437 -Social Work Considerations for Addressing Chronic Conditions

Dr. Dawn-Elise Snipes

Counselor Toolbox Podcast

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~ Chronic conditions such as diabetes, arthritis, chron's disease, and depression

Introduction

~ 60% of people in the US have a chronic illness

~ Many serious illnesses have a much longer course with episodes of exacerbations and remissions

~ Chronic Illness can be highly stressful for patients and families

~ Care for people with chronic illnesses is increasingly done by family in the home.

~ Untreated mood disorders in individuals with co-morbid chronic health conditions increases morbidity and mortality rates and reduces the capacity for self-management

Biopsychosocial Impact of Chronic Conditions

~ Sleep

~ Pain

~ Medication side effects

~ Fatigue

~ Circadian rhythm disruption

~ Physical changes (weight changes, ports, pumps, hair loss)

~ Loss of mobility

~ Depression

~ Anxiety

~ Anger

~ Grief/Adjustment

~ Jealousy or resentment

~ Irritability

~ Withdrawal

~ Self Esteem changes

~ Loss of social support

~ Smothering social support

~ Inability to engage in prior important activities

~ Loss of independence

~ Vocational problems

~ Financial hardships (Medical expenses, job loss, environmental modifications)

~ Access to nutritious food

~ Physical, sexual and emotional relationship problems

Goals of Chronic Care Models

~ Shift from acute, episodic treatment to one of ongoing proactive care

~ Emphasizes

~ Prevention (getting worse, developing other conditions)

~ Patient’s role in managing health with mutual goal setting and action planning (self-management)

~ The goal of self-management interventions are to:

~ Improve knowledge about the condition and intervention options

~ Increase confidence in the ability to change

~ Leverage what he or she can do to promote personal health (prevention)

Goals of Chronic Care Models

~ The goal of self-management interventions are to

~ Improve motivation and problem solving rather than simple compliance with a caregiver’s advice

~ Help the participants’ master six fundamental self-management tasks:

~ Solving problems

~ Making decisions

~ Using resources

~ Forming a patient -provider partnership

~ Making action plans for health behavior change

~ Self-tailoring

Categories of Interventions (FRAMES)

~ Self Management Support

~ Feedback

~ Develop collaborative relationships

~ Use an ask-tell-ask framework with clients and caregivers

~ Responsibility

~ Ability and motivation for self-management fluctuates. Tailor interventions appropriately (symptom exacerbations, med changes, life changes…)

~ Advice

~ Use education and scaffolding to empower clients to adjust their behaviors and take control of health self-management

~ Menu of Options depends on individual circumstances, and resource availability

~ Empathy and Encouragement

~ Self-Efficacy

“5 A’s” of Behavioral Change

~ Assess

~ Advise/engage

~ Agree/collaborate

~ Assist/identify obstacles and interventions (treatment)

~ Arrange for follow up (evaluate/review)

Categories of Interventions

~ Assess

~ Regular assessment and enhancement of motivation and readiness for self-management

~ Ongoing Biopsychosocial Assessment (including quality of life and a Health Risk Appraisal (HRA)

~ An HRA is a systematic approach to

~ Collecting information about risk factors

~ Providing individualized feedback

~ Linking the person with at least one intervention to promote health, sustain function and/or prevent disease

Categories of Interventions

~ Advise:

~ Multimodal education about the condition and treatment options

~ Teach self-monitoring for clients and caregivers

~ Families and clients are educated about

~ The illness

~ What to expect from a family member who has the illness

~ How they can best help

~ How to take care of themselves

Categories of In