Social Work and Health Care

1. Social Work and Health Care

2. Social Work Generalist Practice • Generalist Practice is the application of an eclectic knowledge base, professional values and ethics, and a wide range of skills to target any size system for change within the context of three primary principles, and four major processes.

3. Three Primary Principles • Emphasis on empowerment, strengths, and resiliency. • Importance of understanding how human diversity characterizes and shapes the human experience and is critical to the formation of “identity.” • Advocacy for human rights, and the pursuit of social and economic justice

4. Four Primary Processes • Assumption of a wide range of roles • Application of critical thinking skills throughout the intervention process • Incorporates research-informed practice to determine most effective/best practice principles • Follow a planned change process.

5. Social Work Generalist Practice • Eclectic Knowledge Base • Strengths Perspective • Systems Theory • Ecological Theory • Common Generalist Skills • Planned Change Model

6. Holistic Assessment • Micro Concerns • Mezzo Concerns • Macro Concerns • Strengths • Issues related to Diversity that must be accounted for in planning/intervention: - Gender - Ethnicity - Sexual Orientation - Age - Culture - Disability - Social/Economic Status - Religion

7. Social Work and Health Care • Mental Health – 60 % of mental health professionals are social workers (NASW) • In Patient • Out Patient • Partial Hospitalization • Emergency Services

8. Suicide • In 2010 Idaho had the 6th highest suicide rate in the nation – 49% higher than the national average (latest data available according to the Suicide Prevention Action Network of Idaho) • In 2011 – 284 people committed suicide in Idaho • There is a significant increase in the suicide rate among farmers; higher than the suicide rate among the general male population. (Idaho Suicide Prevention Research Report)

9. Social Work and Health Care • Discharge Planning • Hospice/Palliative Care • Emergency Room Care • Suicide • Substance Abuse • Trauma • Triage • Oncology

10. Social Work and Health Care • Obstetrics • Surgical • Intensive Care • Rehabilitation Programs • Health Literacy • Community Health Clinics • Nursing Homes

11. Social Work and Health Care • Home Health Care • Veterans Service Networks

12. Discharge Planning • Assessment • Coordination • Documentation • Counseling • Linkage

13. Assessment • Assessment: >Bio/Psycho/Social/Spiritual/Financial resources for discharge planning > Interviews with patient and family members/caregivers and engages family in decision-making process > Assists medical team’s understanding of patient’s bio/psycho/social/spiritual/financial needs

14. Coordination • Coordination > Activities concerned with exchanging information with hospital personnel or the patient and the family to facilitate discharge planning.

15. Coordination > The availability, willingness, and ability of family/caregivers to provide care. > Advise patients and family/caregivers about appropriate discharge options addressed in bio/psycho/social/spiritual/financial assessment

16. Documentation • Activities concerned with producing a written record of discharge planning process. • Checklists, Narratives, Forms, Summaries, etc. • Record of required information provided patient or individual acting in patient’s behalf

17. Counseling • Provision of information and intervention to bring about change in client’s feelings, behaviors, attitudes, activities • Assist family with adjustment/adaptation to changes • Referral • Follow-up

18. Linkage • Activities focused on obtaining services for patients and families after discharge • Include patient and family wishes wherever possible

19. Hospice/Palliative Care • Counseling for individuals, couples, and families • Psychosocial education to patents and families/caregivers about coping skills and adjustment to anxiety relative to death, suffering and related stressors. • Crisis Intervention • Mediating conflicts within families, between clients and the interdisciplinary team, and between service organizations

20. Hospice/Palliative Care • Advocacy • Facilitating psycho/educational support groups • Facilitating advance planning • Work closely with interdisciplinary teams • Access needed equipment, services, etc. for patients and families

21. Emergency Room Care • Connecting patients to services they need at home and in the community avoids unnecessary hospital admissions and reduces insurance costs. • Over 80% of patients seen by social workers in emergency departments were not admitted; rather, they were referred to community services (2007) • Crisis Intervention • Patients with a mental disorder • Counseling victims of violence, sexual assault • Child Protection • Counseling with patients and families

22. Emergency Room Care • Suicidal Ideology – or attempted suicide • Substance Abuse “One in eight adults in Emergency Departments present with a mental disorder, substance abuse, or both.” (Agency for Health Care Research and Quality, 2007) • Address acute grief reactions for family members and mobilize support systems.

23. Health Literacy • Health Literacy is the degree to which an individual has the capacity to obtain, process, and understand basic health information an services needed to make appropriate health decisions (Ratzan & Parker, 2000) • More than 1/3 of adults in the U.S. do not have adequate health literacy to manage their own health care needs (Kutner, Greenberg, Jin, & Paulsen, 2006) • Low health literacy coexists with other social disadvantages such as low levels of education, lack of medical insurance, and poverty, often exacerbating its effect on vulnerable populations.

24. Health Literacy • Low health literacy is associated with increased emergency department visits, higher rates of hospitalization, longer stays (by an average of two days) (Nelson-Bohlman et al, 2004) and poorer self-reported health. (Kutner et al, 2006). • The estimated cost of low health literacy ranges from $106 to $238 billion each year (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007).

25. References • Accordino, M.P., Porter, D.F., & Morse, T. (2001). Deinstitutionalization of persons with severe mental illness: Context and consequences. Journal of Rehabilitation, Vol. 67, No.2. • Allen, H. (2012). Is there a social worker in the house? Health care reform and the future of medical social work. Health & Social Work, vol.38, No. 3, 183-186. • Druss, B., Bornemann, T., Fry-Johnson, Y., McCombs, H., Politzer, R., & Rust, G. (2006). Trends in mental health substance abuse services at the nation’s community health care centers: 1998-2003. American journal of public health, 96, 1779-1784. • Hollman, D., Dzieglewski, S.F., & Teare, R. (2003). Differences and similarities between social work and nurse discharge planners. Health and Social Work, Vol. 28, Number 3, 224-231.

26. References • Johansen, S., Kaasa, S., Lorge, J.H. & Materstvedt, L.J. (2005). Attitudes towards and wishes for, enthusiasm in advanced cancer patients at a palliative medicine unit. Palliative Medicine, 19, 454-460. • Kirst-Ashman, K.K,. & Hull, Jr., (2012). G.H. Understanding generalist practice. Sixth Edition. Brooks/Cole, Cengage Learning. • Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education, National Center for Education. • Liechty, J.M. (2011). Health literacy: Critical opportunities for social work leadership in health care and research. Health and Social Work, Vol. 16, No. 2, 99-107.

27. References • Mcoyd, J.L.M. (2010). The implicit contract: Implications for health social work. Health and Social Work. Vol. 35, No. 10, 99-106. • Nielsen-Bohlman, L., Panzer, A.M., & Kindig, D.A. (Eds.). (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academics Press. • Robertson, M. (2008). Suicidal ideation in the palliative care patient: Considerations for health care practice. Australian social work. Vol. 61, No. 2, 150-167. • VanPelt, J. (2010). Making caring connections, cutting costs – Social work in the emergency department. Social work today. Vol. 10, No. 6, 12-15. • Vernon, J.A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national health policy. Retrieved from http:/www.npsf.org/askme3/pdfs/Case_Report_10_07_pdf.