Working with children at the end of life is full of witnessing the absolute strength of the human spirit and the irrepressible joy of children. It is also one of the most profoundly painful clinical experiences a social worker is likely to confront. It is full of hope and despair, belief and fear, compassion and sadness. Pediatric palliative care is vital work that requires a distinct set of clinical skills. This paper will address both the necessary skills and the intense emotions associated with this work. It will also focus on the developmental and spiritual issues of children.

In the past decade much growth has occurred in the numbers of patients and families served by hospices and palliative care services. Thus, not surprisingly, these services have also been subject to increasing regulation by governmental and accrediting entities. In order to stay up-to-date in this ever-changing environment and to continue to provide effective interventions, social workers must stay engaged in the professional community and continuing education. In this quantitative study, 1,169 practicing hospice and palliative care social workers provided information about their practice activities and agency characteristics, professional affiliations and certification, and ongoing educational needs. About one-half of respondents carried a caseload of 21-50 and were most engaged in communicating the psychosocial needs of the patient and family to other members of the team and assessing for grief and bereavement issues. The most important educational needs pertained to the psychological and social needs of patients and families and psychosocial interventions. Most were members of professional organizations and three-quarters were members of NASW. Although many were aware of the joint NASW-NHPCO social work hospice specialty certification, few held this certification yet. The results of this survey can be utilized in the design of continuing education programs and advocacy for programmatic and policy change within agencies and the industry.

Although many of the opinions derived from the survey appear to indicate a willingness to embrace research in a hospice setting, significant barriers, especially time constraints and protective attitudes, remain. Educational efforts and firsthand involvement in the research process might be a useful first step in attempting to address these barriers and traditionally held beliefs against using hospice patients and families in research.

Social workers are major service providers to people who are facing end-of-life issues including the terminally ill and their families. Yet, exemplary models for social work education and intervention methods are limited in rural states. A statewide survey conducted in Kentucky found only two social work courses dedicated to end-of-life care currently being offered by accredited undergraduate and graduate institutions. Another statewide survey found that many hospice social workers are relatively inexperienced and have a need and desire for more education on death, dying and loss. Also, unique cultural, economic and geographic areas, such as Appalachia are enigmas when it comes to the provision of end-of-life care. This partnership provides a varied perspective on delivery of end-of-life care services with an emphasis on social work interventions and education.

Life review (LR) interventions are typically used with older adults and those nearing end of life to identify unresolved conflicts/issues, examine accomplishments, and leave lasting legacies. This study investigated the extent that hospice and palliative social workers engaged in LR with patients and their families. An Internet-based, quantitative survey was available via a hyperlink for 4 weeks and disseminated to several national social work professional organization list serves and Web sites. Of the 346 respondents, most had conducted LRs, however, frequency and scope varied. Barriers to implementation included high caseloads/lack of time, acuity of patients, and short lengths of stay. The opportunity for many individuals to bring closure at the end of life may be lost due to limited access to LR interventions.