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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
