When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services

Abstract

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N=1,509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N=10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED.

From Their Perspective: The Connection between Life Stressors and Health Care Service Use Patterns of Homeless Frequent Users of the Emergency Department

“…This kind of assessment can lead to a more comprehensive care-and-discharge plan that includes referrals to case management programs or other community resources that meet the patients' specified needs. In addition, medical providers and others who refer patients to social workers in the ED might consider an automatic referral to social work for assistance with community linkage when a homeless patient with a predisposing instability presents after a crisis, as social workers can provide a thorough assessment of needs, crisis counseling, and concrete services (M. Moore et al, 2017Moore et al, , 2016.…”

We are at Full Capacity”: Social care workers persisting through work-related stress in a new immigrant settlement context in the United States

“…Multiple studies conducted in a variety of social care settings in the United States, United Kingdom and Australia indicate that conditions of scarcity can lead to work related stress, burn‐out, and have a deleterious impact on the quality of services delivered by social care workers (Judd, Dorozenko, & Breen, ; Quevillon, Gray, Erickson, Gonzalez, & Jacobs, ; Teran, Fuentes, Atallah, & Yang, ; Verdinelli & Biever, ). Much of the literature has focused on examining the causes of work stress and burnout in social care (Ahern, Sadler, Lamb, & Gariglietti, ; Bowden, Smith, Worker, & Boxall, ; Tartakovsky & Walsh, ), however, few focus on social care providers’ motivations and responses to work stress; and how providers positively respond and persist in their jobs despite such stressors (Lloyd, King, & Chenoweth, ; Maslach, Schaufeli, & Leiter, ; Moore et al, ). This gap is especially significant as many social care workers not only persevere, but thrive in their work despite challenges (Mandell, Stalker, de Zeeuw, Wright, Frensch, & Harvey, ).…”

Rapid ethnographic assessment of the COVID-19 pandemic April 2020 ‘surge’ and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center

“…28 The social-ecological model has been also used in other studies of health services delivery in ED settings. 29…”