Caring in a Crisis: Social Work On Call

The project focuses on the Social Work On Call service to ensure that it is effective and efficient to meet the increasing community needs such as domestic and family violence and sudden death.

View a poster from the Centre for Healthcare Redesign graduation November 2022.

Aim

By January 2023, patients and carers with a crisis need after hours have access to specialist social work support that is clear, consistent, coordinated and cost effective.

Benefits

Patients

• Access to a specialised and skilled psychosocial care when they present to hospital having a crisis.
• Timely access to social workers after hours, thereby limiting delays and wait times.
• Patients and families emotional needs in a crisis are responded to and managed with care.

Staff

• Nurses and doctors can easily access social workers after hours for patients and families in need.
• Social workers feel confident to provide the intervention required and understand the need they are being asked to fulfil.
• Nurses and doctors can predict the care they can obtain for distressed patients which helps manage patient expectations.

Healthcare system

• A reduction in length of stay due to timely access to social workers.
• An appropriate response to domestic and family violence presentations may result in a safer community.

Background

The Social Work On Call service was a source of tension for the social workers and the referrers as there was confusion and conflict as to what the service should respond to and prioritise. Referrers identified that they found access to the on call service a challenge. This, along with the pandemic influence, had led to a decrease in referrals to the Social Work On Call service by 50%.

The decrease in referrals is a significant concern because the Central Coast has one of the highest domestic and family violence rates in the state, as well as child protection concerns.¹

If referrers were reluctant to access the Social Work On Call service, then patients would either forgo receiving an appropriate psychosocial safety response, or have a much longer length of stay until they could see a social worker during business hours. Not only does this lack of access to psychosocial care lead to poorer health outcomes for patients and their families, but it also increases the cost to the health service.^{2, 3}

Implementation

Diagnostics

• Process mapping
• Engagement of steering committee
• Staff interviews
• Focus groups
• Data analysis of call out referrals
• Patient file audits
• Root cause analysis and prioritisation
• Options of obtaining consumer representation and feedback was also explored

11 themes were identified with 3 prioritised for this project.

Method

The development of solutions included:

• blitz brainstorming for solutions with focus groups
• surveys sent to individual stakeholders regarding solution generation
• benchmarking other social work on call services to review best practice
• prioritisation voting on the solutions by the steering group.

Solutions

1. Introduce a clear referral criteria document that is easily accessible to referrers with targeted education and promotion.
2. Train social workers in introduction, situation, background, assessment, recommendation (ISBAR) communication training techniques.
3. Provide peer group supervision for on call social workers.
4. Formalise escalation pathway for social workers.

Implementation

The implementation was guided by the Accelerating Implementation Methodology strategy document.

• Co-develop an intensive care unit referral criteria document prototype.
• Test the prototype with intensive care unit clinicians.
• Produce an education workshop on the new prototype.
• Communicate the revised model of care for Social Work On Call.
• Collate data, including pre and post launch survey.
• Focus on reinforcement implementation strategies and involvement.

Status

Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.

Dates

• Start date: 17 August 2022
• Implementation start: 10 October 2022
• End date: 31 July 2023

Implementation sites

• Gosford Hospital

Partnerships

• Centre for Healthcare Redesign
• Catholic Care

Evaluation

Solution 1: Introduce a clear referral criteria document that is easily accessible to referrers with targeted education and promotion

• Measure and analyse referrals against new referral criteria document to assess if there has been a change in clinical practice.
• Measure number of calls to manager for referral clarification.

Solution 2: Train social workers in ISBAR communication techniques

• Review handovers to assess if there has been a change in clinical practice and communication.

Solution 3: Provide peer group supervision for on call social workers

• Measure staff satisfaction and skill confidence from participation in pilot peer group supervision sessions.

Solution 4: A formalised escalation pathway for on call social workers

• Survey staff satisfaction with support pathway pre and post implementation.
• Review and analyse exit interviews where on call is identified as a reason for resignation.

Lessons learnt

• Obtaining consumer feedback on experience has been challenging due to safety and trauma concerns. Therefore, if the project team had more time to establish relationships with agencies involved in ongoing support of these clients, this may have increased options to engage with consumers whilst appropriately managing risk.
• Specific and tight timeframes during a pandemic made it difficult to access all the clinicians required. It was therefore important to flex into the online space for specified focus groups.

References

1. NSW Bureau of Crime Statistics and Research. Domestic violence statistics for NSW. Sydney: BOSCAR; 2022 [cited 15 August 2022] . 
2. Moore M, Cristofala M, Dotolo D, et al. When high pressure, system constraints and a social justice mission collide: A socio-structural analysis of emergency department social work services. Soc Sci Med. 2017 Apr;178:104-14. DOI: 10.1016/j.socscimed.2017.02.014
3. NSW Ministry of Health. Integrated prevention and response to violence, abuse and neglect: Framework - NSW health violence, abuse and neglect redesign program August 2019. Sydney: NSW Ministry of Health; 2019 [cited 14 Aug 2021].

Contact

Sarah Smith
Social Work Manager
Central Coast Local Health District
Phone: 02 4320 3647
sarah.smith5@health.nsw.gov.au