3.13 Social Worker
Karen Piette, MHS, CMA
A rewarding career that focuses on improving the well-being of individuals, families, and communities, social work utilizes various disciplines, including sociology, psychology, healthcare, community development, and policy. Social workers conduct assessments, develop interventions, and work to improve social functioning within communities. Their focus on well-being often includes empowering individuals and advocating for social justice.
Social work is a practice-based profession, with social workers working on the following three levels:
- Micro-level: Social workers at this level work directly with individuals and families, addressing issues such as housing, mental health disorders, behavioral health, and access to healthcare and social services.
- Mezzo-level: At this level, social workers target organizations, such as neighborhoods, nonprofits, schools, and other small communities. The goal is to bring about positive changes that benefit a larger group of people.
- Macro-level: Social workers at the macro level implement systemic changes, including influencing laws, advocating for government petitions, and changing social policies to benefit communities on a larger scale.
These three levels are interrelated and wide-reaching. Social workers need a comprehensive understanding of all three to perform their jobs effectively.
Social workers may work in medical settings such as hospitals and medical centers, where they can specialize in pediatrics, oncology, nephrology, or transplant care. They may also serve in roles such as hospital administrators, managers of allied health programs, or leaders in mental and behavioral health services and community outreach programs.
Skill Stitch: Motivational Interviewing
A common evidence-based approach to behavior change is motivational interviewing. Motivational interviewing is a communication style that emphasizes respectful guidance and empowerment. The healthcare professional must have strong listening skills and refrain from offering unsolicited advice. Instead, they engage the patient or client as an equal partner in the process. This collaborative approach prioritizes partnership, acceptance, compassion, and evocation (providing resources for change).
Motivational interviewing is applied across various settings—healthcare, human services, and education—and with diverse populations, including different age groups, ethnicities, and gender identities. It is commonly used with patients or clients in behavioral health clinics, physician’s offices, and hospitals, addressing issues such as medication adherence, substance use, illegal behaviors, gambling, parenting, risky sexual behavior, and mental health conditions.
Key skills of healthcare professionals during motivational interviewing include:
- Using open ended questions to explore the individual’s experiences, perspectives and ideas
- Providing affirmations of strengths to build the individual’s confidence
- Expressing empathy
Ultimately, motivational interviewing is a client-centered counseling style, often used by social workers and SUDPs, to facilitate behavior change. By helping clients explore their thoughts and behaviors regarding a specific issue, the goal is to reduce internal contradictions and encourage positive change.
Hospital social workers perform a range of crucial functions, including assisting patients and their families during hospital admissions, conducting psychosocial assessments, educating hospital staff about specific patients’ psychosocial needs, facilitating communication among healthcare teams, and employing crisis intervention. According to the Washington State Department of Social and Health Services (n.d.), a crisis is defined as a disruption or breakdown in a person’s or family’s usual pattern of functioning. The three basic elements of a crisis are:
- A stressful situation
- Coping difficulties
- The timing of intervention
It is important to understand that every crisis is unique, and social workers take a flexible, individualized approach to helping the person or family navigate the situation.
Hospital social work often includes addressing conditions related to behavioral health, such as substance use disorders and mental health issues. According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2018), one in five adults in the United States experienced a significant mental health or substance use disorder in 2017. Social workers play an integral role in treating patients dealing with illicit drug use, alcoholism, depression, suicidal thoughts/behaviors, and mental illnesses such as major depressive disorder, schizophrenia, and bipolar disorder.
Comorbidities—defined as the presence of two or more disorders in the same person, either simultaneously or sequentially—are common in behavioral health settings. According to Han, B., et al. (2017), 7.7 million adults in the U.S. have both mental health and substance use disorders. Comorbidities pose challenges for healthcare providers, as it is often difficult to determine which disorder originated first.
Disease Dissection: Mental and Behavioral Health
As discussed above, comorbidities in behavioral health are common. Social workers, along with SUDPs, play a critical role in treating individuals with substance use disorder. When mental health conditions such as major depressive disorder, bipolar disorder, or schizophrenia are present alongside substance use disorder, patients may seek treatment at a behavioral health clinic. However, it is important to note that these three disorders are not the only mental health conditions commonly seen in behavioral health settings.
The American Medical Association (AMA, 2022) defines behavioral health as encompassing mental health and substance use disorders, life stressors, crises, and stress-related physical symptoms. Behavioral healthcare involves the prevention, diagnosis, and treatment of these conditions. In behavioral health settings, patients often interact with a range of professionals, including counselors, SUDPs, social workers, and medical physicians.
In recent years, there has been a growing movement to incorporate behavioral health services into primary care settings. This initiative, known as behavioral health integration (BHI), involves the integration of mental and physical healthcare services to promote accessibility and equitable treatment of a patient’s mental and physical well-being.

Behavior change is a primary goal in behavioral health settings. Professionals in these environments assist patients or clients in altering unhealthy behaviors, such as improving medication adherence, enhancing hygiene, finding stable employment, and accessing affordable housing. In many cases, healthcare professionals in behavioral health focus on modifying detrimental behaviors and habits to improve overall well-being and functioning.
Unfortunately, several barriers often hinder individuals from receiving the appropriate treatment. These barriers can include a shortage of behavioral health practitioners, high treatment costs, fear of involuntary commitment, and lack of awareness about where to access care. Social workers assist in reducing these barriers.
Social Worker Requirements and Qualifications
The requirements for social workers vary from state to state, but most states require a minimum of a bachelor’s degree as well as supervised work experience following graduation. The work experience allows new social workers to develop essential skills under the supervision of a licensed professional. During this period, they typically practice under someone else’s license until they gain the experience needed to practice independently. Some states require a master’s degree or doctorate in social work to practice clinically.
The Association of Social Work Boards (ASWB) offers two examinations in social work. The first is an exam for associate, bachelor’s, or master’s degree holders. The second is the Advanced Generalist or Clinical exam, which is required by most states for clinical social work.
Washington State offers the following two social worker licenses:
- Licensed Advanced Social Worker (LASW): These professionals typically work in healthcare or other settings as part of a treatment team, providing social work services. An LASW is required to pass the Advanced Generalist Clinical Exam and complete 3,200 hours of supervised experience.
- Licensed Independent Clinical Social Worker (LICSW): This license allows individuals to practice independently, providing psychotherapeutic services. An LICSW must pass the clinical exam and complete 4,000 hours of supervised clinical experience.
Social worker associates are individuals who hold a graduate degree in a mental health field but have not yet obtained the required hours of supervised experience to achieve full licensure. They work toward becoming a licensed independent clinical social worker (LICSW), advanced social worker (LASW), or other related licensed professionals. Social worker associates do not require an exam or supervised experience.
For those wishing to work as a social worker in Washington State, a master’s degree is the minimum educational requirement, though many social workers pursue doctorate degrees to expand their qualifications and career options. Some individuals may first earn a bachelor’s degree in social work (BSW) before progressing to a graduate-level degree in the field.
Attributions
- Figure 10.3: Mental Health Portrait.jpg by Rigos101 is released under Creative Commons Attribution-Share Akile 4.0
A patient advocate’s job is to support patients throughout their medical treatment in various ways. They help navigate the insurance system, explain medication and treatment options, and track procedures and medications that the patient has received. Often, a patient advocate interacts with the insurance company on the patient's behalf to ensure they understand their coverage and benefits. This can involve explaining medical bills to help patients understand their financial responsibilities and helping them find resources, such as charitable funds for low-income patients or state and federal assistance programs.
In addition to financial support, a patient advocate may help patients and their families understand treatment options and make informed decisions about end-of-life care. The role often includes providing emotional support for patients who lack strong support systems. Patient advocates may also accompany patients to appointments, including visits with healthcare providers, laboratory tests, and imaging procedures. During these visits, they may take notes, ask questions, and help ensure the patient fully understands their options both during and after the visit.
Patient Advocate Vs. Patient Navigator
While a patient advocate is hired by the patient or their family to act as an outside representative, a patient navigator is an employee of a medical organization who helps patients schedule appointments and services and use them effectively. They also help patients understand diagnoses and treatment options, enabling more informed decision-making. For many patients, the navigator is easier to reach than their physician for questions about medications or discussing complex information about their prognosis (Adler, 2012).
Career Opportunities in Patient Advocacy
Patient advocates have the opportunity to profoundly impact the lives of both patients and their families. Many families struggle to navigate complex healthcare systems due to financial constraints, time limitations, or language barriers. Having a patient advocate allows these families to make more informed decisions and spend more time with their loved ones in medical crises or during end-of-life care. For many families, a patient advocate can be a crucial support system during times of confusion and loss. Often, patient advocates are individuals who have previously experienced such care and were inspired to help others in similar situations.
Patient advocates may work independently or for nonprofit organizations that contract directly with patients. The specific role of a patient advocate may vary depending on the employer and the structure of the organization. However, the primary goal of a patient advocate is always to prioritize the patient’s needs, ensuring they receive the healthcare and attention to which they are entitled as consumers of the organization’s services.
Many patient advocates come from backgrounds in nursing or social work, and their education ranges from an associate degree to a master's degree in fields such as sociology, social work, nursing, or health information. Certification programs are also available to help individuals understand the specific role of a patient advocate within different healthcare settings, including clinical facilities such as nursing homes or assisted living centers.
Some individuals may transition into patient advocacy after a career in nursing, seeking more opportunities to support patients in navigating the healthcare system. In their previous nursing roles, they may not have had the time or resources to assist patients as much as they would have liked. Others enter the field of patient advocacy immediately after completing their degree, continuing their education to better serve their clients and expand their expertise.

As discussed previously, patient-centered care has not always been the norm. In the past, doctors were seen as the authorities in healthcare and patients were expected to do what they were told. NEJM Catalyst (2017) states that “Patient-centered care represents a shift in the traditional roles of patients and their families from one of passive ‘order taker’ to one of active ‘team member.’” Today, patients ask questions and have the ability to research conditions and medications on the internet. The expectation from both patients and healthcare workers is that healthcare will be tailored to the individual. Patient-centered care means the patient is the central decision-maker about their own healthcare, with support being provided by the various members of a healthcare team. Patients and their family or support network are invited to be full partners in planning care and understanding their health. Patient-centered care takes into consideration many factors, such as patient and family preferences, values, cultural traditions, language, and socioeconomic conditions.
The key to patient-centered care is to offer respectful and considerate care, whatever the patient chooses after being informed of their options. For example, patient-centered care takes into consideration any resources the patient may need, such as transportation to clinic or hospital visits, home healthcare, physical therapy, and dietary education. Patient-centered care also considers factors that affect the patient’s access to services, such as whether a patient lives in a rural or urban setting and the type of providers in their area. If the patient wishes to include a person from their faith or spiritual tradition in their care, this is welcomed and facilitated. The goal is that the “right care is provided at the right time and the right place” (NEJM Catalyst, 2017).
Consider Abeba’s story from the beginning of the chapter. Aster, Abeba’s mother, had to navigate the U.S. healthcare system when she began to show symptoms of diabetes. Abeba accompanied her mom to clinic visits. These visits were a challenge, as Aster was still learning English. While Abeba might have wanted to act as a translator, the clinic instead arranged for a medical interpreter. When complex medical discussions are taking place, it is best that family members are not acting as translators. Although family members may not lack the English skills to translate, without the proper training and knowledge of terminology, there is no way to ensure that information is being accurately conveyed. In Aster’s case, the clinic arranged for a medical interpreter to ensure medical information was accurately received and questions and confirmations from Aster were clearly communicated to the healthcare team.
Part of a patient-centered approach is ensuring appropriate care is given by the best healthcare professional for the task. For example, when Aster arrived for her appointment, a receptionist was there to check Aster in. Then, a medical assistant (MA) checked Aster’s weight and vital signs, such as temperature, pulse, blood pressure, oxygen level, and breathing rate. Next, the physician, Dr. Gomez, discussed Aster’s symptoms. Dr. Gomez said Aster needed lab work done, so the MA came back and collected some blood from Aster to send to the lab. Aster was instructed to return to the clinic the next week. After the lab work came back, Dr. Gomez determined that diabetes was the most likely cause of Aster’s symptoms. Working with Aster, Dr. Gomez recommended adjusting Aster’s diet, increasing Aster’s level of exercise, and taking medication to control blood sugar levels. The healthcare team then brought in a registered nurse (RN) who had special training in management of diabetes. The RN met with Aster and Abeba and explained how they could work together on the lifestyle changes Dr. Gomez recommended. Next, Aster was scheduled to meet with a registered dietician to discuss the food choices that Aster was advised to make, taking Aster’s cultural food preferences into consideration. Once Aster indicated understanding of all the new information and had a chance to ask questions, the healthcare team scheduled follow-up visits to track Aster’s progress. Abeba saw this process as Aster being at the center of a circle with different team members around her working together to ensure she had the information and support she needed. Aster’s experience inspired Abeba to pursue a healthcare career. She, like many of us, wanted to be a part of someone’s patient-centered journey.
Attributions
- Figure 1.10: Original Image by Katherine Kelley, SBCTC is released under CC BY 4.0