Background   Social workers provide unique knowledge and psychosocial skills for seriously ill patients and their family (1). Clinicians often collaborate with social workers when caring for seriously ill patients. In fact, the Medicare Hospice Benefit and the National Consensus Project for Quality Palliative Care state that social workers are a core member of a hospice or palliative care (PC) interdisciplinary team (IDT) (2). This Fast Fact will discuss the role of the hospice and palliative social worker.

Training and Certification   Although social work practice requires a Bachelor of Social Work (BSW) degree at minimum, most hospice and palliative social workers have a Master of Social Work (MSW) or Master of Science in Social Work (MSSW) degree, awarded upon completion of a 2-year post-graduate program accredited by the Council on Social Work Education in the United States that includes supervised practicum experience. Licensure, certification, or registration is available in all states, and regulations vary (3). Currently, many palliative programs prefer clinical licensure at the Licensed Independent Clinical Social Worker (LICSW) / Licensed Clinical Social Worker (LCSW) level or similar, which reflects 2 years post master’s degree supervised work experience and denotes qualifications for mental health diagnosis and treatment as well as individual and/or family therapy. Advanced certification in hospice and palliative social work is available and requires experience, licensure, commitment to ethical practice, and passing of an evidence-based exam (3). Most social workers report learning their specialty through interprofessional practice and post graduate continuing education (4).

Scope of Practice   Major social work roles for the seriously ill include providing evidence-based interventions that empower the patient in the context of their health care and family situation and facilitating a dignified death as defined by the patient. According to the NCP Guidelines, “social workers attend to family dynamics, assess and support coping mechanisms and social determinants of health, identify and facilitate access to resources, and mediate conflicts” (2).  A national job analysis further delineated the social work role (6). From this work, a range of direct and indirect patient care services driven by individualized assessments and care planning needs have been described (2,5-10):

Direct Patient Care Services	Indirect Patient Care Services
Utilizing a biopsychosocial assessment of the patient and family as the basis for care planning	Facilitating or co-facilitating family meetings
Facilitating effective communication between patient/family and the IDT	Advocating for effective team dynamics, including conflict management, wellness and self-care
Assisting patients with advanced care directives	Debriefing difficult cases or deaths within the IDT
Patient/family psychoeducation regarding coping with illness, normalization of stress, and palliative care options such as hospice services	Identifying and reporting abuse and neglect as mandated by law
Resource identification and referrals; practical assistance; insurance coverage; system navigation; funeral planning.	Documenting assessments, progress, and response to treatment as required by organizational and professional standards.
Financial counseling related to the cost of care	Improving care delivery for persons with life-threatening illness
Individual and family counseling specific to the disease process, coping, and planning	Educating IDTs about mental health issues, family dynamics, or psychosocial factors impacting care
Assessing and addressing caregiving resources and needs	Advising IDT members of the maintenance of appropriate and therapeutic boundaries
Crisis intervention including suicide assessment and prevention	Facilitating and participating in research and quality improvement activities
Collaborating on discharge planning	Cultivating community relationships and developing community resources
Legacy work including dignity therapy and Acceptance and Commitment Therapy (ACT)	Influencing and improving social policy and ethical practice related to hospice and palliative care
Bereavement care and grief counseling, including anticipatory responses to and processing of grief	Awareness of state laws and regulations regarding end of life care

Like other members of the PC IDT, social workers develop expertise relative to the patient situation. PC social workers are often engaged with adjustment to illness, decision making, and family coping along the illness trajectory. Hospice social workers are focused more specifically on end of life, though the job descriptions and tasks carried out are much the same as those in PC social work. Typically, there are two main models for utilizing social workers to address palliative care needs: 1) utilizing the unit or clinic generalist social worker or 2) utilizing the IDT social worker with specialized training and experience. A specialized palliative social worker is preferred and offers greater expertise relative to the serious illness context of the IDT, patient and family. 

Summary    Hospice and palliative social workers have unique education, skills, and training essential to the interdisciplinary provision of holistic patient-centered care. Their psychosocial expertise and attention to the social determinants of health enables IDTs to better appreciate the complexity of issues patients and families face and thereby develop more effective, feasible, and patient-directed interventions. 

References 

1. National Association of Social Workers. NASW Standards for Social Work Practice in Palliative
    and End of Life Care. Washington, DC: Author; 2004.

2. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative 
    Care, 4^th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018.

3. Chai E, Meier D, Morris J, Goldhirsch S (Eds). Geriatric Palliative Care: A Practical Guide for 
    Clinicians. New York: Oxford University Press; 2014.

4. Social Work Hospice and Palliative Network. APHSW-C Certification. https://www.swhpn.org/aphsw-
    certification. Accessed January 4, 2019.

5. Sumner B, Remke S, Leimena, M, Altilio T, Otis-Green S. The serendipitous survey: A look at the 
    primary and specialist palliative social work practice, preparation and competence. Journal of Palliative
    Medicine. 2015;18(10): 881-883.

6. Head B, Peters B, Middleton AA, Friedman C, Guman N. Results of a nationwide hospice and
    palliative care social work job analysis. Journal of Social Work in End-of-Life & Palliative Care, 2019;  
    15(1):16-33.

7. Gwyther LP, Altilio T, Blacker S, Christ G, Csikai EL, Hooyman, N, …Howe, J. Social work 
    competencies in palliative and end-of-life care. Journal of Social Work in End-of-Life & Palliative Care.
    2005;1(1):87-120. doi: 10.1300/J457v01n01_06

8. Altilio T, Otis-Green S, Dahlin CM. Applying the national quality forum preferred practices for palliative
    and hospice care: A social work perspective. Journal of Social Work in End-of-Life & Palliative Care.  
    2008;4(1):3 – 16.

9. Weisenfluh SM, Csikai EL. Professional and educational needs of hospice and palliative care social
    workers. Journal of Social Work in End-of-Life & Palliative Care. 2013;9(1): 58-73. 
10. Friedman C, Guman, N. A job analysis study of the advanced hospice and palliative care social
      worker. Kansas City: PSI; 2017.

Conflicts of Interest:  None to report.

Authors’ Affiliations:  ¹University of Louisville, Louisville, KY; ²University of Minnesota, Minneapolis, MN

Version History:  originally edited by Sean Marks MD; first electronically published December 2019.