Do any of these situations sound familiar?
- A 14-year-old patient shows up for an appointment without a parent;
- A child is having issues with keeping up in gym class due to pain in his knees and ankles;
- A child on Humira doesn’t show up for an appointment for the second time;
- While discussing treatment recommendations, your patient begins to cry and tells you her husband is abusive and she is considering moving to a shelter;
- A mother calls because her 15-year-old is refusing his medications, not sleeping well, and behaving erratically; or
- A young woman with lupus refuses to take her prednisone because she thinks it makes her look fat?
What do you do in these types of situations? In many clinics, a social worker typically addresses these concerns. Although social work involvement is far more common in the pediatric world of rheumatology, the role social workers play in the clinic can also be beneficial to adult patients. Issues of medication adherence, financial difficulties, and coping with the emotional turmoil created by living with a chronic illness are seen across the age continuum.
In general, the role of the social worker in an outpatient clinic is to offer a broad range of psychosocial services, from emotional support to referrals for community resources. Social workers may intervene by providing brief counseling, offering education and support, and working with the community to develop resources to assist patients in meeting their own needs. Community involvement can include advocating for the patient within the school system and workforce—for instance, writing a letter outlining recommended accommodations that parents can send to their child’s school—and helping families connect to appropriate resources in the community. Social workers also address the patient’s emotional response and reaction to a diagnosis, the impact of the disease on the family, and the effect the disease has on the patient’s relationships and roles. Intervention happens through trained observation of the family, brief counseling in the clinic, and assistance with referrals to counseling in the community.
So, what does that mean for a clinic on a day-to-day basis? Social workers can meet all newly diagnosed patients to establish a friendly, familiar face and facilitate future communication. They can also follow up on clinic no-shows to ensure continuity of care by helping problem solve barriers to attending appointments, and conduct research and advocate for answers to questions that families or the medical team have. When families are struggling emotionally or financially, social workers can meet with them during office visits to provide needed support. Social workers can provide brief counseling; some are even trained or certified to teach biofeedback techniques to patients struggling with anxiety or pain issues. The social worker is a member of an interdisciplinary healthcare team and can provide information about psychosocial issues to the rest of the team. Social workers can help identify and alleviate factors that can limit treatment, disease management, and interaction with the patient, their family, and providers.
Visit www.rheumatology.org and select “Patient Resources” under “Popular Content” for more information on the roles health professionals play in an interdisciplinary team.
For additional information on the social work profession, please visit the National Association of Social Workers at www.socialworkers.org.
Kimberly Holwerda is a social worker in the pediatric rheumatology department at Helen DeVos Children’s Hospital in Grand Rapids, Mich.
