MCS Social Work What you need to know To get Started

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MCS Social WorkWhat you need to know

To get Started

Kristin Malaer, LCSW CCTSW-MCS

Goals• Understand your Role as an

MCS Social Worker

• Understand Tools that can assist you in evaluation process

• Understand the regulatory guidelines for MCS Social work Practice

Medical Social Work

Spyglass View

Binoculars View

Panoramic View

One and Two Year Rule

It takes one year to be accepted

It takes another year to be respected

MCS Social Work-are you effective?

What are your responsibilities?

What is the interdisciplinary team’s expectations for you as a social worker?

What is your relationship with Palliative Care?

MCS Social Work-are you effective?

Where is your office in relationship to the

MCS Clinic and inpatient unit?

LOCATION, LOCATION, LOCATION

Psychosocial Assessment

Basis for Psychosocial Success

The Patient must be able to acquiesce to

the authority of the physician

The Patient must have someone to think for them when they are not able to think for themselves

MCS - Specific Interview(s)

Patient Interview

Caregiver Interview

Body Image Assessment

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Psychosocial Risk Assessment

Psychosocial Assessment

Numerous Models available; but all include

Insight/understanding of illness and treatment

Family composition, Care Plan, Acceptable Housing

Habits (nicotine, alcohol, drugs, etc)

Psych History, Coping, Adherence

Legal Issues (prison, parole, probation)

*Use what works for you and your Team

Psychosocial Assessment

Home Safety Eval: SW or VAD Coordinator?

But Psychosocial Assessment must address:

Phone

Electricity reliability

Reliable running drinkable water

Environmental Hazards

Psychosocial Assessment

Recommendations for Objective Rating Scale:SIPAT

PACT

TERS

Your own system for objective recommendations

Successful Selection Philosophy

Does your Team listen to your assessment?

Does your Team respect your recommendations?

REMEMBER

You broke it

You bought it

Caregiver Interview

Caregiver Interview

As a Social Worker

Is it your practice to do a separate caregiver interview?

How do you find the time to conduct more interviews and write another report?

Why would you want to talk to family or the primary caregiver alone?

How and where do you “catch” the caregiver alone?

Do you have a template or outline?

Do you use it consistently?

Caregiver Interview

The patient should be fully aware that a separate caregiver interview is going to occur

A Caregiver Interview should be conducted away from patient

The caregiver interview provides an opportunity for the caregiver to be free to share information that otherwise might not be said in front of the patient

Caregiver Interview

The purpose of this interview is to:

Assess caregiver’s understanding of treatment options

Assess expectations of their role as a caregiver

Identify caregiver’s coping strategies and support system

Identify caregiver’s risk factors that may limit their ability to fulfill role, address financial impact and concerns of caregiver

Determine caregiver’s short and long term ability to provide care to patient

Identify the caregiver’s COMMITMENT to the patient

Body Image

Body Image Assessment

What does this topic have to do with

anything MCS related?

Body Image Assessment

Why and how do you assess the body image of a patient with advanced heart failure?

What type of Questionnaire will give “Value Added” to the overall assessment?

Questionnaires for Body Image

The basic standard questions:

How do you rate your Body Image today?

How do you rate your Self Esteem today?

Body Image Questionnaire

Mosele/Taylor Body Image Questionnaire focuses on the patient’s perception of the following:

Past and present fitness

Recovery from past surgeries

Pain expectations and tolerance

Expectations of recovery after MCS surgery

Body Image Assessment FindingsNo experience with pain/recovery

Untested ability to recover from painful medical experience

Inability to recognize physical symptoms

Lifestyles contraindicated for MCS

water sports, showers, immersion in baths

Documentation and Tools

CMS Required documentation for Heart Transplantation

Psychosocial Risk Assessment

MRB/Committee Results

Transplant Event

Post Transplant In Hospital Progress Note(s)

Social Work Discharge Interview

The “SECRET” Note (not required but strongly preferred)

Documentation AssistanceAssessment Statement (at beginning of your written psychosocial): Persons interviewed: (name/relationship)“This report is a reflection of the following interviews: Patient and support system; patient alone; and, caregiver alone.”

Body Image: “The patient has had a normal body image throughout his/her life. Patient was most content with his/her physical being when he/she was a young man/woman, He/she expresses never being discontent wit his/her physical self. He/she has good self-esteem and pride which will assist in preparing him/her for any medical challenge and resulting physical changes.”

Secret Note: “I remain available to assist patient and family/caregivers with any new social work/psychosocial issues that need to be addressed or may be identified.”

ToolsBody Image Questionnaire – STSW.org; Members Only; Assessment ToolsCaregiver Questionnaire-STSW.org; Members Only; Assessment Tools

Agreements/Contracts – Individual ProgramsComplianceCaregiverHousingSubstance Abuse

Decision Aids for Left Ventricular Assist Device (LVAD)https://PatientDecisionAid.orgColorado Program for Patient Centered DecisionsUniversity of Colorado

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Groups (pre and post implant)Weekly, Monthly, Quarterly

QAPISocial Work participate in QI programs

JCAHO Regulations

JCAHO Requirements

DSPR.1: Requirement Specific to Ventricular Assist Device Destination Therapy

Etc. (all other Team members)

A Social Worker

A Palliative care provider

JCAHO Requirements

DSDF.1.4

A social worker who has experience and expertise in the assessment and evaluation of a VAD patient and his or her family

A palliative care provider who has experience and expertise working with a VAD patient and his or her family

JCAHO Requirements

DSDF.2.1-4The program is collaboratively designed, implemented and

evaluated.The Team uses the results of the program evaluation to improve

performance.Social Work Lead QAPI Projects:

Palliative Care Consult MonitoringHospice Evaluation and TrainingTransplant Education Attendance for LVAD patients

JCAHO Requirements

DSDF.4.1

The program demonstrates an interdisciplinary approach for the outpatient management of the VAD patient

QAPI participation

Support Groups – Interdisciplinary Leadership

Multi-Disciplinary MeetingsConsultations/Collaborations reflected in EMR

JCAHO Requirements

DSDF.4.4

Patient are identified for palliative care when indicated

Patients are referred to palliative care when indicated

Patient receive palliative care services when indicated

What is your relationship with Palliative Care?

Are you the person that fulfills or manages this role?

JCAHO Requirements

DSPM.5.1

The program evaluates VAD patient’s perception of quality of life at the following intervals: pre-implant and post implant at 3 months, 6 months, and every 6 months thereafter

(Research Nurses are usually in charge of above; However, social work group activities are a plus for the program in addressing quality of life)

JCAHO

DSPM.5.1 Quality of Life

VAD patient’s perception of quality of life

Body Image Assessment

Adaptation Counseling post implant

Support Groups

Socialization Groups/Events

Specialized Groups (VAD and Gastric Sleeve Group)

Talking Points

Talking Points - DiscussionLying or deliberate omission of information

The secret pending divorce

Addiction on part of caregiver

Patient becomes homeless due to …..

The patient has no money for transportation, food, electricity, etc.

The Coerced Caregiver

“We will do whatever it takes”

Talking Points - DiscussionDid you know in advance that the care plan would fail?

What were the red flags?

Sometimes the care plan goes wrong in ways that you could not predict.

At times you know something is wrong, but you cannot put a finger on it.

Do you notify the Team before MRB/Committee or during MRB/Committee of potential problems?

Do the Doctors ignore your recommendations?

How does that make you feel?

What did you have to do to fix the failed care plan?

Clinical Social Work Interventions

Coping Skills Lifestyle Changes

Crisis Intervention

Family Counseling Individual Counseling

Bereavement Counseling

Team Collaboration/Reality Check/Counseling

Community Assistance: Food, clothing, shelter

Medication Assistance Insurance Direction

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