Social Worker

Description of Specialty

Social workers “help individuals, families, and groups restore or enhance their capacity for social functioning…through the provision of psychosocial services and advocacy” (National Association of Social Workers, 2014). The profession utilizes a person-in-environment framework and a strengths-based approach to enable people to surmount challenging life experiences. In long-term care settings, such experiences may include chronic illness, physical disability, mental health conditions, or numerous losses. Many times social workers help long-term care residents and their families cope with all four of these issues simultaneously. Using a person-in-environment framework means that social workers consider both the individual’s internal state and the impact of his or her environment in devising interventions to address problem areas. Using a strengths-based approach means that social workers build on what is going right to minimize clients’ difficulties. Services provided by social workers include psychosocial assessment, psychotherapy, supportive counseling, group therapy, problem resolution, advanced care planning, psychoeducation, and training.

Educational Requirements

A masters’ degree is required for independent licensed social work practice. Completion of the degree usually takes two years, although some schools of social work offer advanced standing programs that allow students with a bachelors’ degree in social work (BSW) to complete a masters’ degree (MSW) in one year. Course work emphasizes theories of practice, understanding common social problems, and honing practice skills for client engagement, assessment, intervention, and evaluation. A supervised internship experience is the “signature pedagogy” of social work education; MSW graduates complete 960 hours to earn the degree.

Licensing Requirements

Requirements for social work licensure vary by State and diverse levels of licensure exist. For the minimum level of licensure, most states require an MSW and passing scores on a test of practice knowledge. Social workers at this licensure level require supervision in order to provide psychotherapy. The highest level of licensure requires a supervised clinical experience post-MSW, ranging from 3200 to 4000 hours, and passing scores on a test of practice knowledge. Social workers with this licensure level may practice independently. Continuing education is required to maintain licensure; emphasis is placed on courses related to ethics and cultural competency. In some states licensure is not required to practice in long-term care settings, but licensure is required to bill third-party payer sources such as Medicare, Medicaid, and management care providers.

Specialty Credentials Related to Geriatrics

Social workers may specialize in gerontology while earning their masters degree; many schools of social work offer concentration programs or certificate programs in gerontology to prepare students for effective practice with older adults and their families. An online certificate program through Boston University allows students or practicing social workers to earn a gerontology certificate at their own pace: http://www.bu.edu/cader/. NASW also offers two MSW-level credentials in gerontology: the Clinical Social Worker in Gerontology (CSW-G) and the Advanced Social Work in Gerontology (ASW-G); http://socialworkers.org/credentials/list.asp. Both credentials require licensure, continuing education in gerontology, and 3000 hours of experience working with older adults. The CSW-G requires supervised provision of mental health-related services. It is important to recognize that neither a specialization nor a credential is required for social workers to practice in long term care settings and many practitioners learn specialty practice skills on the job.

Scope of Services in Long Term Care Settings

System Integration: Social workers bring expertise in problem resolution and are prepared to identify multilevel factors impacting behavioral health care and the delivery of psychosocial services. With in-depth understanding of both the barriers and enablers contributing to quality care, social workers are well equipped to tailor interventions to minimize identified problem areas. Such interventions may include providing nursing home staff education on non-pharmacological strategies to address challenging behaviors, designing communication processes that facilitate effective interdisciplinary team processes, and incorporating resident and family input to inform patient-centered care.

Education/Leadership: Social workers use a strengths-based approach to help nursing home staff identify and develop non-pharmacological approaches that are personalized to individual resident needs. In doing this, social workers encourage staff to incorporate residents’ social history, unique interests, abilities, and cultural preferences into behavioral intervention plans. They also prompt staff to reflect on how the environmental milieu and their own interactions with residents may influence behavioral symptoms and provide necessary training to reduce the negative impact of identified triggers.

Assessment: Social workers are trained in clinical diagnosis using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), but are also skilled in identifying problems in living, which are areas of difficulty that contribute to residents’ emotional distress, but do not represent a psychiatric condition. Such problems in living may include adjustment to placement, managing multiple losses, processing complicated grief, and negotiating relationship difficulties. Social workers use a narrative assessment approach that involves talking to residents and family members about their areas of difficulty; standardized assessment instruments are utilized to further quantify problem areas and associated strengths. Social workers can help nursing home staff identify rigorous but easily implemented measurement instruments that promote identification of resident needs; they are especially skilled in identify measures that reflect cultural diversity.

Clinical Decision Making: Social workers consider both the person and his or her environment in the clinical decision making process, and seek input from all interdisciplinary team members, in devising non-pharmacological treatment plans. Of particular importance is knowing the resident as a unique individual with a rich social history and incorporating that individuality into behavioral treatment planning, especially in the context of advanced dementia. Social workers are able to assume a leadership role in helping other nursing home staff members get to know their residents better and approach behavioral intervention from a strengths-based perspective that considers what residents are able to do as well as the problems they are experiencing.

Non-pharmacological approaches: Social workers draw on diverse psychosocial theories in delivering psychosocial interventions, and utilize approaches that reflect residents’ internal state as well as environmental triggers. They are able to collaborate with multidisciplinary staff for behavioral intervention, but also provide social work specific care. Common approaches may include supportive counseling, group therapy, meaningful activities and pleasant events, and negotiating roommate or co-resident relationship difficulties.

Additional Information about Social Work in Long-Term Care Settings

The information above describes the role of social workers who deliver services as contracted providers retained by the facility to address residents’ intensive psychosocial and behavioral health needs on an as needed basis. It is important to recognize that most long-term care facilities also employ their own social worker or social service provider who addresses the ongoing medically-related psychosocial needs of residents and families. Facilities with more than 120 beds are required by federal mandate to employ a full-time qualified social worker, defined as an individual with a bachelor’s degree in social work or a related discipline such as psychology or counseling. These professionals assess residents’ medically-related psychosocial needs using federally mandated assessment instruments as well as other standardized measures, for example the Geriatric Depression Scale, and incorporate findings into an overall plan of care guiding the resident’s stay in the facility. Supportive counseling and group counseling are often provided for residents with less intensive needs, while a referral to the contracted mental health provider is made for more complex psychiatric conditions. Facility social workers are also responsible for problem resolution, program development, linkage to facility and community resources, advocacy, and discharge planning.