Social Work Resources Research Articles

Abstract A122: Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability

Abstract Background: The rapidly growing population of older adults and racial/ethnic minorities with cancer necessitates innovative patient navigation strategies to address their unique needs. Our Enhanced Vulnerable Elders Navigation (EVEN) Program aims to increase the capacity to deliver high-quality, evidence-based oncology patient navigation services at a comprehensive cancer center, with the goal of improving equity in cancer care delivery. Methods: Based on a comprehensive needs assessment, the EVEN Program comprises three main domains: health information technology infrastructure enhancements, navigation workflow standardization, and stakeholder engagement. The primary outcome measure is time to treatment initiation. A quasi-experimental design compares outcomes of older adults with cancer who receive enhanced navigation during the implementation period to outcomes of historical controls (matched by age, race, and ethnicity) who received standard navigation during the lead-in "pre-implementation" period. We hypothesize that the EVEN Program will improve the timeliness of cancer treatment initiation among vulnerable older adults. Univariate and multivariable analyses using cox regression models will adjust for patient and health system factors. Logistic regression will assess the likelihood of treatment delay between the standard navigation and EVEN groups. Process metrics across multiple domains will be analyzed at 6-month intervals over 2 years. Qualitative interviews with program stakeholders will provide nearly real-time feedback on program implementation. Baseline Data Approximately half of newly diagnosed cancer patients (N>3000) seen at our institution's main campus in 2021 received navigation services, and at least half of those patients are estimated to be 65+. Patient navigators addressed language/communication barriers (17% of navigated patients) and social determinants of health (15%); they facilitated communication and emotional support (45%) and routinely made referrals to clinical care team members (39%) and for resource coordination (37%), such as interpreters, social work, financial counseling, and external resources. Most navigator contacts were in person (61%), followed by phone calls (34%). We found wide variation in time to initial cancer treatment across cancers, suggesting opportunities for improvement in care coordination. Conclusion: Our multi-component enhanced patient navigation program is conceptually grounded, innovative, with the potential to reduce cancer disparities among older adults from vulnerable populations. Our multidisciplinary project team includes expertise in geriatric oncology, implementation of patient navigator programs, health equity, community partnerships, and patient navigators with over 30 years of experience in compassionate coordination of cancer care. If proven feasible and effective, the EVEN Program has the potential to scale to our entire enterprise, other health delivery systems nationally, and long-term, to improve equitable cancer care for underserved older adults with cancer. Citation Format: Ana Tergas, Annette Mercurio, Lauren Cai, Lorena Gaytan, Marianne Razavi, Deborah Lefkowitz, Chrissy Kim, Terry Hernandez, Steven Morales, William Dale, Narissa Nonzee. Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A122.

Study protocol for NeuroCARE: a randomised controlled trial of a psychological intervention for caregivers of patients with primary malignant brain tumours

IntroductionCaregivers of patients with primary malignant brain tumours experience substantial psychological distress while caring for someone with a progressive, life-limiting neurological illness. However, there are few interventions aimed at addressing...

The Shalem Counselling Assistance Plan for Students (CAPS): Delivering Social Work Services to Faith-Based School Systems

In Ontario, Canada, non-Catholic faith-based schools do not receive provincial government funding but are funded primarily by families of students and through fundraising. As a result, historically school-based provision of counselling or school social work resources to students has been the exception rather than the rule, as this has typically been considered an adjunct resource. A new initiative was launched in the province of Ontario in 2011 to address this gap, the Counselling Assistance Plan for Students (CAPS). CAPS was premised on another novel idea, a Congregational Assistance Plan, which itself grew out of concepts derived from Employee Assistance Programming that has roots dating back to the 19th century in Canada. While CAPS has parallels to Student Assistance Programming (SAP), which exists throughout the United States, development of SAP has not taken hold in Canada. This article examines the origins of CAPS, its development, and the nature of assistance it has provided to the schools that have been early adopters.

Baseline Characteristics of Patients Undergoing Brachytherapy for Gynecologic Cancer (GYN-BT) and the Role for an Enhanced Recovery Pathway (ERP)

<h3>Purpose/Objective(s)</h3> ERPs have been adopted by many surgical specialties and have demonstrated improved outcomes, including shorter hospital stay, decreased healthcare costs, improved time to functional recovery and patient satisfaction.¹ There is no current data evaluating ERP for patients undergoing brachytherapy. We plan to implement an ERP for patients with gynecologic malignancies, who will receive brachytherapy, with the goal to standardize and optimize the peri-operative phase and evaluate the impact on patient experience. <h3>Materials/Methods</h3> A single institution, prospective study evaluating the outcomes of patients undergoing GYN-BT before (33 patients) and after (33 patients) the implementation of an ERP. The ERP will include multidisciplinary interventions that span the pre-, intra-, and post-operative phases; including pre-habilitation, early referral to social work and psychiatric services, patient/caregiver education, pre-operative carbohydrate-loading, goal directed fluids, and opioid-sparing analgesia. Questionnaires to assess patient reported outcomes (PROs) at baseline, post-brachytherapy, and 60-day follow-up are collected. The EORTC QLQ-C30 consists of 30 items scored on a 4-point Likert scale and linearly transformed to a score, ranging from 0-100. Higher scores for functional scales and global health represent a favorable outcome, whereas a higher score for a symptom is unfavorable. A difference >10 was considered significant. <h3>Results</h3> Sixteen patients have been enrolled on study and completed baseline PRO questionnaires. Mean EORTC-QLQ-C30 global health score was 41.7, comparing unfavorably to the reference population of females with any cancer diagnosis²(59.3). Social functioning was worse (58.3) compared to the reference population (72.1), but there was no significant difference in physical, role, emotional or cognitive functioning. Additionally, this patient population had a significantly higher symptom burden, specifically fatigue (48.6 vs 37.7), nausea/vomiting (21.9vs 10.8), appetite loss (35.4 vs 23.8), and diarrhea (20.8 vs 9.3). Notably, mean score for financial difficulties was 45.8, more than double the reference value of 17.5. A significant proportion of patients described depression (56.3%), worry (68.8%) and interference with family life (62.5%). <h3>Conclusion</h3> Baseline data show that female patients with gynecologic malignancies represent a population with high-symptom burden and social stress. This data highlights the significant need for improved social support and multi-disciplinary care. We propose an ERP, with pre-habilitation and medical optimization, in combination with early referral to social work and psychiatric resources to standardize and improve care for this high-risk patient population.

Perceptions of Social Workers in the School Social Work Project: The Need for Multicultural Education

Multicultural education is the key to the development process of culture of living together, emphasising human rights. In the legal sense, the study underlines the importance of school social work practices in terms of ensuring Syrian children to have unrestricted access to education in addition to providing them with equal opportunity in education. In the light of those practices, the motivation of the study is to discover social work academics’ perceptions of the path to multicultural education in Turkey and recommendations on how to integrate it into the current educational structure. For this purpose, in-depth interviews were conducted with ten social workers who took part in the “School Social Work Project”. The education structure in Turkey, the attitude towards Syrians, the problems experienced by Syrian individuals and their perspectives on education are summarized as risk factors that affect the participation of Syrian children in education. This study emphasises the importance of establishing cooperation with teachers and non-governmental organisations. With this cooperation, it seems possible to develop multicultural education by integrating the human focus of social work. Therefore, the use of development resources and social work resources together in the context of school social work practices will provide the change that will show the way to multicultural education. The findings point to recommendations such as ensuring family-teacher interaction, adding classes on culture of living together, and integrating non-governmental organisations systematically in the process of multicultural education.

Expanding comprehensive medication management considerations to include responses to the social determinants of health within the BDHelping Build Healthy Communities Program

Expanding comprehensive medication management considerations to include responses to the social determinants of health within the <scp>BD</scp><i>Helping Build Healthy Communities Program</i>

Identify Early and Involve Everyone: Interdisciplinary Comprehensive Care Pathway Developed for Inpatient Management and Transitions of Care for Heart Failure Patients Reported Using SQUIRE 2.0 Guidelines.

IntroductionHeart failure accounts for 1-2% of overall healthcare costs. While the link between re-hospitalization and mortality is unclear, care pathways that standardize inpatient management and establish outpatient follow-up improve patient outcomes and reduce morbidity.AimTo implement a comprehensive interdisciplinary care pathway for heart failure patients with the goal of optimizing inpatient management and improving transitions of care.MethodsTo address this clinical need, New York-Presbyterian Brooklyn Methodist Hospital (NYP-BMH) identified resources needed to optimize patient care, developed an inpatient admission order set (so-called “power plan”), and implemented a multidisciplinary clinical care pathway. The Plan-Do-Study-Act cycle addressed the implementation obstacles. Interdisciplinary rounds guided day-to-day management and addressed barriers. Our team developed a sustainable care pathway, and measured the utilization of pharmacy, nutrition, physical therapy, case management, and social work resources; outpatient appointments were made prior to discharge. We used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines to guide our planning and evaluation of this quality improvement initiative.ResultsOur intervention markedly increased the number of heart failure hospitalizations that were identified on admission, and the use of pharmacy/nutrition services was greater after the intervention. The utilization of our “power plan” promoted adherence to a series of evidence-based best practices, but these measures had no significant impact on readmissions as a whole. The involvement of the case management support team increased outpatient appointments made for patients prior to discharge and aided in the transition of care from inpatient to outpatient management.ConclusionThe management of heart failure patients starts in the hospital and continues in the community. Patients who are treated in a standardized dedicated care pathway have reduced morbidity and better outcomes. Identifying these patients early, involving a comprehensive team, and transitioning their care to the outpatient setting improves the quality of care in these patients.

Abstract PO-045: Experiences of oncologists treating cancer patients living with HIV: Opportunities to improve care and reduce disparities

Abstract Introduction: Prior database studies have demonstrated that cancer patients with comorbid human immunodeficiency virus (HIV) have higher cancer-specific mortality and are less likely to receive cancer treatment. People living with HIV (PLWH) who achieve viral suppression have near normal life expectancy, highlighting the critical importance of reducing cancer treatment disparities. The purpose of this study is to understand how oncologists make treatment decisions for cancer patients living with HIV and to elicit recommendations for improving care in this population. Methods: We conducted in-depth interviews with 25 attending medical, radiation, and surgical oncologists from Duke University, University of Utah, and community practices in Florida, Georgia, Louisiana, Pennsylvania, and Virginia who had recently engaged in a consultation with PLWH and cancer. In semi-structured interviews, we explored three domains: (1) care coordination with other healthcare professionals, (2) knowledge and attitudes regarding patients with comorbid HIV and cancer, and (3) recommendations for improvements in care delivery. Two analysts coded the data using ATLAS.ti. We utilized applied thematic analysis to identify inductive themes across the three domains. Results: Many participants (n=11) reported always communicating with a patient's Infectious Disease (ID) doctor, and others (n=5) said they only communicate with ID if the patient's HIV is not well-controlled. Ten medical oncologists noted they found it helpful to speak to an HIV pharmacist, particularly about drug-drug interactions. Participants also discussed efforts to connect patients with supportive services, such as transportation, payment assistance, and mental health counseling. Many participants described concerns in discussing the patient care plan in the presence of caregivers, given the possibility that patients have not disclosed their HIV status. None of the participants had formal training in management of comorbid cancer and HIV, and most noted that they learned through their own clinical practice. Participants made suggestions for improving treatment decision-making for PLWH, including: more evidence of the risk-benefit ratio of treatment (e.g. treatment goals, life expectancy calculators), greater access to social work and mental health resources, streamlined access to communication with HIV providers, and multidisciplinary HIV cancer rounds. Conclusions: This is the first physician-focused qualitative study interviewing oncologists caring for PLWH. Communication among multiple healthcare providers, particularly oncologist and ID doctor, are noted to be common but not universal in the care of comorbid HIV and cancer. Formal training in cancers in PLWH is lacking in medical training. Future steps to reduce disparities in cancer treatment and outcomes for PLWH may include the establishment of multidisciplinary HIV cancer rounds, facilitating connection and communication between healthcare providers, and enhancing supportive care resources for patients. Citation Format: Ashley Khouri, Jeanette Young, Patrick Galyean, Brandon Knettel, Emily M. Cherenack, Anthony Ariotti, Noelani Ho, Susan Zickmund, Melissa Watt, Kathryn Pollak, Peter Ubel, Angela Fagerlin, Gita Suneja. Experiences of oncologists treating cancer patients living with HIV: Opportunities to improve care and reduce disparities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-045.

Using Quality Improvement and Technology to Improve Social Supports for Hospitalized Children.

To develop and test the feasibility of a caregiver self-administered social needs screener, a Web-based searchable community resource map, and a process map for implementation of these tools as part of social needs screening and referral on a pediatric inpatient unit. A multidisciplinary team used quality improvement methodology to develop an electronic social needs screener, resource map Web site, and electronic health record enhancements. A process map for implementation of these tools was refined through plan-do-study-act cycles before full implementation. Weekly measures included the number of eligible caregivers screened, prevalence of reported social needs, and use of social work resources. During the 22-week study period, 147 caregivers were screened and 2 declined to participate. Thirty-four percent of caregivers endorsed ≥1 social need. The most common needs identified were depressive symptoms (23%), food insecurity (19%), and need for assistance with utilities (10%). All participants received information about the resource map, and 99% of caregivers with an identified need met with a social worker during their admission. Using quality improvement methodology and technology, the team implemented a new standardized process for addressing social needs on an inpatient unit. This led to identification of social needs in more than one-third of caregivers screened and provision of resource map information to all caregivers. These findings reinforce the importance of standardized assessment of social needs in the pediatric inpatient setting. The role of technology, including resource maps and electronic health record enhancements, was highlighted.

Screening for Health-Related Social Needs of Emergency Department Patients

There has been increasing attention to screening for health-related social needs. However, little is known about the screening practices of emergency departments (EDs). Within New England, we seek to identify the prevalence of ED screening for health-related social needs, understand the factors associated with screening, and understand how screening patterns for health-related social needs differ from those for violence, substance use, and mental health needs. We analyzed data from the 2018 National Emergency Department Inventory-New England survey, which was administered to all 194 New England EDs during 2019. We used descriptive statistics to compare ED characteristics by screening practices, and multivariable logistic regression models to identify factors associated with screening. Among the 166 (86%) responding EDs, 64 (39%) reported screening for at least one health-related social need, 160 (96%) for violence (including intimate partner violence or other violent exposures), 148 (89%) for substance use disorder, and 159 (96%) for mental health needs. EDs reported a wide range of social work resources to address identified needs, with 155 (93%) reporting any social worker availability and 41 (27%) reporting continuous availability. New England EDs are screening for health-related social needs at a markedly lower rate than for violence, substance use, and mental health needs. EDs have relatively limited resources available to address health-related social needs. We encourage research on the development of scalable solutions for identifying and addressing health-related social needs in the ED.

The Political and Civic Involvement of Students: a sociological research

On a democratic society, it is desirable to consolidate the relation between citizens and political system through a participatory political culture. Romania – as others post-communism spaces – is characterized by a low level of political communication, poor civic involvement and insufficiently cooperation between government and citizens. During this context, the position of the new generation is crucial in consolidating democracy. Previous studies showed that the young Romanian is perceived rather as an outsider in the relation with the system, have a low trust in institutions by comparison with other age categories, and is not optimistic regarding the capacity of public contestation. On long term, these issues can lead either to a decrease of interest on civic engagement and – in time – to the emergence of a democratic deficit or a subject political culture, or to the emergence of anti-system positions. Nowadays, young people have new tools to help developing a participatory culture, such as new media, new forms of political socialization, an increasing interest in non-governmental organizations et. al. The purpose of the paper is to approach a set of indicators specific to civic and political involvement, using data from a sociological quantitative study conducted on a sample of 430 undergraduates’ students from three specializations: Sociology, Social Work and Human Resources (“Alexandru Ioan Cuza” University of Iasi), in order to observe their civic and political attitudes.

Social Work Assessment: What Are We Meant To Assess?

ABSTRACTThe social work assessment, which takes account of a range of factors, contrasts starkly with health assessment tools which focus individually on one small part of a patient’s functioning. The social work assessment may be viewed with suspicion, or even outright hostility, by hospital professionals particularly if the outcome is different to the prevailing opinion of the multi-disciplinary team. Increasingly, obtaining a global, holistic assessment is becoming difficult as hospitals develop a range of strategies to ‘speed up’ the discharge process. These strategies impact patients’ physical and mental health. Older patients with a cognitive impairment are disproportionately affected – the very group whose hospital admissions are rising fastest. As hospital stays shorten, the assessment is done earlier. Social work managers allocate dwindling resources on a basis of need. The social work assessment is increasingly driven by indicators of ‘critical’ and ‘substantial’. Lower levels of need or need that cannot be met by current service provision is simply not recorded. Thus, the social worker bases the assessment on less information, on a patient subjected to additional factors, using indicators designed to control budgets. However, social work resources are charged so patients themselves may pay the price for an inaccurate assessment.

LESSONS LEARNED FROM MULTIDISCIPLINARY TEAM APPROACH TO TACKLING 30-DAY COPD READMISSIONS AT HARLEM HOSPITAL CENTER

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Chronic obstructive pulmonary disease (COPD) readmissions pose a significant burden on patients as well as hospitalization costs. Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for excess all cause readmissions within the 30 days following discharge. Between 10 to 20% of COPD patients are admitted within 30 days of discharge. Multidisciplinary team approach (MDT) has been proposed as a tool to reduce readmission, and was implemented at Harlem Hospital Center (HHC) since July of 2017 (1). We discuss the results and lessons learnt following its implementation. METHODS: MDT at HHC consists of pulmonologist, internist, respiratory therapist (RT), nurses, case manager ,social worker and pharmacist. All working in concert to implement a safer hospital discharge of COPD patients. RESULTS: COPD readmission rate for each quarter from July 2017 until September 2018 has been 14%,10%,38%, 21% and 17% respectively. Further sub-group analysis of COPD readmissions versus non-readmissions revealed that both groups had 100% compliance with pulmonary consults and smoking cessation counseling. Both groups had a less than 10% show rate at the clinics following discharge. Readmission arm had almost 90% more discharges against medical advice (AMA) compared to the non-readmission arm. CONCLUSIONS: There are valuable lessons learnt from implementation of MDT. Previously, we believed readmissions were due to inconsistent inpatient follow up by pulmonologists and low show rates in clinics following discharge. But after analyzing data acquired from MDT at HHC (shown in results), we have realized that highest readmissions are seen in high risk populations, those prone to AMA and multiple social issues. Identifying this high risk population and initiating appropriate interventions can be pivotal in reducing readmissions. Although, specialist care are valuable assets in their initial management but dedicated and adequate care manager/social work services are mandatory to this patient population. CLINICAL IMPLICATIONS: Thus, we at HHC are advocating towards allocating intensive social work resources to these patient population and also suggest that hospitals while adopting MDT, should consider an equally strong and adequately staffed care manager/social work services along with competent specialist services. Reference: 1. Kuzma AM, et al. Multidisciplinary care of the patient with chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4):567-71. DISCLOSURES: No relevant relationships by Raji Ayinla, source=Web Response No relevant relationships by Margaret Olibrice Saint-Fleur, source=Web Response No relevant relationships by Mallika Pradhan, source=Web Response No relevant relationships by Griwan Rajbhandari, source=Web Response

Suicide, Self-harm Considerations in Holistic Audiological Care

Suicide, Self-harm Considerations in Holistic Audiological Care

Using electronic medical record system to improve compliance with national guidelines for comprehensive distress screening in cancer patients.

309 Background: Psychosocial distress screening (DS) and management is associated with improved quality of life and outcomes in cancer patients and is required for accreditation by the American College of Surgeons Commission on Cancer. Comprehensive distress screening (CDS) consists of routine distress screening, evaluation, referral to appropriate psychosocial services, and follow-up to ensure adequate care. Electronic medical record (EMR) systems can be leveraged to facilitate and document CDS as part of clinical care and to evaluate the CDS process as a quality standard. The aim of this study is to develop and implement an EMR-based tool to document and evaluate the CDS process as part of routine oncology care. Methods: An EMR-based tool with structured data fields is developed for social workers to document risk factors for distress, assessment, management plan including psychosocial service referrals, and time spent delivering care following DS using the NCCN distress thermometer (DT). Evaluation of CDS process is done in cancer patients who have documented psychosocial care in the EMR-system from 1/2017-5/2018. Results: During the study period, 1327 cancer patients underwent 2480 distress screening evaluations. The average distress score was 3.2 (median = 2) on the DT scale of 0-10, with 855 (64%), 326 (25%), and 146 (11%) patients reporting on average mild (0-3), moderate (4-6), and severe (7-10) distress respectively. 400/1327 (30%) patients accounted for 1177 documented social work contact/visits, of which financial (40%) and emotional (15%) were the most common concerns. 89% (1047) of the visits had follow-up plans and 77% of encounters resulted in referrals, of which financial support (26%) and pharmacy assistance (22%) were the most common referral services. The average time spent on each psychosocial care visit was reported to be 21 minutes. Conclusions: EMR-based forms with structured data fields can be used to document and promote improved adherence to national guidelines for CDS as part of routine oncology care by facilitating data collection. Such tools can be leveraged to capture relevant data on impact of CDS on social work resource utilization.

Incorporating Depression Screening into Diabetes Clinics across the T1DX Learning Collaborative

Objective: Depression contributes to suboptimal health outcomes amongst people with type 1 diabetes (T1D). The ADA standards of care recommend regular psychosocial screening, however these guidelines are not universally implemented. Aim: Demonstrate feasibility of expanding depression screening across clinics in the national T1D Exchange Learning Collaborative (T1DX-LC) using a quality improvement (QI) approach. Methods: Six clinics in T1DX-LC participated in bi-monthly calls and three learning sessions for depression screening. Sites shared existing resources and used QI methodology to design iterative plan-do-study-act cycles to develop or refine existing processes and adopt interventions in their respective contexts around the following themes: 1) consistent screening and referral criteria, 2) integration of screening into work flow, 3) acceptance from families and staff, 4) adequate social work and psychology referral resources, and 5) incorporation of health information technology. Results: Screening increased from baseline of 10% across sites to 60% of eligible patients at all sites over 18 months (Figure). Discussion: Through the T1DX-LC, a network of centers were successful at completing depression screening in alignment with ADA standards of care. Sites expanded screening to individuals with type 2 diabetes and additional centers are joining the screening intervention. Disclosure S. Majidi: None. M.C. Jolly: None. G.T. Alonso: None. D.A. Buckingham: None. A.B. Cabrera: None. M.A. Clements: Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Glooko, Inc.. A. Garrity: None. K.A. Gibbs: None. B. Glick: None. K. Hong: None. M.K. Kamboj: None. K.L. Lambert: None. J. Lee: Consultant; Self; Unitio. P.V. Nadkarni: None. R. McDonough: None. A.L. Ohmer: None. N. Rioles: None. K.R. Stanek: None. S. Thomas: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. S. Corathers: None.

“Calibrating” the Distress Thermometer: Demographic and Clinical Determinants of Reported Distress Among Patients Presenting for Radiation Oncology Consultation

Cancer patients are known to experience high levels of various forms of psychosocial distress, which can be heightened during periods of transition or uncertainty. Initiation of radiation therapy can be a distressing experience for many patients. The NCCN currently recommends screening all cancer patients for distress using a thermometer (scoring 0-10) and questionnaire to identify patients who may benefit from referral to social work or mental health resources. This study aims to determine clinical and nonclinical factors that are associated with higher levels of patient distress and demographic differences in distress reporting to help inform better identification and treatment of distress in the radiation oncology patient population. An IRB approved retrospective analysis was conducted following a one year period of accrual of completed distress screening forms from 129 patients upon their initial consultation by one institution's Department of Radiation Oncology. Clinical data, including cancer site/stage, and demographic data, including race, age, and gender, were linked with the distress data. Both univariate and multivariate analyses were conducted to clarify the relationships between these clinical and non-clinical factors on measures of patient distress. Cancer stage was positively associated with distress scores. On average, each increase in stage added 0.80 points to one’s distress score (p<0.05). Patients with skin cancer had higher levels of distress than those with cancers of other sites (p<0.05). Among specific questionnaire items, feelings of sadness, fear/worry, or depression and concerns about pain were the most predictive of higher distress scores. Among these, feeling fear/worry had an 82% sensitivity (95% CI 59-94) and 71% specificity (95% CI 59-81) for a distress score of 7 or greater. Gender, age, and race were not associated with distress scores. Compared to Caucasians, African Americans had a higher prevalence of concerns about finances/insurance, transportation, work/school, and spirituality/religion, independent of distress score. Notably, 54% African Americans reported having concerns about finances/insurance, compared to 16% of Caucasians (p<0.0001). Patient reported distress scores are associated with cancer site and stage and specific emotional and physical factors, and race is associated with key differences in reported components of distress. Increased awareness of how the specific factors identified are associated with distress levels can allow social support services to be better tailored to the individual needs of the radiation oncology patient. Further, this analysis can help develop criteria other than a numerical distress score cutoff to be used as a trigger for referrals to social support services.

Social work interventions in Sweden for patients newly diagnosed with type 1 or type 2 diabetes

ABSTRACTWe evaluated psychosocial work with patients in ordinary clinical practice who were newly diagnosed with type 1 or type 2 diabetes and experienced psychosocial problems at disease onset. We examined types of psychosocial problems, causes of these problems, psychosocial interventions, extent of achievement of psychosocial treatment goals, and whether the patients felt they benefited from the treatment. Eighty-nine working-age (18–65-year-old) Swedish adults newly diagnosed with diabetes were included. Each was interviewed and responded to questionnaires at the beginning and end of the study period. Thirty-four (38%) received psychosocial treatment as needed over 2 years. A psychosocial treatment plan with a defined goal was developed for each. Interventions included counseling, problem-focused support, social information, and advice. The treatment process was documented. Eighteen patients had type 1, and 16 had type 2 diabetes. One-third had emotional problems directly caused by receiving a diagnosis. Several of them had crisis reactions. The rest had problems primarily caused by their life situations. Those with psychosocial problems caused by receiving a diagnosis achieved treatment goals more frequently than the others. Distinguishing the cause of the psychosocial problems of newly diagnosed patients may help ensure that social work resources in health care are used as effectively as possible.

Innovations in Governance: Application to Social Work

This article provides a conceptual framework of utility to social work clinicians, administrators, and resource brokers to increase knowledge of the current paradigms driving the environment in which social workers practice. The historical government paradigm is compared and contrasted with the developing innovative governance paradigm. Elements of each are reviewed and applied to current practice. The core values and skills of generalist social work practice are then highlighted and compared to each dimension of the dueling paradigms. Finally, this article demonstrates that social work is inherently aligned with the ‘emerging’ and innovative governance paradigm, under which social work practitioners have been unknowingly, yet successfully operating within for decades.

Hospital leadership perspectives on the contributions of Ronald McDonald Houses. Results from an international survey.

The purpose of this paper is to describe an international survey of hospital executives and administrators' perspectives on the contributions of their affiliation with a Ronald McDonald House (RMH) as an example of accommodation in family-centered care to the hospital's mission, operations and patient experience. RMHs worldwide provided the names and e-mail addresses of the people holding key leadership positions in their main hospital partner, who in turn were invited to complete an internet-based survey (530 participants; response rate of 54.5 percent). Hospital leaders reported very positive opinions about the contributions of their RMHs affiliation to their ability to serve seriously ill children and their families. This included such important outcomes as increasing family integrity and family participation in care decisions; and decreasing psychosocial stress and hospital social work resource burdens associated with lodging, food, transportation and sibling support. Hospital chief executive offices (CEOs) and medical directors reported very strong and positive opinions regarding the value-added of their RMHs affiliation in many areas, including enhanced marketing of hospital specialty services and reduced length of stay. Survey response bias is a limitation, although the results are still useful in terms of identifying multiple ways in which RMHs are perceived as contributing to hospitals' operations and provision of family-centered care. Overall, the results suggest that, internationally, hospital leaders believe that RMHs play a key and valued role in their provision of family-centered care to seriously ill children and their families. Family accommodation is more than the simple provision of lodging and plays an integral role how hospitals approach family-centered care. This international study contributes to the general literature on the role of family accommodation in hospitals' provision of family-centered care and the specific and very sparse literature on RMHs in particular.