Curriculum Guide – Substance use - The College of Social Work

Curriculum guide – Physical health, dementia and end of life care Dr Julie Fish
Terminology: Physical health
Health is a contested concept. The International Federation of Social Work’s (2008) policy i asserts that ‘health
is an issue of fundamental human rights and social justice’; this guide draws on the UN Declaration of Human
Rights and adopts a definition of health as a state of physical and social wellbeing and not merely the absence
of disease or illness.
Place in the curriculum and links to other curriculum areas (including other guides ())
Health is relevant to all areas of SW practice. Links should be made to other curriculum areas such as ethics,
human rights, diversity and oppression (), life-course approaches to human development in HGD (), mental
health (), inter-professional and inter-agency collaboration (), international social work (), research (),
social model of disability () and the health effects of neglect, violence and abuse on children and adults ().
Key curriculum issues
Health is an interdisciplinary field drawing on sociology, social policy, psychology, ethics and medicine.
Social work practice for health is relevant to all service user and carer groups and all work settings and
often involves inter-professional working with health and allied health professionals.
A person’s physical health is often a cause for, or factor in, social work intervention, while the
disadvantaged lives most service users experience threaten their health.
Social inequalities, that is ‘the conditions in which people are born, grow, live, work, and age’ i often result in
inequalities in health outcomes, including differences in life expectancy and morbidity. Class, disability,
gender, ‘race’, age, religion, sexual orientation and gender identity alongside adverse life experiences,
such as seeking asylum, being a child in public care, domestic abuse, drug misuse and mental distress, all
affect people’s health chances. Social inequalities are amenable to policy action and the commitment to
social justice requires social workers to address social inequalities in their interventions. Students need to
understand that individuals’ health and social needs are interdependent aspects of their wellbeing.
Freely accessible medical services are important. Access to healthcare is influenced by age, class, ‘race’,
gender, disability, religion and belief, sexual orientation and gender identity.
Health inequalities do not only affect those living in poverty. There is a gradient in health chances and
access to services across the whole of society.
Social workers have key roles to play:
promoting good health and preventing illness by securing the necessary social conditions for health,
including promoting social inclusion and preventing isolation;
facilitating access to healthcare (e.g. ensuring looked after children have immunisations);
assisting individuals and families to secure the social, environmental and psychological resources to
manage acute and long term illness.
i International Federation of Social Workers (2008) Policy on health. ifsw.org/policies/health
ii Marmot, M (2010) Fair society, healthy lives – the Marmot Review. Strategic review of health inequalities in England –
post 2010. Retrieved 13 March 2012 from: http://www.marmotreview.org
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development in initial social work education(2012)
December 2012. ©The College of Social Work 2012, 2-4 Cockspur Street London SW1Y 5BH

Key content areas
Understanding health and illness e.g.
a) The social, economic and psychological consequences of illness.
b) Key measures of health and social inequalities (e.g. life expectancy; infant mortality rates; differences in
self-assessed health; the Index of Multiple Deprivation).
c) The relationship between health inequalities and the social determinants of health approach iii .
d) Recognising that conditions for health extend beyond individual hereditary, biological and lifestyle
factors to encompass social and community networks, living and working conditions, housing, access to
education and the wider socio-economic/cultural environment (Whitehead and Dahlgren (1992) Key
resources 7).
e) The social causes of apparently unhealthy behaviours.
f) The interdependence of mental and physical health (e.g. the relationship between being lonely and
blood pressure, depression and mortality rates iv ).
g) The psychosocial impact of changes in health status, (e.g. on sense of personal identity).
Professional responses and practice issues e.g.
a) Health promotion and prevention (e.g. safeguarding children, encouraging positive development,
ensuring access to education, including health education for looked after children, managing the
transition to adulthood for looked after and disabled young people, preventing accidents and isolation
amongst older people.
b) Inter-professional care planning and reablement for people with chronic health conditions including
personalisation and co-production.
c) Addressing specific vulnerabilities (e.g. migration, domestic abuse, homelessness) and promoting
emotional resilience across the lifecourse).
Rights, policy and ethics e.g.
a) National and international statements on:
health as a human right
the social determinants of health
social work policies on health: the IFSW policy i and the Global Agenda for Social Work and
Social Development v
b) National policies on health services including the Health and Social Care Act 2012 (e.g. Health and
Wellbeing Boards and the transfer of public health to local government in England; the Marmot Review. ii
c) Intervention on a preventive or statutory basis in circumstances where health and wellbeing may be
impaired, e.g. safeguarding vulnerable adults and children from abuse, neglect or exploitation.
d) Ethical choices in illness (e.g. euthanasia).
Key resources
1. Bywaters, P, Cowden, S, McLeod, E, Rose, S and Singh, G (2009) Integrating health inequalities in
social work teaching and learning. The Higher Education Academy: SWAP Guide.
http://www.swap.ac.uk/docs/digests/swapdigest_6.pdf
iii
Navarro, V (2009) What we mean by social determinants of health, International Journal of Health Services, 39 (3):
429–441.
iv
Windle, K, Francis, J, and Coomber, C (2011) Preventing loneliness and social isolation: interventions and outcomes.
London: Social Care Institute for Excellence. SCIE briefing 39.
v
IFSW (International Federation of Social Workers) (2012) Global agenda for social work and social development: A
commitment for action. Retrieved 2 April 2012 from http://cdn.ifsw.org/assets/globalagenda2012.pdf
Produced in partnership to support curriculum
development in initial social work education(2012)
December 2012. ©The College of Social Work 2012, 2-4 Cockspur Street London SW1Y 5BH

2. SCIE resources including reablement, outcomes-focused services for older people, social care needs
of children with complex health care needs and their families and promoting the quality of life of looked
after children. http://www.scie.org.uk/publications/index.asp
3. Bywaters, P (2009). Tackling inequalities in health: A global challenge for social work, British Journal of
Social Work, vol. 39, no. 2, pp. 353–367.
4. Gehlert, S and Browne, T (2012) Handbook of health social work. New Jersey: Wiley.
5. Larkin, M (2011) Social aspects of health, illness and healthcare. Milton Keynes: Open University
Press.
6. Wilkinson, R and Pickett, K (2009) The spirit level – why more equal societies almost always do better.
Harmondsworth: Penguin.
7. Whitehead, M and Dahlgren, G (1992) Concepts and principles for tackling inequalities in health.
Copenhagen: World Health Organisation.
Terminology: Dementia
Dementia describes a collection of symptoms which are progressive and incurable including memory loss, problems
with reasoning and communication skills and a reduced ability to carry out daily activities, such as washing, dressing,
cooking and caring for the self.
Place in the curriculum this topic might feature, including links to other guides ()
Work with adults and older people, lifecourse approaches/Human growth and development (), mental health
() and inter-professional and inter-agency collaboration ()
Key curriculum issues
a) The national dementia strategy, Living Well with Dementia 2009.
b) The diverse incidence of dementia, including among younger adults, people with a learning disability
and people from BME backgrounds.
c) Stigma may result in delay in accessing services and low priority from professionals. Lack of support
and treatment leads to inactivity and consequently to poorer physical health (DH (2009) Key resources
4).
d) ‘Seeing the individual’.
Key content areas
Understanding dementia and developing good communication skills e.g.
a) People with dementia lack the opportunity to talk and express their feelings about the quality of their
own life and services they receive. Factors in communication include the type of dementia, the length of
time they have been living with the condition, the effects of previous life history and personality, and the
current caring environment.
b) A number of interventions have been developed to work directly with people with dementia and also
indirectly with family and professional carers and health/social care professionals to improve
communication and quality of life (QOL) for individuals with dementia and their carers.
c) Reminiscence-based activities, if approached sensitively can be an effective therapeutic intervention.
d) Understand the use of assessment tools (for cognition, behaviour, activity limitation and QOL).
Quality of life(QOL) issues e.g.
a) Good nutritional care for people with dementia depends on knowing some basic information: what they
like to eat and drink, what they do not like, and what they find difficult to eat.
b) Effective communication can improve the QOL of a person with dementia (e.g.
through Talking Mats).
Produced in partnership to support curriculum
development in initial social work education(2012)
December 2012. ©The College of Social Work 2012, 2-4 Cockspur Street London SW1Y 5BH

c) Promote the richness of social interactions and relationships and continued engagement in activities.
Professional responses e.g.
a) Aiding communication with people with dementia
http://www.scie.org.uk/publications/briefings/briefing03/index.asp (SCIE, 2004).
b) Work with Mental Capacity Act implementation networks (www.mca2005.co.uk/pdf_files/impnet.pdf).
Key resources
1. Assessing the mental health needs of older people (Nichols, A. 2006).
http://www.scie.org.uk/publications/practiceguides/practiceguide02/index
2. Work with Mental Capacity Act implementation networks
(www.mca2005.co.uk/pdf_files/impnet.pdf)
3. Department of Health best practice tool (www.dh.gov.uk/publications) in dementia care.
4. DH (2009) Living well with dementia 2009. Retrieved from:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalass
et/dh_094051.pdf
Terminology: End of life care
End of life care (EOLC) refers to the care people receive in the final period of their life and includes care for the
terminally ill and those with a condition that is advanced and incurable. Palliative care is relevant for people
throughout the lifecourse.
Place in the curriculum this topic might feature, including links to other guides ()
Work with children, adults and older people, lifecourse approaches/HGD (), palliative care, and interprofessional
and inter-agency collaboration ().
Key curriculum issues
Social workers may take a number of roles to support individuals through the process of dying, including
providing support for family and carers during a person’s illness and following bereavement, initiating
discussions about preferences for end of life care, care planning and coordinating services between home,
hospital, care home and hospice; addressing financial/welfare rights issues. Educators can help students to:
a) reflect on their own attitudes to death and dying and develop their emotional resilience in working in EOLC;
b) develop awareness of cultural, spiritual or humanist needs at end of life;
c) initiate discussions/recognise triggers for discussions about death and dying;
d) explore a range of interventions: one-to-one, self-help support groups, online contacts.
Key content areas
The EOLC strategy was introduced to promote high quality care for all adults at the end of life. It aims to
provide the conditions necessary for a ‘good death’ which include being treated with dignity and respect, being
without pain and other symptoms, being in familiar surroundings and in the company of close family/friends.
a) The framework for social care identifies six steps in the EOLC pathway (DH, 2010):
o discussions as the end of life approaches
o agreed care plan and regular review of needs and preferences
o coordination of care e.g. rapid response services
o delivery of high quality services in different settings and for diverse groups such as LGBT; BME
o care in the last days of life and identification of dying phase
Produced in partnership to support curriculum
development in initial social work education(2012)
December 2012. ©The College of Social Work 2012, 2-4 Cockspur Street London SW1Y 5BH

o care after death: practical issues e.g. registering the death; bereavement support for carer and family.
b) Enabling people to die in their own ‘home’ (including a care home).
c) Anticipatory care planning.
d) Crisis management.
Key resources
1. National End of Life Care Programme (2010) Supporting people to live and die well: A framework for
social care at the end of life.
http://www.endoflifecareforadults.nhs.uk/assets/downloads/Social_Care_Framework.pdf
2. SCIE (2012) End of life care for people with dementia living in care homes
http://www.scie.org.uk/publications/ataglance/ataglance59.pdf
3. NHS (2012) The route to success in end of life care – achieving quality for lesbian, gay, bisexual and
transgender people. National End of Life Care Programme
http://www.endoflifecareforadults.nhs.uk/publications/rts-lgbt
4. Holloway, M (2007) Negotiating death in contemporary health and social care. Bristol: Policy Press.
Produced in partnership to support curriculum
development in initial social work education(2012)
December 2012. ©The College of Social Work 2012, 2-4 Cockspur Street London SW1Y 5BH