There have been postings on Social Work Oncology Network (SWON) recently considering whom oncology social workers report to, and how to establish a base of support to ensure that our practice standards can be maintained. I was asked to describe how we have done so in our setting.

Oregon Health & Sciences University (OHSU) is a large urban academic medical center. The oncology program became an NCI-designated center about 20 years ago. At the time I was one of two oncology social workers; both of us reported to the Department of Care Management after the Department of Social Work was dismantled. We often wondered what it would be like to report directly to the oncology program, and while we certainly felt supported by our oncology colleagues, reporting to a different department often meant different priorities.

Feeling that I had few positions to “grow” into, I chose to leave OHSU in 2003 after 16 years and worked in two different community positions. During that time, a director in Care Management at OHSU made the decision to move the “specialty” social workers directly to the specialist divisions. Thus the oncology social workers, the solid organ transplant social workers, and some pediatric specialty social workers were moved out of the Care Management Department. This decision was based in part to “protect” the positions, as the fear was the department would be viewed as FTE “heavy;” the move was quite visionary in terms of allowing the specialty positions to be maintained.

In the meantime, the oncology service line continued to grow. Driven in part by the fact that our medical director, Dr. Brian Druker, who spearheaded the development of Gleevac, remained at the helm, interest and momentum grew. Gradually, two more oncology social work positions were added, and discussions began about creating a department of Patient and Family Support Services in oncology. Gratefully, I was recruited back to oversee the development of this program. I have been back at OHSU just under four years. My position was established through a unique partnering between the hospital and the Knight Cancer Institute Foundation, the latter agreeing to fund one half of my position for the first three years. I report directly to the Vice President of the Oncology Service Line at OHSU.

The oncology program has continued to gain momentum as a result of a substantial matching challenge grant by Phil and Penny Knight, the founders of Nike, whose home office is in Portland, Oregon.

Over the past four years, we have been fortunate to add more oncology social workers in the outpatient programs, and we currently have 8.7 FTE (and 11 distinct social workers) in our department. All of these positions are funded by the hospital. We are in the process of bringing the inpatient bone marrow transplant social worker into our department. That position previously reported to the department of Care Management and, over the course of time, that department’s social work director grew to appreciate the value of continuity of care across the outpatient-inpatient continuum for the BMT population. Additionally, a .5 fte outpatient oncology palliative care position (grant funded) resides in our department, with plans to make it a permanent position after the grant is exhausted.

Because we work very closely with the foundation, we have been extremely fortunate to have the resources to develop integrative medicine services within oncology—all funded through philanthropy, and all under the umbrella of the Patient & Family Support Services. These include an oncology massage program (both therapists and interns), two yoga classes, a mindfulness-based stress reduction instructor, three writing groups, and an acupuncturist in oncology. We have been careful to select each of these practitioners to ensure they have an oncology expertise and focus; as such, it has been easy to market these programs to both patients and oncology professionals. We hope to further develop survivorship services to include exercise, nutrition, and other wellness services while also continuing to work closely with community resources. We also work daily with our oncology Financial Navigator, who is a social worker, and maintain a patient emergency assistance fund.

It is not lost on us that we have been exceedingly fortunate to have our own unique cost center. It has allowed us to maintain our specialized oncology social work focus and expertise, and I can truly say that our staff and program are valued within the overall oncology service line, as well as the hospital itself. We have utilized the recent College of Surgeon’s Standards on Navigation, Distress Screening, and Survivorship to advocate for adequate staffing and program development. We have also stayed current with regards to the Triple Aim, as hospital drivers in the current era of health care reform, to ensure that our services not only serve our patients well, but also are congruent with the institution’s goals.

Our situation is unique, and again made possible by the confluence of strong momentum within the oncology program, a significant boost in funding by the Knight Challenge (which the State of Oregon has responded to), and solid foundation support. For now, oncology is one of the strongest service lines in our institution, and the department of Patient & Family Support Services is strong as a result of these factors. Because the State of Oregon has helped to meet the Knight Challenge, they have asked us to “give back” through outreach to rural Oregon, and our program is involved in those efforts as well. For us, there have been many advantages to having our own cost center that reports directly to oncology.

I believe there are other opportunities that exist within this era of health care reform not only for oncology social workers, but also for all social workers. Greater attention is being paid to social determinants of health, and social workers possess the unique skills to address these issues. Additionally, as the number of cancer survivors continues to grow; in many ways, cancer survivorship is becoming a population health issue. By paying attention to these movements and drivers in health care, social workers are uniquely positioned to help develop the services that our patients need while also being good ambassadors for our institutions’ goals and resources. Social work is consistently at the table, and should be, as we navigate these unfolding challenges.