Download Oncology Social Work

Oncology Social Work –
Helping Patients and
Caregivers Along the
Continuum
January 20, 2016
Penny Damaskos, PhD, LCSW, OSW-C
Oncology Social Work—Helping patients and caregivers along the continuum
www.MSKCC.org
Talk Outline
• Review the role of oncology social work
• Review of social work interventions along the
disease continuum
• Society funds
• Overview of programs offered
Role of Oncology Social Work
• Primary function is to assist patients and
families in coping with the psycho-social
issues that result from a cancer diagnosis
– Emotional adjustment to the diagnosis
– Assist with practical issues to help patients
through the diagnosis
– Assist family members and support system
– Assess strengths in all systems to provide
support as needed
Role of Oncology Social Work
• We provide resources
– Within the hospital
• Patient Financial Services
• Philanthropy assessment and distribution
• Community settings
– Temporary housing
– Help them to mobiles resources around employment
issues
– Disability
– FMLA
– Other entitlements
Role of Oncology Social Work
• Collaborate with
– Medical/surgical teams, nurses, patient
representative, psychiatry, chaplain,
Integrative Medicine Service, PFS
• Case management for discharge planning
– Home care assistance
– Hospice care
– Skilled nursing facilities—physical rehab
Role of Oncology Social Work
• We work with adult and pediatric
populations all along the disease
continuum
• In both inpatient and ambulatory settings
• We help patients and families
communicate with
– Medical team
– Families, friends and caregivers
Oncology Social Work Interventions Along
the Disease Continuum
• Oncology Social workers intervene to assist
patients and family members at every stage of
the disease
• Each stage can present a new crisis for the
patient and/or family
• Important to have understanding of cancer
diagnosis and treatment plan
• Important part of our clinical assessment is to
explore the patient’s understanding and thinking
about their diagnosis
Stages of the Cancer Experience
• Diagnosis
• Initiation of Treatment
• Effects of Treatment
• End of Treatment
• Survivorship
• Recurrence- living with metastatic disease
• End of Life
How We Get Referrals
• From medical team
– In person—through Interdisciplinary team
meetings/rounds
– Electronic referrals
• Adult Health Screen and Distress Screening
• Self referrals from patients and caregivers
• Additional staff
Crisis Intervention Model (CIM) and
Cognitive Behavioral Therapy (CBT)
• Primarily use both CI M and CBT
approaches to help cancer patients
• Crisis Intervention Model:
– Addresses the perception that the event is
threatening which triggers a response that is
characterized by disequilibrium
• disorganization in thinking, behavior and
perceptions
Crisis Intervention and CBT
• In oncology social work, crisis intervention is used
to help individuals regain equilibrium after a
cancer diagnosis and the treatment is cognitive
behavioral therapy
• Through cognitive behavioral approaches
patients are able to change their behavior and
thinking about the crisis
• Both approaches help the patient move from
destabilization to stability in a short period of
time
Crisis Intervention in the Oncology
Setting
Equilibrium is achieved through:
• Individual counseling
– Problem solving, task oriented
• Psycho-educational support groups
• Family/couple counseling
Cognitive Behavioral Therapy
• C BT increases awareness of inaccurate or
destructive thinking
• Helps in understanding of difficult
situations and to respond to them in a
more effective way
• Emphasis is on the present “here and now”
• Guidance/directive role of the therapist
Rachman (1997)
Financial Support/Emotional Support
• The connection between financial support
and emotional support:
– When some of the practical stressors are
addressed, especially at the start of treatment
or at progression of disease, this can allow
patients to address the emotional impact the
diagnosis has on their lives.
– The level and type of support we offer is
unique to NYC area hospitals and other
cancer centers
Financial Support
• With the financial assistance provided by
the Society, oncology social workers are
able to facilitate financial support to adult
and pediatric patients that helps them
sustain access to treatment
– Transportation/parking
– Housing
– Emergency funds
Support to Patients: What is the
Process?
• Financial need is assessed through the
Patient Financial Assistance office (PFS)
– Social Work provides paperwork and PFS
determines financial need according to
established criteria
– Generous guidelines take into account the
impact cancer has on multiple areas of life
and that life has on cancer
• “Double whammy” factor
– Super storm Sandy, global financial crisis, increasing
unemployment AND Cancer
Support to Patients
• Once financial assessment is completed
and it is determined that the patient is
eligible for funds
– The social worker and medical team evaluates
the patients most pressing needs and
allocates the funds
– The top three areas are transportation,
housing and parking assistance
MSK Society Funds Provided to
Patients
2014
Q1
Q2
Q3
Q4
TOTAL
Individual Patients/
Quarter*
311
313
305
309
1,238
* Incl both peds and
adults
Total Funds
125,372
129,885
118,463
117,569
491,289
MSK Society Funds Provided to
Patients
2015
Individual Patients/
Quarter*
Total Funds
Q1
335
134,097
Q2
317
129,222
Q3
324
141,039
Q4
370
159,785
TOTAL
1,346
564,143*
* Incl both peds and adults
* 14.8% increase over
2014
MSK Society Funds Provided to
Patients
2014
Individual Patients/
Quarter*
1,238
AVG Funds/
Individual
$400
2015
1,346
$419
* Incl both peds and adults
Social Work Programs and Groups
• Multiple programs offered through Social Work
Department
– Collaborate with nursing, physical therapists,
nutritionists
• On treatment, survivorship, chronic cancer,
bereavement
• In person, on line (virtual)
• Specific populations: geriatric, young adults,
Spanish speaking, childhood cancer survivors
Groups--General
• Disease specific
– breast, prostate, lymphoma, etc
• Population specific
– caregivers, children, young adults
• At point of diagnosis
– Post-surgery (breast group)
– On treatment (inpt, outpt)
– Post-treatment– Resources for Life after Cancer
– Advanced disease
Kids Express Program
• Help adults talk with children about cancer
at every phase of the continuum
• Counseling, resources, workshops, online
support group
• CLIMB program specifically for children to
be able to express their feelings in a weekly
meeting with art and discussion
• Separate group for adults
Caregivers program
• On line support groups
– Several times a month
• Educational meetings several times a year
• Spanish and in English
• Caregivers newsletter
Bereavement Program
• Educational panels/meetings
• “Drop in” monthly group
• Time-limited support groups
– Spouses
– Young adult spouses
– Adult children
– Parents who have lost children
65+ programs
• Bi-monthly series of educational lectures
specifically geared for geriatric populations
– Cognitive functioning
– Stamina
– Nutrition
– Meditation
Post Treatment
• Resources for Life After Cancer
• Ongoing informational programs
– Specific topics that address long standing side
effects
– Highlights resources here through integrative
medicine, chaplaincy, psychiatry/behavioral
psych, physical therapy, nutrition, sexual
health
• Support groups
• Individual counseling
Staff Support
• Social work provide support to staff
inpatient and out patient
– Groups, informational meetings
• The Schwartz Center Rounds
• Building Resilience program
• Clinical, patient-oriented programs are
sometimes attended by staff
Programmatic Support
• The Society has provided support to key
programs over the years
– Pediatric programs
– Kids Express
– Social Work student fellows
• 57 fellows trained since inception in 1997
• 11 fellows hired by MSK; 7 of them hired in the last 6
years
– Dream Team
• Social work liaison to this program
• On treatment and in survivorship
Thank you for your support!