The Problem (and the Answer?) to the Limited Availability of Pain Psychologists: Can Clinical Social Workers Help?

In response to concerns expressed by parents of children with emotional and mental disabilities about professionals' attitudes and beliefs, the authors surveyed the views of a sample of clinical social workers. The majority of respondents in a national random sample endorsed statements expressing validating attitudes toward parents, agreement with open information sharing, and agreement with providing specific guidance to parents about how to help their children. However, the views of a substantial minority of social workers were antithetical to a parent-friendly perspective. The most problematic area was the prevalence of parent-blaming beliefs reported by approximately half of the social workers. The view that medication was helpful correlated positively with validating views of parents and correlated negatively with blaming them for their children's problems. The belief that research-based knowledge is important for practice and that medical journals are a good source of information about emotional problems correlated with support for open information sharing and the view that medication was helpful. Seeing a child as the identified patient in a dysfunctional family, perceiving parents' views as useful primarily as clues to family dynamics, and seldom feeling the need to refer to other disciplines, correlated positively with blame, negatively with the use of medication, and negatively with validating attitudes.

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Effectiveness of an advance care planning patient navigator on advance directive completion by electronic versus staff-based referrals at a major cancer hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.20 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 20-20 ◽

Cited By ~ 1

Author(s):

Gayle Ito-Hamerling ◽

Lindsay Emanuel ◽

Finly Zachariah

Keyword(s):

Social Workers ◽

Advance Care Planning ◽

Advance Directive ◽

Completion Rate ◽

Care Planning ◽

Clinical Social Workers ◽

Patient Centered ◽

Advance Care ◽

Screening Platform

20 Background: Advance Care Planning (ACP) is a central component of patient-centered care, helping ensure patient values and preferences guide clinical decisions. Patient navigators have been utilized effectively in healthcare for numerous roles, and more recently for ACP. At City of Hope National Medical Center (COH), an ACP-focused navigator was hired to support patients, families, and staff with Advance Directive (AD) notarization and primary ACP conversations. Methods: The Department of Supportive Care Medicine at COH with significant institutional collaboration and administrative support created a patient-centered ACP program and marketing campaign, called “Plan Today for Tomorrow.” In 2016, an ACP navigator joined the team to facilitate AD completion. Referral to the ACP navigator occurred either through staff endorsement and/or the institution’s technological screening platform deployed in a majority of COH outpatient clinics. Staff referrals came from physicians, clinical social workers, nurses, or from the Sheri & Les Biller Patient and Family Resource Center. Prior to the ACP navigator, all referrals were addressed by Clinical Social Workers (CSWs). Results: In a review of 14 months of data, the ACP navigator followed up on 1,125 referrals, 574 were from staff, while 551 were from the institutional tablet-based screening platform. Follow-up on staff referrals resulted in an 86% AD completion rate. Follow-up on tablet-based screening resulted in a 23% AD completion rate. Conclusions: The presence of an available onsite ACP-focused navigator was more effective in facilitating AD completion of staff generated AD referrals as compared to AD completion of tablet-based patient screening AD referrals. The presence of the ACP navigator to facilitate AD completion decreased workload for CSWs, creating increased opportunity for CSWs to work at the top of their professional license. Further work is needed to increase the effectiveness of AD completion from tablet-based screening referrals.

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Integrating mental health professionals into the care team to better recognize and manage delirium in hospitalized oncology patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.83 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 83-83

Author(s):

Joseph Hooley ◽

Laurel Ralston ◽

Joel Daniel Marcus ◽

Carolyn Best ◽

Diana Karius ◽

...

Keyword(s):

Mental Health ◽

Social Workers ◽

Mental Health Professionals ◽

Health Professionals ◽

Unit Length ◽

Care Team ◽

Clinical Social Workers ◽

Health Providers ◽

Front Line ◽

Order Set

83 Background: Delirium is a common neuropsychiatric condition associated with increased morbidity and mortality, length of hospitalization, and distress. The prevalence of delirium in cancer ranges from 10% to 30% in hospitalized patients and up to 85% in terminally ill cancer patients. Rates of delirium on Cleveland Clinic’s inpatient oncology units were lower than expected. Our goal was to integrate mental health professionals into the care team to assist with better recognition and management of delirium. Methods: Education was developed for a range of caregivers, including physicians, nurses, and advanced practice providers. It was facilitated by a psychiatrist, psychologist, and clinical social workers, and included proper identification of both hyper- and hypoactive delirium through use of the Brief Confusion Assessment Method (bCAM) and use of a delirium order set to treat and manage patients identified as positive for delirium. An important component of this education included a proper assessment and comparison of patients’ current mental status compared to their true baseline prior to hospitalization. Additional integration directly into the care team included participation of the psychiatrist, psychologist, and clinical social workers into each team’s multidisciplinary rounds to facilitate discussions around delirium and its appropriate management, and separate targeted rounding which included one-to-one education with front-line caregivers. Results: During the first year of integration, substantial improvements were noted. The percentage of patients identified as positive for delirium through bCAM screening increased from 3.4% to 15.8% after 12 months, and utilization of the delirium order set increased from 11.1% to 58.3%. Additionally, the average nursing unit length of stay (LOS) for delirium-positive patients decreased by more than 2 days compared to baseline. Conclusions: Integration of mental health providers into the care team to assist with recognizing and managing patients with delirium and to provide direct education to front-line caregivers has helped to rapidly improve delirium identification and management for oncology inpatients.

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