DELIVERING SOCIAL WORK SERVICES TO SCI&D PATIENTS THROUGH VIDEO CONFERENCING TECHNOLOGY

Transcription

1 DELIVERING SOCIAL WORK SERVICES TO SCI&D PATIENTS THROUGH VIDEO CONFERENCING TECHNOLOGY E X PA N D I N G T H E H O R I Z O N S B Y: J O Y C E W I L L I A M S, M S S W, L C S W, M S C S C A R O L G I B S O N - G I L L, M D K A R E N F A R R E L L, R N, M A E D V A N E W J E R S E Y H E A L T H C A R E S Y S T E M S S C I / D C E N T E R M S C E N T E R O F E X C E L L E N C E - E A S T / N J R E G I O N

2 DISCLOSURES The presenters of this session have nothing to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with the Paralyzed Veterans of America. Neither PESG nor PVA nor any accrediting organization supports or endorses any product or service mentioned in this activity. PESG Staff and the Program Planning Committee have no financial interest to disclose. Commercial Support was not received for this activity.

3 LEARNING OBJECTIVES Demonstrate how the use of videoconferencing technology is successful in providing direct social work interventions Identify three social work interventions that can be utilized through the use of home videoconferencing technology Describe methods for identifying appropriate participants for videoconferencing

4 INTRODUCTION/BACKGROUND: TRANSITION IN PROVIDING HEALTHCARE WHERE TECHNOLOGY COMES IN : The role of Virtual Medicine and Spinal Cord Injury/ Disorders Length of hospital stay Wound care Rehabilitation Reintegration into community

5 THE HEALTHCARE TRIANGLE : Triangle of Healthy Caregiving

6 Introduction/Background: THE HEALTHCARE TRIANGLE : Where do the caregivers fit when providing care to the veteran with SCI/D? Skilled vs Family/Friends caregivers in the home Caring for the veterans with SCI/D => caring for the caregivers?

7 INTRODUCTION/BACKGROUND EMBRACE THE WHOLE PATIENT WHEN PROVIDING HEALTHCARE: The Whole SCI/D Virtual Medicine Team

8 THE EVOLUTION: Application of telehealth in SCI/D started out here at the New Jersey VA with managing pressure ulcers utilizing videophone technology in 2005.

9 The Evolution continues: Impact new endeavors have on the caregivers?

10 The Evolution continues: Survey Questions: Do you feel burdened by the patient having the wound even though you are not the one doing the dressings? Do you worry about the patient having a wound and his general health? Do you feel any emotional burden for the patient having a wound? Do you feel any physical burden (actual hands-on care) regarding the wound? Do you have any concerns about strangers being in the home to do the care? Although you are not doing the hands on care, do you experience any physical tiredness? Overall how do you feel about having the videophone in the home for wound management versus having your loved one come for an outpatient visit?

11 The Evolution: Results 100% of caregivers reported no physical burden due to the patients wound care. 50% felt emotional burden seen mostly in those caregivers who did not have Visiting Nurse Agency support for wound care despite having the videophones). The other 50% felt reassured because the agency staff was responsible for the hands-on wound care. 100% found the videophones helpful because of: the decreased number of onsite clinic visits removal of the burden of travel easy availability of videophone appointment times easy access to and visual contact with providers about the patients overall health ongoing education regarding wound care

12 TRANSITION As the caregivers were becoming more comfortable with this technology we were able to assess other needs and incorporate other team members to help meet the needs.

13 ACCESS TO CARE S P I N A L C O R D I N J U R Y A N D D I S O R D E R S O F T E N R E S U LT S I N A S U B S TA N T I A L F I N A N C I A L B U R D E N O N B O T H T H E I N D I V I D U A L A N D S O C I E T Y. T H E C O S T S O F S C I A R E AT T R I B U TA B L E T O B O T H T H E I N I T I A L I N J U R Y A N D H O S P I TA L I Z AT I O N A N D T H E S U B S E Q U E N T L I F E L O N G U S E O F H E A LT H S E R V I C E S B Y P E R S O N S W I T H S C I

14 LIFETIME COST Severity of Injury Average Yearly Expenses Estimated Lifetime Cost by Age at Injury (discounted by 2%) First Year Each Subsequent Year 25 Years Old 50 Years Old High Tetraplegia (C1-C4) $1,023,924 $ 177,808 $ 4,543,182 $ 2,496,856 Low Tetraplegia (C5-C8) Paraplegia Asia ABC Incomplete Motor Functional at Any Level Asia D $ 739,874 $ 103,077 $ 3,319,5332 $ 2,041,809 $ 499,023 $ 66,106 $ 2,221,596 $ 1,457,967 $334,170 $40,589 $ 1,517,803 $ 1,071,309

15 Satisfaction was high about 75% with the quality and accessibility of primary care, particularly the annual comprehensive preventive health evaluation. 23% of visits was to obtain annual follow-up. 72% of their sample reported unmet needs, particularly related to rehabilitation consultation, telephone consultations, and home visits.

16 WHO IS AT RISK? In a study by Beatty, 2003 they found that the respondents with the poorest health and with the lowest incomes were the least likely to receive all health services.

17 PREFERRED METHOD Cox and colleagues found that SCI patients reported that home visits and telephone consultations were preferred methods for increasing accessibility to primary care.

18 VIDEOCONFERENCING TECHNOLOGY Videoconferencing, one mode of telehealth, is an efficient way to deliver education and consultation remotely.

19 SOCIAL WORKERS CAN DO IT TOO!

20 SOCIAL WORK & HEALTHCARE Social workers within a healthcare system address the biopsychosocial needs of complex patients, which include coordinating, monitoring, evaluating and advocating on behalf of the patient and/or his family to facilitate appropriate services.

21 SOCIAL WORK SERVICES CONTINUES POST DISCHARGE.

22 ESSENTIALS

23 IDENTIFYING PARTICIPANTS

24 USING RESOURCES Assess patient social supports

25 QUESTIONS TO CONSIDER Is this a new injury? Is this acute injury upon chronic? Is there a new clinical issue?

26 Is this patient experiencing relapse due to MS? New level of functionality? Is patient due for his annual social work evaluation?

27 Would this patient require a follow-up out patient visit for social work services (case management)? Would caregiver/family involvement improve communication and clinical care? Does patient require a home visit or home based primary care program? Does patient need assistance with completing benefit forms?

28 SOCIAL WORK SERVICES Financial Planning Discharge Services Home Care Services Home evaluation Medical equipment Supportive Counseling Coping and Adjustment Family adjustment Education Advance Directive Pension Compensation VA Forms Transportation Counseling/Benefits Interdisciplinary Team Meeting Family/Caregiver Support

29 PSYCHOSOCIAL ASSESSMENT Satisfaction of Life Survey St. Louis Mini Mental Evaluation Advance Directive: Living Will

30 PREPARING FOR A SESSION Discuss confidentiality/privacy issues Request that patient has necessary documents on hand Provider should know patient s goal for session and prepare for visit

31 CAREGIVER S GOALS?

32 LINK IN REAL TIME Primary Medical Provider Clinical Issues Community Services/Benefits VA local benefits VA Regional Office Benefits Housing Options

33 IMPLEMENTATION Leadership support Support from medical team Clinic set up (ICD code, work load, billing) Equipment CVT Training/Certification Training on proper documentation

34 SCENARIOS VA Referral facility Nursing homes Patient & Caregiver SCI/D Centers SCI/D Social worker

35 SCENARIOS: FACILITY TO HOME Spinal Cord Injury (New Injury) Advanced Multiple Sclerosis Amyotrophic lateral sclerosis (ALS)

36 CHALLENGES Clinic cancellations by patients Technological difficulties

37 [ P U B M E D ] P R I M A R Y C A R E O F P E O P L E W I T H S P I N A L C O R D I N J U R Y : S C O P I N G R E V I E W, M A R Y A N N M C C O L L, A L I C E A I K E N, A L E X A N D E R M C C O L L, B R O D I E S A K A K I B A R A, K A R E N S M I T H C A N F A M P H Y S I C I A N N O V E M B E R ; 5 8 ( 1 1 ) : REFERENCES C E T A R T I C L E E S T D I S P O N I B L E E N F R A N Ç A I S : C A N F A M P H Y S I C I A N N O V E M B R E ; 5 8 ( 1 1 ) : E E W H A T ' S H A P P E N I N G N O W! T E L E H E A L T H M A N A G E M E N T O F S P I N A L C O R D I N J U R Y / D I S O R D E R S C H R I S T I N E W O O, M A R Y L O U G U I H A N, C H R I S T I N E F R I C K, C A R O L M. G I L L, C H E S T E R H. H O J S P I N A L C O R D M E D M A Y ; 3 4 ( 3 ) : S O O P R A M A N I E N A, P A I N H, S T A I N T H O R P E A, M E N A R I N I M, V E N T U R A M. U S I N G T E L E M E D I C I N E T O P R O V I D E P O S T - D I S C H A R G E S U P P O R T. J T E L E M E D T E L E C A R E ; 1 1 S U P P L 1 : [ P U B M E D ] B L O E M A N - V R E N C K E N J H A, D E W I T T E L P, P O S T M W M. F O L L O W - U P C A R E F O R P E R S O N S W I T H S P I N A L C O R D I N J U R Y L I V I N G I N T H E C O M M U N I T Y : A S Y S T E M A T I C R E V I E W O F I N T E R V E N T I O N S A N D T H E I R E V A L U A T I O N. S P I N A L C O R D ; 4 3 : [ P U B M E D ] W E I N E L D. T H E S U N S H I N E N E T W O R K T E L E C O N S U L T A T I O N I N I T I A T I V E. S C I N U R S ; 1 7 ( 1 ) : [ P U B M E D ] M O Z E R E, F R A N K L I N B, R O S E J. P S Y C H O T H E R A P E U T I C I N T E R V E N T I O N B Y T E L E P H O N E. C L I N I N T E R V A G I N G ; 3 ( 2 ) : [ P M C F R E E A R T I C L E ][P U B M E D ] L A P I E R R E N M, B L A C K M E R J, C O U T U - W A K U L C Z Y K G, D E H O U X E. A U T O N O M I C D Y S R E F L E X I A A N D T E L E H E A L T H. C A N N U R S ; ( 7 ) : [ P U B M E D ] W A K E F O R D L, W I T T M A N P P, S C H M E L E R M R. T E L E R E H A B I L I T A T I O N P O S I T I O N P A P E R. A M J O C C U P T H E R ; 5 9 ( 6 ) : [ P U B M E D ]

38 Social work and case management treatment time during inpatient spinal cord injury rehabilitation Flora M. Hammond, 1,2 Julie Gassaway, 3 Nichola Abeyta, 4 Erma S. Freeman, 5 and Donna Primack 6 J Spinal Cord Med July; 34(4): Use of on-demand video to provide patient education on spinal cord injury Jeanne Hoffman, 1 Cynthia Salzman, 1 Chris Garbaccio, 1 Stephen P. Burns, 1,2 Deborah Crane, 1 and Charles Bombardier 1

39 SPECIAL THANK YOU J A Z M I N T O R R E S, R N, T E L E H E A L T H C O O R D I N A T O R

40 CONTACT INFORMATION JOYCE WILLIAMS, LCSW, MSCS SPINAL CORD INJURY & DISORDERS COORDINATOR VA NEW JERSEY HEALTHCARE SYSTEMS EXT. 1729