Social workers are change makers

Abstract

Nephrology social workers focus on minimizing the risk of social determinants on health outcomes for people with end-stage renal disease (ESRD). While the profile of the ESRD patient is older with more medical complexities, the healthcare system has become more complicated to access, with resources becoming more scarce. To work more effectively, nephrology social workers have developed classes for depression management, rehabilitation, smoking cessation, wellness, grief resolution, transplant education, wellness programming, etc., that create support partners to decrease isolation, decrease depression, increase adherence to medical recommendations, and increase transplant referrals. Social workers are acutely aware of the social determinants that impact treatment outcomes for patients, experiencing multiple losses from chronic kidney disease over the course of their lifetime. Thus, identifying barriers to treatment outcomes is critical. Outcomes Driven Nephrology Social Work seeks to isolate these barriers and quality indicators, such as survival, quality of life and cost containment, and develop interventions to ameliorate the barriers and improve outcomes.1 Since publication of my 1998 article in D&T, the Dialysis Outcomes Practice Patterns Study (DOPPS) found, a significant association between depression and increased risks of morbidity and hospitalization. DOPPS acknowledged the need for improved identification and management of depression. Nephrology social workers, educationally prepared to provide counseling, will continue to serve as the lead mental health providers to ESRD patients.2 Several models of depression management for ESRD patients are available as an outgrowth of the Outcomes Driven Model. However, perhaps the most promising model, which is also time and cost efficient, is Symptom Targeted Intervention (STI) developed by Melissa McCool in 2010. In STI, the most problematic symptom of depression is identified and treated using cognitive, behavioral and mindfulness techniques. The focus and intervention with the patient is brief and, thus, well suited to nephrology social work practice. STI is based on systems theory, so it follows that if depression is a system made of up various symptoms and one of the symptoms improves, the trajectory of the depression episode changes.3, 4 The social worker using STI uses the Cognitive Triad, developed by Beck in 1976 to explain to patients the idea of Systems Theory, i.e., changing a thought can lead to a change in a feeling, which will then lead to a change in a behavior. Giving back control to people with chronic illness can be essential in creating autonomy and enhancing self-management. Health-related quality of life measurement is now mandated by the Conditions for Coverage (CfC) and can be used complementarily with depression management. The interdisciplinary team must provide the necessary care planning, monitoring and interventions to support the needs of the patient as measured by a standardized mental and physical assessment tool at regular intervals, or more frequently on an as-needed basis. Additionally, the CfCs promote the original intent of Medicare funding for End Stage Renal Disease patients—rehabilitation. The CfCs require that the interdisciplinary team develop a plan of care for each patient that includes rehabilitation status. Other concrete barriers are the circumstances that many people find themselves in today with deductibles and copayments increasing and insurance premiums being a bigger part of the take-home check, makes buying the right food for the renal diet and getting all of their medications increasingly difficult. Nephrology social workers continue to work as part of the interdisciplinary team to promote improved bone metabolism, a healthy diet, blood sugar monitoring, and a healthier lifestyle for patients by helping the patient problem solve in a tightening healthcare economy, increasing unemployment, and overstretched federal and community resources. Nephrology social workers restore hope, create change, reduce barriers, promote rehabilitation, change futures and partner with management to improve outcomes. Appropriate task assignment and management support are prerequisites to maximize nephrology social work.