Often, caring for a patient with rheumatic disease requires a team of specialists working together to meet the patient’s needs. Social workers can play a variety of roles in helping rheumatology patients manage their conditions, beginning with a patient assessment and counseling.
“By initially conducting a comprehensive psychosocial assessment, a social worker can assess a patient’s ability to manage and cope with their illness,” says Jillian A. Rose, LCSW, MPH, assistant director, Community Engagement, Diversity & Research, Hospital for Special Surgery, New York.
The assessment includes questions about the patient’s concerns, living situation, support network, socioeconomic and health insurance status, coping skills and functioning level, as well as the impact of culture, spirituality and health beliefs on their care. Adena Batterman, MSW, LCSW, senior manager, Inflammatory Arthritis Support and Education, Hospital for Special Surgery, notes, “Having a holistic picture of how the patient functions in these areas informs how we approach interventions. A patient’s challenges, coping mechanisms and strengths can profoundly impact their treatment, management and outcomes.”
Patient strengths may include the presence of a confidante, financial stability, sense of humor, past experience with adversity and previous success in coping with illness, says Gregory Taylor, MSW, RCSW, medical social worker, Mary Pack Arthritis Program, Vancouver Coastal Health in Vancouver.
Mr. Taylor says some patients experience negative effects of their disease early on in various facets of their lives. “Loss of physical function and/or severe symptoms disrupt education or career plans, employment, recreational pursuits, social opportunities, relationships and intimacy,” he says. “The onset of depression, anxiety or damage to self esteem can occur when individuals are side-tracked from their vision of the future.”
Social workers can conduct counseling sessions with the patient to help them maintain psychological health and reestablish a sense of meaning to their life. They will work with a patient to renew their self-confidence and formulate realistic expectations about their competency to meet challenges on the horizon, Mr. Taylor says.
Also during these meetings, social workers can help patients prioritize their health concerns. They can coach patients on how to maximize time with their provider, think about treatment goals and empower patients to share what’s most valuable to them, Ms. Rose says.
Community & Educational Resources
Chronically ill patients face myriad issues that affect care, such as health literacy, depression, discrimination, access to benefits and entitlement, financial concerns, lack of transportation, challenges with childcare, homelessness and food insecurity.
In her role, Ms. Batterman identifies resources to help patients more effectively manage their health and treatment. She provides short-term counseling around coping with illness and makes referrals for ongoing mental health services, as well as peer-led or professionally led illness-related support and education groups. Some patients who are homebound or isolated may benefit from outside services. Often these services provide volunteers who can run errands, accompany patients to doctor’s appointments or serve as friendly visitors.
Additionally, social workers provide patients with educational resources to enhance understanding of their illness. “When recommending resources, it’s important to keep in mind a patient’s level of health literacy, access to technology, the source’s integrity and cultural appropriateness,” Ms. Rose says.
Social workers also connect patients with resources that may help them obtain government benefits or financial assistance with medications, Ms. Batterman says.
Working with Rheumatologists
As part of a patient’s care team, social workers can identify barriers to care, such as cultural beliefs and values.
“Social workers are problem solvers. They know key details about patients beyond their medical concerns that can impact care outcomes,” Ms. Rose says. She believes it’s important for a rheumatologist to include a social worker in a patient’s care at the initial visit. “This will normalize their role as a part of the care team,” she says.
She suggests the rheumatologist reads the social worker’s notes to gain a more holistic perspective of the patient’s life, including their mental and emotional health concerns, changes to their support systems, safety issues, financial issues and coping concerns.
Social workers should also be considered for research. “We have a wealth of knowledge related to psychosocial assessments, drivers of patient behaviors and skills, and tools to help engage patients in research,” Ms. Rose says.
Sometimes, patients have difficulty voicing their concerns or circumstances to their rheumatologists and other members of their healthcare team. Social workers often act as advocates for these patients and help empower patients to raise questions and concerns with their providers, Ms. Batterman says. They discuss issues with the healthcare team from the patient’s perspective, so the team can integrate patient concerns and values into care plans that address the patient’s needs, challenges and strengths.
The opinions of healthcare team members may differ from the social worker’s assessment. “The social worker must understand other team members’ roles and excel in negotiating, seeking common ground and reaching compromise,” Mr. Taylor says. “The social worker may outline a process that brings parties together, focuses on the issue, collects the needed information and finds mutually beneficial solutions.”
Karen Appold is a medical writer in Pennsylvania.
