.Vol. 412). Winter1818 @ 197BbyTheHaaorthRes~.AU~hCslsa~ed
233
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SOCIAL WORK I N HEALTH CARE
know that a large number of patients who come to our attention during hospitalizationneed significantly more than the "concrete" assistance arounddiscl&ge plans. If the vrofessional social work function (held is indeed to he fulfilled. the aork to be done must zero in on the impact of the illness upon the individual patient and the immediate and extended family, currently and in the future. Without this focus, a superficial discharge plan can be developed that will quickly break down in the context of the family's functioning. Such patients often reenter the health and mental health systems through emergency rooms as urgent readmissions because of further sociallhealth crisis, or pleas for help because of accelerating family system breakdowns, and as referrals from the police, child care agencies, the courts, and others. The shunning of a professional social work role in discharge planning also must be seen as the abdication of our roles in primary and secondary prevention. 2. Ambivalenceabout carrying our responsibility in discharge planning raises questions about our concern for the quality patient care. Maintaining our role . of . &planning for posthospital care is ktegral to our social work identit; In such planning we need the full range of our professional acumen, skills, and techniques to help patients and families cope with one of the most difficult and poignant of life's crises. 3. Discharge planning could well become a political issue for the sai-vivd of professional social work in health care. If we maintain that it involves only "technical" rather than professionallevePs of skill, then the nonprofessional will certainly be seen a s able to perform the function as well as the MSW. We think that accepting this premise dilutes and diminishes the function of the socid worker and the value of the professional contribution that he or she can make,to a total treatment plan involvingpatient and family. Nonprofessionals may be involved on some levels in some phases of the discharge planning process, but surely from our history and tradition, skills, training, and experience, it is evident that the full range of our annamentarium is c&ed for ina professional approach to discharge pl&iing. To see it as narrower is politically suicidal and professionally shortsighted. 4. Discharge planning is one of the functions in which social work manpower rand resources will need to be more heavily employed. To help patients and families and to enhance our influence in health care, it is important for social work professionds to be active in the gatekeeping functions of admission, review. and discharge. Carving our social work roles in these areas will lead to improved patientcareand to thegrowth of social workprograms. To settle for less than a major role in discharge planning is to abdicate our professionalresponsihility to patients and families, to negate our value system, and to view the current and anticipated realities of health care in the United States with professional and political myopia. Abraham Luke, BhD EaurenceShulrnan, ACS W Leonard hrzrnan, ACSW Department ofSocial Work Services Long IslandJewisk-Hillside Medical Center New Hyde Park, New York
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
LETTER TO THE EDITOR a
b
Abraham Lurie PhD , Laurence Shulman ACSW & Leonard Tuzman ACSW
b
a
Department of Social Work Services, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York b
Department of Social Work Services, Long Island Jewish-Hillside Medical Center, New Hyde Park, NY Published online: 26 Oct 2008.
To cite this article: Abraham Lurie PhD , Laurence Shulman ACSW & Leonard Tuzman ACSW (1979) LETTER TO THE EDITOR, Social Work in Health Care, 4:2, 233-234, DOI: 10.1300/J010v04n02_09 To link to this article: http://dx.doi.org/10.1300/J010v04n02_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Downloaded by [McGill University Library] at 18:27 08 February 2015
LETTER TO THE EDITOR
The three articles on discharge planning by Davidson, Foster and Brown, and Schrager et al. in the Fall 1978 issue of Social Work in Health Care evoked these thoughts which we want to share with other readers. In the early years of this century, when hospital social work first began in general and psychiatric hospitals, helping techniques were elementary, and support systems were natural ones or those created by the worker. The principal activities of that time were to help patients with their adjustments to their illness, emotional or physical, and to help them move into the community with appropriate supports. Over the years many social workers moved away from their original realityfocused beginnings and pursued more actively treatment of interpersonal and intrapsychic systems. New expectations were placed on us by outside forces as well as bv new roles and functions that evolved out of our own orofessional growth &d development. We sought out more "highly skilled and hofessional" roles. In this process, what has occurred? Some social workers in the health field have come toiook with disdainupon and resist those functions havingto do with the "concrete matters" which often are related to discharge planning. We note with concern that many social workers have tended to abdicate their responsibility in this area. They have been active in splitting-off discharge planning from other functions in health care social work, considering this activity nonclinical and, therefore, not warranting the investment and involvement of professional social work skills. Therapeutic counseling in interpersonal relationships is presumed to have much greater validity. But for whom? The patient and the patient's family? Are some of their needs more "worthy" than others? We raise these issues: 1. Since patient service is our focus, then discharge planning becomes a vital social work function. Much may be technical, but the process of working with the patient and the family in weighing alternatives, hel~iingto set goals, and in enhancing ego capacity to cope with altered circumstances is clearly the core of good social work practice in the health field. Discharge planning offers an opportunity for social workers to use all of their skills, not only those interpersonal counseling skills but also those used in work with planning and community groups to develop needed support systems for persons who require such resources as they leave the institution. The hospitalization of an individual usually creates a social crisis both for the patient and the family. When the skilled social work professional moves in to help them a t this point, he or she has the opportunity to use the full range of diagnostic skills and treatment modalities including the creative utilization of family and community resources. As professional social workers we clearly 8ocial WorkinHealthCare.Vol. 412). Winter1818 @ 197BbyTheHaaorthRes~.AU~hCslsa~ed
233
Downloaded by [McGill University Library] at 18:27 08 February 2015
234
SOCIAL WORK I N HEALTH CARE
know that a large number of patients who come to our attention during hospitalizationneed significantly more than the "concrete" assistance arounddiscl&ge plans. If the vrofessional social work function (held is indeed to he fulfilled. the aork to be done must zero in on the impact of the illness upon the individual patient and the immediate and extended family, currently and in the future. Without this focus, a superficial discharge plan can be developed that will quickly break down in the context of the family's functioning. Such patients often reenter the health and mental health systems through emergency rooms as urgent readmissions because of further sociallhealth crisis, or pleas for help because of accelerating family system breakdowns, and as referrals from the police, child care agencies, the courts, and others. The shunning of a professional social work role in discharge planning also must be seen as the abdication of our roles in primary and secondary prevention. 2. Ambivalenceabout carrying our responsibility in discharge planning raises questions about our concern for the quality patient care. Maintaining our role . of . &planning for posthospital care is ktegral to our social work identit; In such planning we need the full range of our professional acumen, skills, and techniques to help patients and families cope with one of the most difficult and poignant of life's crises. 3. Discharge planning could well become a political issue for the sai-vivd of professional social work in health care. If we maintain that it involves only "technical" rather than professionallevePs of skill, then the nonprofessional will certainly be seen a s able to perform the function as well as the MSW. We think that accepting this premise dilutes and diminishes the function of the socid worker and the value of the professional contribution that he or she can make,to a total treatment plan involvingpatient and family. Nonprofessionals may be involved on some levels in some phases of the discharge planning process, but surely from our history and tradition, skills, training, and experience, it is evident that the full range of our annamentarium is c&ed for ina professional approach to discharge pl&iing. To see it as narrower is politically suicidal and professionally shortsighted. 4. Discharge planning is one of the functions in which social work manpower rand resources will need to be more heavily employed. To help patients and families and to enhance our influence in health care, it is important for social work professionds to be active in the gatekeeping functions of admission, review. and discharge. Carving our social work roles in these areas will lead to improved patientcareand to thegrowth of social workprograms. To settle for less than a major role in discharge planning is to abdicate our professionalresponsihility to patients and families, to negate our value system, and to view the current and anticipated realities of health care in the United States with professional and political myopia. Abraham Luke, BhD EaurenceShulrnan, ACS W Leonard hrzrnan, ACSW Department ofSocial Work Services Long IslandJewisk-Hillside Medical Center New Hyde Park, New York
