Grace H. Christ

Advancing social work practice in end-of-life care.

Abstract Insufficient training of health professionals has often been cited as a major barrier to improving the system of care for dying patients and for the bereaved. Although specific problems have been identified for physicians and nurses, the problems of social work in this substantive area have only recently been explored. This study used a practitioner survey, focus groups, and a survey of faculty of schools of social work to broaden the information base. Results suggested that not unlike the professions of medicine and nursing, social work knowledge and skill development in the care of the dying is uneven and not integrated sufficiently with theoretical concepts and research. Social workers felt unprepared for this work by their masters level training and unsupported by continuing education programs. They recognized few social work scholars who could function as role models by providing comprehensive training, knowledge building, innovation, and advocacy. A program for leadership development was created to test new approaches to professional development in the care of the dying and the bereaved.

Current Approaches to Helping Children Cope with a Parent's Terminal Illness

Much has been learned about childhood bereavement in the last few decades as studies have increasingly focused on the direct interviewing of children about their recovery from the tragic loss of a parent. It has been shown that children do indeed mourn, although differently from adults. Important moderating and mediating variables have been identified that impact their recovery from the loss of a parent, which can be the focus of intervention. When death is expected, the terminal phase of an illness has been found to be particularly stressful for children, yet seldom investigated. Similarly, few studies have explored the impact of development on childrens experience and expression of grief. We present research findings that clarify phases in childrens experience during the terminal illness, hospital visits, the death, and its immediate aftermath, as well as how the parent is mourned and issues in longer term reconstitution. Variations in childrens responses in these phases are described as they were experienced by 87 children from 3 different developmental groupings: 3 to 5 years, 6 to 8 years, and 9 to 11 years. Recommendations are suggested for parents and professionals about ways to understand and support children during the terminal illness, at the time of death, and during the phase of reconstitution.

Psychosocial adaptation of long-term survivors of bone sarcoma

Previous studies comparing amputation and a limbsalvage procedure as treatments for bone tumors described no differences between the two treatments regarding the incidence of psychopathology or quality-of-life outcomes. These studies were limited by the absence of standardized measures of psychopathology, by samples that included an overly broad age range, or by including patients who had either upper- or lower-limb bone cancers. A sample of 45 patients (43 with lower-limb osteosarcoma and 2 with Ewings sarcoma) who were aged 11-24 years at diagnosis and had survived an average of seven years at the time of the study were evaluated using both standardized measures of psychological symptoms and a semistructured clinical interview. No differences were found in the mean psychopathology scores of the two treatment groups (32 treated with a limb salvage procedure and 13 with initial amputation). Significant differences in psychosocial adaptation were found between the two groups. The amputees felt they were n...

Historical Threads in the Development of Oncology Social Work

As the Association of Oncology Social Work celebrates its 25th year, we pause to reflect on the many historical threads that contributed to its development and hear from each of the presidents who helped create the organization, as we know it today. Set within hospitals, medical social work was born in the early 20th century. In the 1940s medical social work became necessary for hospital accreditation. Two additional historical shifts, one in medical improvements in treating cancer, the other a shift to a consumer-oriented American Cancer Society, contributed to the push for a greater role for the federal government in funding cancer research. Oncology social work came to full blossom in the 1970s, a result of the physicians’ need for a member of the health care team who understood cancer, its treatment, and the patients need to address his or her psychosocial needs resulting from cancer. Today, oncology social work is a fully developed profession with a national organization providing education and support to oncology social workers’ in their use of psychosocial interventions and research in behalf of cancer patients and their families.

An Examination of Interactions between Hospice Health Care Providers and Adolescents with a Parent in Hospice.

Interviews conducted with adolescents living with a dying parent were examined to identify the type of interactions the adolescents had with members of a hospice health care team. Four types of interactions were identified: no interactions, in-passing interactions, engaged interactions, and formal interactions. Results indicated that most of the adolescents had no contact with the hospice health care team or interacted with providers only briefly. Some adolescents reported more engagement with 1 or more hospice health care team members, and a few received formal counseling services from the hospice health care team or outside provider. Overall, limited contact occurred because of logistics or because the teens perceived that hospice services were exclusively targeted to dying patients, not their families. Based on these findings, strategies to increase engagement between adolescents and hospice health care team are discussed.

Social work contribution to a comprehensive model of mourning: the experience of bereaved families of fire-fighters killed on 9/11/01

Abstract Recent research on the grief process supports the need to create a comprehensive model of mourning that more fully incorporates reactions to unexpected traumatic losses as well as to expected losses from illness. A more comprehensive model also needs to reflect an understanding not only of adaptation hampered by emotional problems and pathologies but also of resilient adaptation. Lastly, it requires an exploration of extrinsic factors affecting the mourning process as well as intrinsic factors – those that are intrapsychic, psychological, and emotional. Research has generally focused on individual intrinsic factors that affect the mourning experience. This article considers more recently identified extrinsic factors that can temporarily delay even resilient adaptations to the mourning process. It draws on both clinical and research experiences with a long-term (5-year) social work intervention with a cohort of 50 bereaved widows and children of fire-fighters who lost their lives as a result of the attacks on the World Trade Center on 11 September 2001. The extrinsic factors that affected the mourning of the bereaved families included: (i) multiple burials and memorial services for the fire-fighters and their colleagues; (ii) terrorist threats leading to school lockdowns; (iii) the long, often unsuccessful, search for remains; (iv) the closing of the disaster site approximately 9 months after the disaster although the remains of many victims had not been recovered; (v) constant evocative coverage by the media; and (vi) numerous other concurrent losses and stresses. The question addressed here is the following: In what ways might external conditions have prolonged, intensified, or otherwise altered a normative grief experience?

Defining Core Competencies for Generalist-Level Palliative Social Work

CONTEXT Care provided to seriously ill patients by frontline social workers is a component of generalist-level palliative care. The core competencies for high-quality generalist-level palliative social work are necessary to promote training curricula and best practices but have not yet been defined in the U.S. OBJECTIVE The objective of this study was to develop consensus-derived core competencies for generalist-level palliative social work. METHODS Fifty-five proposed social work competencies were categorized by the eight domains of palliative care identified by the National Consensus Project for Quality Palliative Care. The competencies were rated by 41 regionally dispersed, Masters level social workers selected through purposive and snowball sampling using a Delphi method. Each was rated as essential for generalist-level palliative social work, acceptable with modifications, or rejected based on the judgment that it was not essential for generalist-level palliative social work or was outside the scope of practice. Consensus was defined as >70% agreement to accept or reject a competency. Three review rounds were needed to achieve consensus on all competencies. RESULTS Two competencies were added to the original list. Of the 57 proposed competencies, 41 were accepted (19 after modification) and 16 were rejected. Competencies in the social, spiritual, cultural, and ethical/legal aspects of care domains were relatively more likely to be accepted compared with those in structure and processes of care, physical care, psychological care, and care of patient at the end of life. CONCLUSION The 41 consensus-derived competencies for generalist-level palliative social work may inform the development of training curricula and standards for high-quality care.