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Using the Social Work Assessment Tool in Psychosocial Visits

The Social Work Assessment Tool, also known as SWAT, was developed by the National Hospice and Palliative Care Organization (NHPCO) to address the requests of social workers in the hospice and palliative practice arenas to have a quantitative analysis for the effectiveness of social work intervention in patient and family care.

Why Hospice Organizations Use the SWAT Tool

Social worker involvement in patient care has shown to improve outcomes for patients, families and overall team functioning, including decreased on-call visits, fewer hospitalizations, decreased staff turnover and increased job satisfaction for the entire interdisciplinary group, as well as higher satisfaction and quality of life for patients and families. As the requirements for who is qualified to be a social worker for hospice organizations now includes persons who are not degreed social workers, the ease of use of the SWAT tool effectively focuses attention to several key areas for the hospice social work team and improving outcomes.

Variables Measured in the SWAT Tool

Development began in 2006 in conjunction with the NHPCO Social Work Section Steering Committee and social work experts in the field and was based on previous research in hospice social work. The tool includes items measuring the major psychosocial and spiritual variables identified as predictors of hospice social work outcomes for clients. The items include:

  • End-of-life decisions consistent with their religious and cultural norms
  • Patient thoughts of suicide or wanting to hasten death
  • Anxiety about death
  • Preferences about environment (pets, own bed, etc.)
  • Social support
  • Financial resources
  • Safety issues
  • Comfort issues
  • Complicated anticipatory grief (guilt, depression, etc.)
  • Awareness of prognosis
  • Spirituality (higher purpose in life, sense of connection with all)

How the SWAT Tool Works

The scores for each item assign the level of how well the patient and primary caregiver are coping with each area. The scores assign a lower number to poor coping and a higher number as the patient and caregiver improve in coping with each assessment item. The scores for each item are:

  1. Not well at all
  2. Not too well
  3. Neutral
  4. Reasonably well
  5. Extremely well

Results of the SWAT Tool

Studies tested the instrument in hospice and palliative care programs and found significant improvement in social work outcomes compared to the first and last sessions. The SWAT score is not a risk assessment but a quantitative measure of improvement in function, based on social work intervention in care, so larger numbers over time show the effectiveness of the social work plan of care

Social workers learning to embrace the opportunity to contribute to quantitatively driven discipline-specific outcome measures will demonstrate the effectiveness of social work intervention and provide measurable outcome data that surveying bodies require. Axxess Hospice is proud to use the Social Work Assessment Tool in our innovative enterprise hospice software to assist social workers in achieving this goal.


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