Module 2 Judith Anne DeBonis PhD Department of Social Work California State University Northridge Module 2 The Role of Social Work in Integrated Health By the end of this module students will ID: 928546
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Slide1
The Role of Social Work in Integrated Health
Module 2
Judith Anne DeBonis PhD
Department of Social Work
California State University Northridge
Slide2Module 2
The Role of Social Work in Integrated Health
By the end of this module students will:
Understand the changing role of social work in healthcare
Recognize the importance of clearly communicating the social work role as it relates to IH
Practice skills necessary to work as an effective team member
Realize the value of their personal leadership qualities in IH
Be aware of the positive impact of practice and policy advocacy actions on IH
Learn how emotional intelligence and relational leadership can support the need for collaboration in IH
Identify special issues related to ethical standards apply to IH
Slide3Definitions, Primary Care Teams, Functions and Benefits
Slide4Significant Shifts and Changes in Healthcare
Changes in healthcare have impacted the role and responsibilities of both providers and patients. These changes have also resulted in a call for “new roles,” “new models of treatment,” and “new professional competencies and training”
1
For example—increases in the number of patients who have chronic health conditions requires a different model of treatment and more collaboration between patients and providers.
2
Social Work has been interested in chronic care for close to 100 years
3
Slide5Historical Role of Social Work in Healthcare
As early as 1915, medical social work was defined as a specific form of social case work focused on the relationship between disease and social maladjustment.
3
With an emphasis on the social impediments to health, social workers were charged with “providing some occupation or experience for the person jolted out of his regular plan of life by chronic disease, to offset what he has lost and to make him feel that he has still a useful place in the world.”
3
Do these concepts apply to social work and healthcare today?
“It is an important part of the social worker’s function to concern herself with the social problems arising directly out of the nature of the medical treatment.”
Harriet Bartlett
3
Slide6Current Role of Social Work in Healthcare
Little consensus in the literature as to the role of social work in healthcare
A wide variety of descriptions reflecting a range of responsibilities and functions. Including broad conceptual roles such as the promotion of equality of opportunity, the advancement of social change, and the task of challenging injustice
4
Responding to the call for increasing accountability, application of evidence-based practices, and cost effectiveness, there is movement in Social Work:
Shift to adapt and integrate as behavioral health specialists in primary care settings
Shift to community-based treatment models implementing evidence-based practices which serve consumers in a cost effective manner, while providing more comprehensive and integrative quality of care.
5
Shift to expand Social Work to include research as an important aspect of the social work role.
5,6
Slide7Then:
Social Work Looked to Medicine as the Model Profession
Medical Social Work did not meet the criteria for a profession:
Social Work had a “professional spirit” but members did not have sufficient individual responsibility, lacked a written body of knowledge and educationally communicable techniques”
3
Initially social work viewed medicine as a model profession and an intrapersonal approach as more professional than one focused on social and environmental factors
3
Slide8Now:
Medical Professionals Look to Social Work to Guide Training
Tenets and principles of social work are being incorporated into the competencies and training of other healthcare providers—physicians, residents, nurses. Several examples:
7
Well-trained residents/physicians are those who further the quality of care and the humanistic mission of the medical profession. Residents are required to be:
Ethical, compassionate, effective at creating therapeutic relationships with patients
Able to educate and empower, providing useful information to patients and families
8
Skilled at working collaboratively with interdisciplinary healthcare teams
A shift in attitude toward the relationship between physician and patient- stressing collaboration, the importance of positive interactions, and the role that all contributing parties serve in meeting the patient’s goals.
1Interpersonal Communication
Process Vs. Outcomes
Systems Based Practice
7
Slide9What Social Work Tenets and Principles Contribute to Integrated Health
Includes a wide range of settings, organizations, populations where social workers practice.
Focuses on a broad range of health, mental health, as well as the social and economic aspects of the lives of individuals, groups and communities
9
Has lead to a health paradigm that more readily acknowledges a range of psychosocial contributions to the etiology, course and outcome of illness.
10
Importance of a therapeutic relationship
Collaboration
Communication skills
Resilience
AdvocacyJustice 7Client Empowerment
Self-Determination
Social work’s value to healthcare delivery remains its comprehensive view of social and psychological circumstances as they interact with health and illness, and its flexible range of helping interventions to deal with the personal, interpersonal, and environmental barriers.
10
Slide10Role of Social Work in Primary Care
Defining Primary Care
– the provision of collaborative, accessible healthcare services by clinicians who are accountable for
addressing a large majority of personal healthcare needs
developing a sustained partnership with patients
practicing from a biopsychosocial systems perspective in the content of family and community
7
Primary Care
Refers to Family Medicine, pediatrics, geriatrics, internal medicine…not specialty care
Often the first line of entry to the healthcare system for patients—their medical home
Role of Social Workers in PC
Prevention
Health Promotion
Service Delivery Design
Acute and Chronic Care
Treatment
Rehabilitation
Long-Term Care
12
Slide11Specific Functions: A day in the life of social workers in…
Primary Care
Behavioral health practices must be adapted to adhere to the fast pace of a primary care setting
See patients for 15-30 minutes to conduct a focused assessment and to develop a treatment plan. This information is then discussed with the Primary Health Provider (PHP) and details a behavioral health change plan.
Implement, monitor, or change the intervention, using one to four 15-30 minute appointments.
Use the 5 A’s
Assess- Gather information on symptoms, emotions, thoughts, and behaviors
Advise – Describe treatment options to patients
Agree- Patients decide on their course of action
Assist- Help patients learn new information, develop new skills, solve problems, and overcome barriers
Arrange- Specify when the patient will follow-up with the provider.
13
Behavioral Health
Discuss medication side effects with patients, remind patients of skills used to reduce anxiety
Arrangement for patients for AA Groups, Anger Management Groups, etc.
Meet with patients during crisis situations, determining suicidality (and need for referral to community services for those patients who are already reintegrated back into their communities.
Referrals, where applicable, for patients needing psychiatric services
One on one and group therapy sessions
Charting
Sit in with presentations on issues relating to patient care (medications, nutrition)
Attention to self-care
14
Slide12Group Activity
Using the 5A and 5R Brief Intervention Models
Combining the 5 A’s with the 5 R’s:
Use the 5 A’s (Assess, Advise, Agree, Assist, and Arrange) when the person is ready and willing to make a change.
Use the 5 R’s (Relevance, Risks, Rewards, Roadblocks, Repetition) to educate and motivate a person who is not ready to make a change
Using Brief Interventions:
Highlights how essential health behaviors are to overall health
Helps identify when a person is ready to make a change so that appropriate assistance can be offered
Offers an opportunity to check on health behavior “vitals” during every visit
Using the 5A and 5R Handout the group will role play and practice how they would assess a person’s health behavior “vitals” and apply the As and Rs from the models. Debrief to see what works and where more practice is needed.
Slide13How can Social Workers Function Effectively in an Interdisciplinary Healthcare Team?
Skills
Knowledge in:
Medical Literacy
Consultation Liaison skills
with medical problems
Population Screening
Chronic Disease Management
Care Management Skills
Educating medical staff about integrated care
Evidence-Based Interventions
Group Interventions
Working within the fast-paced, action-oriented ecology of primary care
15
Characteristics
Ability to be:
Responsive
Committed to social justice
Commitment to the ethical practice of social work
Commitment to social change
Functional independently and collectively with others
Sensitive to relationships
Interact positively and
instructively with clients
16
Slide14Group Activity
Building Skills for Effective Interdisciplinary Practice
Skills
Knowledge in:
Medical Literacy
Consultation Liaison skills
with medical problems
Population Screening
Chronic Disease Management
Care Management Skills
Educating medical staff about integrated care
Evidence-Based Interventions
Group Interventions
Working within the fast-paced, action-oriented ecology of primary care
15
Put Skills and Knowledge into Action
Have students identify and briefly share their knowledge on
one
of the skill topics listed
Discuss as a group how that skill might be applied to different practice settings and clinical scenarios
Role play an interaction related to the skill highlighting the social work
Characteristics
that were observed (from the previous slide)
Example:
A student is working to increase their knowledge about diabetes as a chronic condition. The role play might offer a chance for the student to discuss with a patient who has been managing diabetes for many years, the challenges and stress of the daily care necessary to keep the condition under good control.
Slide15Social Workers as Leaders
*Note: There are multiple leadership models. Blanchard (2009) model was chosen because it applies to leadership for individuals as well as self-leadership.
Slide16Defining Leaders and Leadership
?
When you think of
leaders
, who comes to mind?
Slide17“Famous” Leaders
Presidents, patriots, world leaders, inventors, explorers, educators, authors, religious leaders, activists
Abraham Lincoln
Mahatma Gandhi
Dalai Lama
Mother Teresa
Rev. Martin Luther King, Jr.
Walt Disney Bill Gates Rosa Parks
Slide18“Everyday” Leaders
Not as visible or famous but may have enormous impact and be responsible for incredible change
Parents
Teachers
Neighbors
Boy Scout Leaders
Veterans
Team Coach
Slide19Group ActivityQualities of Leaders
Instructions
The goal is to record some of your personal strengths as a leader.
Think about:
People who acted as leaders in your life
A time or situation when you acted as a leader
Identify the leadership qualities that you exhibited
and posses
. Are these qualities also present in the people you identify as leaders?
Slide20The Good News
No one is born a leader… but leadership capacity and qualities can be developed
17
All leaders have a cause that motivates them to act. Leaders will sacrifice and persevere to achieve their vision.
Slide21What qualities do
all
leaders have?
“A great leader is a person who
listens
, and asks the kinds of questions that gives those around him or her
a
chance to be heard
.”
17
Slide22The Serve Model 17
S
ee the future
Envision a picture of the preferred future
E
ngage and develop others
Invested in a cause, and inspire others to collaborate toward success
R
einvent continuously
Lifelong learners who put new information to good use
V
alue results and relationships
Progress and success can be measured in outcomes and partnerships
E
mbody the values
Talking the talk and walking the walk
Slide23Connecting Leadership Capacity to Health
Slide24Using Leadership to Enhance Health 18
As
self-leaders
, we’re able to draw on our leadership qualities to increase our feeling of competence and self- determination which can maximize our health.
Developing self-leadership skills can help individuals to participate more fully in a “partnership” with healthcare providers.
Patients who are self-leaders will experience an “internal” satisfaction with decision making and taking actions that enhance their health.
Slide25Group ActivityIdentifying Leadership Qualities in Patients
Think about a patient that you’ve met and talked with recently.
What leadership qualities did that person possess?
How were each observed?
Was the quality included as part of the discussion?
How could that one quality be used by the patient to enhance their health?
Consider how you would incorporate this information into your next visit with the patient.
Slide26Serve Model 17
Revisited and Applied to Self-Leadership
Self-Leaders
Know the changes they want to make
Are optimistic that change is possible
Identify steps to take toward those goals
How Am I Doing?
Can I describe what it would look like when the change is made?
Am I recognizing what I’m already doing, no matter how small, toward achieving that goal?
S
ee
the future
Envision a picture of the preferred future
Slide27S
ERVE
WHAT WE KNOW
19
Believing that change is possible is essential
Investing in details about the change is more likely to lead to desired results
When practiced consistently, small changes have a big impact
Slide28E
ngage and develop others
Self-Leaders
Aware of when they’re fully engaged
Focus on goals that they care about
Identify strengths that serve to accomplish the goal
How Am I Doing?
Is the goal I set for myself something that I want, or what others want for me?
Does achieving the goal engage me?
Do I have the skills and support necessary to take action?
E
ngage and develop others
Invested in a cause, and inspire others to collaborate toward success
Slide29S
E
RVE
WHAT WE KNOW
20
Having a positive and respectful self-relationship serves as the foundation for change and helps to sustain the process.
Potential rewards for change efforts provides the motivation needed to take action.
Slide30R
einvent continuously
Self-Leaders
Approach change as a learner
Allow for experimentation
Adapt and customize
Know what works for them
How Am I Doing?
Do I take the time to explore?
Do I have the information I need?
What past accomplishments can I use or apply?
Can I translate failures into opportunities?
R
einvent continuously
Lifelong learners who put new information to good use
Slide31SE
R
VE
WHAT WE KNOW
20,21
Taking time to discover means that the plan has better potential for success.
If a strategy or an approach works, do more of it.
If a strategy is not working, try something different.
Exceptions to problems exist, and if identified, lead to a path of change.
Slide32V
alue results and relationships
Self-Leaders
Take pride in accomplishments
Have a sense of self-acceptance
Value both personal choices and partnerships to direct their life course
How Am I Doing?
Do I acknowledge small steps toward goals?
Have I set up rewards that keep me motivated?
Do I give myself credit for hard work and effort required?
V
alue results and relationships
Progress and success can be measured in outcomes and partnerships
Slide33SER
V
E
WHAT WE KNOW
22
Sustaining change requires reinforcement and ongoing motivation.
Reviewing goals that were accomplished reinforces the actions that need to continue to sustain it.
The way that one change is accomplished can be applied to other changes.
Social support networks provide multiple benefits in the change process.
Slide34E
mbody the values
Self-Leaders
Have clear sense of values
Aware of how daily actions reflect values
Recognize that there are numerous ways to enhance health and vitality
How Am I Doing?
How does my process of making changes toward health serve others around me?
Do I share my experiences in the change process to help others?
Talking the talk and walking the walk
E
mbody the values
Slide35SERV
E
WHAT WE (MAYBE) KNOW
There are multiple options to show that we value our health.
We can decide to participate at any time.
If we commit to the value of optimal health, how we go about living that value is up to us.
Relying on our leadership qualities is our own best asset to change.
Slide36Group ActivityApplying the SERVE Model to Integrated Health
What opportunities do each of the 5 aspects of the SERVE model offer to the patient and the social work provider?
Consider the following case example:
A 48 year old Latina woman was referred to the behavioral health specialist by the PCP. The patient was diagnosed with Type 2 diabetes 3 years ago and prescribed oral medication and lifestyle changes.
She states that she hopes she will be able to lose weight and not need the medications anymore but the report from the PCP indicates that her recent HbA1C indicates that her condition is not well-managed. She is the primary cook for her husband, and two children (ages10 and 12) and doesn't want to cook any special meals. She says she tries to "cook healthy food and not too many sweets" but sometimes just skips meals to help lose weight. She has also started an exercise program, walking about 30 minutes at least 3 times each week. Patient was treated briefly for depression after the death of her Mother from a sudden heart attack last year but currently is not taking medication for depression or seeing her counselor.
Slide37Group ActivityUnderstanding Why People Follow
23
Instructions from
a Gallop Poll
What leader has the most positive influence in your daily life?
Now please list 3 words that best describe what this person contributes to your life.
Slide38How Did 10,000 People Respond?
23
In some cases over 1,000 people had listed the exact same words even though no categories or options were provided
Followers have a very clear picture of what they want and need from the most influential leaders in their lives
They Need...
Trust
Compassion
Stability
Hope
Given that there are more than 170,000 words in the English language, this was impressive!
Slide39Taking an idealistic vision
Taking an idealistic vision can be much harder work but the payoffs are enormous
Do these concepts apply to social work and healthcare today?
Slide40Social Workers as Advocates
Slide41The Need for Advocacy
Jansson (2011) reports that patient care can be compromised by seven common problems that often go unaddressed when healthcare consumers and providers do not effectively engage in advocacy.
24
Both healthcare professionals and consumers must engage in advocacy to increase the odds that consumers will receive:
(1) funding for care,
(2) quality care based on acceptable guidelines,
(3) protection of their ethical rights,
(4) culturally competent services,
(5) access to services in their community,
(6) preventive services, and
(7) attention to their mental health needs.
Slide42A Call to Action
Patient advocates are needed to protect and support healthcare consumers
Advocates must be willing to speak on behalf of the patient, act as their representative, and coach the patient and the family to advocate on their own behalf
25
Social work professionals are in a strategic position to become leaders in promoting the role of patient advocate:
by the nature of their values, their commitment to social justice
their ability to effectively communicate and engage individuals representing diverse backgrounds
their application of the “person in environment” or psychosocial perspective
25,26
Slide43Taking Action to Protect and Assist Patients
Social Workers serving as:
Care Managers
Medical Social Worker
Navigator or Health Coach
Discharge Planner
Regularly take advocacy actions:
Expedite referrals, gather consumer information, help obtain second opinions, mediate between care providers, educate consumers on self-care management, link to inpatient and outpatient services.
Slide44Using Influence for Successful
Social Work Advocacy
24
Influence in Interpersonal Exchanges. Advocates can exert influence by drawing upon the following interpersonal experience:
Expertise:
Tactfully display personal knowledge, credentials, and suggest evidence-based practices
Coercion:
Cite adverse implications for consumer dissatisfaction, potential reputational losses
Rewards:
Praise physician for helping a consumer and promise to go the “extra mile” in the future
Charisma: Become admired for “putting patients first” or being a “team player” by displaying qualities of leadership, moral authority to motivate others to follow
Authority:
Hold leadership positions in departments or persuade administrators to serve as intermediaries
Slide45Successful Strategies for
Social Work Advocacy Engagement
24
Using Medical Culture
Portray advocacy as coming from concern about consumer’s well-being
Present concern from a medical ethics perspective to promote multi-professional collaboration
Engage physician, “I bring this case to your attention so that we can provide the best services possible”
Employing Power-Dependence
Social worker is viewed as credible when others depend on expertise
Assume multiple functions beyond job description to enhance dependence
Taking Initiative and Responsibility
Initiate improvements in consumers’ health care and follow through with action
Participate in in-service training sessions, rounds, case findings, contribute to medical records
Slide46Successful Strategies for
Social Work Advocacy Engagement (Cont’d)
24
Develop Positive Track Record
Positive reputation demonstrates competency and trustworthiness.
Appropriate Assertiveness
Assert influence that will not compromise ability to engage in future advocacy.
Design Communication Strategy
Communicate skillfully with various audiences in different situations.
Consider audience and alter approach appropriately:
Physician/Administrator- Provide options and ask for preference.
Hostile audience- Create commonalities
Encourage Consumer Empowerment
Guide consumer confidence by informing of rights and encourage self-advocacy.
Slide47Group Activity
Excessive Fatalism as a Barrier to Advocacy
Jansson (2011) has described that “excessive fatalism” can impede a social worker’s involvement in advocacy by “undercutting the belief that change is possible.”
24
You are a newly graduated MSW and the only social worker working in a primary care setting with 3 PCPs, 2 medical residents and 3 nurses. You have considerable experience and interest in health, mental health and substance use problems. The program director intimidates you and after your first team meeting, where you did not offer any input about issues that concerned you, you decided that any of your ideas would not be valued by the group and the only way to keep your job was to be compliant with the medical staff who appear to have all of the power. While you initially believed that your social work perspective would complement the medical services offered at the agency, you do not feel that it is possible to change the agency structure or policies and therefore have become more apathetic that the system can work to benefit what you observe as client needs.
Comment on this case based on your thoughts about the social work role in Integrated Health. What strategies recommended by Jansson could be used to combat fatalistic thinking? Given a scenario that you believe might lead you to feel powerless and hopeless, what resources, knowledge, and personal capacities do you have that could assist you? In what ways does fatalistic thinking impact providers, patients, families, agencies?
Slide48Social Workers as Collaborators
Slide49Importance of Relational Leadership in Collaboration
28
Relational leadership is dispersed throughout an organization, focusing on process rather than individuals.
For IH, this type of leadership is essential to creating successful settings and relationships:
IH offers exciting possibilities for healthcare—as an evolving model, there is no preexisting formula for how IH should operate
IH organizations are likely to prioritize “learning” and generating knowledge about the best ways to function
Simultaneously, IH models will require significant change for all stakeholders—patients, providers, payors
Slide50Relational Leadership Mirrors the Spirit of Care Prescribed by IH
27
Both consider the partnership/relationship essential to success
Patient and Provider
Provider and other providers (multidisciplinary team)
All with the community
Movement beyond traditional top management leaders and compliance of followers, the power structure is inclusive
Can traditional primary care embrace this paradigm?
Slide51An Italian Feasibility Study Offers Hopeful Evidence about Collaboration
29
Project Leonardo
Tested the feasibility of including nurse “care managers” trained in an empowerment self management model into the primary care/family practice setting to support patients with chronic conditions
Historically Doctors worked as single practitioners in their office without a nurse
Patient Satisfaction Surveys
“My Care Manager and my GP work together to help me,”
“My Care Manager tells my Doctor about the things I need”
Physicians reported:
Care Managers as the “ambassadors” of the project, collaborating with the community and “angels” supporting the patients to achieve better health
85% “My communication and relationship with the patient was improved”
78% Satisfaction that “the quality of my time with the patient was improved”
Care
Managers:
Care Managers (96%) felt comfortable working in the GP office and Doctors
Slide52Defining Collaboration
27
“Collaboration is a process of social interaction which has it’s foundation that each individual is responsible for the group’s success and achievement of a common goal”
With collaboration, new opportunities to achieve extraordinary outcomes become possible
For IH, the goal of collaboration is to provide the most clinically effective care to patients at the most efficient cost possible
While IH settings will vary with the amount of collaboration, ideally as collaboration increases, shared decision making would also increase
To foster collaboration relational leaders use Emotional Intelligence (EI)
Slide53Emotional Intelligence (EI) as the Key to Collaboration
27
Social Worker training reflects clinical practice skills which are essential to effective collaboration and emotional intelligence
Two Areas of Competence Related to Emotional Intelligence:
ONE
Personal Competence
1. Self Awareness
Understand/manage emotions
self confidence
2. Self Management
Adaptive, optimistic, manage response to conflict
TWO
Social Competence
3. Social Awareness
Empathy, sensitivity to verbal and non verbal cues, keen sense of others
4. Relationship Management
Persuasion, conflict management, collaboration
Slide54Group ActivityEmotional Intelligence
Discussion Questions:
Development and mastery of 4 domains of emotional intelligence related to personal competence (self awareness and self management) and social competence (social awareness and relationship management) can contribute to your ability to effectively collaborate as a social worker.
Considering the 4 domains of EI, in which one are you strongest?
State how you developed that strength. How might you leverage this strength in an IH environment to enhance your collaboration with the PCP?
What is your weakest EI domain? How can you develop additional dimensions in this area?
Slide55Social Workers as Promoters of Ethical Practices
Slide56Ethical Standards for Integrated Health
Integrating different but complementary ethical standards is an expected challenge for Integrated Health settings and providers:
While the various professional disciplines represented in Integrated Health do not share one set of ethical codes, most share a common purpose – to protect both healthcare consumers and providers
28
In the spirit of collaboration, “professional pride” should yield to opportunities to focus on the complexity of heath conditions and the need for collaboration by practitioners to improve patient care and provider satisfaction
28
5 ethical
issues of particular importance to integrated health
Informed consent
Confidentiality
Relationships with patients
Relationships with colleagues
Scope
of practice
Slide57Informed Consent
28
Medical /PCP
Definition
Part of the registration protocol, patients give one consent for all care
Necessary for the provision of any healthcare treatment
Social Work /BHP
Definition
An important part of the therapeutic relationship; related to the patient’s self-determination about their treatment
Integration Issues
The streamlined medical consent may not be adequate for the BHP.
Careful consideration and respect for differing consent needs.
Try
out your skill…
Practice how you would explain to the patient your role and find out whether they understand about their right to understand the treatment options and freely choose to participate..
Slide58Confidentiality
28
Medical /PCP
Definition
How much and what type of information to be shared with whom?
Some information can be treated with different levels of privacy on a “need to know basis” (keep certain information from non-provider staff) or just between the PCP and BHP (separate notes protected from being released as part of the general medical record)
Social Work /BHP
Definition
Able to let patient know that there are options to keep some discussions completely confidential (BHP/patient)
Need to review exceptions to confidentiality regarding danger to self, others, homicidal or suicidal ideation or intent, child abuse reporting.
Integration Issues
Patient must be informed as to the nature of the relationship between PCP and BHP as well as with other IH team members, how information is shared
Try
out your skill…
Consider what you would say to a patient who wants you to keep in confidence information that they have been using an illegal drug
Slide59Relationships with Patients
28
Medical /PCP
Definition
Protection of the patient/provider relationship. Based on trust that the PCP holds the patient welfare above his/her self interests and will advocate for their health needs
Social Work /BHP
Definition
The therapeutic relationship is built on trust and respect; social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the patient
Integration Issues
Both put patient needs first
Less formal restrictions for PCPs who may choose to treat relatives or co-workers (multiple relationships permitted for PCP)
BHPs can model a different way to think about the patient/providers relationship
Try
out your skill…
Practice what you would share with your patient as to why you would not initiate conversation with them if you saw them in public
Slide60Relationships with Colleagues 28
Medical /PCP
Definition
May work in collaboration with other allied health professionals and hire them if they are appropriately trained and licensed
Social Work /BHP
Definition
Respectful of colleagues and avoid unwarranted negative criticism of them in communication with patients and other professionals
Integration Issues
There are ideological differences (PCPs trained as leaders /decision makers whereas BHPs trained as facilitators /consensus builders)
May pose some need for discussion so both are comfortable
Try
out your skill…
What strategies could a BHP take to address their discomfort regarding power differential in primary care
What actions might a BHP take to build a collaborative relationships with colleagues
Slide61Scope of Practice 28
Medical /PCP
Definition
Patient/Physician relationship is contractual ---both are free to enter or decline the relationship
Social Work /BHP
Definition
Social worker should provide services and present themselves as competent only within the boundary of their education, licensure, relevant professional experience
Integration Issues
BHPs may be asked to perform duties that they see as outside their area of expertise (physical symptom or medication management)
IH must address special concerns regarding the level of psychiatric care which can be managed in a primary care setting (including a collaboration with psychiatric specialist)
Both PCP and BHP can learn from the expertise of the other which will result in better integration of patient care
Try
out your skill…
What are the advantages and disadvantages of treating patients with mental health or substance use disorders in primary care? What issues might be better served in specialty care? What safeguards might you build into a primary care setting to allow more patients with severe diagnoses to be treated in that environment?
Slide62Group ActivityFour Quadrant Model
Given a clinical case example, use the Curtis and Christian Four Quadrant Clinical Integration Model
30
and answer the following questions:
What specific needs and goals are a priority for the patient at this time?
Which quadrant offers the best opportunities for the patient to receive the care they need?
Given the setting where the patient is being served, how might that setting be modified to enhance care?
Slide63A final note…
Questions?
Thoughts?
Comments?
Slide64References: The Role of Social Work in Integrated Health
1. Bowen, J., Stevens, D. Sixta, C., Provost, L., Johnson, J., & Woods, D. (2010). Assessing Chronic Illness Care.
J Gen Internal Medicine, 25
(4), 586-592. Doi: 10.1007/#11606-010-1358-1
2. Wagner, E. H., Austin, B. T., Davis, C., Hindmarsh, M., Schaefer, J., Bonomi, A. (2001). Improving chronic illness care: Translating evidence into action.
Health Affairs, 20
, 64-78. r
3. Gehlert, S. (2011). The conceptual underpinnings of social work in health care. In S. Gehlert & T. Browne (Eds.),
The handbook of health social work (1-22).
New Jersey: John Wiley& Sons.
4. Spencer, M. S. (2008). A social worker’s reflections on power, privilege, and oppression.
Social Work, 53
(2), 99-101.
5. Philips, S. D., Burns, B. J., Edgar, E. R., Mueser, K. T., Linkins, K. W., Rosenheck, R. A.,…McDonel Herr E. C. (2001). Moving assertive community treatment into standard practice.
Psychiatric Services, 52
(6), 771-779
6. Ell, K. (1996). Social work and health care practice and policy: A psychosocial research agenda.
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