Pediatric Social Work in 2020: Supporting Children in Medical Settings

Your young child needs cancer treatment. Sitting anxiously in waiting rooms and wondering whether he’s going to be OK isn’t how you thought you would be spending these precious early moments of his life. You want to put on a brave face for your child, but inside, you’re distraught. You need to talk to someone. It’s situations like these where pediatric social workers can step in to offer a shoulder to lean on.

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What Is a Pediatric Social Worker?

Pediatric social workers work in inpatient and outpatient medical settings to support children who are experiencing chronic and/or severe medical conditions. They also work with the families of pediatric patients, providing emotional support, care coordination, connections to important resources, and help navigating the medical system and communicating with medical teams. Pediatric social workers typically work in the pediatric departments of hospitals and medical centers, but may also work at private practices and clinics, community health centers and other settings that provide medical care to children and adolescents.

Job Description at a Glance

Pediatric social workers integrate a child’s social and psychological needs into a medical care plan by:

  • Providing counseling and support to adjust to illness and grief.
  • Providing crisis intervention.
  • Assisting with communication between family and medical team.
  • Advocating on behalf of the child and family on medical treatment and other services.
  • Connecting to community resources and trauma services.
  • Participating in discharge planning.

Education Requirements

According to the National Association of Social Work’s standards for social work practice in health care settings (PDF, 122 KB), social work education requirements vary depending on the state where you work and type of licensure. Social workers with a bachelor’s degree are more limited with career options, whereas those who earn a master’s degree can seek licensure and have more job opportunities. If you’re interested in becoming a licensed clinical social worker, requirements vary by state, but you will need relevant experience and clinical supervision hours. For social workers whose job functions include diagnosing mental health conditions and providing treatments, becoming a licensed clinical social worker is required. While not necessary, choosing a master’s degree in social work with a clinical focus may be helpful.

Social work students interested in becoming pediatric social workers should prepare for this field by completing their field practicums in medical settings if possible, and by taking coursework that relates to medical social work and caring for children and families. Working with children in a service capacity through volunteer work, supervised clinical hours, internships and other avenues is helpful, as is meeting with pediatric social workers to understand this field.

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Salary

Social workers who work in health care settings earn a mean annual wage of $58,470, according to the U.S. Bureau of Labor Statistics. And health care social workers who work in general medical and surgical hospitals earn a higher annual mean wage of $64,910. Hospitals also employ the most people in this industry. Nevada, California and Connecticut are the top paying states for health care social workers.

How to Become a Pediatric Social Worker

Pediatric social workers recommend a combination of solid academic preparation and internships or professional experience in a medical setting for people interested in entering this field. To become a pediatric social worker:

  1. Complete a bachelor’s degree in social work (BSW) or related field.
  2. Pursue a master’s degree in social work (MSW) with relevant coursework.
  3. Seek internships in a medical setting and complete fieldwork hour requirements.
  4. Sit for your state’s licensure exam.
  5. Apply to become licensed in your state.
  6. Maintain licensure.

The pediatric social worker’s role combines clinical social work duties with medical care coordination and work with vulnerable children and their families. As a result, social work students who want to work in pediatric social work should build strong skills in clinical counseling and therapeutic methods, crisis interventions and management, and caring for children and families experiencing hardships. They should also familiarize themselves with health care systems and actively seek internships in medical (and if possible, pediatric) settings.

Due to the intense challenges and demands of this area of social work, people who wish to become pediatric social workers typically must complete an MSW degree program that has been accredited by the Council on Social Work Education. They should also be proactive about selecting classes (and potentially a concentration) that focus on clinical social work in medical settings, caring for children throughout their development, family dynamics and counseling, trauma, and grief/loss counseling.

“In preparing to work in a pediatric hospital setting it is important that you have taken courses in childhood development, child abuse and neglect, domestic violence, death and dying, stages of grief, crisis intervention, motivational interviewing and strengths-based therapy,” said DeEtta Barnhardt, a licensed clinical social worker at Lucile Packard Children’s Hospital Stanford (LPCHS). “Additional classes that could help are individual and family therapy, mindfulness, psychology-based courses (personality disorders, bipolar, depression, etc.).”

In addition to completing relevant coursework, social work students interested in pediatric social work should seek field practicums in hospital settings and/or settings that allow them to work with children and their families. “I recommend that you try to find a field placement that allows you to work with pediatric patients and their families,” Barnhardt said, “Ideally, this would be in a hospital; however with there being few pediatric hospital internship possibilities in the area, working in an organization that has direct patient contact with children and families such as CPS, schools, homeless shelters or clinics would all be beneficial.”

Andrea Kido, LCSW, who worked as a clinical social worker in the Surgical Acute Care and Pediatric Intensive Care Units at Lucile Packard Children’s Hospital at Stanford, recommends students go beyond field practicums and find additional experiences through fellowships and other programs after their MSW program. “[Pediatric social work] is definitely the kind of work that you learn through doing,” Kido noted. “Thus, getting an internship (or two) in an inpatient setting would be a great way to prepare for full-time employment. Because the internship is quite short and protected, however, I would also recommend a post-grad fellowship.”

Barnhardt also told OnlineMSWPrograms.com that researching and preparing for the social work licensure requirements in one’s state of residence is important. “Researching and navigating all the requirements for licensure is also something that students should devote proper time and planning to,” she said. “North Dakota and Minnesota are different than California, in that you must take multiple exams to become clinically licensed.”

Pediatric social work is a field that requires a great deal of preparation, compassion, skill and resilience. It is not a field for the faint of heart, as it involves holding up and guiding children and their families during some of the most trying and potentially tragic moments in their lives. However, with the rigors and difficulties of this profession come deeply rewarding relationships with clients and colleagues, and the knowledge that one’s work has a positive impact on the quality of medical care pediatric patients receive.

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What Pediatric Social Workers Do

Families of children with serious medical conditions often experience intense hardships that can negatively impact their mental, emotional, social and financial well-being. They may also have difficulty advocating for themselves and their child in a complex and at times confusing medical system. Pediatric social workers provide a wide variety of services to assist these families, including but not limited to individual and group counseling, guidance in applying for insurance and other benefits, connections to community resources and support, crisis interventions and facilitating effective communication between patients, families and the larger medical team.

Pediatric social workers are typically assigned to one or more medical departments or units and work with specific medical teams. Barnhardt explained how social worker services are structured at LPCHS in an interview with OnlineMSWPrograms.com. “Each social worker works with specific medical teams depending on their assignment,” she explained. “For example, the liver transplant social worker works primarily with the GI team and liver team in addition to the PICU team if their patient is in the PICU. I on the other hand follow all services except those listed above (cardiology, oncology, transplant and CF) so I work closely with all the other medical specialists.”

While the teams and specific medical conditions that pediatric social workers interact with and encounter may vary depending on their assigned medical unit, their core responsibilities to pediatric patients, their families, and medical staff stay the same. Here are some of the types of services that pediatric social workers provide to patients and their families:

Emotional Support and Counseling

One of the primary responsibilities of pediatric social workers is helping young patients and their families cope with the emotional and psychological trauma and strain of dealing with severe illness. “Understandably, the greatest challenge faced by [families of pediatric patients] is the sudden or chronic infirmity of their child,” Kido said. “Patients I worked with suffered from conditions as relatively mild as a perforated appendix or supracondylar fracture (broken elbow), to very serious mitochondrial or autoimmune disorders (e.g. lupus nephritis or Leigh syndrome).”

Children who are afflicted with acute or chronic medical problems can experience sudden and/or severe escalations in their condition, which can be deeply stressful for their parents and family. “The children with chronic illnesses would be hospitalized frequently for acute issues – such as pneumonia – to which they are more susceptible and for whom it could mean a severe deterioration of their condition or even death,” Kido said. “It is during these times that families are in the most need of care coordination, resource attainment, psychoeducation and support.”

Barnhardt described the complex, challenging and at times sad situations pediatric patients and their families face. “Emotionally, patients and parents are often dealing with the unknown and the ongoing need to maintain hope,” she said. “They are often confused by medical terminology and differing opinions on treatment plans. Sometimes parents don’t want the patient to know what diagnosis they have, to protect them, which can be difficult for the medical team to support. Other times parents tell their children too much information, causing anxiety and fear in the patient. It is difficult at times for the parents to find a middle ground, and of course if the diagnosis is terminal or life limiting – the patient and families are grieving, each in their own way.”

During this time of confusion, anxiety and vulnerability, pediatric social workers provide patients and families with compassionate support and short-term counseling. When counseling patients and their families, pediatric social workers may use a number of psychotherapeutic methods, including but not limited to psychosocial assessments, risk assessments, supportive psychotherapy, cognitive behavioral therapy, psychoeducation, and mindfulness-based stress reduction.

Note: For more information on psychotherapeutic techniques, check out our Guide to Clinical Social Work.

In addition to providing one-on-one and group counseling, pediatric social workers may also facilitate larger therapeutic groups to promote intrafamily communication and support. Shellie Leger, MSW, who worked at MassGeneral Hospital as a pediatric social worker for six years, told OnlineMSWPrograms.com: “I supported my patients/families by offering short-term psychotherapy; psycho education regarding their child’s illness and the needs of siblings; formation and facilitation of support groups as needed, such as sibling support and family recreation; and grief work.”

Guidance and Support in Navigating Medical System

In addition to providing emotional support, pediatric social workers help patients and their families comprehend their situation, the medical system, and what processes and procedures will be involved in the care of their child.

Kido described how pediatric social workers help patients’ families find their footing and move forward with the medical team to address their child’s condition. “[Pediatric social workers orient] families to the large and complex hospital system, and [prepare] them for what to expect; [help] them navigate the many different components of that system (from insurance benefits, to who’s who on the medical specialty teams, to how to obtain a parking pass); [and ensure] they have the necessary resources to be present with their child and active in care (e.g. food, a place to sleep, transportation, letters for work and school, etc.).”

Pediatric social workers can often be a source of stability in an environment of rapid change. “At LPCHS the social worker follows the patient and family throughout the hospitalization. Therefore, should the patient move to the PICU, I follow them on that unit and if they move from the PICU to the med-surg floor, I continue to work with them as their social worker,” Barnhardt explained to OnlineMSWPrograms.com. “Since LPCHS is a teaching hospital, the medical teams change weekly, which can be difficult for patients and families. As a social worker I remain consistent in the lives of the patient and family, which is often very important to them. If a patient discharges from the hospital and is readmitted to the hospital, I will again follow them throughout their hospitalization.”

Crisis Interventions

Pediatric social workers provide support and crisis management services to families experiencing medical emergencies or acute emotional distress in response to their child’s condition. “Many families are in crisis mode and I provide crisis intervention services, which would include general support, resources, referrals to appropriate agencies or services within the hospital, specific steps to follow (like homework), suicide assessments, and even walking parents to the ED for mental health assessments if needed. At times it is important to discuss death, dying, grief and bereavement,” Barnhardt told OnlineMSWPrograms.com.

“Crises were a routine aspect of the work. Because the children were so ill, they would often suffer from ‘codes’ (loss of oxygenation to the body, or cardiac arrest), complications during procedures, and ‘rapid responses’ (immediate need for transfer from acute to intensive care),” Kido said of her time at LPCHS. “Families would need social workers to provide support, guidance, and information while the medical team was focused on the child and unable to attend to the family.”

In addition to medical crises, personal crises also occur in pediatric medical settings – and social workers are called upon to address these situations. “Families would experience their own crises in the form of panic attacks, dangerously high blood sugars from forgetting their insulin at home, fighting with an ex in the hallway, and being verbally abusive to the medical team,” Kido said. “[Social workers] help [these families] find healthier ways to manage their emotions and situations.”

Care Coordination and Treatment Planning with Medical Team

Social workers coordinate patient care by communicating with and helping to organize all parties that are invested in a patient’s medical treatment. Social workers discuss patients’ needs with physicians, nurses, medical assistants and other staff during their development of a treatment plan and relay any ongoing concerns that patients’ families have to the team.

“I work closely with the medical teams in development of treatment plans,” DeEtta Barnhardt, LCSW, told OnlineMSWPrograms.com. “The medical teams utilize family centered rounds, multidisciplinary rounds, bedside meetings, care conferences and ongoing direct communication to include social workers in on treatment planning. I have direct access to medical teams through paging them or calling their ASCOM phones.”

Social workers serve as the point of contact between not only patients’ families and the medical team, but also medical and non-medical teams within the hospital that all collaborate to provide medical care. “LPCHS employed physicians, nurse practitioners, nurses, NAs, case managers, chaplains, child life specialists, financial counselors, pharmacy techs, nutritionists, patient experience reps, and all colors of administrators, all of whom played their part in the journey of the patient and family,” Kido explained. “Social workers document extensively in the electronic medical record, attend rounds daily, organize care conferences, and are in constant communication with other providers via phone, email, pager, and in person to communicate the issues and needs of the family.”

Through their strong understanding of their clients’ mental and emotional health, as well as their social, cultural and financial circumstances, pediatric social workers help guide other members of the hospital staff in providing sensitive, compassionate and consequently effective care. “This was why obtaining a thorough psychosocial assessment was so important,” Kido noted. “[O]thers were relying on social workers to know how best to interface with the family based on their unique needs and circumstances.”

In addition to communicating with the various teams within the hospital setting on a daily basis, social workers also schedule and facilitate meetings between medical teams and between patient families and medical staff. Leger noted that one of her core responsibilities at Massachusetts General Hospital was “the planning and forming of patient care conferences to assure coordination of care amongst the multidisciplinary teams that served each child/family.”

Leger also mentioned the important role that pediatric social workers play in interpreting the at times emotionally charged reactions patients’ families have. “[It] is not surprising that we are often cultural brokers, being educated and trained to appreciate the cognitive dissonance that ensues when there is a culture clash at play,” she said. “Social workers are often integral in interpreting behavior of family members and/or patients through the lens of social norms in the context of culture, and carrying this information to the greater team.”

Resource Connections

Pediatric social workers are deeply connected to organizations, programs and other resources within and outside of the hospital setting that may be helpful to patients and their families, and actively work to connect their clients to these resources. “I work closely with many community agencies and often make referrals to organizations such as the Family Advocacy Project, Ronald McDonald House, Child Protective Services, TANF/CalWorks, WIC, Public Health Nursing, the Shelter Network, Legal Aid and Make-A-Wish to name a few,” Barnhardt told OnlineMSWPrograms.com. I also refer patients to services within our hospital including child life, chaplaincy, palliative care and psychology.”

Similarly, during her time at LPCHS, Kido “[connected] families to external resources, such as food banks, outpatient therapy, and in-home support services, as well as coordinating with external organizations, such as Child Protective Services, probation officers and attorneys/legal aid representatives.”

Pediatric social workers can also reach out to community resources on behalf of their patients. For example, in addition to providing her clients with “information and referral to all appropriate community resources,” Leger regularly conducted “outreach to school systems regarding the IDEA and ADA eligibility for [her] patients.”

Challenges Faced by Pediatric Social Workers Face

Many pediatric social workers describe their work as both intensely challenging and deeply rewarding; often, the very aspects of their job that are rewarding are the same ones that present the toughest challenges.

“It is absolutely rewarding to work with pediatric patients and their families in the hospital setting. […] Having the opportunity to witness the strength of [children’s] spirit and innocence is truly a gift, and imparts a sense of awe, respect and inspiration to those in their presence,” Kido said. “The most rewarding part, however, was also the most devastating. Walking with a family, carrying a tiny piece of their burden as they process, live and grieve the death of their child is something few people have the chance to experience. Although social workers in this position are witnesses to the most palpable, heaviest pain imaginable, in the same moment, they are witness to the strongest love.”

Pediatric social workers may also encounter frustrations with the medical system and being unable to thoroughly address their clients’ struggles. “The most challenging aspect of this work was the inherent inability to meet the needs of every family,” Kido said. “Given the number of patients to which we were assigned, the complexity of their lives and illnesses, the scarcity of resources both within and outside the hospital system, and the expectations of the medical teams, there was simply no way to achieve everything I set out to.” When encountering this challenge, pediatric social workers may need to prioritize their tasks according to the severity and urgency of their patients’ needs, and accept the limitations of their own abilities, resources and schedules.

To manage the challenges, pediatric social workers should develop and maintain a strong and consistent self-care plan. During her time as a field instructor, Kido discussed with her student the importance of establishing healthy boundaries between work and personal life. “I encouraged the student under my supervision to set limits for himself and to leave on time whenever possible,” she said. “I recommended being responsive to the needs of the medical team, while setting limits with them as well.”

Why People Become Pediatric Social Workers

Despite the intense demands and strains of the job, the relationships that pediatric social workers forge with their colleagues and clients can be deeply fulfilling. “The rewarding aspects of my job are that I am able to follow patients and families through their experience,” Barnhardt said. “I sometimes watch patients improve and go home, never to return again. Other times I see patients during each admission as they transition from being ‘intensive care’ to being ‘acute’ and then going home, only to return in the future. And then there are the other times, where I have developed a wonderful working relationship with a family, having seen them through many obstacles, only to be at a place that is the end. This is a very difficult time, but it means so much to be there with a family through the last steps of hope, through the grief, the loss, and the time of bereavement, knowing that I made a difference, just from being there with them during that time.”

Giving their clients the knowledge and the means to understand and advocate for their needs is another great reward that pediatric social workers cite as being sustaining and energizing. “The greatest reward for me was empowering the patient/family to come to the table with the greatest minds in medicine where they unapologetically demanded what they needed/wanted,” Leger told OnlineMSWPrograms.com.

Note: For more information on clinical social work programs, please see our full list of clinical social work degrees.