Social Work in Health Test

November 4th

Who is Ida Maude Cannon

Considered the pioneer of social work in health / medical social work

worked with Dr. Richard Cabot

Dr. Richard Cabot

His conception was that medical social work is a social practice under the patronage of doctors.

• Urged social workers to be scientific in their approach; to practice the scientific spirit is necessary to social work whether it is a real profession or only a go-between craft.

19th Century Roots of Social Work

Social work did not emerge in a vacuum - the 19th century charity organization movements and settlement house reformers recognized that poverty, housing, and sanitation were health problems as much as social ones

Bi directional influence between medicine and social work

each discipline shaping the other — gave rise to what we now call public health, a legacy that continues to define social work's role in healthcare today.

20th century origins of social work

1905: the founding movement  - the profession was born at Massachusetts General Hospital when Harnet Pelton became the first medical social worker - physician Richard Cabot recognized that effective patient care required understanding the whole person, not only their diagnosis

• Ida Cannon, succeeded in Pelton and rose to become chief of social work @ MCH pioneering a holistic, community based model of care that would define the field for generations

20th century core or medical social work

• Helping patients navigate treatment plans

• Educate families on illness management

• Connect patients to community resources

• Integration into medical teams - social workers as essential collaborators

4 major areas defining the history of medical social work

Religious beginning of social work

1. Early 20th century shift -

2. Late 20th century -

3. Dark Period

4. Modern Era

Early 20th century shift in medical social work

Specialization & the welfare states

• Welfare helps address poverty - the great depression is when people fell into significant poverty and the government had to step in to help

• Psychoanalytic theory: 

  • Split between medical (physical health) & psychiatric (menta health) social work

Late 20th Century medical social work

care coordination

• People started thinking the interventions are isolated and that care needed to be coordinated

• More holistic care

• Ethics and Patient rights 

Dark Period of medical social work

periods where doctors did treatments on patients without patients consents

• Syphilis study where 600 black men and 600 white men were injected with syphilis and only gave white men treated - most black men died, transmitted to many black women - US hid this for a long time

modern era of medical social work

social determinates of health and holistic care + cultural safety and anti-oppressive practice

• Medicine shifts focus to see how poverty, and other social aspects had an effect on health

• Informed consent - the paitent has the right to make the final decisions about their health

Evolution of medical social work - 1900-1950s

hospital-based casework focused on individual patient discharge planning and family support

Evolution of medical social work 1960-1980s

Expanded into community health, mental health and public health - moving beyond hospital walls

Evolution of medical social work - present day

Holistic health care that covers the biopsychosocial well-being of clients and the community.

What is Health Social Work:

a specialized field that integrates core social work values — dignity, justice, and self-determination — with the complex realities of healthcare delivery.

• Integrated practice

• Holistic Focus

• Person-in-environment

 

Integrated Practice

Combines clinical skills with advocacy, linking patients to resources across systems of care.

Holistic Focus

Addresses biopsychosocial–spiritual and environmental factors — the full range of forces shaping a person's well-being.

person - in - environment

Situates health within social context: family, community, culture, and structural conditions all matter.

Disease

Objective medical condition. Defined by biological pathology — measurable changes in the body identified through clinical assessment, lab results, or imaging

• The main domain of diagnosis and biomedical treatment

Illness

• Subjective lived experience. How a person feels, interprets, and copes with sickness — shaped by personal history, cultural beliefs, family, and social context

  • The domain of meaning, identity, and social response

Key Distinctions between Illness & Disease

disease = the objective, medical aspects of a health condition

illness = to the subjective, lived experience of being unwell.

• Disease focuses on biological abnormalities that can be identified and measured through medical assessments, laboratory testing, or imaging.

• illness focuses on how an individual experiences, interprets, and copes with their condition, which can be influenced by their personal experiences, cultural beliefs, family, and social environment.

Social workers role in disease & illness

Social workers address both dimensions simultaneously — supporting disease management while honoring the unique experience of illness each person carries

Defining health - Social work perspective

• Beyond the absence of disease

• Health is the state of complete mental and social wellbeing

• Biopsychosocial model - outcome of dynamic interaction of biological, psychological and social systems

1986 Ottawa charter definition of health

• health is a resource for everyday life and not an objective of living

  • Health is one of the things you need to live everyday - your life objective shouldn't be to be healthy - but you should take advantage of your health to live your life

2011 Huber definition of health

Ability to adapt and self manage in the face of physical, social, mental challenges

• Indigenous and holistic definition of health - health is balance and harmony - among the mind, body, spirt, community land, ancestors

  • Health is not simply the absence of illness. For social workers, health encompasses physical, mental, and spiritual well-being — a dynamic state shaped by culture, values, relationships, and social context.

definition of health and social work

How health is defined guides how social work and all health-related practice occur.

•  A narrow biomedical definition leads to narrow interventions; a holistic definition opens space for whole-person care.

• Social work's definition of health is inherently political — it challenges systems that treat disease while ignoring its root cause

quality of life

a multi-dimension evaluation - a person's subjective evaluation of their well-being across multiple life domains—not a single metric, but a rich portrait of how someone experiences life

Quality of Life vs Standard of living + health related quality of life

quality of life is distinct from standard of living (economic measures) and health-related QoL (health-specific functioning).

It encompasses personal health, relationships, education, work environment, social status, wealth, security, autonomy, and physical surroundings.

•  Health, Relationships, physical environment, education, work, social status, security, autonomy

• How YOU interpret your health subjectively - 2 ppl could have the same illness but different outlook on life and contentness

aspects of quality of life

• physical well-being

• psychological + emotional wellbeing

• relationships

• physical environments + living conditions

• material + economic wellbeing

• rights + personal values

physical wellbeing

absence of pain, disease, mobility, energy levels, sleep, ability to perform ADLs

psychological and emotional wellbeing

mental health, life satisfaction, emotional balance & cognitive function

relationships and quality of life

what is the quality of your different relationships, romantic partnership, community connection,

physical environment + living condition quality of life

quality of housing - mold, temperature, mice, neighborhood safety -access to clean water & nature, public transportation

material + economic wellbeinf

financial security, employed/unemployed/underemployed/satisfied employed, access to adequate nutritious food, clothing, personal autonomy of ADLs

rights + personal values wellbeing

political freedom, personal safety, spiritual and religious fulfillment, freedom from discrimination

Frameworks designed to measure QoL  primary indicators

WHOQOL world health organization quality of life

HHCCW holistic health & cross-cultural wellbeing

OECD - better life index

human development index

WHOQOL world health organization quality of life

holistic health & cross-cultural wellbeing - primary indicators - physical health, psychological, level of independence, social relations, environment & spirituality

HHCCW holistic health & cross-cultural wellbeing

primary indicators - physical health, psychological, level of independence, social relations, environment & spirituality- impact on disease & treatment on daily life, burden of symptoms, functional status  mental health ADLS , physical limitations

OECD - better life index

housing., income, jobs, community, education, environment, governance, work/life balance

Human development index

global social economic development - life expectancy, education, capital income

life expectancy and education + gender

Societies that are more educated = more life expectancy

• Women are currently more educated than men - helps their already higher life expectancy

  • Not as reckless, prioritize community, prioritize their health

Social determinants of health

economic, social, environmental, and contextual factors—such as employment, race, disability, and housing—that interact to shape health outcomes.

• Non-medical conditions in which people are born, grow, live and age within - shaped by distribution of money, power and resources at national and international levels

clinical care vs social determinants

• 20% - Clinical Care - Accounts for only 20% of county-level variation in health outcomes

• 80% - Social Determinants - SDH affect as much as 50-80% of health outcomes—far outweighing medical care

5 categories of the social determinants of health

• Economic stability: Income, employment, poverty

• Education & Quality: literacy, educational attainment

• Social & community context: social support, discrimination, social exclusion

• Neighborhood & Build environment: housing, transportation, environmental quality

• Healthcare access & quality: insurance coverage, preventative care access

In NB economic stability impacts

• multiple jobs to pay rent - less sleep, cant eat properly, more likely to get sick

• Minimum wage vs livable wage

• Part time jobs w no health insurance

• Consuming fast food or packaged foods due to it being all they can afford

• Precarious employment or odd jobs

• Stigma of people living in poverty - healthcare stigma + internalized stigma

• Area of neighborhood - health safety and wellbeing safety

• Being able to afford medications - having access to a doctor

• Education

In NB education impacts

• The types of jobs and opportunities you are able to get

• Knowledge of how to take care of yourself

• Impact ability to further learn and adapt, research - ability to educate yourself

• Medical literacy

• Education not transferring from other countries - accreditation

• Knowing when to seek information and how to know what is reliable

• Protective factor against memory loss in old age

which SDH has the highest impact on your ability to live long

education

In NB social & community impacts

• Social supports

• Places where you can build community - your village

• Language - being able to communicate withing your community

• Connection - ability to gather more information

•  loneliness & social isolation = biggest predictor of health decline

• Childcare + communal support

• Independent vs communal societies

• Racism, sexism, homophobia and other forms of discrimination - makes people stressed and on-guard - stress takes toll on health - quality of healthcare they receive or trust, quality of life

• Types of available services - access to those services

example of impact of social and community in relation to health

•  needing to travel for certain procedure such as abortion

  • Without the service, they with pass on this struggle - they are already to struggling to take care of themselves and now they are forced to give birth (health risk) and now try and support themselves and a child without support

  • Access to contraceptive + sex education + class factors

In NB Neighbourhoods and environments impacts:

• Homelessness

• Pollution - breathing in air from refinery

• Quality of water - boil orders in certain areas - tap water

• Quality of housing - mold, safety

• Occupational diseases - 

• Asbestos in schools

• Safety of neighborhood

• Accessibility 

In NB healthcare access and quality impacts

types of available services

rural access to healthcare - shitty transport system within that

How do social conditions become biological illness

Chronic stress & allostatic load - when individuals are faced with persistent stressful life factors all time the bodies stress response systems remain perpetually activated - continually flood body with cortisol and epinephrine - this increases allostatic load - which leads to wear and tear on tissues and organs due to the over activation of systems 

• When you experience SDH on a persistent level - the hormones in your body are overactive - allostatic load - wear and tear of organs - sick

Allocastatic load causes

• Chronic systemic inflammation

• Hypertension & Arterial damage

• Insulin resistance

• Age faster

Epigenetic pathway:

Social environments can alter dna expression without altering underlying genetic

• Early childhood adversities + chronic malnutrition - trigger epigenetic modifications

• Turning off regulatory genes + predisposing individuals to autoimmune disorders, metabolic syndromes + mental health conditions across generations

• When men are healthy it is encoded in their dna - embryo takes this from their genes - when individuals experience a lot of structural inequalities - likely that child's dna is likely to be affected - born malnourished

why social workers are essential regarding health and social determinants

• Social workers bring a uniquely holistic lens to healthcare—understanding individuals within the context of the larger systems they inhabit

  • We do not look at individuals from a pathological lens - all factors of total health and wellbeing

  • psychosocial, ecological, measurable

Social workers & psychosocial problems:

• Hospital social workers identify many more patient psychosocial problems than their physician colleagues

• They are not just diagnosis

• Psycho social affects health problems so they need to be addressed for the likelihood of them coming back and be minimized

social workers ecological perspectives

• Skilled at situating individual needs within broader structural and community contexts

• Living by the refinery and they keep coming to hospital with lung problem - not just looking at meds - looking at housing 

social workers and measurable impact

• Social work presence is associated with fewer emergency visits and reduced hospital stays

• Fewer cased of people coming back and emergencies reduced through social workers as they address the systemic factors driving them to the hospital

which social determinants of health do social workers address most

Most commonly addressed SDH domains focus on immediate individual needs.

• We do more micro-level work - advocating for access + adequate care

• Healthcare services top the list at 92%, with disability, housing, and income support close behind.

• This pattern reflects the downstream focus of much current health social work practice—responding to presenting needs rather than root cause

• Many social workers for social investigation to find out economic status of the patient

gaps in current practice

Under-addressed Determinants

• Few health social workers tackle racism, Aboriginal status, gender, or social exclusion in their daily practice, yet these are among the most powerful drivers of health inequity.

• People don’t like when biases are pointed out and take offence - doctors don’t want to be challenged - relationship changes

the opportunity ahead for social work and social determinants

• There is a clear opening to expand practice focus toward structural inequities and systemic barriers, moving beyond individual need toward advocacy and social change.

• Does the hospital want us doing things that create real structural changes?

evidence based interventions

housing first

food & nutrition

transportation

income support

evidence based interventions: housing first

Strong evidence as cornerstone SDH intervention

• approaches provide supportive housing directly to people with chronic health conditions, including behavioural health conditions, without requiring sobriety or treatment compliance as preconditions.

Research demonstrates that these programs deliver:

• Improved health outcomes for participants

• Reduced healthcare costs in multiple studies

evidence based interventions: food & nutrition

•  Improving access to healthy food environments reduces healthcare costs and leads to better long-term outcomes, particularly for chronic disease management.

  • Healthy food = more expensive here than global south

evidence based interventions: transportation

Non-emergency medical transportation increases preventive care utilization and decreases reliance on costly emergency services

evidence based interventions: income support

Direct cash payments and income support programs for low-income individuals show measurable improvements in health outcomes and family stability.

3 level approach to social determinants of health

upstream

midtream

downstream

• All 3 levels require coordination and adequate funding

upstream approach to Social determinants of health

root causes - poverty, employment, education addressed at community level

midstream approach to Social determinants of health

human services meeting individuals social needs through community-based organizations

downstream approach to Social determinants of health

healthcare referrals and individual care coordination

most recognized social determinants of health

housing, food, transport, income, employment

Social work and the whole person and in the hospital

understand the context

bring a social perspective

support through illness

social work and understanding the context in diagnosis

Psychosocial assessment on admission: coping, relationships, resources, risks

social work and bringing a social perspective

Multidisciplinary teams link treatment to everyday realities

social work and support through illness

Support patients and families through illness, distress and changing roles

social workers in community health and primary care keep people well:

• Identify needs early

  • Notice social pressures before they become barriers to health

• Connect practical support

  • Link patients to housing, income and food supports

• Stay Connected

  • Build continuity of care close to home, with follow-up as needs change

Social workers and Mental Health Units - combine treatment and recovery

• Assessment and safety

  • Assess strengths, risks and immediate needs; develop collaborative safety plans 

• Family and Understanding:

  • Involve chosen supports with consent; offer psychoeducation

social workers role in life after the unit

• Plan housing, community support and follow up around the persons recovery goals

  • Long-term care protects dignity and quality of life

• Support relationships

  • Work with residents, families and caregivers through changing needs.

• Support adjustment

  • Make space for grief, transition and difficult decisions.

• Protect residents' rights

  • Keep preferences, consent and participation central to care.

what social workers do: 5 core functions

1. case management

2. discharge planning

3. crisis intervention

4. health education

5. advocacy

social workers and case management

• Assess needs & strengths

• Plan shared priorities

• Link services and supports

• Monitor access and progress

• Review revise as needs change 

social workers and discharge planning

Starts at admission

• Assess - home environment, available supports and finances

• Arrange - Services, equipment and follow-up before the transition

• Confirm - a workable plan, clear contacts and agreed responsibilities

social workers and crisis intervention

Stabilize first

• Ensure safety - address immediate danger and involve urgent help when needed

• Understand the situation - listen, clarify immediate needs and identify available supports

• Mobilise support - agree manageable short-term steps and a follow up contact

social workers and health education

Builds capacity to self-manage

• Understand plain language - explain conditions and treatment - check understanding

• Navigate Practical Skills - teach coping, navigation of services and awareness of rights

• Connect shared learning - link people to support groups and community programs

What is a psychosocial assessment?

A structural process for understanding how health, emotions, relationships and environment interact

• A social workers summary of a problem that is to be solved or list or problems to be solves - the social workers considers a variety of factors, physical and psychiatric illness and its impact, results derived from psychological tests, legal status, assets and resources, and the plan to resolve the problem

• Rooted in the biopsychosocial model and person-in-environment interact

• Ongoing and collaborative, not a one-time form

  • Things change, clients change, their environment and psychosocial factors change

• Guides care planning, discharge and referral

  • Impacts how we plan treatment, discharge, and when and where we refer a patient

bio-psycho-social model

Biological ,psychological, and sociological impacts on wellbeing

a psycho-social assessment should:

Communicate pertinent info about a client to colleagues or case planning and referrals

• Establish in writing, an account of where client is at

• Provides baseline information about a client when they enter an agency for services

• Opportunity to reflect, refine our thinking and ask ourselves questions about the client and their situation

• include:

  • basic info

  • referral -

  • presenting prob

  • soures of data - where referral from, prev diagnosis

  • general description of client - what you observe

  • background + current funtioning

  • Impression, assessment, and recommendations

background and current functioning of psychosocial assessment

• Family composition and background

• Educational background

• Employment and vocational skills

• Religion/spiritual involvement

• Psychical functioning, health conditions, and medical background

• Psychological and psychiatric functioning and background

• Social, community and recreational activities

• Basic life necessities  

• Legal concerns

• Other environmental or psychosocial factors

• Client strengths, capacities and resources

Impression, assessment, and recommendations section of psychsocial assessments

• Clinical summary, impressions and assessments

• Goals and recommendations for work with client

3 levels of psycho social assessment

1. individual

2. family

3. community

level 1 individual assessment - what to explore

• Psychical health, symptoms, functioning

• Mental heath, coping, cognition

• Substance use, safety and risk

• Strengths, values, spiritual and cultural beliefs

level 1 individual assessment key questions

• "What does this diagnosis mean to you?"

•  "How are you managing day to day?"

• "Who do you turn to for support?"

• "What matters most to you right now?

level 1 individual assessment tools

• Biopsychosocial interview

  • Biopsychosocial model

• PHQ-9 and GAD-7 screeners

• Suicide risk screening (e.g., C-SSRS)

level 2 family assessment - what to explore

• Family structure, roles, communication

• Caregiver capacity and burden

• Decision-making and cultural norms

• Impact of illness on routines, finances, children

level 2 family assessment key questions

• Who is family to you?

•  "Who helps make health decisions?

• "How has illness changed home life?"

• "What support do caregivers need?"

level 2 family assessment tools

• Genogram (family history and patterns)

• Ecomap (family-system connections)

• Family APGAR

• Zarit Caregiver Burden Interview

level 3 community assessment - what to explore

• Housing, income, food security, transport

• Access to services and health literacy

• Stigma, discrimination, safety

• Community assets and informal supports

level 3 community assessment key questions

• Which services exist nearby, and are they reachable?

• What barriers block follow-up care?

• Which groups face the greatest inequities?

• Who are community allies and leaders?

level 3 community assessment tools

• Social determinants screeners (PRAPARE, AHC-HRSN)

• Community asset mapping

• Needs assessment and ecomap

• Resource and referral mapping

assessment proccess and ethical practices

1. Engage

   1. Build rapport

   2. Explain purpose, consent, confidentiality limits

2. Gather

   1. Interview, observe, collateral sources

   2. Use validated tools

3. Formulate

   1. Integrate strengths, risks, needs

   2. Name priorities with the client

4. Plan and document

   1. Goals, referrals, interdisciplinary handoff

   2. Objective, concise notes

Cultural humility, trauma-informed, self-determination, strengths focused, reassess as circumstances change

Documentation principles

• Use observable, behavioural language

• Record the clients own words, briefly

• Separate observation from interpretation

• Document risk, protective factors and your rationale

• Include strengths and client goals

• Date, sign, and follow agency policies