Medical social work is a sub-discipline of social work, also known as hospital social work.

Medical social workers typically work in a hospital, skilled nursing facility or hospice, have
a graduate degree in the field, and work with patients and their families in need of
psychosocial help. Medical social workers assess the psychosocial functioning of patients
and families and intervene as necessary. Interventions may include connecting patients
and families to necessary resources and supports in the community; providing
psychotherapy, supportive counseling, or grief counseling; or helping a patient to expand
and strengthen their network of social supports.

Medical social workers typically work on an interdisciplinary team with professionals of

other disciplines (such as medicine, nursing, physical, occupational, speech and
recreational therapy, etc.)
History[edit]

Britain and Ireland[edit]

Medical social workers in Britain and Ireland were previously known as Almoners, or
Hospital Almoners. In Ireland, the origins of medical social workers go back to Dr. Ella
Webb, who, in 1918, established a dispensary for sick children in the Adelaide Hospital in
Dublin, and to Winifred Alcock, who trained as an Almoner and worked with Dr. Webb in
her dispensary.[1]

In 1945, the Institute of Almoners in Britain was formed, which, in 1964, was renamed as
the Institute of Medical Social Workers. The Institute was one of the founder organizations
of the British Association of Social Workers, which was formed in 1970. In Britain, medical
social workers were transferred from the National Health Service (NHS) into local
authority Social Services Departments in 1974, and generally became known as hospital
social workers.
United States[edit]
The Massachusetts General Hospital was the first American hospital to have professional
social workers on site, in the early 1900s. The position was created by Richard Clarke
Cabot to help patients to deal with areas of their life that made treatment difficult. This was
important from an epidemiological point of view, as it made it easier to control and prevent
outbreaks of syphilis and tuberculosis.[2]
The medical social worker profession[edit]

Role and required skills[edit]

Medical social workers play a critical role in the area of discharge planning. One
responsibility of medical social workers is to collaborate in the development of a discharge
plan that will meet the patient's needs and allow the patient to leave the hospital in a
timely manner. There are a number of factors that influence the timing of discharge; in
private, community hospitals, it can be costly to allow patients to remain inpatient when it
is no longer medically necessary. Discharge delays can prove costly to the hospital and to
the patient depending on the patient's funding source.

For example, a medical provider informs the medical social worker that a patient will soon
be "cleared for discharge" and will need in-home services. Depending on the setting, it may
be the medical social worker's responsibility to arrange in-home services to coincide with
the patient's discharge date. If the home care service is not in place at time of discharge, the
patient may not be able to leave the hospital, resulting in a delay in discharge and the
patient being placed on alternate level of care status (that is, deemed no longer requiring
acute level of medical care, for which the hospital will receive a substantially lower rate of
payment) until the necessary services are arranged.

Another skill required of medical social workers is the ability to work cooperatively with
other members of the multidisciplinary treatment team who are directly involved in the
patient's care. Medical social workers also need to have excellent analytical and assessment
skills, an ability to communicate clearly with both patients and staff, and an ability to
quickly and effectively establish a therapeutic relationship with patients. But of paramount
importance, medical social workers must be willing to act as advocates for the patients,
especially in situations where the medical social worker has identified problems that may
compromise the discharge and put the patient at risk.

For example, a medical provider may report that a frail elderly patient, who lives alone, is
medically stable for discharge and plans to discharge the patient home with in-home
services. After assessing the patient's psychosocial needs, the medical social worker
determines that the patient does not have the ability to manage at home safely even with
the intervention of a home care worker. The medical social worker informs the medical
provider that the proposed discharge plan may place the patient at risk and the discharge
plan is deferred pending further assessment. The medical social worker can then
collaborate with multidisciplinary providers to develop a more appropriate discharge plan
even if that leads to discharge delays.

Medical social workers value the ethical concept of patient self-determination although this
value can conflict with the values and ethics of other disciplines in a medical setting.
Medical social workers strive to preserve the patient's right to make his or her own
decisions about goals of care, treatment planning, discharge, etc. as long as the patient is
capable of making those decisions him/herself. Patients often make decisions that medical
professionals disagree with but the medical social worker advocates for the patient's right
to self-determination. If the patient is not able to make his/her own decisions based on a
cognitive or other impairment, the right of self-determination can be superseded by
concern that a patient is a risk to self or others.
Challenges[edit]
As medical social workers often have large case-loads and have to meet tight deadlines for
arranging necessary services, medical social work is a demanding job. Medical social
workers often deal with highly complex cases involving patients who come into the
hospital with multiple psycho-social issues, all of which require assessment and treatment.
It is not uncommon for medical social workers to treat cases involving homelessness,
chronic unemployment, lack of income, lack of health insurance coverage, history of
incarceration, and substance abuse problems. Any of these problems, separately and
together, can impede timely discharge. Sometimes situations as seemingly mundane as the
patient needing bus fare or a decent pair of shoes can lead to delays in discharge, especially
if these needs are not identified quickly and early. This is why a complete and timely
assessment of the patient's psychosocial needs is critical.

Medical Social Worker

 Assesses a patient’s social, emotional, environmental, financial, and support needs.
 Informs other members of the health care team about these factors, which may affect
the patient’s health and well-being.
 Works with the patient’s family and other service provider agencies to develop a plan
for care of the patient in his or her home or other living arrangement.
 Typically has a master’s degree in social work (MSW).
 In hospital settings, has a critical role in the area of discharge planning, ensuring that
the services a patient will require are in place before the patient is discharged.
Expand All | Collapse All

Who is a Medical Social Worker?

A Medical Social Worker is a social worker who works in a medical setting such as a
hospital, outpatient clinic, hospice, long-term care facility, or community health agency. It is
important to note that Medical Social Workers are most often referred to as “social
workers,” but occasionally may have other titles, including Case/Care Manager.
What does a Medical Social Worker do?
Medical Social Workers assist patients and their families with health-related problems and
concerns. The Medical Social Worker performs a comprehensive assessment of a patient’s
social, emotional, environmental, financial, and support needs and informs other members
of the health care team about these factors, which may affect the patient’s health and well-
being. Medical Social Workers work with the patient’s family or support systems as well as
other service provider agencies to develop a plan for the care of the patient in his or her
home or other living arrangement.
Patient counseling is an important part of the Medical Social Worker’s role. Medical Social
Workers lead support group discussions, provide individual counseling, help patients
determine appropriate health care and other health services, and provide support to
patients with serious or chronic illnesses.
In the hospital setting, Medical Social Workers play an important role in coordinating
patient discharge planning. They assist patients and families, access in-home health care
services, arrange for in-home medical equipment, provide for transportation, coordinate
follow-up treatments, and refer patients to a wide variety of community social service
agencies. Medical Social Workers are often also responsible for helping patients access
financial assistance and health insurance coverage. In some settings, Medical Social
Workers work closely with public and private health insurers to determine the patient’s
benefits and advocate for the patient.
What education, training, and experience must one have to function as a Medical
Social Worker?
The large majority of Medical Social Workers have a master’s degree in social work (MSW).
The MSW program provides both fundamental social work knowledge and the opportunity
to focus on a special area. Most Medical Social Workers have specific training in health and
behavioral health conditions, health care policy, and systems of providing health care
services. All MSW training includes a significant amount of time in a practicum experience
known as a field placement. Occasionally, a social worker in a health care setting may have
a bachelor’s degree in social work (BSW), an undergraduate degree in which social work
courses are undertaken in the last two years of study. BSW students also must complete a
practicum experience as part of their degree requirements.
How and by whom is a Medical Social Worker supervised?
The Medical Social Worker in a hospital or health clinic often works as part of a social work
department. The Medical Social Worker is supervised by experienced Medical Social
Workers who are supervisors or department directors. In hospitals and larger health care
facilities, the director of the social work department is usually a member of the medical
center’s administrative team. In some instances, Medical Social Workers may report to the
administrator of a particular department within a hospital. In smaller community health
agencies, and often in long-term care facilities, the Medical Social Worker may be the only
social worker employed at the agency. In this instance, the Medical Social Worker is
generally supervised by a health care administrator.
What are the typical day-to-day activities of a Medical Social Worker?
The typical day-to-day activities of a Medical Social Worker vary considerably depending
on the health care setting. In the hospital, the Medical Social Worker has a critical role in
the area of discharge planning. It is the Medical Social Worker’s responsibility to ensure
that the services the patient requires are in place in order to facilitate a timely discharge
and ensure that the patient’s needs will be cared for at home.
The Medical Social Worker does a complete psychosocial assessment on all patients
referred for social work services by the physician. After the assessment has been
completed, the Medical Social Worker works with the patient, his or her family, and other
health professionals to develop a discharge plan. When the doctor determines that the
patient will be ready for discharge soon, it is the Medical Social Worker’s job to implement
the plan by arranging for the home care services, coordinating transportation, working
with the family to facilitate the discharge, and providing other appropriate
services/referrals for the patient’s care at home.
Due to the high number of patients for whom the Medical Social Worker is responsible and
the tight deadlines required to avoid delays in discharge, medical social work is a highly
demanding job. In addition, the Medical Social Worker often is confronted with complex
cases involving patients with multiple psychosocial issues.
A Medical Social Worker usually participates as a member of a health care team to identify
the patient’s needs and develop a treatment plan. Medical Social Workers also provide
counseling services to individual patients and their families; provide support groups for
patients and/or caregivers; collaborate with other social service provider agencies; link
individuals to resources; and help restore individuals, families, and groups to successful
social functioning. A major role of the Medical Social Worker is to be an advocate for the
patient and, at times, an advocate for broader social causes.
Must a Medical Social Worker be licensed or certified to function in his or her role
as part of the health care team?
Each state has different licensing, certification, or registration requirements regarding
social work. Although standards for licensing vary, a growing number of states are placing
greater emphasis on communication skills, professional ethics, and sensitivity to issues of
cultural diversity. Most states require a certain amount of supervised clinical experience
for licensure of clinical social workers. Although not required in order to practice, many
health care agencies require Medical Social Workers to be licensed, and most insurance
providers require a Medical Social Worker to be licensed in order to reimburse for services.
The National Association of Social Workers offers voluntary credentials. Social workers
with an MSW may be eligible for the Academy of Certified Social Workers (ACSW), the
Qualified Clinical Social Worker (QCSW), or the Diplomate in Clinical Social Work (DCSW)
credential, based on their professional experience. Credentials are particularly important
for those in private practice; some health insurance providers require social workers to
have them in order to be reimbursed for services.
What types of patients would benefit from the care of a Medical Social Worker?
Many, if not all, patients could benefit from the care of a Medical Social Worker. In
particular, individuals with chronic degenerative illnesses; the terminally ill; individuals
with mental illness; transplant patients; homeless individuals; and individuals with
multiple social, financial, emotional, or housing problems.
 How and when does a Medical Social Worker become involved in the care of a
particular patient?
In many health care settings, the physician requests social work services. In some settings,
all patients receive social work services.

Medical social workers coordinate services for and counsel patients and their families in a
variety of settings. You will find social workers in hospitals, schools, hospice, and anywhere
support and guidance is needed. Victims of crimes, trauma, or abuse also may especially
benefit from the services of a medical social worker.

To learn more about this versatile, demanding, and rewarding career, I consulted with a
fellow Guide at About.com, Elizabeth R. Rose, MSW.

Rose is a travel writer and Guide to Southwest for Visitors, and a former full time medical
social worker. She has over 30 years of experience in medical social work, including
management roles such as directing ethics and social services departments. Although
retired from the field, Elizabeth is still involved in supporting the efforts of social workers
via her websitesocialworkworld.org, which includes a variety of resources, information,
and articles for people who work in social work or who are planning a career in social
work.

Rose was kind enough to take time out of her busy schedule to answer some in-depth
questions regarding the ups and downs of a career in social work.

What are Some of the Roles and Jobs Available in Medical Social Work?

 Discharge Planning
 Crisis Intervention
 Mental Health Evaluation
 Chemical Dependency Evaluation
 Short term decision making counseling
 Facilitating support groups (ex. Cancer Support Group, Rehab Family Group)
 Ethical decision-making counseling
 Grief Counseling
 Specialty evaluations and coordination such as on a Renal Transplant Team
 Child Abuse investigations and reporting

What is a Typical Work Week Like for a Medical Social Worker?

Typically medical social workers are scheduled 24/7 and, if not, there is an on-call
arrangement so that a social worker can be reached at all times, in case of emergency or
crisis.

A typical day in a hospital may begin with a review of new admissions to the facility,
current referrals and unresolved case issues from the previous day. The day will often
continue with rounds on the various nursing units to collaborate with the physicians and
nurses in planning for the patient.

Additionally, a social worker will spend part of his or her day implementing plans for
patients' discharge(release from the facility) or problem-resolution. This includes patient
and family meetings and, often, healthcare team meetings.

One of the big roles of the social worker is crisis intervention, so the social worker's day
never goes as expected. There may be a death on one unit, where the family needs grief
counseling, a suspected child abuse case on another unit, where an evaluation needs to be
made to assist the team in reporting to Child Protective Services.

And, of course there are always members of the healthcare team and patients who need to
"talk to the social worker right now!" Social work in health care requires a healthy dose of
patience, along with great skill in prioritizing cases and intervention.

The medical social worker's day may end with finishing charting and wrapping up
documentation, such as statistics paperwork or data entry and, in an ideal situation,
debriefing with colleagues.

What Did You Like Most About Your Career in Medical Social Work?

I thoroughly enjoyed being part of the medical team and providing a service that was
needed and appreciated. Often the social worker is the only one who sees things from a
systems perspective and can remove barriers that seem to be immobile. I also appreciated
the opportunity to be trained in Medical Ethics and to provide ethics consultations in very
difficult situations.

What Were Some of the Greatest Challenges Facing You as a Medical Social Worker?

Juggling an ever-increasing caseload and having to take a pager home on weekends was
difficult. I believe strongly in worklife-homelife balance and when you are working in a 24
hour, crisis-oriented environment, this is difficult to maintain.

What are the Educational Requirements for Medical Social Workers?

Most hospitals and healthcare facilities require that the social worker have a master's
degree in social work from a CSWE accredited program. Occasionally a facility will hire a
BSW (Bachelor of Social Work) to do discharge planning under the supervision of a MSW
(Master's of Social Work). Many facilities require that their Master's level social workers be
working toward licensure.
What Skills are Required for a Successful Career in Social Work?

In addition to normal social work training it is helpful to have:

 Knowledge of medical terminology

 Understanding of the roles of the healthcare team
 Understanding of the psychosocial aspects of illness and health
 Knowledge of community facilities and resources for discharge planning
 Crisis intervention skills
 Short-term counseling skill
 Knowledge of the care planning and discharge planning processes

What Advice Would You Give to Those Seeking a Career as a Medical Social Worker?

I always advise prospective social workers to make sure they have dealt with their own
issues and fears before trying to help others. They also need to have a strong family,
colleague or friend circle of support. It's not easy to lose a young cancer patient you have
been counseling for a year, for example, and not have someone to talk to about that
experience.

Medical social work is a stressful role, in general, and the social worker is often expected to
be the glue that keeps the discharge plan together (and, often the healthcare team.) That's a
big expectation and a role only for the most "together" and mature practitioners.