Social Workers have been recognized by the Canadian Hospice Palliative Care Association (CHPCA) as core members of the inter-professional palliative care team in all settings of care-residential hospice, acute and long-term care facilities, cancer centres and community care. Social workers provide end-of-life care to many patients and their families across these care settings, as well as in many non-health-related situations.
The evidence supporting social work involvement in end of life care is primarily anecdotal and experience-based and derives from the experiences of clients and professionals themselves. However, a review of evidence-based research literature by Rizzo and Rowe found that social work interventions had a positive and significant impact on quality of life and health care costs and use for aging individuals and their caregivers. A further study by Reese and Raymer demonstrated that increased social work involvement in hospice care was significantly associated with lower hospice costs, improved team functioning, reduced medical services, fewer visits for other team members and lower severity of case. The ability of social workers to make psychosocial assessments generally improved planning and, ultimately, care. Other articles examine the general benefits of early social worker assessment and intervention, which can be assumed to apply to end-of-life care. Planning and intervention from those skilled and knowledgeable regarding the psychosocial needs of patients and families increase family cooperation and patient satisfaction, decrease the need for crisis management and reduce the need for contact from other disciplines.
While this project is aimed at general social work curriculum, the competencies upon which it is to be based are derived from the practice of palliative care social workers. One would assume that the outcome of this education will serve to advance the practice of all social workers in the area of end-of-life care. Opportunities for social workers to better understand psychosocial care at the end-of-life and their role and practice within that will further help them articulate their contribution and expertise to clients and their families, colleagues and policy makers.
Despite the prevalence of social work interactions with individuals and families facing end-of-life, the existing education for social workers in HPCis inconsistent and limited. This is true in Canadian university schools of social work, regional college programs and in social work continuing education programs.
From the work done to date on the competency development, there are reports from both practitioners and educators that gaps exist in current social work programs. Practitioners said they learned about end-of-life issues through experience and often felt ill-prepared to deal with them. Educators indicated a need for resources that can be used within existing courses. Field instructors reported students expressing frustration with the lack of preparation in undergraduate programs to work with issues of grief and loss, death and dying, and family issues.
To address this gap, in 2005 Health Canada’s Secretariat on Palliative and End-of-Life Care funded a task group, known as the SCOPE (Social Work Competencies on Palliative Education) team, to conduct national research aimed at developing a set of core social work competencies to guide education for practice with people facing end-of-life issues. The SCOPE team, lead by Wendy Wainwright of Victoria Hospice and Dr. Susan Cadell, who was then at the University of British Columbia, consisted of nine social work educators and practitioners. In this first phase, the (2002) Canadian Hospice Palliative Care Association (CHPCA) Standards – A Model to Guide Hospice Palliative care: Based on National Principles and Norms of Practice framework was used as the foundation for the development of 11 core competencies essential to social work practice in HPC. National consensus regarding these competencies was sought using a modified Delphi technique, focus groups and surveys. Each competency included the values, knowledge and skills most salient to it. The 11 core competencies developed as a result of this research were: Advocacy; Assessment; Care Delivery; Care Planning; Community Capacity Building; Decision-Making; Evaluation; Education and Research; Information Sharing; Interdisciplinary Teamwork; and Self-Reflective Practice (Appendix 4).
In 2008 the Canadian Partnership Against Cancer funded a second phase of this project. This phase was based at Lakehead University and was led by Dr. Mary Lou Kelley and members of the SCOPE team. It built upon phase one and extended the development of social work competencies by undertaking a national consultation process to validate them and to create a strategic plan for implementing them in education and practice settings.
That consultation process engaged four groups with the following purposes: 1) social workers across Canada – to validate the competencies across jurisdictions and settings of care, and to identify effective strategies for implementing them in the workplace; 2) oncology patients facing end of life and their families-to validate the competencies based on their lived experience; 3) social work educators – to disseminate the competencies and consult about effective strategies to incorporate them into curricula of schools of social work; and 4) professional social work associations and others responsible for the continuing education of social workers- to consult about effective strategies to make competency-based education accessible through their programs. The consultations involved national workshops, telephone and face-to-face interviews, and online surveys.
The project was completed in June 2009. The consultations provided a broad validation of the original competencies with their purpose more clearly articulated, and resulted in the preliminary development of a strategic plan with the schools of social work regarding their implementation into formal curricula. The consultation process served to engage social work educators and professional associations in planning an implementation process and began to create a foundation for developing system partnerships between practitioners, educators, and professional associations. In particular, developing a partnership with the Canadian Association of Social Work Education (CASWE) to influence the use of the competencies in curriculum development at all levels of social work education and training was seen as a positive next step. Both educators and practitioners across the country were clear in their conclusion that, while palliative care social work is a small speciality area within the profession, all social workers need and would benefit from education in end-of-life issues, approaches and interventions.
The third phase of the project, Implementation of Canadian Social Work End-of-Life Competencies into Professional Education Curricula, involved the development and evaluation of model curricula based on the competencies that can be used in schools of social work at the undergraduate and graduate levels, as well as in continuing professional education.
Now completed, this three-phase project will result in the advancement of education and training for social work practitioners caring for Canadians who are faced with progressive life-limiting illness, dying, death and bereavement. Ultimately, this work will build capacity and support system change by increasing the number of expertly trained/educated social workers who provide hospice palliative care and psychosocial end-of-life care.
The National Team is now ready to launch their newly created educational learning modules – available April 1, 2011. This unit contains a series of five teaching modules specific to hospice palliative care that can be used to enhance Social Work competencies with people at end of life. The unit was developed with the knowledge that all Social Workers, at some point in their careers, will work with people facing life-limiting illness, death, and bereavement.
The information and tools included aim to enhance knowledge, skills, and practice fundamental to hospice palliative care. The modules can be used together as a unit, or each module can stand alone and be used individually. The intent of this teaching unit is to make competency-based, end of life care content and materials available to social work education programs in Canada, without requiring the addition of new courses to existing curricula.
The five unit modules are as follows:
- Module 1: Fundamentals of Social Work in End of Life Care
- Module 2: Communication
- Module 3: Care Planning and Delivery
- Module 4: Advocacy
- Module 5: Evaluation and Self-Reflective Practice
Modules are available on the CHPCA Marketplace
Journal Article in Palliative Medicine:
Creating Social Work Competencies for Practice in Hospice Palliative Care