The present study focused on understanding social work services in the Emergency Department (ED), a critical setting for social justice oriented interventions for individuals who are medically vulnerable, disenfranchised, oppressed, or living in poverty.ġ.1. Medical social work has developed with a focus on enacting the social justice mission of the profession, specifically this focus includes working to “meet the basic human needs of all people, with a particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” ( NASW, 2008). ![]() They are integral members of interdisciplinary medical teams and provide many different services in a variety of settings ( Beder, 2006). Social workers now have access to evidence-based practices developed to address behavioral and psychosocial concerns in medical settings. Cannon’s initial ideas about the components of medical social work practice necessary for successful intervention on social conditions provided a foundation in the field and have been expanded. There now exists a substantial body of evidence to support what Cannon and other progressives of her time observed in their work: remediable social conditions impact health and are responsible for inequalities in health outcomes ( World Health Organization, 2016). In addition, she outlined key mechanisms for addressing patient needs such as social worker skill, knowledge, and availability of community resources ( Cannon, 1913). She connected social factors like environmental conditions and poverty to human health outcomes. In her formative book on medical social work at the turn of the 20 th century she outlined what are now called social determinants of health long before the term or its underlying concepts were widely used. Cannon, one of the first hospital social workers in the US, wrote “The problems of many hospital patients are social as well as medical.” (pg 2). A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. ![]() All of these forces were at play in patient-social worker interactions and impacted service provision. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. ![]() Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. This paper reports a qualitative content analysis of social work medical record notes (N=1,509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N=10). This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. Social workers have long been part of interdisciplinary ED teams. The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs.
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