2 Social work in health care as
2.2 Roles and tasks
Social work was introduced into Finnish health care in the 1920s through influences from other countries such as the US, the UK, Sweden, Denmark, Germany, and Switzerland (Hakola 1965). The arguments for social work were economical (more efficient use of hospital beds), preventive (prevention of relapses) and humanistic (more humane care) (Åberg 1942, 31–32; cf. Stuart 2004). The task of the social nurse (as health social workers in Finland were called until the 1970s) was defined as constituting a link between the hospital and the community to ensure that relevant care continued after a hospital stay (Larsson 1945, 76–77). Offering practical help and advice to indigent hospital patients was often seen as an important task (Heinonen &
Metteri 2005a) and, alongside relational help, still is (Toikko 2005, 216).
The Finnish Ministry of Social Affairs and Health defines the aim of health care as being ‘to maintain and improve people’s health, wellbeing, work and functional capacity and social security, as well as to reduce health inequalities’5. This can be understood as social work playing an important role in health care services but may also be connected more to the national social welfare and health care reform (Sote) plan currently in progress. The authorities have defined health social work as being performed in health care institutions that pursue national social and health policy goals for the benefit of maintaining people’s health and social functioning (Sosiaalityö... 1982, 9–10; Sosiaalityö... 2001, 8).
The mission of health social work, as defined by the Finnish Association of Health Social Workers (Terveyssosiaalityön... 2007, 9), is to prevent marginalisation; to help
5 Retrieved January 28th, 2018, from http://stm.fi/en/health-services
31 patients in concrete problematic situations through guidance, advice and rehabilitative measures; and to promote their general social functioning by providing psychosocial support. No one specific social work practice method is considered superior to other methods. The focus is on the social determinants of health and the consequences of illness and impairment. Health social workers are supposed to work at all levels.
Establishing a clear role for social work in health care and engaging in
interprofessional collaboration was not easy in the beginning (Larsson 1945, 77).
Health social workers have seen their work change a great deal due to educational, organisational, legal and environmental circumstances, but they have also been able to develop their own work. However, the role of health social work remains unclear, both legally (Metteri 2014) and professionally. This has both positive and negative implications: on the one hand, social workers have some freedom to develop their own role but, on the other hand, organisational interests still strongly determine what they can do. (Davis et al. 2004; Korpela 2014.)
The roles and tasks of health social workers vary in different countries depending on the contextual, organisational and societal circumstances. In Finland and many other countries, the focus is on providing different kinds of material and non-material support (Toikko 2005, 213–221; Wilson et al. 2011, 347) and on advocating patients’
rights to services (cf. Levy & Payne 2006; Romakkaniemi 2014). In Sweden, health social workers do not generally work on securing material help and social benefits for patients, nor are they involved in discharge planning, which is an important task of health social workers in most countries; they mainly provide counselling around life situations created by illness (Blom et al. 2014). In the US and Australia, psychotherapy is a social work task and is reimbursed by a third party (cf. Healy 2014, 68).
The general roles of health social workers, as listed by the Finnish Association of Health Social Workers, are those of expert, consultant, therapist, crisis worker, networker, coordinator and rehabilitation contact person (Terveyssosiaalityön... 2007, 9). These roles partly overlap the self-described roles mentioned in a Canadian study (Craig &
Muskat 2013): bouncer, janitor, glue, broker, firefighter, juggler and challenger, which give a somewhat harsher picture of health social work. However, the suggested role of a
‘positive heckler’ (Laine 2014), balancing between various demands, for Finnish health social workers also highlights the conflicts often inherent in the work.
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Social work performed in health care services differs in certain respects from social work performed in the municipal social services, which is the largest employer of social workers in Finland (Sub-study I). One main difference is that in health care, social workers very seldom exert social control as representatives of authority. Most social work clients experience some kind of crisis related to, for example, lack of material resources, drug abuse or relational problems. In addition, in health care, social work clients experience crises caused by illness, impairment and/or death, and health social workers often deal with a complex set of social, physical, psychological, existential and relational aspects of their clients’ lives (Blom et al. 2014). The clients represent all socio-economic classes and may have very different types of needs.
A Finnish study (Korpela 2014) found that health social workers consider their most important tasks to be assessing the social situation of clients; providing guidance and advice on social security and social welfare services and, when necessary, assisting clients in applying for these services; planning discharge; participating in multidisciplinary collaboration; networking; and providing psychosocial support.
The respondents felt that they could provide more psychosocial support to patients if organisational practices allowed this. They considered building trustful relationships essential for the work to be successful. Psychosocial support, in this context, is understood as the general relational and motivational support of individuals in their social environment.
In doing their job, health social workers depend greatly on collaborating with partners both inside and outside of the organisation. In Finland, medical hegemony is strong; many social security benefits and rehabilitation services require a physician’s recommendation, so working relationships with doctors are essential. Working with health professionals in the organisation often takes place in multidisciplinary teams.
In most types of collaboration, the multidisciplinary setting challenges social workers’
professional self-confidence and identity as well as their professional competence and negotiation skills.
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