The Behavioral Health Role in Nursing Facility Social Work

1. The Behavioral Health Role in Nursing Facility Social Work Dennis R. Myers, Ph.D., L.C.S.W.; Robin K. Rogers, Ph.D.; Harold H. LeCrone, Ph.D.; Katherine Kelley, MSW, L.C.S.W.; & Hannah Eaton, MSW Candidate. Garland School of Social Work-Baylor University Contact: Dennis_Myers@baylor.edu

2. Agenda • Introduction/Benefits • Case Vignette • Need for Research • Conceptual Frame • Behavioral Health Challenges • Behavioral Health Role, Function & Skills • Application-Group Work • Implications

3. Benefits • Identify the major problematic resident behaviors encountered by nursing facility administrators  • Review the behavioral health role, functions, & skills of social workers in nursing care facilities • Increase competence in responding to problematic resident behaviors

4. Case Vignette An 85 year old female with a diagnosis of dementia, hypertension, diabetes, depression, macular degeneration and severe hearing loss was admitted to the long-term care facility. About a month after her admission she began to yell out obscenities at staff, other residents, and visiting family members including her own. What affective, spiritual, and intellectual responses are you having to the behavior?

5. Need for Research • Discontinuity between what the resident is seeking and the responsiveness of the care environment • Situational compromised behaviors of nursing facility residents • Bonifas (2015) researched staff responses to resident behaviors

6. Conceptual Frame Need-Driven-Compromised Behavior Model (NDB) (Algase et al., 1996)

7. Methodology • 20 Licensed Nursing Facility Social Workers • Averaging 8.8 years of experience • Reported experiences with resident behaviors and the range of responses they employ

8. Limitation • Sample drawn from only one catchment area in a southwestern region of the United States. • Significance of social worker’s training/experience in dealing with compromised resident behaviors was not considered

9. Physically Aggressive (n=17) Socially Inappropriate (n=9) Sexually Inappropriate (n=7) Verbally Aggressive/Disruption (n=17) Passive Disruption (n=10)

10. Care Manger (n=17) Educator (n=17) Investigator (n=15) Preventer (n=9) Advocate(n=5) Mediator (n=8)

11. Social Work Skills with Compromised Resident Behaviors • Attention/Affirmation/ Active Listening (70%; n=14) • Assessment (70%; n=14) • Behavior Management (60%; n=12) • Building Relationship (Familiarity) with Resident) (55%; n=11) • Teamwork (50%; n=10) • Redirection (40%; n=8)

12. Application- Case Vignettes • A 77 year-old male with a diagnosis of congestive heart failure, depression, diabetes, and COPD begins to refuse bathing and resists taking medications. Additionally, he refuses to participate in activities and instead prefers self-isolation in his room. His wife of 55 years died recently and he has no other family members. • An 83-year-old female resident with a diagnosis of polysubstance use disorder, bipolar disorder coronary artery disease, GERD, and diabetes is verbally abusive to her roommate and her roommate’s family. Recently, after many complaints from her roommate and roommate’s family about the loud volume of the residents television, the resident picked up a heavy object and threw it at her roommate hitting her in the face. The residence roommate has voiced suspicions that the residents family is bringing in illegal drugs to her.

13. Application- Group Discussion • What are 3 potentially ineffective and 3 effective responses? • What educational resources would be helpful in preparing for competent assessment intervention with the presenting behaviors?

14. Implications • Micro Aspects of the Behavioral Health Role • Macro Aspects of the Behavioral Health Role • Educational Initiatives

15. Competencies • Recognize and respond effectively to resident behaviors that adversely affect their behavioral health. • Apply generalist practice micro skills of engagement, assessment, and intervention to promote resident behavioral health. • Create and sustain effective transactions between the resident and the care environment. • Review and critically evaluate evidence-informed approaches for promoting resident behavioral health. • Improve the capacity of direct care staff to nurture and sustain resident behavioral health.