A correspondent mentions an article by people from Marie Curie producing a model of social work for use in palliative care settings. This mimics for social work the NICE analysis of levels of psychological care, which has led to so much resentment from social workers (because it assumes that social workers are low-grade psychological workers, when in reality their psychological work is integrated into a much broader conception of their role).

I tend to think that if someone has family problems, the social work approach of getting into the family and negotiating among them all is much better than the psychological approach of getting a focal client to deal with their emotions or cognitions so that they can problem-solve. The research on social work tends to show that being prepared to get involved is highly valued in a family rather than being an external therapist. It is also more highly valued in my experience by colleagues.

Marie Curie has a similar levels analysis for spiritual care which was were also taken up by NICE.

The new article produces a model of four levels of social work, although its second ‘level’ is more a different type of social care practice than a different level. I think the advanced level should explicitly mention child and adult safeguarding, which are crucial social work roles, as I and a commentator on this blog have mentioned, is a really important area of social work rather neglected in many hospices.

They are right to say that healthcare organisations tend to look at the psychological of psychosocial and have very little idea about the social; mainly I find healthcare people cannot conceive what the social might be, aside from families, which is perhaps why so many social workers have allowed themselves to be called family support workers. Also, I found when I did an analysis of recent research on staff stress on palliative care (for Mari Lloyd Williams’s book on psychosocial issues in palliative care), that this is mainly about nurses (inevitably, as the majority staff group) one of whose big stressors is family conflicts. Therefore, there is certainly a demand from colleagues to focus on families when there are problems.

However, I do have a problem about levels of social work (or any other professional group). For one thing, it tends to lead to an assumption that there are lower and higher workers, and I think that many different kinds of interpersonal relationship are achieved with patients and their families by different kinds of people. For example, I think day-to-day carers often get closer to older people, particularly if they are more of the same age and social background as the older person than a professional with all sorts of therapeutic skills. Then I think levels tends to lead to an assumption that work will be referred up the levels, but complex work is often mixed with simpler issues and many people are unhappy about being referred up once they have got to know someone who is caring for them day-to-day. So I think enhancing or supporting through consultation the capacity of the nurse or whoever is actually daily in contact with a patient or carer is often better than referral upwards. And I don’t like the elitist implications of levels. Looking at the American assumption that ‘clinical’ social workers need masters qualifications while the bachelors can do something less demeans the real importance to many clients and complexity of service provision, and supportive and practical work.

Hearn, F., Jackman, E., Lake,T., Popplestone-Helm, A, and Young, A. (2008) Re-emphasising the social side: anew model of care. European Journal of Palliative Care. 15(6): 276-8.