System Capacity Initiative Social Work Workforce Working Group Update

Transcription

1 System Capacity Initiative Social Work Workforce Working Group Update Jane Dabney, LISW-S, OSW-C The Cleveland Clinic Foundation Marion Kalbacker, MSW, LCSW Duke University Medical Center Tandem Meetings BMT Center Administrators Conference February 13, 2015

2 Financial Disclosure - None 2

3 Learning Objectives At the conclusion of this activity, you will be able to: Summarize the scope of the NMDP System Capacity Initiative (SCI) Define aims of the SCI Social Work Workforce Group (SWWG) Discover the key findings of the Social Work Workforce Survey Review the BMT Clinical Social Worker Role Description Summarize audience dialogue around challenges and solutions to optimally utilize social workers as core members of the BMT Team 3

4 System Capacity Initiative Background Analysis of the U.S. health care system s capacity to support the increase in patients needing transplant by 2020* Collaboration by representatives of all facets of BMT Recommendations and solutions for issues affecting the delivery of BMT** * Analysis by NMDP and CIBMTR estimates a need of approximately 21,000 allogeneic transplants based on current indications in patients up to age 74. ** Also referred to as HCT.

5 Professional Organizations and Stakeholder Engagement 5

6 Steering Committee SCI Organization and Participants Year 5 ( ) Workforce Groups Participants Physician Nurse Practitioner / Physician Assistant Nursing Pharmacy Social Work National Marrow Donor Program /Be The Match American Society of Blood and Marrow Transplant Special Interest Groups Center for International Blood and Marrow Transplant Professional Societies U.S. Transplant Centers Transplant Experts Hospital Administrators BMT Program Administrators Government Payers Patient Advocacy Organizations 6

7 Social Work Working Group Geographic Representation 7

8 Social Work Working Group Aims Assessment of the BMT SW Workforce Identify care models that optimally utilize social workers as core members of the BMT Team Recommend innovative solutions to meet the psychosocial care needs of patients and families 8

9 Social Work Workforce Working Group Conduct SW Workforce Survey and publish findings Educate others on the specialized role of the BMT clinical social worker including: Members of the multidisciplinary team Program administrators Care management/social work department leaders Provide recommendations to: Structure care delivery models to fully utilize clinical social workers in delivering patient-centered psychosocial care to optimize outcomes Enable clinical workers to practice at the top of their licensure 9

10 BMT Clinical Social Worker Workforce Challenges Variation in level of integration of the SW within the core BMT team Barriers to practice at the top of licensure e.g. time spent clerical tasks; covering non- BMT service lines Increasing patient caseloads with no increase in FTEs Proposed Solutions Care models and processes that involve the SW at key points in patient care throughout the transplant continuum Dedicated staff resources for clerical tasks, lodging referrals, etc. Dedicated SW FTEs to BMT Program Recognition of the impact of psychosocial care on patient outcomes 10

11 Social Work Workforce Survey Aims Understand the structure of SW within BMT programs Describe the role of BMT clinical social workers Assess social workers job satisfaction and support for their roles Identify the challenges that affect social workers ability to meet the needs of their patients/families Identify the capacity and challenges in assuring adequate SW staffing for future BMT needs 11

12 Social Work Workforce Survey Methods The survey was in the field for 1 month October to November 2013 The online survey (SurveyGizmo) was sent to 160 NMDP network BMT social workers and interested APOSW and AOSW members Sent 2 follow-up s, made 1 set of follow-up phone calls and sent 1 final reminder Received 91 replies (57% response rate) from social workers from 66 different transplant centers 12

13 Table 1. Demographics of Clinical Social Work Workforce Survey Respondents by Hospital Program N(%) Total 13 Care Management and Social Work BMT and Hematology/ Oncology N=88 N=58 N=30 Gender Female 80(91) 53(91) 27(90) Male 6(7) 3(5) 3(10) Age (Years) < 41 38(43) 24(41) 14(47) (24) 14(24) 7(23) > 50 29(33) 20(34) 9(30) Years as BMT CSW < 6 41(47) 26(45) 15(50) (23) 15(26) 5(17) > 10 22(25) 13(22) 9(30) Ethnicity Not Hispanic or Latino 79(90) 51(88) 26(87) Hispanic or Latino 4(5) 3(5) 1(3) Race White 75(85) 47(81) 26(87) Black or African American 8(9) 5(9) 3(10) Asian 3(3) 3(5) - Columns may not add up to 100% because some respondents selected decline to answer or did not answer BMT Blood and Marrow Transplant ; CSW Clinical Social Work

14 Table 1. Continued Total Care Management and Social Work BMT and Hematology/ Oncology N=88 N=58 N=30 Mean social work FTE (range) 1.76(0-6.8) 1.78(0-6.8) 1.23(0-5) 2010 BMT volume (patients) < 50 25(28) 16(28) 9(30) (19) 10(17) 7(23) > (49) 31(53) 12(40) Populations served by respondents* Pediatric inpatient 28(31) 22(38) 6(20) Pediatric outpatient 27(30) 21(36) 6(20) Adult inpatient 45(49) 29(50) 16(53) Adult outpatient 60(66) 37(64) 23(77) Columns may not add up to 100% because some respondents selected decline to answer or did not answer BMT Blood and Marrow Transplant; CSW Clinical Social Work *Column will exceed 100% due to check all that apply option 14

15 Time Spent Addressing Patients / Families Psychosocial Needs (N=83) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4% 11% 17% 22% 47% Referral to financial assistance, entitlement programs* 17% 5% 18% 12% 10% 32% 6% 9% 4% 38% 35% Individual, family, or group counseling 13% 16% 17% 14% 28% 11% Case management* 22% 22% 27% 25% 20% 33% 7% 16% 11% 12% 10% 4% 8% Crisis intervention Psychosocial assessment for BMT patients Anticipatory grief and bereavement counseling Daily 4 times/week 3 times/week 2 times/week 1 time/week <1 time/week 15 *Non-clinical responsibilities

16 Question: How much do you agree or disagree with the following statement, My clinical social work expertise is utilized to the fullest potential (N=88) Agree (60%) I am fortunate to be a part of a team that strives to enhance and utilize all of our skills, both clinical and non-clinical. We have a supervisor that supports enhancement of our expertise. Neutral (24%) Because I am assigned to not only [BMT] patients but other hematology/oncology patients as well. I feel like I do not have time to provide the adequate support to [BMT] Disagree (18%) There are many days when I need to spend too much time filling out forms or applications. I also don't feel that my team recognizes my clinical skills and will call in a psychiatrist or psychologist without checking first with the social worker who usually has a thorough knowledge of family situation.

17 Percentage Top 3 Most Satisfying Aspects of CSW Role Ability to provide psycho-social care over the continuum of care Opportunity to work with patients and families in life threatening situations Working as a valued member of a team 17

18 Percentage Top 3 Least Satisfying Aspects of CSW Role Insufficient time to provide clinical social work services Emtional drain of caring for chronically or critically ill and dying patients Insufficient salary 18

19 Question: Please help us understand how workforce challenges impact your ability to care for patients (N=88) Prioritizing competing patient needs (59%) [ ] I don't have enough time for routine follow-up as they proceed through the transplant process. Prioritizing is often done on a crisis basis. I feel that if I had more time to see my patients more regularly, these crises could sometimes be averted... Uninsured or underinsured patients (41%) I spend so much of my time in resource management, trying to find money for patients who do not have any [ ] other disciplines do not understand that I am a trained therapist. Caring for patients in more than one program (40%) [ ] I am responsible for multiple service lines e.g. pediatric oncology, general hematology and BMT [ ]

20 Report of BMT Social Worker Shortage 20

21 Percentage Where do you expect to be in 1 to 3 years? Same institution, same potition/title 14 Same institution, more advanced position/title 11 Different institution, but similar or more advanced position/title 7 Retire 3 Leave social work entirely for a career change 7 Other 21

22 What Does a Social Worker Do?. 22 Source: Yeliab Eniahsor

23 Defining our Role During the World Café at the BMT Center Administrator's Conference Tandem 2014 Need identified To better understand the BMT clinical social worker skill-set SCI SW WG developed BMT Clinical Social Worker Role Description document User testing (N=28) Feedback from multidisciplinary team members Endorsement AOSW APOSW NMDP /Be The Match 23

24 Review of BMT Clinical Social Worker Role Description The purpose of the document is to educate health care professionals, BMT program staff, social work department leaders on the role of BMT social worker Describes: Educational background Core competencies Aims of BMT Clinical SW interventions Unique psychosocial care needs of BMT patients 24

25 Recommendations Ensure comprehensive psychosocial care interventions occur at key time points along the transplant continuum Transplant consultation Work-up evaluation Inpatient phase Outpatient/survivorship follow-up End-of-life 25

26 Recommendations cont. Consistently and actively involve BMT clinical social workers in treatment planning and decision-making Implement care models that enable BMT social workers to practice at the top of their licensure 26

27 Audience Discussion Please share some of the successes your transplant center has had with care models that optimally utilize social workers as core members of the BMT team. To fully utilize the skill-set of the BMT Clinical SW? How has the utilization of the BMT social worker s clinical skills been promoted in your program? How might your transplant center utilize the BMT Clinical SW role description document? 27

28 Future Initiatives of the SW Workforce WG Podium presentations at national meetings Leaders in Building Capacity: Advocating for the Role of BMT Clinical Social Workers APOSW, May 13-15, 2015 AOSW, May 20-22, 2015 Development of a training curriculum for new BMT social workers Identify future research to better understand the impact of social work interventions on patient outcomes 28

29 Social Work Workforce Group Membership Co-Chairs Jane Dabney, LISW-S, OSW-C Marion Kalbacker, MSW, LCSW Members Nancy Barbach, MSW, LCSW Nancy Boyle, MSW, LCSW Carrie Breitwieser, LISW-S, ACHP-SW Eleanor Bruin, MSW, LCSW Erica Bryan-Wegner, LICSW Tiffany J. Courtnage, LICSW Mary Crooks, MSW, LCSW Sumnee Joo, MSW, MPH, LMSW, CHES Jeanette Lavecchia, MSW, LCSW ( ) Eleanor Leary, MSW, LICSW Kathy Roundtree, MSW, LCSW Andrea Starkschall, LCSW, OSW-C Anita Vargas, MSW, LSW Elyse (Burk) Wells, LSW, MSW, OSW-C NMDP Ex-Officio Jeffrey Chell, MD Elizabeth Murphy, EdD, RN NMDP Lead Staff Stacy Stickney Ferguson, MSW, LICSW Jill Randall, MSW, LICSW Nicole Heino (admin.) Health Services Research Staff Support Ellen Denzen, MS Viengneesee Thao, MS 29

30 Questions or Comments Jane Dabney: Marion Kalbacker: 30