N A T I O N A L A S S O C I A T I O N O F S O C I A L W O R K E R S

Palliative &End of Life

Care

Palliative &End of Life

Care

National Association of Social Workers

Gary Bailey, MSW

NASW President (2003–2004)

Palliative and End of Life Care

Expert Steering Committee

Susan Blacker, BSW, MSW, RSW,

Volunteer Leader

Iraida V. Carrion, LCSW

Yvette Colón, ACSW, BCD

Pamela M. Jackson, MEd

Stuart Kaufer, CSW, ACSW

Patricia O’Donnell, DSW, LICSW, CCM

Mary Raymer, ACSW

Sherri Roff, CSW, PhD Candidate

Elizabeth Smart, MA

Sharon Hines Smith, PhD, QCSW, MSW

Mila Ruiz Tecala, ACSW, DCSW, LICSW

Katherine Walsh-Burke, DSW

NASW Staff

Elizabeth J. Clark, PhD, ACSW, MPH

Executive Director

Toby Weismiller, ACSW

Tracy Whitaker, ACSW

Karyn Walsh, ACSW, LCSW

©2004 National Association of Social Workers.All Rights Reserved.

Contents

7 Introduction

9 Definitions

13 Background

14 Guiding Principles

15 Standards for Professional Practice

26 Standards for Professional Preparation and Development

29 References

31 Resources

31 Acknowledgements

Standards for Pal l iat ive and

End of L ife Care

Standard 1. Ethics and ValuesThe values, ethics, and standards of both theprofession and contemporary bioethics shallguide social workers practicing in palliative andend of life care. The NASW Code of Ethics(NASW, 2000) is one of several essential guidesto ethical decision making and practice.

Standard 2. KnowledgeSocial workers in palliative and end of life careshall demonstrate a working knowledge of thetheoretical and biopsychosocial factors essentialto effectively practice with clients and professionals.

Standard 3. AssessmentSocial workers shall assess clients and includecomprehensive information to develop interventions and treatment planning.

Standard 4. Intervention/Treatment Planning Social workers shall incorporate assessments indeveloping and implementing intervention plansthat enhance the clients’ abilities and decisionsin palliative and end of life care.

Standard 5. Attitude/Self-Awareness Social workers in palliative and end of life careshall demonstrate an attitude of compassion andsensitivity to clients, respecting clients’ rights toself-determination and dignity. Social workersshall be aware of their own beliefs, values, andfeelings and how their personal self mayinfluence their practice.

Standard 6. Empowerment and AdvocacyThe social worker shall advocate for the needs,decisions, and rights of clients in palliative andend of life care. The social worker shall engagein social and political action that seeks to ensure

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that people have equal access to resources tomeet their biopsychosocial needs in palliativeand end of life care.

Standard 7. DocumentationSocial workers shall document all practice withclients in either the client record or in the medical chart. These may be written or electronic records.

Standard 8. Interdisciplinary TeamworkSocial workers should be part of an interdisciplinaryeffort for the comprehensive delivery ofpalliative and end of life services. Social workersshall strive to collaborate with team membersand advocate for clients’ needs with objectivityand respect to reinforce relationships withproviders who have cared for the patient alongthe continuum of illness.

Standard 9. Cultural CompetenceSocial workers shall have, and shall continue to develop, specialized knowledge and understanding about history, traditions, values,and family systems as they relate to palliativeand end of life care within different groups.Social workers shall be knowledgeable about,and act in accordance with, the NASWStandards for Cultural Competence in SocialWork Practice (NASW, 2001).

Standard 10. Continuing EducationSocial workers shall assume personal responsibility for their continued professionaldevelopment in accordance with the NASWStandards for Continuing ProfessionalEducation (NASW, 2002) and state requirements.

Standard 11. Supervision, Leadership,and TrainingSocial workers with expertise in palliative and endof life care should lead educational, supervisory,administrative, and research efforts with individuals, groups, and organizations.

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7

Introduction

All social workers, regardless of practice settings,will inevitably work with clients facing acute orlong-term situations involving life-limitingillness, dying, death, grief, and bereavement.Using their expertise in working withpopulations from varying cultures, ages,socioeconomic status, and nontraditionalfamilies, social workers help families across thelife span in coping with trauma, suicide, anddeath, and must be prepared to assess suchneeds and intervene appropriately.

Social work practice settings addressingpalliative and end of life care include health and mental health agencies, hospitals, hospices,home care, nursing homes, day care and seniorcenters, schools, courts, child welfare and familyservice agencies, correctional systems, agenciesserving immigrants and refugees, substanceabuse programs, and employee assistanceprograms. Thus, social work is a broadly basedprofession that can meet the needs of individualsand families affected by life-limiting illness and end of life issues.

Social workers are challenged to provideexpertise and skill in direct services to clientsand their families. At the same time, they have the opportunity to influence a range of professionals, consumers, and laypersonsregarding life-limiting illness, care of the dying,and the bereaved. The need for social workerstrained and skilled in working with palliative andend of life care situations has increased, becauseof advancements in medical technology, risingrates of chronic illness, increasing number ofelderly people, and longer life spans.

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Palliative and end of life care is a growing area of practice, and social workers may feelunprepared to deal with the complex issues itencompasses (Csikai & Raymer 2003; Christ &Sormanti, 1999). These standards are designedto enhance social workers’ awareness of theskills, knowledge, values, methods, andsensitivities needed to work effectively withclients, families, health care providers, and thecommunity when working in end of lifesituations.

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Definitions

End of Life Care

End of life care refers to multidimensionalassessment and interventions provided to assistindividuals and their families as they approachend of life. Whether sudden or expected, theend of a person’s life is a unique experience thathas a great impact on the person, his or herfamily system, and the family legacy.

End of life decisions encompass a broad rangeof medical and psychosocial determinations thateach individual may make before the end of hisor her life. No person has to make decisions;one can delegate, with or without an advancedirective, depending on one’s capacity to do so.Individuals may address such decisions throughadvance planning, or in emergencies, whencareful consideration is not possible, they mayleave the difficult decisions to be made by familymembers and friends who may be ill prepared todecide what their loved ones might have wanted.Such decisions can include where one plans tospend the final months before death and thedegree of self-sufficiency one wishes at that time.The use of personal, family, and societal resourcesto attain these decisions may change, dependingon the course of a particular illness, and areamong some of the most important decisionsindividuals and family members may face.

Health care and end of life decision makingcrosses ethical, religious, cultural, emotional,legal, and policy areas. The complexity of issuesincludes aspects such as weighing risk andbenefit; allocation of individual, family, andsocietal resources; and the recognition ofchanging goals of care. It concerns individuals’

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deepest and most dearly held fears, values, andbeliefs. Palliative and end of life issues are oftendelicate and controversial and require skilled,insightful interdisciplinary care.

There is increasing agreement that attending toneeds along the continuum of illness, coming toterms with end of life issues, making informeddecisions and ensuring society honors them, arevital life tasks. It is with just such a constellationof responsibilities that social work’s values andskills can make a significant contribution(Kaplan, 1995).

Palliative Care

Palliative care is an approach that improvesquality of life for patients and their familiesfacing the problems associated with life-limitingillness. This is accomplished through theprevention and relief of suffering by means ofearly identification and comprehensiveassessment and treatment of pain and otherphysical, psychosocial, and spiritual problems.Palliative care:■ provides relief from pain and other

distressing symptoms;■ affirms life and regards dying as a

normal process; ■ intends neither to hasten nor to

postpone death; ■ integrates the psychological and spiritual

aspects of patient care; ■ offers a support system to help patients live

as actively as possible until death; ■ offers a support system to help the family

cope during the patient’s illness and in theirown bereavement;

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■ uses a team approach to address the needs of patients and their families, includingbereavement counseling, if indicated;

■ enhances quality of life and may alsopositively influence the course of illness; and

■ is applicable early in the course of illness, in conjunction with other therapies that areintended to prolong life, such aschemotherapy or radiation therapy, andincludes those investigations needed to betterunderstand and manage distressing clinicalcomplications (World Health Organization,2003).

Hospice and Palliative Care

Considered the model for quality, compassionatecare for people facing life-limiting illnesses orinjuries, hospice and palliative care involve ateam-oriented approach to expert medical care,aggressive pain and symptom management, and emotional and spiritual support expresslytailored to the patient’s needs and wishes.Support is also provided to the patient’s lovedones. At the center of hospice and palliative careis the belief that each of us has the right to liveand die free of pain, with dignity, and that ourfamilies should receive the necessary support toallow us to do so.

Hospice focuses on caring, not curing and, inmost cases, care is provided in the patient’shome. Care also is provided in freestandinghospice centers, hospitals, and nursing homes,and other long-term care facilities. Services areavailable to patients of any age, religion, race, orillness. Hospice care is covered under Medicare,Medicaid, most private insurance plans, HMOs,and other managed care organizations.

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Palliative care extends the principles of hospicecare to a broader population that could benefitfrom receiving this type of care earlier in theirillness or disease process. No specific therapy isexcluded from consideration. An individual’sneeds are continually assessed, and treatmentoptions should be explored and evaluated in thecontext of the individual’s values, symptoms, andchanging goals. Palliative care may segue intohospice care if the illness progresses (NationalHospice and Palliative Care Organization,2003).

NASW endorses the Last Acts Precepts forPalliative Care. (The precepts can be obtainedfrom http://www.lastacts.org)

Bereavement

Bereavement has been defined by several expertsas the objective situation of a person who hasexperienced the loss of a significant person orother attachment figure.

Grief

Grief is a reaction to loss, and, for each personwho has sustained a loss, is an individualexperience. Certain losses affect entire groupsystems such as families, communities, cultures,and countries. Grief affects people from everystandpoint, including physical, emotional,behavioral, cognitive, and spiritual.

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Background

During the past decade, consumer advocacygroups, health professional organizations, andgovernment agencies have paid increasedattention to the quality and accessibility of carealong the continuum of illness and at the end of life. As a result, health care professions arefocused on their own ability to train members of their respective disciplines and to contributeto the building of a knowledge base forexcellence in care. Social work is no exception.

A 2002 Social Work Leadership Summit onEnd of Life and Palliative Care addressed theneed for a formalized collaborative effort in the social work profession that focuses onpalliative and end of life care. During thismeeting, participants designed an agenda for the profession to improve care and to elevatesocial work’s role and contributions in this arena(Project on Death in America, 2002).

Building on this foundation, the NationalAssociation of Social Workers (NASW) hasdeveloped Standards for Social Work Practice in Palliative and End of Life Care, a usefulpractice tool for social workers. The standardsreflect core elements of social work functions inpalliative and end of life care and professionalsocial work practice, and are targeted towardsocial workers practicing in various settingsdealing with these issues. For many practicingsocial workers in palliative and end of life care,these standards reinforce current practices. Forothers, they provide an objective to achieve andguidelines to assist in practice.

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Guiding Principles

Social workers have unique, in-depth knowledgeof and expertise in working with ethnic, cultural,and economic diversity; family and supportnetworks; multidimensional symptom manage-ment; bereavement; trauma and disaster relief;interdisciplinary practice; interventions acrossthe life cycle; and systems interventions thataddress the fragmentation, gaps, and insufficiencyin health care. These are critical areas for imple-menting change in palliative and end of life care.

Social workers also have expertise in analyzing,influencing, and implementing policy changeand development at local, state, and federal levelsthat can be used to make important improvementsin the care of patients living with life-limitingillness and the dying. Social work research in thecare of the dying is also developing and addressingmany previously overlooked areas of end of lifecare, such as issues concerning ethnic, cultural,and economic diversity, substance abuse,incarceration, interventions at different life cyclestages, problem-solving interventions, andintervention in community contexts.

Social workers are concerned with enhancingquality of life and promoting well-being forindividuals, families (defined broadly), andcaregivers. When confronting issues related topalliative and end of life care, social workershave a multidimensional role as clinicians,educators, researchers, advocates, and communityleaders. When confronting ethical dilemmas inpalliative and end of life care, social workers candraw on the principle of client self-determinationin matters where clients or their proxies are facedwith such issues (National Association of SocialWorkers, 2003).

The scope of social work in palliative and end oflife care extends across many practice settingsand populations, and requires intervention at theindividual, family, group, community, andorganizational levels. The standards may beregarded as a basic tool for social work practicein palliative and end of life care, althoughpractice priorities may vary among settings.

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Standards for Professional Practice

Standard 1. Ethics and ValuesThe values, ethics, and standards of both theprofession and contemporary bioethics shallguide social workers practicing in palliative andend of life care. The NASW Code of Ethics(NASW, 2000) is one of several essential guidesto ethical decision making and practice.

Interpretation:

Social workers who practice in palliative and endof life care must be prepared for challenges thatencompass evaluation of ethical dilemmas andvalue conflicts and consider questions related toreligion, spirituality, and the meaning of life. To be an effective practitioner in this area,specialized training in palliative and end of life care is preferred.

The minimal knowledge base needed for workin this practice area includes an understandingof the following basic ethical principles: ■ Justice: the duty to treat all fairly, distributing

the risks and benefits equally■ Beneficence: the duty to do good, both for

individuals and for all■ Nonmaleficence: the duty to cause no harm,

both for individuals and for all■ Understanding/Tolerance: the duty to

understand and to accept other viewpoints, if reason dictates that doing so is warranted

■ Publicity: the duty to take actions based onethical standards that must be known andrecognized by all that are involved

■ Respect for the person: the duty to honorothers, their rights, and their responsibilities,as showing respect for others implies that wedo not treat them as a mere means to our end

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� Universality: the duty to take actions thathold for everyone, regardless of time,place, or people involved

� Veracity: the duty to tell the truth� Autonomy: the duty to maximize the

individual’s right to make his or her owndecisions

� Confidentiality: the duty to respect privacyof information and action

� Equality: the duty to view all people asmoral equals

� Finality: the duty to take action that mayoverride the demands of law, religion, andsocial customs

In addition, the social workers working inpalliative and end of life care are expected tobe familiar with the common and complexbioethical considerations and legal issues suchas the right to refuse treatment; proxy decision-making; withdrawal or withholding oftreatment, including termination of ventilatorsupport and withdrawal of fluids and nutrition;and physician aid in dying. End of life issues arerecognized as controversial, because they reflectthe varied value systems of different groups.Consequently, NASW does not take a positionconcerning the morality of end of life decisions,but affirms the right of the individual todetermine the level of his or her care. Particularconsideration should be given to specialpopulations, such as people with mental illness,with developmental disability, individuals whosecapacity or competence is questioned, children,and other groups who are vulnerable to coercionor who lack decisional capacity.

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Standard 2. KnowledgeSocial workers in palliative and end of life careshall demonstrate a working knowledge of thetheoretical and biopsychosocial factors essentialto effectively practice with clients andprofessionals.

Interpretation:

The social worker possesses knowledge aboutnavigating the medical and social systems thatfrequently present barriers to clients. Socialworkers have expertise in communication, bothwithin families and between clients/families andhealth care or interdisciplinary teams. Drawingon knowledge of family systems andinterpersonal dynamics, the social worker is ableto examine the family’s experience in a uniqueway, to conduct a comprehensive assessment,and to assist the team to integratebiopsychosocial, spiritual factors into theirdeliberations, planning, and interactions.

Social work’s view includes an appreciation of the socioeconomic, cultural, and spiritualdimensions of the family’s life. As experts inhelping individuals and families maximizecoping in crisis—and at addressing thepsychosocial domains of symptoms, suffering,grief, and loss—social workers are able toprovide intensive counseling as well as practicalservices for those confronted by life-limitingillnesses and assist with complex problems.

Essential areas of knowledge and understandingabout palliative and end of life care include:■ the multifaceted roles and functions of social

worker clinicians■ the physical and multidimensional stages

of the dying process

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■ the physical, psychological, and spiritualmanifestations of pain

■ the range of psychosocial interventions thatcan alleviate discomfort

■ the biopsychosocial needs of clients and their family members;

■ the impact of ethnic, religious, and culturaldifferences

■ illness-related issues such as decision making,relationship with health care providers, dyingand death

■ the range of settings for palliative and end of life care, including home care, nursinghomes, and hospice settings

■ the available community resources and howto gain access to them

■ the impact of financial resources on familydecision making along the continuum ofillness and at the end of life

■ the development, use, support, and revision of advance directives throughout theprogression of the illness

■ disparities across cultures in gaining access to palliative and end of life care

■ the accreditation and regulatory standardsgoverning settings providing palliative andend of life care

■ the needs faced by members of specialpopulations and their families, such aschildren; those with physical, developmental,mental, or emotional disabilities; and those in institutionalized settings such as nursinghomes and nonmedical settings such ascorrectional facilities.

Standard 3. AssessmentSocial workers shall assess clients and includecomprehensive information to developinterventions and treatment planning.

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Interpretation:

Assessment is the foundation of practice. Social workers plan interventions with theirclients based on assessments and must beprepared to constantly reassess and revisetreatment plans in response to newly identifiedneeds and altered goals of care. Comprehensiveand culturally competent social work assessmentin the context of palliative and end of life careincludes considering relevant biopsychosocialfactors and the needs of the individual client and the family (as defined by the client).

Areas for consideration in the comprehensiveassessment include:■ relevant past and current health situation

(including the impact of problems such aspain, depression, anxiety, delirium, decreasedmobility)

■ family structure and roles■ patterns/style of communication and decision

making in the family■ stage in the life cycle, relevant

developmental issues■ spirituality/faith■ cultural values and beliefs■ client’s/family’s language preference and

available translation services ■ client’s/family’s goals in palliative and end

of life treatment■ social supports, including support systems,

informal and formal caregivers involved,resources available, and barriers to access

■ past experience with illness, disability, death, and loss

■ mental health functioning including history,coping style, crisis management skills and risk of suicide/homicide

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■ unique needs and issues relevant to specialpopulations such as refugees and immigrants,children, individuals with severe andpersistent mental illness, and homeless people

■ communicating the client’s/family’spsychosocial needs to the interdisciplinaryteam.

Standard 4. Intervention/Treatment Planning Social workers shall incorporate assessments indeveloping and implementing intervention plansthat enhance the clients’ abilities and decisionsin palliative and end of life care.

Interpretation:

Social workers in all practice areas use varioustheoretical perspectives and skills in deliveringinterventions and developing treatment plans.Initial assessments and team input inform andguide plans of care. Social workers must be ableto adapt techniques to work effectively withindividuals from different age groups,ethnicities, cultures, religions, socioeconomicand educational backgrounds, lifestyles, anddiffering states of mental health and disability,and in diverse nonmedical care settings.

Essential skills for effective palliative andend of life care include:■ the ability to recognize signs and symptoms

of impending death and prepare familymembers in a manner that is guided byclinical assessment

■ competence in facilitating communicationamong clients, family members, and membersof the care team

■ competence in integrating grief theories into practice

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■ competence in determining appropriateinterventions based on the assessment

■ competence in advocating for clients, familymembers, and caregivers for needed services,including pain management

■ competence in navigating a complex networkof resources and making appropriate linkagesfor clients and family members

■ competence in supporting clients, families, andcaregivers including anticipatory mourning,grief, bereavement, and follow-up services.

Interventions commonly provided inpalliative and end of life care include:■ individual counseling and psychotherapy

(including addressing the cognitive behavioralinterventions)

■ family counseling■ family-team conferencing■ crisis counseling■ information and education■ multidimensional interventions regarding

symptom management ■ support groups, bereavement groups■ case management and discharge planning■ decision making and the implications of

various treatment alternatives■ resource counseling (including caregiving

resources; alternate level of care options suchas long term care or hospice care; financialand legal needs; advance directives; andpermanency planning for dependents)

■ client advocacy/navigation of systems.

Standard 5. Attitude/Self-Awareness Social workers in palliative and end of life careshall demonstrate an attitude of compassion andsensitivity to clients, respecting clients’ rights toself-determination and dignity. Social workers

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shall be aware of their own beliefs, values, andfeelings and how their personal self mayinfluence their practice.

Interpretation:

To practice effectively, social workers inpalliative and end of life care must demonstrateempathy and sensitivity in responding to thepain, suffering, and distress of others. Specificsocial work attitudes and responses thatencompass compassion and sensitivity in caringfor clients shall include, but not necessarily belimited to, the following:■ flexibility and adaptability on a daily basis,

to be able to confront human suffering ■ consistent individualization of client/client

system needs as the primary care unit■ facilitative interactions with clients/client

systems ■ ability to communicate and work

collaboratively as an interdisciplinary team member to achieve care goals

■ willingness to advocate for holding the focus in palliative and end of life care onclient/client system choices, preferences,values, and beliefs

■ awareness of compassion fatigue and theethical responsibility to mitigate thiscondition

■ confidence and competence in professionalidentify and in empowering the profession inits vital role in palliative and end of life care.

Standard 6. Empowerment and AdvocacyThe social worker shall advocate for the needs,decisions, and rights of clients in palliative andend of life care. The social worker shall engagein social and political action that seeks to ensurethat people have equal access to resources to

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meet their biopsychosocial needs in palliativeand end of life care.

Interpretation:

In advocacy efforts, social work provides uniqueand essential skills and perspectives such as arich understanding of the person-in-environment, communication skills, expertise ingroup process and systems, a social justicecommitment, a strong background in values andethics, and a broad psychosocial and spiritualknowledge base. Among the crucial componentsof effective empowerment and advocacy areidentifying and defining needs from the client’sperspective, including cultural and spiritualbeliefs, and communicating the concerns andneeds of the client to decision makers and providersof care. Advocacy and empowerment come intopractice at both the micro and macro level.

Practice examples include linking clients withresources, identifying and supporting the familyof choice, assisting individuals and familiesnegotiate their goals of care, navigating throughsystems of care, monitoring pain and symptommanagement, addressing quality-of life issues,team conferencing, consulting, and providingcaregiver support. Broader examples of advocacyinclude advocacy with special populations,institutions, and communities, as well as thehealth care policy arenas where efforts need tointegrate cultural and ethnic variation. It isessential to identify barriers to effectivepalliative and end of life care at the macro levelby addressing issues of financial inequities, lackof culturally competent services, and otheraccess issues and to address those barriers sothat individuals experience the highest quality oflife possible to the end of life.

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Standard 7. DocumentationSocial workers shall document all practice withclients in either the client record or in themedical chart. These may be written orelectronic records.

Interpretation:

Ongoing documentation of social work serviceshould reflect the assessment, issues addressed,treatment offered, and plan of care, and mustassure continuity of care between all settings(for example, hospital to hospice, nursing home to hospital).

The transfer of medical records must beconducted in compliance with current federaland state law with an emphasis on confidentiality/privacy of medical information. Compliancewith agency policy, particularly regarding thetransfer of electronic records, is essential.

Standard 8. Interdisciplinary TeamworkSocial workers should be part of aninterdisciplinary effort for the comprehensivedelivery of palliative and end of life services.Social workers shall strive to collaborate withteam members and advocate for clients’ needswith objectivity and respect, to reinforcerelationships with providers who have cared forthe patient along the continuum of illness.

Interpretation:

Interdisciplinary teamwork is an essentialcomponent in palliative and end of life care.Social workers are integral members of a healthcare team. Social workers should advocate forthe views and needs of individuals and familiesin palliative and end of life care within the team,

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and should encourage and assist clients incommunicating with team members. Often,clients, families, and team members rely on theexpertise of the social worker in problem solvingconcerns and conflict resolution.

Teamwork requires collaboration, and an abilityto empower and advocate when necessary. Thepsychosocial expertise of the social workerassists the interdisciplinary team to enhanceunderstanding, form interventions anddecisions, and formulate treatment plans. Inaddition, the social worker identifies resources,provides counseling, support services, andpractical interventions.

Standard 9. Cultural CompetenceSocial workers shall have, and shall continue to develop, specialized knowledge andunderstanding about history, traditions, values,and family systems as they relate to palliativeand end of life care within different groups.Social workers shall be knowledgeable about,and act in accordance with, the NASWStandards for Cultural Competence in SocialWork Practice (NASW, 2001).

Interpretation:

Social workers respect and integrate knowledgeabout how individuals and families areinfluenced by their ethnicity, culture, values,religion- and health-related beliefs, andeconomic situations. Social workers shouldunderstand systems of oppression and how thesesystems affect client access to, and utilization of,palliative and end of life care. Many culturesmaintain their own values and traditions in theareas of palliative and end of life care.

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Culture influences individuals’ and families’experience as well as the experience of thepractitioner and institution. Social workersshould consider culture in practice settingsinvolving palliative and end of life care. Eachcultural group has its own views about palliativeand end of life practices and these need to beunderstood as they affect individuals’ responseto dying, death, illness, loss, and pain.

Social workers who understand how cultureaffects the illness and end of life experience ofan individual and family will be better able toindividualize care and intervene in thepsychosocial impact of illness, pain, dying, anddeath. Therefore, social workers should befamiliar with the practices and beliefs of thecultural groups with whom they practice todeliver culturally sensitive services.

Standards for Professional Preparation andDevelopment

Standard 10. Continuing EducationSocial workers shall assume personalresponsibility for their continued professionaldevelopment in accordance with the NASWStandards for Continuing ProfessionalEducation (NASW, 2002) and staterequirements.

Interpretation:

Social workers must continue to grow in theirknowledge of theories and practices in palliativeand end of life care to effectively work withindividuals and families. Palliative and end of lifecare is a rapidly expanding and changing field,which crosses all practice settings. In addition to

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clinical competence, social workers need toenhance their skills and understanding bykeeping abreast of research, so their practicereflects the most current knowledge.

Numerous opportunities in professionaldevelopment are available through NASW andother professional organizations, institutions,coalitions, and service agencies at local, state,and national levels. Social workers shouldparticipate in and contribute to professionalconferences and training activities on a regularand consistent basis to provide the highestpossible level of care. Social workers should alsoassist in identifying palliative and end of lifeprofessional development needs by participatingin research and encouraging organizations andinstitutions to collaborate, advocate, and provideappropriate education for the field.

Standard 11. Supervision, Leadership,and TrainingSocial workers with expertise in palliative andend of life care should lead educational,supervisory, administrative, and research effortswith individuals, groups, and organizations.

Interpretation:

Social workers shall offer their expertise toindividuals, groups, and organizations as well asoffering training and mentoring opportunities tobeginning social workers or those transitioninginto palliative and end of life care. When able,skilled social workers shall work in conjunctionwith schools of social work to advocate forprograms in palliative and end of life care andenhance and encourage interest in thisspecialization.

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Social workers shall offer supervision topracticing social workers, interns, and studentsto provide a guiding expertise to clinicians inthis area. Social workers shall contribute toresearch initiatives not only to demonstrate theefficacy of the social work profession and socialwork interventions, but also to advance therecognition among colleagues in otherprofessions of the essential need to addresspsychosocial needs of individuals and theirfamilies.

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References

Christ, G., & Sormanti, M. (1999). Advancingsocial work practice in end of life care. SocialWork in Health Care, 30(2), 81–99.

Csikai, E. L., & Raymer, M. (2003). TheSocial Work End of Life Care EducationProject: An assessment of educational needs.Insights. Retrieved October 6, 2003, fromhttp://www.nhpco.org/files/public/InsightsIssue2_2003Social_Worker_pp8-9.pdf.

Field, M. J., & Behrman, R. E. (Eds.). (2002).When children die: Improving palliative and endof life care for children and their families.Washington, DC: National Academy ofSciences, Institute of Medicine, Committee onPalliative and End of Life Care for Children.

Field, M. J., & Cassel, C. K. (Eds.). (1997).Approaching death: Improving care at the end oflife. Washington, DC: National Academy ofSciences, Institute of Medicine.

Kaplan, K. O. (1995). End of life decisions. InR. L. Edwards (Ed.-in-Chief), Encyclopedia ofsocial work (19th ed., Vol. 1, pp. 856–868).Washington, DC: NASW Press.

National Association of Social Workers.(2003). Client self-determination in end of lifedecisions. Social work speaks: NationalAssociation of Social Workers policy statements,2003 – 2006 (6th ed., pp. 46 – 49).Washington, DC: NASW Press.

National Association of Social Workers.(2000). Code of Ethics of the NationalAssociation of Social Workers. Washington,DC: Author.

National Association of Social Workers.(2002). NASW standards for continuingprofessional education. Washington, DC: Author.

National Association of Social Workers.(2001). NASW standards for cultural competencein social work practice. Washington, DC:Author.

National Hospice and Palliative CareOrganization. (2001). Competency-based educationfor social workers. Arlington, VA: Author.

National Hospice and Palliative CareOrganization. (2003). Hospice and palliative care.Retrieved September 3, 2003, fromhttp://www.nhpco.org/i4a/pages/index.cfm?pageid=3281.

Project on Death in America. (2002). SocialWork Summit on End of Life and Palliative Care.(Press release). Retrieved October 6, 2003,from http://www.swlda.org/Summit.htm.

Taylor-Brown, S., Blacker, S., Walsh-Burke,K., Altilio, T., & Christ, G. (2001). Care at theend of life (Best Practice Series: InnovativePractice in Social Work). Philadelphia: Societyof Social Work Leadership in Health Care.

World Health Organization. (2003). WHOdefinition of palliative care. Retrieved September23, 2003, from http://www.who.int/cancer/palliative/definition/en/.

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Resources

NASW has developed several policy statements, which arepublished in Social Work Speaks: National Association ofSocial Workers Policy Statements, 2003 – 2006 (6th ed.),related to palliative and end of life care. These statementsare listed below:

Client Self-Determination in End of Life DecisionsHealth CareHospice CareLong-Term CareManaged Care

Acknowledgements

NASW would like to acknowledge the work of thefollowing individuals for their contributions to the “Social Work Scope of Practice and CompetenciesEssential to Palliative Care, End of Life Care and GriefWork” (as yet unpublished), as part of the National SocialWork Leadership Summit on Palliative and End of LifeCare, in conjunction with the Last Acts ProviderEducation Committee, the Duke Institute on Care at theEnd of Life, and the Soros Foundation’s Project on Deathin America: Lisa P. Gwyther, Terry Altilio, Susan Blacker,Grace Christ, Ellen Csikai, Nancy Hooyman, BettyKramer, Julie M. Linton, Mary Raymer, and Judy Howe.

The work of the aforementioned authors provided thefoundation of the NASW Standards for Practice for SocialWorkers in Palliative and End of life Care.

NASW would also like to acknowledge and thank Project on Death in America for the grant to fund thedevelopment of practice standards for social workers inpalliative and end of life care.

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