Educating Students for a Changing Health Care Environment: An Examination of Health Care Practice Course Content
Kadushin, Goldie, Egan, Marcia, Health and Social Work
Students in the health care concentration are the third largest group of students in graduate social work programs (Lennon, 1992). Social work educators are confronting several challenges in preparing students for health care practice. Given the changing environment in which health care social workers practice and the changing nature of practice itself (Berkman, 1996; Strom & Gingerich, 1993), it is surprising that there have been no surveys of the health care curricula since the 1980s (Caroff & Mailick, 1985; Marshack, Davidson, & Mizrahi, 1988). Consequently, social work has no current information on what is taught in graduate schools to prepare students for practice. This issue prompted this survey of the initial graduate-level health care practice course.
CHANGES IN THE HEALTH CARE ENVIRONMENT
Five trends in the health care environment are affecting practice roles: (1) deinstitutionalization, (2) a growing elderly population, (3) the more frequent occurrence of biomedical ethical issues in health care delivery, (4) the AIDS epidemic, and (5) a growing population of people from diverse cultural backgrounds.
Drastic changes in health care financing - such as the adoption of the Medicare prospective payment system and the emergence of managed care - have resulted in fewer hospital admissions and reduced length of patient stays. An increasing amount of care is being provided outside hospitals in community-based, ambulatory, and long-term care settings (Berger et al., 1996; Berkman, 1996; Poole, 1995; Rosenberg, 1994; Simmons, 1994).
The current tendency to reduce inpatient stays suggests that discharge planning will remain an important focus for hospital social workers (Kadushin & Kulys, 1993). The need to coordinate care more efficiently while a patient is hospitalized and after discharge makes care coordination and case management a pivotal social work role (Berger et al., 1996; Berkman, 1996; Rosenberg, 1994; Simmons, 1994). Skills in interdisciplinary collaboration are important both within the institution and in the community (Abramson & Mizrahi, 1996; Berkman, 1996). As patients receive more care in their own homes, social workers will need to provide support to families, who bear most of the burden for community-based care (Lurie, 1995; Poole, 1995; Rosenberg, 1994). The emphasis of managed care and the prospective payment system on outcomes, profits, and regulation of service delivery creates a need for practitioners to be skilled in short-term treatment and practice evaluation (Vourlekis & Leukefeld, 1989; Strom & Gingerich, 1993).
The proportion of people older than age 65 increased from 4 percent of the U.S. population in 1900 to 13 percent in 1994 and is expected to increase to 17 percent by 2020 (Keigher, 1995). As people live longer, they are more likely to suffer from chronic rather than acute illnesses (Rosenberg, 1994). Health care for this population should be focused on primary care with an emphasis on disease prevention and health promotion (Berkman, 1996). These clients also will require an array of supportive services to remain in the community (Simmons, 1994). Thus, there will be a demand for social workers trained in aging and gerontology (Keigher, 1995).
Issues such as patient rights, advance directives, and ethics review committees have become a part of the practice arena. Social workers are increasingly called on to respond to practice situations involving biomedical ethical decisions. Concerns related to the rationing of health care resources and the implementation of advance directives have been identified as areas in which social workers require more education and training (Foster, Sharp, Scesny, McLellan, & Cotman, 1993).
New diseases, most notably AIDS, are becoming part of the health care environment. The need to train social workers to provide services to people with HIV/AIDS has received increasing attention in the literature (Dane & Miller, 1990; Diaz & Kelley, 1991; Miller & Dane, 1990; Schinke, Schilling, Krauskopf, Botvin, & Orlandi, 1988; Silberman, 1991; Steiner, 1995; Taylor-Brown & Garcia, 1995; U. …