Showing papers in "Social Work in Health Care in 2015"

Moving Toward Integrated Health: An Opportunity for Social Work

Abstract: With the passage of the Patient Protection and Affordable Care Act (PPACA) and ongoing health care reform efforts, this is a critical time for the social work profession. The approaches and values embedded in health care reform are congruent with social work. One strategy is to improve care for people with co-morbid and chronic illnesses by integrating primary care and behavioral health services. This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform. We consider how social workers can prepare for health care reform and discuss the implications of these changes for the future of the profession.

Professional Distress and Meaning in Health Care: Why Professional Empathy Can Help

Abstract: For human service care providers working in hospitals, balancing the motivation for interpersonal engagement with patients alongside self-protective emotional boundaries is a familiar struggle. Empathy is a critical, although not thoroughly understood, aspect of patient care as well as an important ingredient for feeling work satisfaction and meaning. However, empathy can lead to feelings of sympathetic emotional distress and even burnout. This article uses an illustrative case study from a medical social worker in the emergency room to explore these themes of empathy, burnout, and the search for meaning in work. The discussion examines areas for further empirical study and intervention to support care-provider empathy and avoid burnout.

Why do patients keep coming back? Results of a readmitted patient survey.

Abstract: Hospital readmissions can negatively impact cost and patient outcomes. Predictors of 30-day readmissions have been primarily identified using medical claims data. Reported here are results of a patient survey developed as part of regular hospital quality assurance activities. Two-thirds of patients reported good discharge experiences but were still readmitted. One-third of patients discharged had a post-discharge doctor appointment scheduled; half were readmitted before that scheduled appointment. Results suggest post-discharge experiences could be improved, especially the timing of follow up doctor appointments. Identified weaknesses in the survey process highlight need for engagement of survey methodologists in efforts to understand patient experiences.

Somali Refugees’ Perceptions of Mental Illness

Abstract: Nearly 13% of the U.S. population is comprised of foreign-born individuals, with Somalis constituting one of the largest resettled groups. Research suggests that, among Somali refugees, rates of mental illness are high. Yet research shows Somalis underutilize mental health services. Understanding their perceptions of mental illness and its cures may help practitioners to design more effective treatments for this population. Thus, this pilot study investigated Somali refugees' perceptions of mental illness and its treatments. Using purposive sampling, this qualitative study interviewed 20 Somali refugees using a semi-structured interview guide. Qualitative analysis yielded participants' perceptions of mental illness through their descriptions of physical symptoms accompanying mental illness, the stigma of mental illness, causes of mental illness, medical and non-medical treatments for mental illness, spirit possession causing mental illness, and the Qur'an as treatment for mental illness. Such information may help practitioners in the United States approach Somali clients in the most culturally coherent manner.

Linguistic acculturation and perceptions of quality, access, and discrimination in health care among Latinos in the United States.

Abstract: This study examined the relationship between acculturation and Latinos' perceptions of health care treatment quality, discrimination, and access to health information. The results of this study indicated that participants who had lower levels of acculturation perceived: 1) greater discrimination in health care treatment; 2) a lower quality of health care treatment; 3) less confidence filling out health related forms; and 4) greater challenges understanding written information about their medical conditions. Participants who identified as immigrants also perceived that their poor quality of medical care was due to their inability to pay and to their race/ethnicity.

Low Health Literacy and Older Adults: Meanings, Problems, and Recommendations for Social Work

Abstract: Many older adults struggle to manage their health care problems. Low health literacy exacerbates such struggles and contributes to a variety of adverse health behaviors and outcomes. Addressing how health literacy impinges on the lives of older adults is a neglected area of social work practice and knowledge. This article explores seven areas: defining health literacy, the problem and prevalence of low health literacy among older adults, health inequalities and health literacy, a brief literature review, neglected issues in the literature, suggestions for macro and micro social work interventions to improve health literacy for older adult populations, and conclusion.

Thinking big, supporting families and enabling coping: the value of social work in patient and family centered health care.

Abstract: Patient and family-centered care has become a focus in health services. Social work has a rich history of providing responsive patient care. This study identified the contribution and value of social work to PFCC from the key stakeholder perspectives of health social workers (n = 65). Utilizing interpretive description, four themes emerged: (1) Thinking big and holistically, (2) Intervening with families, (3) Enabling patient and family coping, and (4) Maximizing hospital and community resources. Barriers included a lack of power, professional isolation and role creep. Implications for research and practice are provided.

Predictors of Self and Surrogate Online Health Information Seeking in Family Caregivers to Cancer Survivors.

Abstract: The purpose of this research is to investigate various factors predicting online health information seeking for themselves (self OHIS) and online health information seeking for others (surrogate OHIS) in family caregivers to cancer survivors. To address this purpose, this study applies the comprehensive model of information seeking as a theoretical framework for explaining the relationships between various predictors and two types of OHIS. The data used in this study were taken from the Health Information National Trends Survey 4. A total of 1,113 family caregivers were included in this study. Logistic regression analyses were conducted to examine the effects of predictors on Internet use for health information seeking. Caregivers' self and surrogate OHIS were commonly predicted by their self-rated health and attention to the Internet. However, age, race, and education were significantly associated with self OHIS only, while gender and marital status were significantly associated with surrogate OHIS only. These results suggest that family caregivers' self and surrogate OHIS are predicted by common factors, as well as predicted by different specific factors.

A role for social workers in improving care setting transitions: a case study.

Abstract: High 30-day readmission rates are a major burden to the American medical system. Much attention is on transitional care to decrease financial costs and improve patient outcomes. Social workers may be uniquely qualified to improve care transitions and have not previously been used in this role. We present a case study of an older, dually eligible Latina woman who received a social work–driven transition intervention that included in-home and telephone contacts. The patient was not readmitted during the six-month study period, mitigated her high pain levels, and engaged in social outings once again. These findings suggest the value of a social worker in a transitional care role.

Examining the relationships between resources and online health information seeking among patients with chronic diseases and healthy people.

Abstract: The Internet is increasingly used as an important source of health and medical-related information for people with chronic diseases. It is recognized that online health information seeking (OHIS) is influenced by individuals’ multi-dimensional factors, such as demographics, socio-economic factors, perceptions of the Internet, and health conditions. This study applies the conservation of resource theory to examine relationships between various multi-dimensional factors, daily challenges, and OHIS depending on individuals’ health conditions. The data used in this study was taken from the U.S. Health Tracking Survey (2012). In this study, Internet users aged 18 and older were classified into patients (N = 518) and healthy people (N = 677) based on their health status related to chronic diseases. Multiple regression analysis was used to examine the relationships between multi-dimensional factors (resources), self-rated health, and OHIS. Patients’ various resources (e.g., age, income, education, having a smart...

Stressors and Caregivers’ Depression: Multiple Mediators of Self-Efficacy, Social Support, and Problem-Solving Skill

Abstract: Caring for an older adult with memory loss is stressful. Caregiver stress could produce negative outcomes such as depression. Previous research is limited in examining multiple intermediate pathways from caregiver stress to depressive symptoms. This study addresses this limitation by examining the role of self-efficacy, social support, and problem solving in mediating the relationships between caregiver stressors and depressive symptoms. Using a sample of 91 family caregivers, we tested simultaneously multiple mediators between caregiver stressors and depression. Results indicate that self-efficacy mediated the pathway from daily hassles to depression. Findings point to the importance of improving self-efficacy in psychosocial interventions for caregivers of older adults with memory loss.

Experiences of stigmatization and discrimination in accessing health services: voices of persons living with HIV in Ghana.

Abstract: Drawing on Earnshaw and Chaudoir’s HIV stigma framework, this study explored the experiences of persons living with HIV and AIDS regarding stigmatization and discrimination in accessing health services. Using a qualitative research methodology, 42 participants were purposively recruited during support group meetings of persons living with HIV and AIDS (PLWHA) at Amasaman in Accra, Ghana. Four focus group discussions (n = 22) and 10 in-depth interviews were conducted. Discussions and interviews were audio-taped, transcribed, and categorized based on the objectives of the study. The findings indicated that PLWHAs had knowledge of stigma that was experienced through enacted, anticipated, and internalized stigma mechanisms. Evidence showed that PLWHA did not experience stigma and discrimination when they accessed services at the Korle-Bu Teaching Hospital, the largest hospital in Ghana. However, the situation was different when they accessed services at other public health facilities. Based on the findings, i...

Medication adherence skills training for African-American breast cancer survivors: the effects on health literacy, medication adherence, and self-efficacy.

Abstract: There are gaps in research regarding medication adherence, self-efficacy in proper medication adherence, and health literacy among breast cancer survivors. This pilot randomized controlled study was conducted to provide information addressing health literacy with respect to medication adherence and self-efficacy in African American breast cancer survivors. The study sample consisted of an intervention group (n = 24) of medication adherence skills training (MST) and a control group (n = 24), with a total sample population of 48 participants. The MST workshop was a collaborative intervention between pharmacy and social work and was designed to address issues that may be encountered while taking multiple medications for various acute and chronic conditions, increase participant confidence in accessing necessary resources for improved medication usage, and enhance personal self-efficacy regarding health care. A statistically significant relationship was detected between initial health literacy and medication adherence, as well as initial health literacy and self-efficacy. These findings indicated that individuals with higher health literacy were more likely to have higher levels of self-efficacy and were more likely to adhere to medication instructions. Analysis of the intervention and treatment groups did not show a statistically significant effect on health literacy, medication adherence, or self-efficacy from pre-test to post-test.

Integrated and Culturally Relevant Care: A Model to Prepare Social Workers for Primary Care Behavioral Health Practice.

Abstract: Policymakers and researchers emphasize needs for an integrated, effective, and efficient health care system to address well-documented disparities and inequities in care experienced by diverse populations. The Affordable Care Act, through its support of integrated health care, addresses social determinants of health with a goal of increasing access to care. Social work is poised to assume a central position in health care reform and integrated behavioral health, but must prepare practitioners to work alongside medical providers in health care settings. This article describes a social work field education model developed in partnership with community mental health and health care providers. The model, Integrated and Culturally Relevant Care, prepares social work students to provide behavioral health services in integrated primary care environments.

The paradox of homeless youth pregnancy: a review of challenges and opportunities.

Abstract: Compared to their housed counterparts, homeless youth become pregnant at exceptionally high rates. Causes of such pregnancies are multifaceted, while a paradoxically high proportion of these pregnancies are intended. This review discusses causes and risk factors associated with homeless youth pregnancies, and notes experiences of pregnancy decision-making discord, challenges encountered during and following pregnancy, and difficulties faced by homeless youth when or if they become parents. Because homeless youth face a wide array of unique risks, future research would benefit from exploring alternative approaches to prevention to reduce pregnancies and improve sexual and reproductive health outcomes among this population.

Effects of a Psychosocial Transitional Care Model on Hospitalizations and Cost of Care for High Utilizers.

Abstract: Evidence of care coordination programs to reduce readmissions is limited. We examined whether a social work transitional care model reduced hospital utilization and costs with a retrospective cohort study conducted from 9/3/2010-8/31/2012. Patients enrolled in the Preventable Admissions Care Team (PACT) program were matched to controls. PACT patients received follow-up from a social worker to address psychosocial strain. PACT reduced thirty-day readmission rate by 34% (p = <0.001), Sixty-day hospitalization rate by 22% (p = 0.004); ninety-day hospitalization rate by 19% (p = 0.006), and but not 180-day hospitalization rate. Inpatient costs thirty days post-index were $2.7 million for PACT patients and $3.6 million for controls.

From Organizational Awareness to Organizational Competency in Health Care Social Work: The Importance of Formulating a “Profession-in-Environment” Fit

Abstract: Today's health care environments require organizational competence as well as clinical skill. Economically driven business paradigms and the principles underlying the Patient Protection and Affordable Care Act of 2010 emphasize integrated, collaborative care delivered using transdisciplinary service models. Attention must be focused on achieving patient care goals while demonstrating an appreciation for the mission, priorities and operational constraints of the provider organization. The educational challenge is to cultivate the ability to negotiate "ideology" or ideal practice with the practical realities of health care provider environments without compromising professional ethics. Competently exercising such ability promotes a sound "profession-in-environment" fit and enhances the recognition of social work as a crucial patient care component.

Living Better With Dementia: Strengths-Based Social Work Practice and Dementia Care

Abstract: This article first argues that quality of life is possible despite the onset of dementia in late life. It also demonstrates how core concepts of social work practice, such as family systems theory, the strengths perspective, and use of self, can be applied to practice with dementia-affected persons. In addition, it provides practical suggestions for supporting care partners in nurturing "we-ness", focusing on what remains rather than was is lost, and remaining authentic. When strengths-based social work practice is integrated into dementia care protocols, wellbeing can increase. As a result, the more than 40 million persons worldwide who are affected by dementia do not have to resign themselves to the despair, devastation and inevitable demise of quality of life that dominate perception of the illness.

Social Support Throughout the Deployment Cycle for Women Veterans Returning From Iraq and Afghanistan

Abstract: Social support throughout the deployment cycle and the challenges of readjustment to civilian life for veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom were explored. Eighteen participants from the New England and Indiana Veterans Administration catchment area were interviewed using a semi-structured interview guide. All participants identified perceptions of social support but their utilization of these supports was compromised due to the need to protect family and friends from the strain of war, post-traumatic stress symptoms, and depressive symptoms. Resilience, fortitude, and commitment to their military mission were evidenced by all the women of this study. Implications for future service delivery are identified.

Informal Caregivers’ Use of the Internet for Caregiving Information

Abstract: Using data extracted from the Caregiving in the U.S. 2009 survey, this study describes caregivers' use of the Internet for caregiving information and identifies factors related to their use. This study includes 800 informal caregivers for community-residing older adults age 65 and over. In the study, more than one-half of caregivers searched online caregiving information. The results from an ordered logistic regression analysis showed that caregivers' use of the Internet was significantly related to caregivers' age, education, income, primary caregiver status, caregiving strain, self-reported health, and information/service needs. Implications of these findings are discussed.

The Evolving Role of Geriatric Emergency Department Social Work in the Era of Health Care Reform.

Abstract: In the era of Medicaid Redesign and the Affordable Care Act, the emergency department (ED) presents major opportunities for social workers to assume a leading role in the delivery of care. Through GEDI WISE-Geriatric Emergency Department Innovations in care through Workforce, Informatics and Structural Enhancements,-a unique multidisciplinary partnership made possible by an award from the Center for Medicare and Medicaid Innovation, social workers in The Mount Sinai ED have successfully contributed to improvements in health outcomes and transitions for older adults receiving emergency care. This article will describe the pivotal and highly valued role of the ED social worker in contributing to the multidisciplinary accomplishments of GEDI WISE objectives in this new model of care.

Social Service Counseling in Cancer Centers Certified by the German Cancer Society

Abstract: Social workers are an integral part of care provided in cancer centers that are certified according to the requirements of the German Cancer Society. This article reports on the tasks of social workers in German cancer care and on the proportion of patients that receives social service counseling (SSC) in breast, lung, colorectal, skin, gynecological, prostate, pancreas, neurological, and head and neck cancer centers based on data from 367,297 patients treated between 2009 and 2012. The highest proportions of patients (median >75%) are provided with SSC in breast and colorectal cancer centers, whereas the median is below 30% in skin cancer centers. Variation between centers and center types is high.

Reflections on Recovery in Mental Health: Perspectives From a Muslim Culture

Abstract: This article describes the outcomes of research into how individuals with mental health problems at the National Centre of Mental Health in Jordan perceived the causes of their mental health problems, the coping strategies they employed, how they sought help, and how they experienced what is termed the process of recovery. Semi-structured interviews were conducted with 10 male and 10 female patients diagnosed with a range of mental health problems. The research suggests that each person perceived recovery uniquely and that, for some, religion was viewed as being central to recovery. The research also suggests that social workers and other mental health professionals working with Muslim patients can better contribute to their recovery if they understand and respect the central role of these patients' religious beliefs and "faith journeys."

Development of the Emergency Medical Services Role Identity Scale (EMS-RIS).

Abstract: This article describes the development and validation of the theoretically grounded Emergency Medical Services Role Identity Scale (EMS-RIS), which measures four domains of EMS role identity. The EMS-RIS was developed using a mixed methods approach. Key informants informed item development and the scale was validated using a representative probability sample of EMS personnel. Factor analyses revealed a conceptually consistent, four-factor solution with sound psychometric properties as well as evidence of convergent and discriminant validities. Social workers work with EMS professionals in crisis settings and as their counselors when they are distressed. The EMS-RIS provides useful information for the assessment of and intervention with distressed EMS professionals, as well as how role identity may influence occupational stress.

In Sickness and in Debt: Do Mounting Medical Bills Predict Payday Loan Debt?

Abstract: Cash-strapped families sometimes turn to small, short-term loans with exorbitant fees—payday loans—to cope with mounting medical bills. Given that about three-fourths of payday loan customers are repeat borrowers, consumer advocates and policymakers have increasingly raised voices of concern about the use of payday loans to finance various household expenses, including, among other things, medical bills. The present study hypothesized that increases in medical debt are associated with increases in payday loan debt among a sample of Chapter 7 bankruptcy filers. The results of a multivariate tobit regression analysis showed that medical debt was associated with increased payday loan debt, controlling for various types of debt and other socioeconomic variables. This article concludes with implications of the results for social work policy- and direct-practice.

House Calls: The Impact of Home-Based Care for Older Adults With Alzheimer's and Dementia.

Abstract: Older adults with Alzheimer's/dementia have high health care costs; they may benefit from home-based care, but few have home visits. This article describes a home-based care program for frail elders, including those with Alzheimer's/dementia. Descriptive statistics are provided for Medicare-enrolled program participants and matched controls with Alzheimer's/dementia on expenditures along six services: skilled nursing facility, inpatient acute, physician, home health, hospice, and social services. Cases with dementia were significantly more likely to have home health and hospice expenditures than controls, suggesting potential for the program to improve end-of-life care. Very few cases or controls had any social service expenditures. Social workers should advocate for the expanded role of home-based care for older adults with dementia and for increased Medicare reimbursement of social work services.

Social Work Intervention Research With Adult Cancer Patients: A Literature Review and Reflection on Knowledge-Building for Practice

Abstract: The results of a literature review of social work intervention research with adult cancer patients found only a small number of studies conducted by social work researchers. The findings of the review are presented followed by a reflective discussion on the nature of knowledge-building and research knowledge for practice. Knowledge building is considered as a continuous, negotiated process within communities of practice focused on psychosocial perspectives that draw on a range of knowledge sources. Epistemology, worldviews and research orientations are considered along with the values and stance of social work, all of which create the domain of the practice-researcher.

Prolonged Exposure for Treating PTSD Among Female Methadone Patients Who Were Survivors of Sexual Abuse in Israel.

Abstract: The aims of this pilot study were: (a) to test the feasibility of prolonged exposure (PE) therapy conducted by a social worker staff on female patients in methadone program clinics who were survivors of child sexual abuse or rape and (b) to examine preliminary outcomes of PE on posttraumatic stress disorder (PTSD), depression, and illicit drug use at pre- and posttreatment, and up to 12-month follow-ups. Twelve female methadone patients who were survivors of child sexual abuse or rape diagnosed with PTSD were enrolled in 13-19 weekly individual PE sessions. Assessments were conducted at pre-, mid-, and posttreatment, as well as at 3, 6, and 12-month follow-ups. The treatment outcomes measures included PTSD symptoms, depressive symptoms, and illicit drug use. Ten of the 12 study patients completed treatment. PTSD and depressive symptoms showed significant reduction. No relapse to illicit drug use was detected. These preliminary results suggest that PE may be delivered by methadone social workers with successful outcomes. Further research should test the efficacy of PE among methadone patients in a randomized control trial with standard care as the control condition.

Living With Dementia: An Exploratory Study of Caregiving in a Chinese Family Context.

Abstract: This qualitative study explored themes that described families taking care of elderly relatives with dementia in Chinese society. Ten families were invited for two in-depth family interviews involving spousal caregivers, child caregivers, and care recipients. Five themes resulted: positive affection as coping strategies, power and control in the caregiving relationship, adult children's involvement in caregiving, sibling rivalry, and intergenerational conflicts. The ways these themes functioned and helped in dementia care, the research implications, and limitations are discussed.

The Role of Social Work Leadership: Mount Sinai Care, the Accountable Care Organization, and Population Health Management

Abstract: In July 2012, The Mount Sinai Medical Center was selected by the Centers for Medicare and Medicaid to join the first cohort of Accountable Care Organizations (ACOs) in this country under its Medicare Shared Savings Program. A critical component of an ACO is care coordination of patients, which is a complex concept, intertwined with other concepts related to quality, delivery and organization of health care. This article provides an overview of the development, structure and functionality of Mount Sinai Care, the ACO of The Mount Sinai Health System, and how it was the beginning of its work in population health management. It describes the important role of social work leadership in the development and operation of its care coordination model. The model's successes and challenges and recommendations for future development of care coordination and population health management are outlined.