Psychosocial Assessment, Intervention and Treatment Planning N. Joel Fry, MSW, LISW President, TEAM Restoration Ministries, LLC Consultant, Weatherbee Resources, Inc. MDP Faculty, National Hospice and Palliative Care Organization Simpson College Adjunct Faculty University of Iowa School of Social Work Adjunct Faculty Ministries, LLC 1 Handouts Please click the links button below the video. You can save and/or print the documents. Ministries, LLC 2 Objectives Define the components of the psychosocial assessment in end-of-life care. Identify the psychosocial assessment s relevance to the IDG. Identify the social worker s role in enhancing the psychosocial assessment. Ministries, LLC 3 1
Social work areas of expertise what are they? Aggressive/palliative decision Hospice transition Processing the course of illness Life cycle transition Support patient and family Bereavement support Ministries, LLC 4 Social workers how can they help? Counselor vs. therapist IDG member Advocate Liaison Ministries, LLC 5 Psychosocial assessment how should it happen? At time of admission In conjunction with another IDG member?? With patient and caregivers Time allotted to learn about the patient and caregivers At convenience of patient and caregivers - Reese & Raymer, 2004 Ministries, LLC 6 2
Psychosocial assessment what s the purpose? Initial assessment information Biological information Psychological information Social information Spiritual information - Reese & Raymer, 2004 Ministries, LLC 7 Social Work Assessment Tool - SWAT Designed to be used at each visit Psychosocial domains assessed Spirituality Death anxiety Social support Denial End of life care decisions Cultural Group Safety Comfort Suicidal ideation Preferences about the environment Assistance with financial resources Complicated anticipatory grief - Reese et al., 2006 Ministries, LLC 8 Psychosocial interventions what are they? Assess, diagnose, screen, and document Stimulate and teach psychosocial coping skills Crisis intervention Nonpharmacological symptom relief Enhance responsiveness of environment Evaluate one s own practice Information and referral Counseling (dying process and anticipatory grief and bereavement) Reminiscence, life review and legacy projects Decision making Pain and suffering management -NHPCO Ministries, LLC 9 3
NASW Standards for Palliative and End-of-Life Care Standard 3 Assessment Social workers shall assess clients and include comprehensive information to develop intervention and treatment planning. - NASW, 2004 Ministries, LLC 10 NASW Standard 3 interpretation Assessment is the foundation of practice. Social workers plan interventions with their clients based on assessments and must be prepared to constantly reassess and revise treatment plans in response to newly identified needs and altered goals of care. Comprehensive and culturally competent social work assessment in the context of palliative and end-of-life care includes considering relevant biopsychosocial factors and the needs of the individual client and the family (as defined by the client). - NASW, 2004 Ministries, LLC 11 NASW Standard 3 Assessment should include the following: Past/present health condition (pain, mental health, mobility, etc.) Family structure and roles Family communication and decision making patterns/styles Life cycle stage and developmental issues Spirituality Cultural values and beliefs - NASW, 2004 Ministries, LLC 12 4
NASW Standard 3 Assessment should include the following: - con t Language preference and translation services Care goals Support systems (informal and formal caregivers, resources available, and barriers to access) Past experience with illness, disability, death and loss Mental health (history, coping style, crisis management) Suicide/homicide risk Special population s needs and communication back to the IDG (refugees, immigrants, children, mental illness, homeless, prison, etc.) - NASW 2004 Ministries, LLC 13 Other areas to assess Understanding/preparedness of illness process, imminent death, loss, and anticipatory grief Strengths and vulnerabilities Methods of coping Conflicted relationships Legal documents (POA, DPOAH, Living Will, Estate Wills, Guardianships, etc.) Desired location of death and reality of this desire Quality of life issues Physical environment and promotion of psychosocial well being Volunteer needs Respite or continuous care needs - KFL&A Palliative Care Integration Project, 2003 Ministries, LLC 14 Intervention and Treatment Planning Ministries, LLC 15 5
NASW Standards for Palliative and End of Life Care Standard 4 Intervention and Treatment Planning Social workers shall incorporate assessments in developing and implementing intervention plans that enhance the clients abilities and decisions in palliative and end-of-life care. - NASW, 2004 Ministries, LLC 16 NASW Standard 4 interpretation Social workers in all practice areas use various theoretical perspectives and skills in delivering interventions and developing treatment plans. Initial assessments and team input inform and guide plans of care. Social workers must be able to adapt techniques to work effectively with individuals from different age groups, ethnicities, cultures, religions, socioeconomic and educational backgrounds, lifestyles, and differing states of mental health and disability, and in diverse nonmedical care settings. - NASW, 2004 Ministries, LLC 17 Standard 4 Intervention/Treatment Planning should include the following skills: Ability to recognize and prepare family for signs and symptoms of impending death as guided by the clinical assessment Competence in communication facilitation (family and team) Competence in integration of grief theories Competence in determining i interventions ti based on the assessment Competence in advocating for needed services, including pain management Competence in resources available and making appropriate linkages/referrals Competence in supporting through anticipatory mourning, grief, bereavement and follow-up services - NASW 2004 Ministries, LLC 18 6
Standard 4 Intervention/Treatment Planning often include the following interventions: Individual counseling and psychotherapy (cognitive behavioral interventions) Family counseling Family-team meetings Crisis counseling Information and education Multidimensional interventions for symptom management Support groups, bereavement groups Case management and discharge planning Decisions in various treatment alternatives and the implications Resource counseling Client advocacy/navigation of systems - NASW, 2004 Ministries, LLC 19 psychosocial assessment? Communication time and space Availability Verbal and nonverbal communication of availability Clarify for understanding of concerns Clarify for understanding of client and care team Clear, simple information about how symptoms, issues, and concerns will be addressed Ministries, LLC 20 Communicate respect and acceptance Develop an awareness of the values and beliefs Allow as much control as possible Avoid direct questioning of coping mechanisms allow denial Ministries, LLC 21 7
Avoid premature withdrawal from dying person/family Understand practitioner grief Understand d the natural response of withdrawal from painful emotions Avoid abandonment of the dying Ministries, LLC 22 Accept that dying may be difficult for the person/family Avoid minimizing painful emotion Avoid communication of over-positive view of dying Understand the hospice desire to die a good death Recognize that death may not always be beautiful Ministries, LLC 23 Always be honest Guard against promising Guard against over-committing Guard against being late or changing appointment times Ministries, LLC 24 8
Provide a holistic assessment and treatment plan Convey respect for full range of concerns (physical, social, psychological, spiritual, financial, etc.) Ensure client/family recognizes the entire care team and their roles of assisting Ministries, LLC 25 Communicate your commitment for providing care Ensure that needs and concerns are addressed Be present Ministries, LLC 26 What do the social workers bring to the IDG? Systems-based approach in assessment Multidimensional assessment skills Boundaries Model for open communication Leadership Ministries, LLC 27 9
New Discovery Points 1. 2. 3. Ministries, LLC 28 Contact information N. Joel Fry TEAM Restoration Ministries, LLC 515.238.9010 jfry@team-restoration.org Ministries, LLC 29 Sources http://endoflife.northwestern.edu/social_considerations /understanding.cfm KFL&A Palliative Care Integration Project (2004). National Association of Social Workers (2004). (NASW) National Hospice and Palliative Care Organization (NHCPO) Raymer, M., & Reese, J.D. (2004). Relationships between social work involvement and hospice outcomes: Results of the national hospice social work survey. Social Work, 49(3), 415-422 Reese, D.J., Raymer, M., Orloff, S.F., Gerbino, S., Valade, R., Dawson, S., Butler, C., Wise-Wright, M., & Huber, R. (2006). The social work assessment tool (SWAT). Journal of Social Work in End of Life and Palliative Care, 2(2), 65-95. Ministries, LLC 30 10