Comprehensive Rehabilitation Assessment in Multiple Sclerosis Social Work Perspective By Judy Soderberg,MSW, LISW

1. Comprehensive Rehabilitation Assessmentin Multiple SclerosisSocial Work PerspectiveBy Judy Soderberg,MSW, LISW

2. Different types of Social Workers (In Minnesota – may differ in various states and countries.) All are licensed by State. A. Licensed Bachelor of Science in Social Work, BSW B. Licensed Social Worker, MSW C. Licensed Clinical Social Worker, MSW D. Licensed Ph.D. Social Worker

3. Social Workers work in a variety of settings and have various assessment and functions depending on setting and type of licensure. • Intake for various program, i.e., MSAC, Courage Center, Long Term Care B. Intake and follow for various county/state programs

4. C. Discharge planning D. Intake/follow up for home care services E. Information/referral services at local M.S. Societies F. Attached to Comprehensive M.S. program

5. Because of the variability of M.S., and the length of time people/families will deal with it, social workers from various settings and different licenses can be involved over time. • Tendency to be more involved with social workers as disease progresses particularly social workers who work in program of all types and in hospitals and home care. These are generally BS & MSW licensed social workers.

6. Global assessments done by programs, hospitals and home care. Depending on information gathered in global assessment, other types of assessments may be requested.

7. Sample of Global Assessment

8. Ability to express thoughts/needs/feelings: ___Expresses thoughts/feeling/needs without difficulty ___Requires extra time or cuing ___Speech limited to single words ___Uses only gestures (eye blinking/eye or head movement/pointing) ___Unable to express thoughts/feelings/needs (speech unintelligible or inappropriate) ___Unresponsive

9. Patient’s living arrangement/care setting: ___Patient’s own home/residence ___Home of family member/friend ___Boarding home ___Assisted living facility/retirement center ___Hospital/Acute care facility ___Skilled nursing facility ___Long term care facility/Nursing Home ___Other (specify)__________________

10. Patient’s Relationship Status: _Single _Married _Divorced _Domestic partner _Widow/Widower _Common law _Separated _Unknown

11. If in a relationship, name of partner/spouse: _________________________________ Age:_________________ Duration of relationship:_____________ Anniversary date:_____________

12. Relationship of Primary Caregiver __No primary caregiver available __Spouse/significant other __Natural child __Step child __Sibling __Parent __Friend/Neighbor __Community/Church volunteer __Paid Help __Other (specify):_______________________

13. Does the Caregiver Appear to Have any Limitations? __Vision __Hearing __Speech __Mobility/Endurance __Emotionally unstable __Alcohol/Substance abuse __Conflict with patient

14. __Concurrent treatment of own illness __Inability to cope with potential loss __Difficulty with own ADLs __Lack of time __Resistant to performing medical tasks Family Members/Significant Others Not a Member of the Household: ________________________________ ________________________________

15. Social Support Systems (select one best description) _Excellent social support system which includes three or more willing family members or friends _Good social support system which includes two or less willing family members or friends _Fair social support which includes one willing family member or friend _Poor social support; no willing family members or friends; basically ALONE

16. Patient’s Description of Illness/Current Health Status:___________________ _______________________________ __Patient unable/unwilling to discuss __Knowledge/Understanding of Disease Process __Burden of Care

17. Risk Factors: _Alcohol abuse _Financial resources inadequate to meet basic needs (food/house/etc.) _Financial resources inadequate to meet health care needs (supplies/equipment/medications) _Food/Nutrition resources inadequate _Home environment unsafe/inadequate for home care _Homicidal risk

18. Risk Factors: _Lives alone or without concerned relatives _Multiple medications/complex schedule _Physical limitations increase likelihood of falls _Plan of care/treatments complicated _Substance use/abuse _Visual impairment threatens safety/ability to perform self-care _Other (specify):__________________

19. Abuse/Neglect (actual/potential risks): _No signs of abuse/neglect _Physical _Sexual _History of abuse/neglect _History of domestic violence _Lacks adequate physical care _Lacks emotional nurturing/support _Lacks appropriate stimulation/cognitive experiences _Left alone inappropriately

20. _Lacks necessary supervision _Inadequate or delayed medical care _Unsafe environment (I.e. guns/drug use/history of violence in the home/etc.) _Bruising or other physical signs of injury present _Other (specify):_________________

21. _Refer to child/adult protective services _Other (specify):_________________ • Mental Status: _Alert – Oriented to _Person _Place _Time _Comatose – responds to: _Verbal Stimuli _Tactile stimuli _Painful stimuli

22. _Forgetful _Disoriented/Confused _Lethargic _Agitated Other (specify):___________________

23. Emotional Status: (mark all that apply) _Angry _Euphoric _Anxious _Fearful _Apprehensive _Flat affect _Avoidant _Helpless _Clinging _Hostile _Depressed _Impulsive _Distraught _Irritable _Elated _Labile

24. Emotional Status: (continued) _Manic _Restless _Sad _Suspicious _Tearful _Withdrawn

25. Cognitive Functioning: _No signs of impairment _Impaired decision making _Does not understand nature of health condition on lifestyle _Non-compliant with medical regimen _Non-compliant with assistance _Other (specify):_____________________

26. Functional limitations: _Amputation _Bowel/Bladder incontinence _Contracture _Hearing _Paralysis _Endurance _Ambulation _Speech

27. Functional limitations: (continued) _Legally blind _Dypsnea with minimal exertion _Other (specify):________________

28. Current Sources of Stress in Addition to Current Illness: • _None reported _Bills/Dept _Career/Job change _Child care (short term) _Child care (long term) _Death of a child (recent) _Death of a parent (recent)

29. Current sources of Stress in Addition to Current Illness: (continued) _Death of a spouse (recent) _Employment status changed _Family discord _Financial loss/Inadequate income _Job loss _Legal issues unresolved -Lifestyle change

30. Current sources of Stress in Addition to Current Illness: (continued) _Marital discord _Marriage within the last year _Paperwork (insurance/legal,etc.) overwhelming _Separation/Divorce _Other (specify):__________________

31. Patient’s Income Level (per year): _Less than $8,000 _$8,001-$14,000 _$14,001-$25,000 _$25,001-$40,000 _Greater than $40,000 _Patient refuses to provide information Current source (s) of income:____________ ___

32. Handling Finances: _Independent: Manages financial affairs without assistance _Minimal Assistance: Needs prompting (cuing/repetition/reminders to pay bills/make deposits/cash checks or manage financial accounts) _Moderate Assistance: Needs supervision of all financial tasks

33. Handling Finances: (continued) _Total assistance: Unable to manage her/his own financial affairs _Financial matters handled by family/friend • Financial Concerns Expressed by Patients/Spouse:____________________ __________________________________

34. Current Community Resources Being Utilized (list): _________________________________ _________________________________ _________________________________

35. Interventions/Plan of Care • _Assess social and emotion factors _Counseling for long range planning and decision-making _Short term therapy _Community resource planning/referral _Other (specify):____________________

36. Community Resources Planning/Referrals: _Child care _Financial management/counseling _Final arrangements _Food/Nutrition support _Home maintenance/repairs/handyman services _Homemaker services

37. Community Resources Planning/Referrals: (continued) _In-Home grooming services _Legal assistance _Mental health referral _Protective services _Relocation to different care setting _Transportation _Other (specify):

38. The global assessment gives information that could suggest a more targeted intervention. At this point a referral could be made to a clinical social worker to work with the person on their individual issues. • Referral from a team member if part of comprehensive MS Center • Self referral

39. VII. Individual Assessment – Clinical S.W. A. Social Workers would assess social and emotional factors related to the impact of M.S. and the disability caused by it on the total life of the individual, their family, and the other social memberships, i.e., work, recreation interests, larger community.

40. VIII. Areas to be addressed in targeted assessment – In no special order. A. Life style of individual – who they are as they define themselves 1. Family/home 2. Characteristics – coping style 3. Work 4. Recreation/interests 5. Other

41. B. Perception of how MS has affected their life style C. What are the stresses in their life? D. Specific areas of concern 1. Physical changes 2. Cognitive changes 3. Fatigue 4. Depression 5. Relationship Issues (partner, parenting) 6. Work ? 7. Other

42. E. Risk Factors: Alcohol abuse, social risk,finances, abuse. F. Impact of MS on various parts of their life G. Perception of things that need to be modified or changed H. Grief/loss issues I. What is issue that brought them to you. J. Future focus

43. Development of plan based on individual perception of problem -Many different options -Individual counseling -Couples counseling -Family counseling -Information or support group offered by M.S. Society

44. -Community Resources -OT/PT Speech referral -Referral for specific services offered by physician, I.e., symptom management, depression management -HUGA Program -Volunteer opportunities County/programs

45. Assessment by Social Worker and patient to ascertain whether goals were met – decision point -End point _Additional referrals/services