Specialty and Primary Palliative Care Social Work: A Podcast with Bridget Sumser

Specialty and Primary Palliative Care Social Work: A Podcast with Bridget Sumser



welcome to the Jerry Pell podcast this is Eric wood heiresses Alex Smith and Alex I spy a couple people in our office do you have a couple I mean our Studios studio studio office studio who are these people we have Bridgette some sir who is a palliative care social worker at UCSF welcome to the Jerry Powell podcast Bridgette thanks for having me and coming back for as a repeat guest host we have Ann Kelly who's a palliative care social worker here at with our palliative care service welcome glad to be here and we're gonna be talking about social workers in palliative care services and Bridget's new book palliative care a guide for health social workers but before we get into this topic Bridgette do you have a song for Alex's sing I do revolution by Tracy Chapman Stuart don't you know we're talking about a revolution it sounds don't you know we're talking about a revolution it sounds yeah I like the little assistance there okay I'm gonna get at the end we're gonna play the song yeah and I'm your cue is it sounds it sounds like a revolution no we're doing a revolution why did you pick this song Bridget well it's really just one of my favorite songs and you know there may be some subtle political undertones which maybe we'll talk about as we talk about the book fascinating hmm so um why did you why did you write a book that seems like a a big undertaking yeah so um to be fair and clear this book is co edited by myself Megan lion'll Amina and Terry L Tilly oh and we were really fortunate to work with some incredible contributors who put a lot of time and heart and soul into this project over the course of five years and we did it because in the aftermath or in the aftertime of the oxford textbook of palliative Social Work Terry and her partner Shirley Otis Greene were approached about sort of what's the next project and so in working with Terry at that time we sort of went out to figure out what the next project was and out of that search and research this was born and you have a question no okay yes I was gonna ask who is the target audience for this particular book yeah so this is really a guide for health social workers health social workers is a huge term it means sort of any social worker working in health care setting and certainly has relevance for new palliative care social workers also so we know there's not a lot of training opportunities for social work in palliative care and there's some good nuggets and gems for people practicing in specialty settings but the heart is really for health social workers you guys mention in your book that there's a lot of talk around bridging the gap between what's considered specialty in height of care social work and where there might be a lot overlap or differences between what we think of as more general health social work and I was wondering if you could say more about that and what what that process was like and sort of trying to distinguish between the two yeah so we we started with a really strong conviction that social work practice and palliative care practice are are inherently aligned and really at their core congruent and so we started with this sort of theoretical frame that as specialists we could figure out how to extend our work to sort of primary providers and as we tried to conceptualize that over time we realize that that split that dichotomy is actually pretty hard to make tangible and partially that's because social work practice clinical social work skills are so similar to palliative care skills and so to talk about how health social workers should be integrating or already are integrating palliative care into their practices and sometimes felt a little redundant or it felt like in the process of making a specialty and a specialty of palliative care Social Work we had sort of forgotten or moved away from all of that work that was already happening just in general a Social Work practice hmm so the comparison would be for example to like physicians where there's you know a primary care physician or a hospitalist who's practicing primary palliative care might have a distinct skill set that they need to learn around communication symptom management etc that might be really important for all doctors to know but is a little bit and and you know arguably every doctor should know but and should have known already and maybe that's more simply what you're saying here is that's or so in the case of social workers where these kind of core palliative care principles and Social Work are kind of core principles of Social Work yeah absolutely so is their case for specialty level palliative care Social Work like if if it is so ingrained into Social Work and Social Work is it so ingrained in Social Work and Social Work training that there is no need for specialty level of care interchangeable so I think there's absolutely a need for specialty palliative care Social Work and there will continue to be yeah what I think we sort of uncovered in the process of putting this book together is a resurfacing of the primary sort of vision and values of Social Work practice of Health Social Work practice and sort of a reminding or reflecting back that that's what people are doing I think part of the challenge is that the healthcare setting in general does not ask social workers often to practice sort of to the highest level of their license so are you suggesting this around that's a discharge planning possibly and it's not to say that discharge you know discharge planning is incredibly important there are profound therapeutic components of good care plans and I'm saying that facetiously that that often times medical centers what they really do care about a lot is length of stay and getting people discharged as quickly as possible yeah and I feel and the concrete resources necessary for that yeah and sometimes people's the scope practice could be narrowly focused on this one issue absolutely yeah and I would you know this is maybe a political thing to say but I don't think most social workers get master's degrees to give taxi vouchers I think most social workers continue on with education because they're interested in sort of the therapeutic dynamics to helping people in their lives and I do not want to say that you're planning and discharge planning can't be a part of that yeah but to have your entire job really focused on getting people in and out of a health care center overlooks really core qualities of Social Work practice I noticed throughout the chapters there was a lot of there was discussion around social work core values and also sort of the and specific skills or interventions that are used that bring those values to life and yeah I noticed you guys gave a lot of case examples around what that might look like in real life for patients who were in a health care setting yeah I think what we learned so this book came out of a survey of Health social workers sort of assessing their sense of competency and capacity in what we had identified as core palliative care skills and competencies and also how they like to learn and what we heard from social workers over and over and over again is but what should I do and how do I do it and how do I name it and so we really wanted to ground the theory of this book in real-life examples and articulate really clearly what we think the social worker was doing so that that can be translated to other folks on the team and to build the confidence in the clinical social work skills so instead of just saying supportive counseling provided what does that mean what did you do who did you know how did you talk to these folks about what they are going through and with those case examples we also really wanted to talk about different types of people different types of patient populations different disease trajectories different settings and locations of care over different amounts of time so that more health social workers could could find themselves somewhere in the book yeah I remember you split up these stories into sort of three different levels micro meso and macro could you talk a little bit more about why that was intentionally done throughout yeah so there were a couple of key theoretical principles that we used throughout the book and this idea of micro meso and macro sort of speaks to Social Work practice which is of course sort of at the center for many folks is is one-on-one relationship or the or the micro and the person in their environment who who is in their life sort of their most immediate circle and then we are also thinking about interventions on more of a different levels of systems so in the community and then the biggest system being sort of policy and healthcare at large and we wanted to explore way as social workers could take palliative care principles and advocate or enact them on multiple layers this is part we cut out in the audio but video this is where we add our new ads and let me catch my breath I just I I have some some non book questions but I want to make sure we stay on this book theme for a little bit more any other book questions you know it's let's pause to close the mic I'm wondering about sort of how you and the all the contributors of the book as you guys worked on writing this and editing it and re-editing it did this process did you find that it changed your practice or your attitudes in some way how did it change you and what you bring to your work each day yeah it's a good question I think you know um just a comment on the process this was extraordinarily laborious in that we asked specialty palliative care social workers to write about taking what they do all day every day and integrate it into settings that maybe they don't actually work right so just right there we've asked them for this kind of massive cognitive I mean for example like somebody does primarily outpatient Social Work to write about something that's more of an inpatient issue or take a person who's primarily on a palliative care consult eehm and ask them to imagine how they might apply some of what they do in a dialysis center okay right so really trying to take specialty palliative care and to imagine it in primary settings mm-hmm so right there that was challenging from they get and then you have many many contributors writing it from about different subjects from different locations and you're trying to make a cohesive statement on some level at least not contradict yourself too much and so the editing process was you know layers and layers and layers and we actually read the chapters out loud on conference calls over and over again Wow and that was that was three of us across time zones really with this deep sort of commitment to making it the best book possible so one way that changed my practices I was really tired a long time as we did this many nights a week for you know why felt like yours but I do think really importantly it gave me a really different appreciation for what healthcare social workers do and I think in my own professional identity building as a specialist had separated myself some from health social work and reignited my commitment to social work as a field most broadly and there are chapters on a number of different topics in this book you know pain cultural issues spirituality culture so many diverse topics that really cover the whole spectrum of psychosocial and physical spiritual distress in palliative care yeah so it's interesting that you sort of interweave all of these components and and yet there are also chapters are specifically about you know sort of palliative care and end-of-life and about social aspects and I you know is you know working through this book I wondered if there if you feel like there is a core of you know this is what social work is and this is what the main things that social workers should attend to and then these are other things that they should be aware of around it and I wonder what you would put sort of in that Center and what you'd sort of put around it yeah it's a good question so we organize the book around the domains of palliative care as defined by the national consensus project in a hope to really orient health social workers to how many people conceptualize the most important parts of palliative care recognizing also that while we separate them for chapters and we separate them as domains are really quite intertwined and overlapping and so that's sort of a false separation I think social workers are for sure psycho socially oriented and maybe you can put that like right at the center who who are your patients and families what are the social factors influencing their experience how are they processing psychologically psychiatrically emotionally what's happening with their relationships I think what we really encouraged people is to do in this book is to find things that speak to them and to get more into it you know really in many ways is a sort of a survey course in in palliative care for health social workers and many people are studying all of the things in this book and spending their entire lives studying the things in this book into what we were hoping to encourage people as if spirituality speaks to you or symptom management speaks to you or systems issues speaks to you integrate that into your practice and and let it be a personal thing that's really driven by what you think is important and going moving a little into from primary palliative care in social work just specialties palliative care Social Work it sounds like it's a pretty exciting time right now there's a new end is that right you just took a test just a new certification exams did you take it yesterday I did this exam it's the advance I know Bridget was on you've been on the board to help you sort of develop it maybe you could speak yeah so it's the advanced practice palliative and hospice Social Work certification exam and it was built in the lineage or reflection of similar nursing credentials and Social Work up until this point has been without a credentialing exam so there if there is an NASW credential that is really just based on experience and it was felt and husband felt for a long time that was really important important for people to be able to sort of prove competence and that just started this year it did the first test was yesterday after a lot of hard work by a lot of people so why should why should social workers in palliative care take this exam you know it's a good question I think that this is part of building a solid reputation as specialists and really being able to prove and own maybe less about proving actually but the internal process of owning expertise and capacity and I think there's some hope that that equals some of the hierarchical stuff over time with nursing and physician colleagues way there's hierarchical issues in the I mean sometimes maybe another place yeah I think you know even from like hiring perspective and developing teams it it does do something when you're trying to develop a team to see that this person has this expertise and it is shown also by this certification not just Oh you know I'm really interested in this subject and that's why I'm applying for this position yeah it certainly highlights commitment right and I think what we have heard is that employers are really excited about this certification and because there are so few options for specialty level palliative care Social Work training this is a really important component of building out the professional identity and sort of confidence and when you're looking in the future let's say the next five or 10 years any any other things that excite you as far as specialty level palliative care Social Work yeah there's there's so many things I think swept in the National Organization the Social Work in hospice and palliative care network is really building membership and the annual meeting has you know increasingly large groups of social workers that are really committed to this work and to the that both the clinical care and the academic component of palliative care Social Work there are more and more jobs which means we have more and more opportunity to sort of build our workforce and to build some evidence base in it and then I think palliative care social workers are going to have an awesome opportunity as exampled by this book to really think about how can we change healthcare so outside of providing specialty level care how can we take what we do and influence how more people are cared for I mean you're excited about it I agree entirely I think it's wonderful to just be thinking about our discipline the evolution of our discipline and really becoming to not only be recognized by others but really recognizing our ourselves and being able to identify the the heights of what social workers can contribute to this kind of care for people yeah and I think you know that to be moving away from the idea that social work and chaplaincy but that social work is sort of a support to physician and nurses but actually when we look at what is most important to people with serious illness its psychosocial issues right like these are the things that are actually like making or breaking people's experiences okay so if you look yeah so why do you think it is when we look at a lot of the randomized control trials in palliative care it's often a the team let me talk a lot about teams in palliative care this is a team based like health care's team team team but if you look at the randomized control trials a lot of them are a physician and a nurse or a physician and nurse practitioner yeah so why do I think there aren't social workers on those studies yeah it seems like if we say this is so integral important to what we do man there should be like social workers and chaplains included in these studies I recognize that part of it is just funding a trial but I think it is one of the I think the services that we do sometimes too to our literature when we don't actually include the core principle of what makes a good valve care team I think a huge part of that is job structure so if you have somebody who has a hundred percent clinical time job is essentially running a palliative care service or at least providing the continuity for that palliative care service where do they get the time to be on a study right there aren't there are very few models of Social Work jobs that integrate time for projects program development research and that's partially a funding issue and that's partially that Social Work jobs are generally either managerial or clinical jobs hmm so we talked a little bit about moving looking forward and what we're hoping for of the next five years because you talk about and you talk a little bit about this in the book the history of Social Work in palliative care I'm thinking now not so much about health social workers but about specialist palliative care social workers mmm-hmm and there as you mentioned in the book too there are different ways in which they become integrated and part of the teams in different local environments and sort of nationally is there is like a bigger sense of where we've come from mm-hmm yeah you know I've been really fortunate to be sort of trained and mentored by Terry LT Leo who's one of the editors on this book both Megan and I have been and that has led to a really international process and our learning and certainly in the creating of this book but in many ways they're sort of were in a place now where there's first generation and second generation palliative care social workers and a lot of the first-generation palliative care social workers came out of oncology care and worked so hard advocated so hard to have a seat at the table right that was sort of a lot of the effort to be to bring social work to feel heard to be valued to not be second thought and now I think there's an opportunity right there is all the talk that this is interdisciplinary or interprofessional we work as team this is important that's sort of an assumption and now we get to sort of see what we're gonna do with that that said there's huge regional differences right so we are sitting in the Bay Area we're sort of lucky to have social workers on most palliative care teams but there are plenty of specialty palliative care teams that do not have social workers or have one for 60 patients and so while we're in this place of a sort of slow change of leadership to sort of second generation folks and and some passing of some torches we also have places where hospital systems are just trying to conceptualize palliative care social work for the first time so that's that's a pretty dynamic space to say you know this is where we are and this is where we're going and a huge role for this book then is to educate all social workers all Health social workers in core principles of palliative care it's a sort of a vision for like look at the potential of what you can do yeah you know if you had these sort of skills yeah it's almost like you have to create a revolution [Laughter] no more whispering I don't know Bridget as you said not only just teaching other people the core principles of palliative care but I think what you're saying is hey social workers out there there's a lot of this stuff that you know already and you can apply in these different ways when we're caring for really when we're caring for seriously ill folks and it's a call to everybody to recognize a lot of the similarities yeah sure absolutely and I think you know for better and or worse in the building of a specialty um within social work practice I think a lot of people experience a lot of turf issues right of like the palliative care social worker will do this or won't do that and the medicine social worker will do this or will not do that and I think our hope with this book and I think certainly my hope in the future is that um Abe this all starts to exist on much more of a gray continuum and that palliative care social workers can really respect and honor the deep work that that primary social workers do and that there's much more sharing of patient so it's less about like but this is my specialty and this is what I do and this is what I'm really good at and and more collaboration it's great vision yeah see thanks and and ruined with the last question my transition I know I don't have a good chance this is my daddy right yeah how do we say Thank You Roger how about before though we leave we end a little bit more with talking bout a revolution talking about a revolution aren't you thinking about it all right I'm gonna try to I'm gonna try to join for the whisper all right we look forward to a little whisper okay up start yet don't you know talking about a revolution sounds don't you know we're talking about a revolution it sounds like whisper stand in the welfare line live near the doorsteps of those armies of salvation wasting time in the unemployment lines sitting around wait for a promotion don't you know we're talking about a revolution it sounds don't you know we're talking about a I see I'm just gonna throw that in it's fine the starting to turn talk about revolution the tables are starting to turn talk about revolution behold tamo revolution that's perfect in every way thank you again for joining us today and thank you to all our listeners for joining us if you have a moment again please take a second to rate us on your favorite podcasting software thank you again

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