How do I order a Medical Social Work (MSW) evaluation?

How to Order a Medical Social Work (MSW) Evaluation

Refer patients to social work services when they have identified psychosocial or practical problems, including illness-related concerns, concrete needs (housing, food, financial assistance, help with activities of daily living, transportation), employment concerns, cultural/language issues, caregiver availability, family conflicts, social isolation, difficulties in decision-making, quality-of-life issues, advance directives, domestic abuse/neglect, or functional changes. 1

Screening-Based Referral Process

Initial Identification of Need

• Screen all patients using a validated distress screening tool (such as the Distress Thermometer and Problem List) at initial visits, at appropriate intervals, and when disease status changes 1
• Patients scoring ≥4 on distress screening require further evaluation by the oncology team to determine appropriate referral type 1
• Review the Problem List to identify specific practical and psychosocial problems that indicate need for social work intervention 1

Specific Clinical Triggers for Social Work Referral

Refer to social work when patients have:

• Practical problems: Housing instability, food insecurity, financial assistance needs, transportation barriers, help with activities of daily living, employment/school concerns, cultural or language issues, inadequate caregiver availability 1
• Psychosocial problems: Adjustment to illness, family conflicts, social isolation, decision-making difficulties, quality-of-life concerns, advance directive discussions, domestic abuse/neglect, coping or communication skill deficits, functional changes (body image, sexuality), end-of-life and bereavement issues 1
• Impaired social support: Any instrumental support item (help with daily tasks) or emotional support item rated as "none, a little, or some of the time" on screening 1
• Functional impairments: Any IADL items requiring help (walking, transportation, meals, housework, medicines, money) or any ADL items requiring assistance 1

Ordering Process

Documentation and Communication

• Place the referral order through your institution's standard referral system (electronic health record order entry, phone consultation, or paper referral form depending on your facility) 1
• Document the specific problems identified from the Problem List or assessment that triggered the referral 1
• Ensure at least one primary oncology team member is familiar with available social work services and maintains an updated list of contact information 1

What to Include in the Referral

Specify in your order:

• The identified practical or psychosocial problems requiring intervention 1
• Level of urgency based on distress severity and safety concerns 1
• Whether the patient has consented to the referral 2
• Any relevant medical or psychiatric history affecting social needs 1

Common Pitfalls to Avoid

• Don't wait until discharge to refer - early identification and intervention during admission improves outcomes and facilitates discharge planning 3, 4
• Don't assume mild distress (score <4) never needs social work - if specific practical problems exist (housing, food insecurity, caregiver needs), refer regardless of distress score 1
• Don't refer only for discharge planning - social workers address psychosocial adjustment, family conflicts, advance care planning, and quality-of-life issues throughout the care continuum 1
• Don't confuse social work with mental health referrals - patients with practical and psychosocial problems go to social work; those with primarily emotional/psychological problems requiring psychotherapy or medication go to mental health professionals 1

Follow-Up After Referral

• Confirm the referral was accepted by the social work service 2
• Coordinate with the social worker regarding the patient's needs and intervention plan 1
• Re-screen at transition points (post-hospitalization, post-ED visit, treatment changes) as social needs may evolve 1