Standard 4. Cultural and Linguistic Competence
Social workers practicing in health care
settings shall provide and facilitate access to
culturally and linguistically appropriate
services, consistent with the NASW
Standards
and Indicators for Cultural Competence in Social
Work Practice
(NASW, 2015b).
Interpretation
The increasing racial, ethnic, and linguistic
diversity of the United States requires health
care social workers to strive continuously for
cultural competence. Recognition and
affirmation of cultural and linguistic diversity
are critical to both therapeutic alliances with
clients and cooperative working relationships
with colleagues. Given the many facets of
culture, every interaction between a health
care social worker and a client is potentially a
cross-cultural exchange, as two individuals are
unlikely to be identical in every aspect of
cultural identity.
The practice of health care social work requires
an understanding of the broad scope of
diversity in the United States. Client diversity
is expressed in many ways, including race,
ethnicity, socioeconomic class, sexual
orientation; gender, gender expression, and
gender identity; religion, age, health and
family status; cognitive, physical, or psychiatric
ability; and sensory differences, preferred
language, immigration status, degree of
acculturation, level of formal education, and
literacy, among others. Health care social
workers must also recognize that cultural self-
awareness is an integral component of cultural
competence. Such awareness entails
understanding how one’s own cultural values,
beliefs, biases, experiences, and perceptions
affect interactions with clients and colleagues.
Health care social workers must acquire a
cross-cultural knowledge base to provide
effective, culturally competent practice. In
particular, social workers must develop and
maintain an understanding of the history,
traditions, rituals, values, family systems, and
communication patterns of major client
groups served, as well as an understanding of
the influence of culture on help-seeking
behaviors and perceptions of health, illness,
health care treatments, disability, caregiving
roles, and death and dying among client/patient
groups served. Social workers should also
recognize how societal oppression and privilege
related to cultural and linguistic diversity (such
as racism, sexism, homophobia, ageism, or
xenophobia) affect clients’ biopsychosocial–
spiritual well-being, access to and use of
supports and services, and health outcomes.
Health care social workers should advocate for
organizational practices and policies that
promote and support cultural diversity among
staff and throughout the health care
organization. These may include hiring and
retention policies that ensure various client
groups are represented among personnel and
institutionwide education and training programs
to develop specialized expertise (such as
bilingual and bicultural skills) among staff.
There is no endpoint in the achievement of
cultural competence; rather, developing and
maintaining cultural competence is a lifelong
process of learning and self-reflection. To
develop and promote cultural competence at
the individual, institutional, or societal level,
social workers should be guided by the NASW
Standards and Indicators for Cultural Competence
in Social Work Practice
(NASW, 2015b). HHS’s
National Standards for Culturally and
Linguistically Appropriate Services in Health and
Health Care
(HHS, 2013) may also serve as a
guide for social workers.
Standard 5. Screening and Assessment
Social workers practicing in health care
settings shall engage clients and, when
appropriate, members of client support
systems, in screening and assessment, by
gathering information for use in developing
evidence-informed care plans.
Interpretation
Screening for psychosocial issues is now common
in health care settings. Within emergency
departments, clinics, and other points of entry,
individuals are often screened for pain, mental
health disorders, domestic violence, substance
use disorders, self-harm, and distress, among
other concerns. Screening can also occur
throughout a disease trajectory. The presence
of psychosocial screening programs has
become a criterion for institutional
accreditation in certain health care settings.
Early identification of psychosocial issues can
assist health care social work staff in effectively
prioritizing situations that may affect client
safety or indicate a high need for social work
services. Preventive screening results can also
inform a comprehensive client assessment.
Social workers should be trained and
demonstrate competency in the use of
psychosocial screening tools used within their
institutions and organizations. Social workers
should also participate on institutional
committees that implement and monitor
psychosocial screening programs.
Biopsychosocial–spiritual assessment is a
fundamental process of social work practice in
health care settings. The foundation of client
care planning is the comprehensive assessment,
which requires social workers to engage clients
in identifying their needs and strengths and
supporting clients in establishing priorities and
goals. In conducting an assessment, the health
care social worker must use empathy, client-
centered interviewing skills, and methods
appropriate to clients’ capacity. In the
assessment process, social workers may find
standardized instruments helpful in identifying
and responding to client concerns. Such
instruments are viewed as starting points in
the development and refinement of an
individualized, comprehensive assessment.
Assessment is an ongoing activity, not a
onetime event. During the reassessment
process, the social worker and client (and, if
appropriate, members of the client support
system) revisit the needs, assets, and priorities
identified in the initial assessment and discuss
the client’s emerging concerns.
A comprehensive assessment may include the
following:
- Behavioral and mental health status, including
current level of functioning, coping style,
crisis management skills, substance use
history, and risk of suicide or homicide
- Physical and cognitive functioning
- Psychosocial–spiritual well-being, including
ability to fulfill social roles
- Cultural values, beliefs, and practices
- Client strengths, protective factors, and
points of resilience
- Employment, educational, or vocational
history, including challenges, goals, and
objectives
- Living arrangements, including suitability
and safety of the home environment
- Family composition, structure, and roles
- Language preferences and proficiency levels
- Degrees of literacy, including health,
behavioral health, and financial literacy
- Risk of abuse, neglect, or exploitation of or
by the client, and underlying causes for such
mistreatment
- Social supports, including formal and
informal support systems
- Need for economic or other psychosocial
resources, supports, and services
- Ability to navigate relevant service systems
(such as educational, employment, health
care, housing, legal, nutritional, social
services, or transportation systems)
- Life-span planning (which may include
advance care planning, anticipation of
caregiving responsibilities, permanency
planning for minor children, retirement
planning, or other domains)
- Client’s perceptions of changes needed to
improve her or his situation
- Identification of barriers to adherence to the
plan of care.
Assessment processes should, to the extent
possible, be customized for vulnerable
populations, including children, people with
severe and persistent mental illness,
immigrants and refugees, people with
substance use disorders, survivors of violence
or trauma, people who are homeless, and
people with physical or cognitive disabilities.
Standard 6. Care Planning and Intervention
Social workers practicing in health care
settings shall develop and implement
evidence-informed care plans that promote
client well-being and ensure a client- and
family-centered continuum of care.
Interpretation
Care plans outline the necessary steps—
identified collaboratively by the social worker,
the client, the client support system (at the
competent client’s discretion), and other
members of the health care team—to achieve
the goals and objectives identified in a
comprehensive biopsychosocial–spiritual
assessment. Implementing care plans with
individuals across the life span, and with
different health conditions and cultures,
requires health care social workers to tailor
practice techniques to best meet client needs.
Case management—a historical function of
the social work profession—remains an
efficient and cost-effective approach to care
plan implementation that can optimize client
functioning. Health care institutions have
multiple titles for social workers who engage
in case management functions. “Case manager,”
“care manager,” “care transition manager,”
“discharge planner,” “patient navigator,” and
“care coordinator” describe work that resembles,
to varying degrees, case management. Through
case management, health care social workers
engage clients in the collaborative process of
identifying, planning, accessing, coordinating,
monitoring, evaluating, and advocating for
resources, supports, and services.
Clinical social workers who are employed or
contracted to provide mental or behavioral
health services should use evidence-informed
treatment interventions with clients. These
interventions may include cognitive–behavioral
therapy, motivational interviewing, chronic
disease self-management, psychoeducational
services, brief intervention/brief therapy, and
trauma-informed care, among other modalities.
When implementing care plans, social workers
should strive to
- Develop and maintain a therapeutic
relationship with the client and the client
support system
- Engage the client in a culturally responsive
manner and with a strengths-based approach
that facilitates, supports, and recognizes the
client’s capabilities, resources, and resiliency
- Apply evidence-informed practice models to
facilitate the client’s accomplishment of
goals and objectives
- Facilitate access to a range of financial,
housing, health, mental and behavioral
health, education, and community resources
- Ensure care continuity through safe
discharge, appropriate transition between
different levels of care, and client follow-up
- Seek consultation from health care team
members and social work supervisors, as
necessary, to facilitate plan implementation
- Safeguard the privacy and confidentiality of
client information.
Standard 7. Advocacy
Social workers practicing in health care settings
shall advocate for the needs and interests of
clients and client support systems and promote
system-level change to improve outcomes,
access to care, and delivery of services,
particularly for marginalized, medically
complex, or disadvantaged populations.
Interpretation
Social workers have a responsibility to advocate
for the needs and interests of clients and client
support systems. Social workers in health care
settings serve as client advocates by promoting
client access to health care, identifying and
removing barriers to services delivery, and
helping clients navigate between and among
complex health and social services systems.
Social workers also strive to promote clients’
self-advocacy skills and to enhance the
capacity of communities to support clients’
biopsychosocial–spiritual quality of life.
To strengthen services and enhance client
outcomes, social workers should promote and
participate in quality improvement initiatives
within their health care institutions. Quality
improvement programs offer an opportunity for
health social workers to advocate for the
expansion of the profession’s role in health care
settings. These programs can also build social
work capacity for institutional leadership roles.
Social workers should play an active role in
community education efforts, speaking on
behalf of their health care institutions about
disease prevention, health promotion, access
to care, and other timely health-related topics.
Health social workers must understand the
concept of health disparities—the
disproportionate burden of preventable disease,
death, and disability experienced by many
minority communities, people living in poverty,
and other disenfranchised groups. Health
disparities are closely linked with the social
determinants of health, that is, the social,
economic, and environmental conditions that
strongly influence heath status. Population
health requires minimizing health disparities
and promoting health equity among all
socioeconomic groups. Social workers have an
ethical obligation to address health disparities
by educating colleagues, the media, allied
professionals, decision makers and policymakers,
and other stakeholders on the impact of health
disparities and unequal access to health
services and by engaging in social and political
action to reduce health disparities.
Standard 8. Interdisciplinary and
Interorganizational Collaboration
Social workers practicing in health care
settings shall promote collaboration among
health care team members, other colleagues,
and organizations to support, enhance, and
deliver effective services to clients and client
support systems.
Interpretation
Collaboration between the social worker and
the client is the foundation of health care social
work practice. Therefore, the client (and when
appropriate members of the client support
system) is at the center of the health care team.
Within health care settings, multiple practitioners
are often involved in a client’s care, making
teamwork and collaboration essential.
Teamwork and good communication among
health care practitioners can improve health
care delivery, resulting in better client outcomes.
Social workers should be competent in different
teamwork models that are common in health
care settings, including multidisciplinary models
(different disciplines working together, each
drawing on their own knowledge);
interdisciplinary models (different disciplines
working in a coordinated fashion toward a
common goal for the client); and transdisciplinary
models (a team of health care professionals
cooperating across disciplines to improve patient
care through practice or research). Working
effectively as members of a health care team
also requires health care professionals, including
social workers, to engage in interdisciplinary
education programs. These efforts allow team
members to learn about each other’s
contributions to improving client outcomes.
The health care social worker plays an integral
role in fostering, maintaining, and
strengthening collaborative partnerships on
behalf of clients, families, and communities
and should demonstrate the ability to
- Articulate and fulfill the mission and functions
of the employing health care organization
- Differentiate social work perspectives,
values, and interventions from those of
other health care disciplines
- Ensure that the social work roles and
responsibilities are clearly delineated and
communicated to other members of the team
- Provide psychosocial insight, guidance, and
recommendations to other members of the
health care team regarding client and family
well-being
- Describe the roles of other health care
practitioners and organizations involved in
supporting the client
- Ensure that the roles and responsibilities of
each collaborating organization are clearly
delineated and communicated
- Communicate effectively with all
professionals, paraprofessionals, and
volunteers involved in supporting social
work clientele in the health care setting
- Advocate for the client’s or, when
appropriate, the client support system’s
integral role in team communications and
care planning, delivery, and monitoring
- Communicate the client’s information in a
respectful and objective manner while
protecting the client’s confidentiality and
privacy
- Foster an organizational culture that
promotes effective, coordinated services for
clients, families, and communities
- Develop and maintain partnerships across
disciplines and organizations to enhance
access to and continuity of care for social
work clientele
- Share and, where appropriate, team
leadership in planning and improving
services to clients.
Standard 9. Practice Evaluation and Quality
Improvement
Social workers practicing in health care settings
shall participate in ongoing formal evaluation
of their practice to advance client health and
well-being, assess the appropriateness and
effectiveness of services and supports, ensure
competence, and strengthen practice.
Interpretation
Evaluation of social work practice is an essential
component of social work services delivery.
Evaluation entails soliciting and integrating
internal and external feedback on the process
and outcomes of social work practice in health
care settings. Ongoing formal practice evaluation
is vital to ensure that services provided to
clients are appropriate, effective, and timely in
helping clients achieve their goals. Moreover,
practice evaluation outcomes are increasingly
used for position justification, performance
review, practice standards, goal setting, risk
management, utilization review, and research
efforts. Social work evaluation methods may
include peer review, self-evaluation,
supervision, and other research methods.
Evaluation practices may include the following
activities:
- Application of appropriate tools such as
clinical indicators, practice guidelines,
satisfaction surveys, and standardized
performance assessments to evaluate client
progress and satisfaction
- Solicitation and incorporation of feedback
from clients regarding the extent to which
social work services have helped them
identify and achieve their goals
- Solicitation and incorporation of feedback
from the interdisciplinary treatment team
regarding the effectiveness of social work
services and opportunities for increased or
improved interdisciplinary collaboration
- Measurement of both process and outcome
objectives
- Practitioner, program, and organizational
self-evaluation
- Participation in qualitative and quantitative
social work research to strengthen the
evidence base for social work services in
health care settings
- Dissemination of evaluative data to clients,
payers, and other health care providers on
request, and with consideration for clients’
rights to privacy and confidentiality
- Use of internal and external practice,
program, or organizational evaluators
- Application of evaluation and research
findings, including evidence-informed
practice, to facilitate client goal setting and
to enhance practice and program quality
and outcomes
- Use of peer review, supervision, and
consultation with other social workers and
across disciplines.
Standard 10. Record Keeping and Confidentiality
Social workers practicing in health care settings
shall maintain timely documentation that
includes pertinent information regarding client
assessment, and intervention, and outcomes,
and shall safeguard the privacy and
confidentiality of client information.
Interpretation
Clear, concise, and ongoing documentation of
social work services in health care settings
facilitates effective communication with other
health care providers and organizations,
thereby promoting continuity of services.
Documentation serves as a foundation for care
planning and for practice and program
evaluation. In addition, professional
documentation is often required for services
reimbursement, utilization or legal review, and
demonstration of organizational accountability
to payers or funding sources. The purpose of
documentation is to foster strong working
relationships with, and services for, clients in
health care settings.
Documentation of social work services should
be recorded on paper or electronically and
must be prepared, secured, and disclosed in
accordance with regulatory, legislative,
statutory, and organizational requirements.
High-quality social work documentation includes
- The client’s identifying information
- Screening results
- Initial and subsequent biopsychosocial–
spiritual assessments
- A client care plan, with procedures for
monitoring and quantifying progress toward
accomplishment of client goals, services
provided, and other information about plan
implementation
- Referrals to or from other practitioners,
organizations, or resources, including
rationale for referrals, and other
collaboration on behalf of the client
- Dates, times, and descriptions of contact with
the client, the client’s support system, and
other health care providers or organizations
- Quantifiable service outcomes
- Supervision or consultation sought or
provided to enhance social work services
- Transfer or termination of services
- When indicated, written permission from
the client to release and obtain information
- Documentation of compliance with
confidentiality and privacy rights and
responsibilities
- Accounting of receipts and disbursements
related to client services provision.
Health care social workers must safeguard all
client information and adhere strictly to local,
state, federal, and tribal requirements
regarding confidentiality. They should inform
clients both verbally and in writing of
confidentiality requirements and limitations
before services are initiated. This is necessary
to ensure that the client has the information
needed to provide informed consent and to
facilitate the client’s understanding of how the
social worker discloses client information to
other health care professionals and how the
health care organization responds to external
requests for confidential information.
Technology, including e-mail, text messaging,
videoconferences, and other mechanisms, may
increase the efficiency of social work services,
but must always be used in a professionally
appropriate manner that ensures client
confidentiality in all venues. Disclosure of
identifying information should be avoided
whenever possible. In particular, social
workers should refrain from disclosure of
client information on social media.
Health care social workers should be
knowledgeable about the confidentiality
implications of electronic record keeping
specific to health care settings. Social workers
should receive training on and demonstrate
competence in the health care organization’s
electronic medical record (EMR) system and
should demonstrate competency in its use,
including an understanding of the EMR’s
unique confidentiality and privacy implications.
Health care social workers should also be
knowledgeable about the Health Insurance
Portability and Accountability Act of 1996,
and the Health Information Technology for
Economic and Clinical Health Act (2009).
Standard 11. Workload Sustainability
Social workers practicing in health care settings
shall responsibly advocate for workloads and
scope of work that permit efficient and high-
quality social work services delivery.
Interpretation
Health care organizations, social work managers,
and social work staff have joint responsibility
for establishing and maintaining a workload
that allows for adequate and appropriate
interventions and monitoring of services and
outcomes. A workload consists of any social
work function, including direct contact with or
on behalf of clients and administrative, policy,
research, or educational functions performed
in accordance with a health care social work
position. The workload reflects the needs and
goals of the clientele and the health care
organization and may include social work
coverage outside of regular office hours.
A caseload, in contrast, refers to the number of
clients served at a given point in time. Client
caseload size directly affects a social worker’s
capacity to establish relationships with and
provide services to clients. Consequently,
caseload size should allow for meaningful
opportunities for client contact. The number
of clients a health care social worker can serve
effectively is limited by the degree to which
health care organizations serve clients in acute,
high-risk situations or other circumstances
requiring intensive, frequent contact with
clients. The workload also reflects the
demands of the population served.
Multiple factors affect both caseload size and
workload manageability within health care
settings, including but not limited to
- Complexity of client needs, including
patient acuity and requirements for care
transitions and follow-up services
- Availability of institutional, community, and
family resources to meet client needs and goals
- Number of clients the health care
organization serves
- Administrative support and access to
technology.
For maximum effectiveness, the size of the
social work staff reflects the mission of the
health care organization, the scope of the
social work program, and the number and
complexity of clients served. On behalf of
health care social workers and their clientele,
social workers should advocate for and support
research to determine reasonable caseloads
with diverse populations and within different
health care practice settings, to provide
ethical, quality-based services.
Standard 12. Professional Development
Social workers practicing in health care settings
shall assume personal responsibility for their
own continued professional development, in
accordance with the
NASW Standards for
Continuing Professional Education
(NASW, 2003)
and the licensure or certification requirements
of the state(s) or jurisdiction(s) in which she or
he practices.
Interpretation
Social workers must engage in ongoing
professional development to maintain
competence within their fields of practice.
Professional development activities relevant to
social work practice in health care settings may
include developments in clinical care, research
or technology, health care policy and legislation,
community resources and services, ethics, and
leadership and administration, among other
topics. Numerous opportunities for professional
development exist within NASW, allied
professional organizations, schools of social
work, health care institutions, and organizations
providing services to or on behalf of various
constituencies (such as children, older adults,
or people with disabilities) at the local, state,
national, and international levels.
Employing organizations should encourage
and support social workers’ participation in
professional development activities. This can be
accomplished through organizational sponsorship
of multidisciplinary and social work–specific
continuing education programming; promotion
of supervision and mentorship opportunities
for social workers; and support for social work
involvement in peer review, research,
publication, and volunteer activities. To
advance the field, social workers must take an
active role in opportunities, both within their
employing institutions and within the larger
social work community.
Standard 13. Supervision and Leadership
Social workers practicing in health care
settings shall strive for leadership roles in
educational, supervisory, administrative, and
research efforts within their institutions and
shall mentor others within the social work
profession, to develop and maintain a robust
health care social work workforce.
Interpretation
The purpose of social work supervision in
health care settings is to enhance the professional
skills and knowledge of a supervisee to
increase her or his competence in providing
quality services to clients and families.
Supervision facilitates professional growth and
development and improves clinical outcomes.
Best practice dictates that within health care
settings, social work departments be directed
by a master’s-level social worker with experience
and expertise in health care practice. A licensed
clinical social worker—be it the supervisor or
another individual—should be available to
provide clinical supervision for licensure, in
accordance with state licensing laws.
Qualifications for social work supervisors
should be consistent with the
Best Practice
Standards in Social Work Supervision
(NASW &
Association of Social Work Boards, 2013).
Supervisors play a key role in the professional
development of their supervisees. The actions
and advice of the supervisor are keenly
observed by supervisees and, consequently,
influence much of the supervisees’ thinking and
behavior. Teaching is an important function of
the supervisor, who models the behavior the
supervisees will emulate. Supervisors should
create a supportive educational environment in
which supervisees learn about the health care
systems in which they work and the clients and
communities they serve.
To sustain and nurture the practice of health
care social work, all experienced social workers,
regardless of their supervisory status, should
offer guidance, mentoring, and consultation to
students, interns, and their less experienced
peers. Social workers in senior management
roles should provide mentorship to other social
workers aspiring to leadership positions within
health care settings.
In addition, social workers should play an active
role in all types of clinical research, as well as in
health services and quality improvement research.
Such involvement not only demonstrates the
leadership capability of the social work
profession, but also advances recognition among
interdisciplinary colleagues of the essential
role of biopsychosocial–spiritual intervention
in quality care to clients and families.
In addition, social workers should play an active
role in clinical, health services, and quality
improvement research, to demonstrate the
leadership capability of the social work
profession and to advance recognition among
colleagues in other disciplines of the essential
role of biopsychosocial-spiritual intervention
in quality services to clients and families.
Experienced social workers should promote
relationships with schools of social work in
their states and communities to encourage
interest in health care practice through field
placement arrangements, joint research
initiatives, and collaborative continuing
education activities.
Social workers should initiate and participate
in qualitative and quantitative social work
research to strengthen the evidence base for
social work services in health care settings and
improve the broader health care system.