社会工作的核心能力外文文献 Defining Core Competencies for Generalist-Level Palliative Social Work

Original Article Defi ning Core Competencies for Generalist Level Palliative Social Work Myra Glajchen DSW MSW Cathy Berkman PhD MSW Shirley Otis Green MSW MA ACSW LCSW OSW C Gary L Stein JD MSW Tom Sedgwick MSSW LCSW CCM Mercedes Bern Klug PhD MSW Grace Christ DSW PhD Ellen Csikai PhD LCSW MPH Deirdre Downes PhDc LMSW Susan Gerbino PhD MSW Barbara Head PhD RN MSSW Debra Parker Oliver PhD MSW Deborah Waldrop PhD MSW and Russell K Portenoy MD MJHS Institute for Innovation in Palliative Care M G R K P New York New York Fordham University Graduate School of Social Service C B New York New York Collaborative Caring S O G Toluca Lake California Wurzweiler School of Social Work at Yeshiva University G L S New York New York New York University Langone Medical Center T S New York New York University of Iowa School of Social Work M B K Iowa City Iowa Columbia University School of Social Work G C New York New York University of Alabama School of Social Work E C Tuscaloosa Alabama Isabella Geriatric Center D D New York New York New York University Silver School of Social Work S G New York New York University of Louisville School of Medicine and Kent School of Social Work B H Louisville Kentucky Missouri University School of Medicine D P O Columbia Missouri Buffalo School of Social Work D W Buffalo New York Abstract Context Care provided to seriously ill patients by frontline social workers is a component of generalist level palliative care The core competencies for high quality generalist level palliative social work are necessary to promote training curricula and best practices but have not yet been defi ned in the U S Objective The objective of this study was to develop consensus derived core competencies for generalist level palliative social work Methods Fifty fi ve proposed social work competencies were categorized by the eight domains of palliative care identifi ed by the National Consensus Project for Quality Palliative Care The competencies were rated by 41 regionally dispersed Master s level social workers selected through purposive and snowball sampling using a Delphi method Each was rated as essential for generalist level palliative social work acceptable with modifi cations or rejected based on the judgment that it was not essential for generalist level palliative social work or was outside the scope of practice Consensus was defi ned as 70 agreement to accept or reject a competency Three review rounds were needed to achieve consensus on all competencies Results Two competencies were added to the original list Of the 57 proposed competencies 41 were accepted 19 after modifi cation and 16 were rejected Competencies in the social spiritual cultural and ethical legal aspects of care domains were relatively more likely to be accepted compared with those in structure and processes of care physical care psychological care and care of patient at the end of life Conclusion The 41 consensus derived competencies for generalist level palliative social work may inform the development of training curricula and standards for high quality care J Pain Symptom Manage 2018 56 886e892 2018 American Academy of Hospice and Palliative Medicine Published by Elsevier Inc All rights reserved Key Words Generalist social work education training clinical practice palliative care hospice domains Address correspondence to Myra Glajchen DSW MSW MJHS Institute for Innovation in Palliative Care 39 Broadway 3rd Floor New York NY 10006 USA E mail mglajche mjhs org Accepted for publication September 3 2018 2018 American Academy of Hospice and Palliative Medicine Published by Elsevier Inc All rights reserved 0885 3924 see front matter https doi org 10 1016 j jpainsymman 2018 09 002 886Journal of Pain and Symptom ManagementVol 56 No 6 December 2018 Introduction In the U S social work is recognized as a core disci pline in specialist level palliative care Social workers are part of the interdisciplinary team supported by the fed eral hospice benefi t and a comparable role was endorsed in the 2001 2009 2013 and 2018 versions of the clinical practice guidelines developed by the Na tional Consensus Project for Quality Palliative Care 1 2 Specialist levelpalliativesocialworkhasbeen advanced through both an evolving literature3e7and the efforts of U S based professional groups such as theSocialWorkHospiceandPalliativeNetwork theNa tional Association of Social Workers and the National Hospice and Palliative Care Organization 8e10In some countries professional certifi cation is used to demonstrate the acquisition of specialist level compe tencies by social workers trained in palliative care Although this emergence of palliative care as a specialization in social work is a very positive develop ment most patients living with serious chronic illness and their families receive palliative interventions from professionals without specialist training 11e13Frontline social workers in all venues of care implement diverse interventions to prevent or mitigate the suffering and illness burden experienced by the patient and family throughout the course of the illness Collectively these interventions may be characterized as generalist level palliative social work Guided by a comprehensive assessment they may focus on the management of poorly controlled symptoms psychological distress caregiver burden care fragmentation disturbances in communication or decision making or other concerns Best practices in generalist level palliative social work require a set of explicitly defi ned professional competencies that contribute to successful perfor mance of palliative interventions as well as observable and measurable skills specifi c to each competency These can be used to guide the development of training curricula evaluation tools and practice stan dards used to determine the quality of care Initiatives to defi ne core competencies for palliative social work have been undertaken in the U S Canada and Europe 3 5e7 9 14 15The current project expanded onthispriorworkbyfocusing specifi callyon generalist level palliative social work and incorpo rating the eight domain framework for best practices developed by the National Consensus Project for Quality Palliative Care 1 2The aim was to elicit consensus about the competencies needed by front line social workers to provide high quality generalist level palliative care in any venue Methods An Advisory Group of academic social workers with expertise in palliative care and health social work was empaneledtooverseeitemcreationandthe consensus development process The project was approved by The New England Institutional Review Board which exempted it from signedconsent requirements Item Creation Based on a review of the literature 1e16existing so cial work curricula in palliative care 17e20and pallia tivesocialworkjobdescriptionsobtainedfrom Advisory Board members 93 competencies were drafted by the fi rst author Each competency depicted a specifi c skill that a social worker may possess to contribute to the prevention or management of distress and burden experienced by the patient or family living with serious illness The draft compe tencies were systematically reviewed by the Advisory Group and proposed edits additions and deletions werediscussedinconferenceandresolvedby consensus Redundantcompetenciesandthose perceived as specialist level competencies were elimi nated and many competencies were modifi ed The 55 competencies remaining after this review were arranged within the framework of the eight do mains of palliative care 1 2This categorization also was reviewed by the Advisory Group and there was unanimity in designating 15 competencies as part of Structure and Processes of Care domain four in the Physical Aspects of Care domain eight in Psychologi cal and Psychiatric Aspects of Care fi ve in Social As pects of Care three in Spiritual Religious and Existential Aspects of Care eight in Cultural Aspects of Care nine in the Care of Patients at the End of Life domain and three in Ethical and Legal Aspects of Care Delphi Survey The55competencystatements organizedby domain were subjected to an iterative Delphi method of review by a larger and diverse group of social workers 21e23The aim was to elicit consensus about the competencies needed by frontline social workers to provide high quality generalist level palliative care in any venue The Delphi process was completed in June 2017 The criteria for participants in the Delphi survey were developed by the Advisory Group and included regionally dispersed in the U S practicing primarily in a hospital long term care setting home care or hos pice and with specifi c experience in the management of seriously ill patients Potential participants were identifi ed using purpo sive and snowball sampling approaches Each member of the Advisory Group nominated three social workers who were perceived to meet the eligibility criteria Nominated social workers were contacted through Vol 56 No 6 December 2018887Competencies in Palliative Social Work telephone The purpose of the project was explained and the eligibility criteria were reviewed If eligible the social worker was invited to participate and to nominate up to three other social workers who would be appropriate for the Delphi review Irrespective of whether the fi rst nominated social worker agreed to participate the newly nominated individuals were called This sampling approach yielded a group of 51 social workers who agreed to participate An online survey was used to implement the Delphi method using Qualtrics Survey Software to evaluate the 55 competencies organized by the eight do mains 24Each competency had four response cate gories 1 Accept as written this is a competency for all practicing social workers 2 Accept as a compe tency for all practicing social workers but with changes in the wording text box included for suggested wording 3 Accept as a competency only for social workers practicing at the specialized or advanced level and 4 Reject as a competency for both generalist and specialist level social workers For the fi rst round of the Delphi method each of the 51 social workers who agreed to participate was sent an e mail reminding them of the project aim with a link to the online survey The landing page stated that the competencies were being evaluated to determine whether each was considered necessary to perform generalist level palliative social work in a manner consistent with best practices Participants were asked to select one of the four response cate gories for each competency To profi le the partici pants they were also asked about degrees held and the year each was awarded social work license s held primary practice setting and location urban suburban rural or other zip code of the primary practicesetting andwhethertheyhadtaken continuing education classes in palliative care or hospice Reminders were sent to nonresponders at two weeks and at four weeks The fi rst round of the Delphi was closed two weeks after the second reminder was sent The responses of participants to the fi rst Delphi round were exported to a spreadsheet Competencies accepted by 70 of participants without requests for wording changes were considered to be endorsed and were not subjected to additional review Similarly com petencies rejected by 70 were considered to be inappropriate for further review and were removed Those competencies that yielded requests for wording changes and or failed to elicit a consensus to accept or reject were retained for further review in a second round of the Delphi process Most wording sugges tions were stylistic and were implemented several were substantive changes and were made after confer ring with the Advisory Group One survey participant in the fi rst round of the Delphi suggested a new competency which was evaluated by the Advisory Group and added to the next Delphi round The online survey program was revised for the sec ond Delphi round and included competencies that did not yield a consensus to accept or reject compe tencies with wording changes and the one new com petency suggested during the fi rst round A link to this survey was sent to all the Round 1 participants In structions were identical to the fi rst round but no pro fi le information about the participant was collected Nonresponders were sent an electronic reminder after two weeks and if there was again no response a sec ond reminder was sent The second round of the Del phi was closed two weeks after the second reminder was sent The responses to the second round were evaluated similar to the fi rst round Competencies receiving 70 acceptance or rejection were removed from furtherreview Thoseforwhichtherewasno consensus and or a request for wording change were retained Substantive wording changes were re viewed by the Advisory Group Another new compe tency was suggested by one survey participant during the second Delphi round this was evaluated by the Advisory Group and retained for review in the next round The online program was revised for a third round of the Delphi process and the link was sent to those re spondents who participated in the second round The program included only those competencies that did not yield a consensus or required wording changes and the one new competency suggested during the second round The third and last round of the Delphi was closed two weeks after the second reminder was sent to nonresponders Results Fifty one social workers agreed to participate in the Delphi surveys 41 participated in one or more rounds The response rates for the fi rst second and third Del phi rounds were 80 80 and 73 respectively Re spondents were from the Northeast 51 Midwest 26 South 10 and West coasts 10 of the U S All respondents had a Masters Degree or higher and worked in hospital 37 home care 24 long term care 20 or hospice settings 18 During the fi rst Delphi round 28 of the 55 compe tencies were accepted without wording changes by 70 of participants and eight competencies were re jectedby 70 These36competencieswere removed from the subsequent rounds The second Delphi round included 20 compe tencies There were three that had not achieved consensusduringthe fi rstround 16thathad 888Vol 56 No 6 December 2018Glajchen et al undergone substantive wording changes and one that had been newly suggested during the fi rst round Dur ing this round eight of these 20 competencies were accepted without wording changes by 70 of re spondentsandanothereightwererejectedby 70 These 16 competencies were removed from the next round The third Delphi round included fi ve compe tencies This included the four competencies that did not achieve consensus in the second round and the one competency newly suggested in the second round During this round 70 of the participants accepted three of the fi ve competencies There was no consensus on two items and no modifi cations were suggested With concurrence of the Advisory Group these competencies were rejected The three rounds of the Delphi method yielded consensus that 41 of the proposed competencies are essential to perform specifi c tasks as part of high quality generalist level palliative social work Fig 1 A total of 16 competencies were rejected Fig 2 The extent of consensus varied among the eight Fig 1 Competencies That Achieved Consensus Vol 56 No 6 December 2018889Competencies in Palliative Social Work domains of palliative care used to organize the compe tencies in the Delphi survey There was a high rate of consensus with few suggested wording changes and no eliminated competencies in the Social Spiritual Cultural and Ethical Legal domains of care Rejected competencies included items in four domains Struc ture and Processes of Care Physical Aspects Psycho logical Aspects and Care of Patient at the End of Life Some of the suggested changes in wording were informative For example the original competency provide support and counseling was modifi ed by re spondents into two separate competencies provide support and provide counseling In addition the word attention in the competency identify com plex situations that require attention was unclear to some participants and a change to utilize assessment to identify complex situations that require attention by social worker or other team members yielded consensus in the subsequent round Discussion Thiswork refl ectsthe fi rstefforttodevelop consensus derived competencies for generalist level palliative social work in the U S Using a well acceptedconsensusdevelopmentprocess 21e23a diverse group of practicing social workers agreed that frontline social workers caring for patients or fam ilies living with serious illness should possess at least 41 competenciestoperformtasksconsistentwith generalist level palliative social work In the consensus development process that yielded agreement about these competencies those items in the Social Spiri tual Cultural and Ethical Legal aspects of Care do mainsachievedrelativelyhigherconsensusas compared with those in Structure and Processes of Care Physical Care Psychological Care and Care of Patient at the End of Life These consensus derived competencies focus on the need to improve training of social workers in palliative and end of life care and establish a framework that may be used to develop or refi ne social work training curriculaandevaluationtools Practicingsocial workers report a lack of adequate preparation for the specialized work they are expected to provide in the areas of palliative and end of life care and cite thisasasourceofstress compassionfatigue decreased job satisfaction and high turnover at work 25e27Competency based training may reduce these outcomes Improved training may also help address a serious workforce shortage by enhancing the quality of generalist level care and encouraging larger numbers of social workers to seek specialist level training and qualifi cations 28e33At present very few Master s level social work schools in the U S or Canada have dedicate