SocW 514
Caring for Persons with Life Limiting Illness: A Lifespan Approach

Instructors for Spring 2008:

• Bonnie Letinich*

Course Description

"Caring for Persons with Life-Limiting Illness: A Lifespan Approach" is a foundation practice course with a focus on multi-systemic social work practice with seriously ill people who have a life-limiting condition. In childhood, conditions that could end in death include diseases such as cancer, cystic fibrosis, and AIDS, as well as congenital birth anomalies and neurodegenerative disorders. For adults, common end of life conditions are endstage organ diseases, various cancers and endstage AIDS. Traumatic injuries can also create situations where the anticipation of death requires symptom control and care planning.

A strengths-based, multigenerational, multicultural and community- focused framework undergirds the SW 514 practice courses. In this course we will examine how families care for a member who is critically ill, and the differences that occur across the lifespan when the seriously ill person is a child or adolescent, a mid-aged adult, or an elder at the end of life. In each family, the culture of the family in terms of its ethnic and spiritual heritage, values, and beliefs drive decision making about end of life care. Families have differential levels of access to institutional and community resources based on economics, legacies of racism and homophobia, and gendered caregiving demands. These differing experiences have profound implications for how decisions around end of life care will be made.

Families state that they want helpful communication and coordinated care throughout the course of an illness, no matter its length, in an institution that feels safe. To accomplish this goal, the focus of this course is on developing skills in empowerment-oriented social work practice within the context of the current service delivery system. To work effectively, social workers need skills in identifying multigenerational family strengths based in an appreciation of the client's culture, as well as the capacity to work effectively within interdisciplinary teams of care providers. This framework is consistent with the social change and social justice mission of the MSW curriculum.

Topics in this course will develop skills in three areas: theoretical knowledge; development of self-awareness in issues related to death, dying and grief; and application of this knowledge to social work practice with families. Foundational theories related to grief, loss and attachment are used to interpret case examples from a variety of settings. Students will become familiar with tools for psycho-social-spiritual assessment and decision-making. Hospice and palliative care models appropriate for social work practice at the end of life will be presented and critiqued.

Course Objectives

At the end of this course, students will have acquired the following skills in self-awareness, theory and practice:

Self-Awareness Skills

1. Demonstrate awareness of one's own assumptions, beliefs, values, and behaviors with regard to death, dying and grief and one's own mortality.
2. Affirm and respect one's own and others' cultural identities as they interface with choices regarding death and grief.
3. Be mindful of the role of power differentials and social inequalities in influencing family and professional staff behavior and relations in end of life care.
4. Demonstrate awareness of the role of self in group dynamics and decision-making conferences related to care planning.

Theory Skills

1. Understand the complexity and reciprocity of multicultural, multigenerational dynamics across different populations, substantive areas and families and communities.
2. Use theory on grief and loss and information on differing cultural views on death and dying to inform understanding of family functioning.
3. Apply theories related to grief, loss and attachment to understand family decision making processes.
4. Identify developmental issues for children, mid-life adults and elders as they apply to end of life care.
5. Evaluate models of end of life care, including hospice and palliative care models and what they offer that differs from the standard practice of hospital-based death.
6. Identify issues related to the professional caregiver's experience of grief, attachment and loss.

Practice Skills

1. Develop the ability to bring a multigenerational, multicultural lens to their assessment of the strengths of individuals, families and communities.
2. Recognize how both strengths and challenges - physically, socially, and emotionally - may be transmitted across multiple generations.
3. Perform psych-social-spiritual assessments of individuals and families encountering life-limiting conditions.
4. Understand skills to co-facilitate family decision-making conferences with professional interdisciplinary care teams regarding end of life care options.
5. Evaluate common ethical dilemmas facing social work practitioners working in end of life care.
6. Identify methods to empower families and teams to work collaboratively to develop a plan of care.

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