20-21 student research projects - socialwork.pitt.edu
TRANSCRIPT
Edith M. Baker Integrated Healthcare FellowshipBehavioral Health Workforce Education and Training Program University of Pittsburgh School of Social Work Sinika Calloway, MSW, LSW, Program ManagerValire Carr-Copeland, PhD, MPH, Program Director, PI
2020-21 Student Research Projects
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Evaluation of Client Perceptions of Telehealth on Care Delivery Among Geriatric Patients, Becky Miller...........................................1
Individuals Diagnosed with A Substance Abuse Disorder and Their Stance on Telehealth Services, Taylor Eppinger........................3
Evaluating the Effectiveness of UPMC Magee Womens Hospital Pregnancy and Infant Loss Support Programs, Claire Engels,
Anna McGovern, and Teresa Reiter...........................................................................................................................................................5
An Examination of Mood Disorders and Health Conditions in Women Receiving Pregnancy Care, Brooklyn Bahlow.......................7
Analysis of Teletherapy Utilization Within Primary Care During the Covid-19 Pandemic, Dana Duncombe and Emily Halicek......9
Substance Use Resources: From the Emergency Room to the Medical Observation Unit, Brandon Thomas.....................................11
Importance and Prevalence of Advanced Directives for Patients with Chronic Illness, Alexa Harms............................................................13
The Effects of Covid-19 on Hospital Social Workers, Julianna Giannantonio, Hope Lowry, Maggie Schmitt and Samantha Yule.............................................................................................................................................................................................................15
Addressing Social Determinants of Health in Primary Care Setting, Emmanuela Abraham...............................................................17
The Relationship Between Patient Demographics and Drug Testing, Mary Ackourey and Kelly Polosky........................................19
Covid-19 Impact on Therapy and Warm-Referral Availability, Srinidhi Alur, Jonathan Peitzman and Ryan Martin....................21
Combating Hunger and Assessing the Covid-19 Pandemic Impact on Food Access and Affordability, Aubrey Masters........23
Implementing Social Determinants of Health Screening in an IBD Clinic, Echo Eggebrecht................................................25
Dementia and Skilled Nursing Facility Barriers, Amanda Bricker......................................................................................................27
Understanding Urban and Rural Trauma Patients: Comparing Injuries and Health Outcomes, Alexandra Winter and Cole Rapso.........................................................................................................................................................................................................29
Impact of “Discharge Planning Huddle” on Family Satisfaction, Livia Slabodkin............................................................................31
Evaluating Mental Health/Substance Usage Concerns in Braddock Borough, Alexandria Hickman...............................................33
Evaluation of Client Perceptions of Telehealth on Care Delivery Among Geriatric Patients
UPMC St. Margaret Geriatric Care Center
Becky Miller
Purpose: To combat both the issue of the novel COVID-19 virus and continuing care for older adults, medical providers have shifted some of their treatment to a Telehealth model by phone or video. This project explores how geriatric patients in an integrated health care setting perceive their Telehealth visits.
Methods: Participants were identified by reviewing the list of the clients who had seen either a Licensed Clinical Social Worker or the Psychiatrist in the last 6 months. Possible participants were added to a list based on cognitive and auditory A list of 30 possible participants was identified. The total number of surveys administered was 25, (n=25). The evaluation was conducted by administering an 11-question Likert-scale questionnaire adapted from Bhandari (2020) via telephone. All patients were read an informed consent statement and consent was recorded by two witnesses. Each participant was assigned a number to protect identity. The survey was read aloud and responses were recorded in Microsoft Forms. Once the data was collected it was exported into Excel and statistical package for social science (SPSS) software.
Results: Using SPSS several bivariate tests were conducted. The first test conducted was an independent T-Test which compared satisfaction levels between phone vs. video. There
was no statistical difference in satisfaction between phone vs video. Phone = 3.7 vs Video = 3.8. Another independent T-test analyzed the relationship between satisfaction and gender. It was found that women had overall higher satisfaction (mean score of 4) compared to men (mean score 3). However, due to the sample size of men (4 men vs 21 women) and the small sample of all participants, it is not statistically significant (p =.315). The third test conducted was a Pearson product-moment correlation to determine any correlation between age and satisfaction with telehealth. It was found that there is a correlation between age and satisfaction (r = .40, p=.047), demonstrating that younger age is associated with higher levels of satisfaction.
Conclusion and Implications: It is likely that Telehealth will continue to be used to monitor patients. While the majority of participants were satisfied with Telehealth, they indicated a preference for in-person services. Lower levels of satisfaction with Telehealth were correlated with advancing age. Due to the small sample size of this study findings are not generalizable, however, this project provides a brief overview of a unique population affected by virtual healthcare. Future research should seek to expand on these findings.
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q With the onset of the COVID19 pandemic, the healthcare industry had to adapt rapidly.
q Older adults are considered one of the most vulnerable population in terms of COVID19 relatedmortality1
q Older adults often need consistent medical care. It has been found that 80% of older adults are diagnosed with at least one chronic disease.2
q To combat both the issue of the novel COVID-19 virus and continuing care access for older adults' medical providers have shifted some of their treatment to a Telehealth model.
q Due to timing and resources, limited informationand research are available which assess client satisfaction and perceptions of Telemedicine and its effectiveness.
q How do geriatric patients who utilize behavioral health services perceive telehealth visits?
q Are there differences in satisfaction between those who use phone or video? Among gender?And between ages?
q Bhandari, N. (2020). Validation of newly developed surveys to evaluate patients’ and providers’ satisfaction with telehealth Obstetric Services. Telemedicine Journal and e-Health., 26(7), 879–888.
q Choi, W. (2014). Acceptance of home-based telehealth problem-solving therapy for depressed, low-income homebound older adults: qualitative interviews with the participants and aging-service case managers. The Gerontologist, 54(4), 704–713. https://doi.org/10.1093/geront/gnt083 (1)
q National Council on Aging. (2018, February 13). National Council on Aging (NCOA). NCOA. https://www.ncoa.org/. (2)
q This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the author and shouldnot be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
q UPMC St. Margaret Geriatric Care Center is anintegrated healthcare clinic comprised of Physicians, Psychiatrists, Pharmacists, Neuropsychologists & Social Workers who provide comprehensive care to individuals aged 60+.
q The clinic serves hundreds of older adults in the greater Pittsburgh area to provide services in the areas of behavior health and counseling, geriatric medical assessment and primary care, long term care planning, and neuropsychological testing/memory loss management
Introduction Methods
Results
References & Acknowledgements
Sample q A purposeful sample was utilized due to setting and population needs.q Clients who see either the LCSW or the Psychiatrist in the last 6 months
were identified. A list of possible participants were compiled based on varying abilities and who had had contact with the office within the last 8months.
q 30 participants were identified to take the survey; 25 surveys were completed(n=25)
Data Collection q An 11 question Likert-item questionnaire3 about Telehealth perception and
satisfaction was administered via phone over the course of two months q Questionnaire was read aloud, and responses were recorded in Microsoft
Forms. All patients were read an informed consent statement and consent was recorded by two witnesses.
q Excel and SPSS were used to analyze data for trends
q It is unlikely that Telehealth will become obsolete in the near future. Therefore, future studies should continue to look at how Telehealth is perceived by their patients. The implications from this study begin to highlight some of the differences that may exist among populations. It should also be noted that the majority of participants were satisfied with Telehealth but indicated a preference for in-person services.
q Due to the small sample size of this study findings are not generalizable, however, this project provides a brief overview of a unique population impacted by virtual healthcare. Future research should seek to expand on these findings.
Research Questions
Evaluation of Client Perceptions of Telehealth on Care Delivery Among Geriatric Patients Becky Miller - Edith Baker Integrated Healthcare Fellowship
The Issue
q Interpersonal Communication – Surveys are adapted to consider the populations unique needs and are administered in a way that is easyfor patients to participate.
q Screening & Assessment – Administered athorough questionnaire to participants.
q Informatics – Evaluating the satisfaction withTelehealth program to better meet client needs.
IHC Competencies
Implications for Social Work76%
24%
VIDEO VS. PHONE USERS FOR TELEHEALTH
Phone Video
q An independent T-Test was conducted to compare satisfaction scores between participants who used the phone compared to those who used video for their telehealth visits. The scores were similar and showed nostatistical significance in satisfaction between those who use the phone vs video.
q Another independent T-test was run to understand the relationship between satisfaction and gender. It was found that women did have overall higher satisfaction compared to men. However, due to the sample size of men (4 men vs 21 women) it is not statistically significant (p =.315).
q The third and final test conducted was a Pearson product moment correlation (r). It was found that there is acorrelation between age and satisfaction (r = .40, p = .047). The correlation showed an inverse relationshipbetween age and satisfaction, indicating that the younger the age the higher the satisfaction.
Age
Scatterplot showing the inverse relationship; the younger age the higher rates of satisfaction.
Mean satisfaction scores0
1
2
3
4
5
Male Femaile
Mean Satisfaction Score by Gender
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Individuals Diagnosed with a Substance Use Disorder and their Stance on Telehealth Services
UPMC McKeesport Addiction Medicine
Taylor Eppinger
Background For many people with a substance use disorder (SUD), attending regular recovery meeting such as Alcoholics Anonymous (AA) or Narcotics Anonymous is a very important part of that routine. Individuals diagnosed with a SUD are encouraged to rely on their “we”, or a group of individuals also in recovery who are acknowledged as supports.
Since the start of the pandemic in March of 2020, many of these recovery meetings and groups have either switched to an online platform or shut down entirely until it is safe to continue in-person programming. The purpose of this needs assessment is to gauge how patients in recovery feel about using virtual AA/NA meetings and in-person services.
Method The addiction medicine unit at UPMC's McKeesport location opened in February of 2018. The unit consists of detox beds as well as short-term rehab beds. The unit services individuals diagnosed with a substance use order as well as a co-occurring medical disorder that requires medical supervision. Any individual in need of medical detox from drugs or alcohol is admitted to our unit (ASAM level 4WM), but only those in need of ongoing medical supervision may step down to the rehab program (level 4). To be admitted to the unit, patients must present to the emergency department via ambulance or through their own means of transportation. Once the patient arrives at the hospital, they are then triaged by our evaluator clinicians to see if they meet criteria to be admitted for medical detox. Once admitted, individuals receive a specific regimen of medications to lessen withdrawal symptoms and potential seizures. The unit also provides acute intensive therapy programming to engage the individuals in recovery planning. The unit holds daily group sessions beginning at 8am that
last until 7pm with topics ranging from relapse prevention, Medication Assisted Treatment education, anger management, coping with cravings, music therapy, spirituality, peer lead sessions and more. The unit is staffed with a leading physician, a nursing team, a social service team, evaluator clinicians, clinical leadership and care managers. As a member of the social service team, we work with individuals to complete biopsychosocial assessments, secure post-hospital medical appointments, link patients with MAT providers, aftercare treatment (from inpatient to ¾ house programs), mental health providers, service coordination, and much more.
Hypotheses Although telehealth has proven to be beneficial for individuals living in areas who would otherwise experience difficulty receiving services, in person services will be preferred by a majority of the respondents who took the survey. Individuals in recovery find in person connection beneficial to their recovery process.
Results Several factors affect an individual's preference of aftercare treatment delivery methods. Around 37% of individuals stated they preferred in-person services due to the connections they can make with others in recovery.
A few individuals stated in-person services are more beneficial because they hold the patient more accountable to maintain their sobriety, while on telehealth it is easier to be untruthful about relapse to the group or to the facilitator. For 25% of participants, telehealth services were simply more convenient because the individual did not have their own vehicle or finances for public transportation. Among many of the older males who participated in the survey, there was a lack of understanding or access to the technology that telehealth services require.
Lastly 77% of patients stated that if they attended in-person aftercare services they were most likely to maintain sobriety for at least one month, compared to 40% of the individuals participating in services via telehealth.
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Evaluating the Effectiveness of UPMC Magee -
Womens Hospital Pregnancy and Infant Loss
Support Programs
UPMC Magee Womens Hospital
Claire Engels, Anna McGovern and Teresa Reiter
Background & Purpose
UPMC Magee-Womens Hospital serves families across
Western Pennsylvania and neighboring states specializing in
both medical and surgical services and obstetrical and
gynecological services (OBGYN). The OBGYN services
include treating pregnant patients, over 10,000 births per year,
and caring for families who experience pregnancy and infant
loss. Holston (2015) notes in "Supporting Families in Neonatal
Loss: Relationships and Faith Key to Comfort" that positive
support and staff experiences at the time of loss aids in a
healthier progression of grief than those who have poor
experiences.
Research Question
How well does Magee Women’s Hospital support families that
experience pregnancy loss?
Methodology
This study was evaluative in nature. Data was collected from
families who attended the Tree of Remembrance Memorial
Service. One hundred forty-four (144) invitations were sent
out. Of the 30 attendants, there were 19 families who
experienced loss in the past year. Seven families completed our
ten-question survey, which included scaling, rating, and open-
ended questions on the memorial service and their experience
with support at Magee. For our research project, we only
analyzed the questions regarding their stay at Magee.
Results & Recommendations
The research indicated that families felt that culture, spirituality
and values were respected, though there were discrepancies
among support person protocols. The survey results also
indicated that staff noise levels and room location near the
nursery hindered the healing process and respondents
appreciated staff empathy and support. Several
recommendations were given by the authors based on survey
results including: provide sensitivity training regarding
neonatal death; move families to a different part of the unit
where it is quieter and away from the nursery; provide staff
with hospital protocols on bereavement support and extra
support people; implement follow-up with families who
experienced loss and facilitate opportunities for peer support.
Limitations
Due to the small sample size and sensitivity of perinatal loss,
our study is not representative of those who experience
pregnancy or neonatal loss at Magee. The data has potential for
bias as those who attended the ceremony most likely felt
supported during their time at Magee. Those who did not feel
supported would be less likely to attend a Magee sponsored
event.
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Evaluating the Effectiveness of UPMC Magee WomensHospital Pregnancy and Infant Loss Support Programs
BackgroundUPMC Magee-Womens Hospital serves families across Western Pennsylvania and neighboring states, specializing in both medical and surgical services and obstetrical and gynecological services (OBGYN). The OBGYN services include treating pregnant patients, delivering over 10,000 births per year, and caring for families who experience pregnancy andinfant loss.
Research QuestionHow well does Magee Women’s Hospital support families that experience pregnancy loss?
MethodologyThis study was evaluative in nature. Data was collected from families who attended the Tree of Remembrance Memorial Service. One hundred forty-four (144) invitations were sent out. Of the 30 attendants, there were 19 families who experienced loss in the past year. Seven families completed our ten-question survey, which included scaling, rating, and open-ended questions on the memorial service and their experience with support at Magee. For our research project, we only analyzed the questions regarding their stay at Magee.
IHC Competencies1. Collaboration and teamwork: work together with social workersand care managers from varying disciplines such as outpatient,antepartum, postpartum, and NICU.2. Cultural competence and humility: the survey includes aquestion regarding whether a patient’s culture, spirituality, andvalues were respected during their patient experience.3. Practice-Based Learning & Quality Improvement: allows thesocial workers to assess and implement practice-based learningand quality improvement measures in the services and supportdelivered to families who experience pregnancy or infant loss.
LimitationsDue to the small sample size and sensitivity of perinatal loss, our study is not representative of those who experience pregnancy or neonatal loss at Magee. The data has potential for bias as those who attended the ceremony most likely felt supported during their time at Magee. Those who did not feel supported would be less likely to attend a Magee sponsored event.
Recommendations• Sensitivity training regarding neonatal death• Move families to a different part of the unit where it is
quieter and away from the nursery• Provide staff with hospital protocols on bereavement
support and extra support people• Implement follow-up with families who experienced loss
and facilitate opportunities for peer support
Acknowledgements: This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.References: Holston, J. T. (2015). Supporting families in neonatal loss. Journal of Christian Nursing, 32(1), 18–25. https://doi.org/10.1097/cnj.0000000000000118
Results from Families• Culture, spirituality and values were respected, though
there were discrepancies among support personprotocols.
• Staff noise levels and room location near thenursery hindered healing process
• Appreciation for staff empathy and support
“It would be nice if there was a specific community (even a Facebook group
or something) of families who have experienced this kind of loss at Magee.”
Implications for Social Work PracticeThis research helps to ensure that Magee social workers develop and share knowledge of improvements that will best serve families in their grieving process. Holston (2015) notes in "Supporting Families in Neonatal Loss: Relationships and Faith Key to Comfort" that positive support and staff experiences at the time of loss aids in a healthier progression of grief than those who have poor experiences.
Claire Engels, Anna McGovern, Teresa Reiter, Edith M. Baker Integrated Healthcare Fellowship
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An Examination of Mood Disorders & Health Conditions in
Women Receiving Pregnancy Care
UMPC Latterman Family Health Center
Brooklyn Bahlow
Background
Latterman Family Health Center (FHC), located in McKeesport, PA,
offers comprehensive prenatal and postpartum care as well as
targeted care to women between pregnancies. During the child's
checkup visit from 0 to 2 years old, providers ask patients about 4
evidence risk factors (smoking, depression, contraception, and
multivitamin use). Negative health behaviors associated with these
risk factors may put women at higher risk for preterm or low birth
weight infants in their next pregnancy. McKeesport is an
underserved community where many community members face
physical and mental health challenges.
Research Question
Do evidence risk factors (smoking, depression, contraception, multi-
vitamin use) and health conditions (hypertension, pre-eclampsia,
gestational diabetes and substance use) affect a women’s mental
health during prenatal and postpartum care?
Method
Chart audits utilizing Epic Systems were conducted on 50 randomly
selected patients who were patients at Latterman FHC for prenatal
and postpartum care between July 2020 and November 2020. The
data collected came from birth summaries, prenatal visits,
postpartum care, as well as IMPLICIT Network ICC spreadsheets.
Patient charts were evaluated for a diagnosis of hypertension,
preeclampsia, gestational diabetes, depression, and substance use.
Demographic information was recorded; age, race/ethnicity, marital
status, education level, intimate partner violence (IPV), smoking
history. To screen for depression diagnoses patient charts were
reviewed along with collecting PHQ-2 and PHQ-9 data from the
IMPLICIT Network ICC spreadsheets.
Results
Of the 50 moms reviewed in this project, 21 (42%) had a depression
diagnosis either during pregnancy or up to 1 year postpartum. Of the
21 moms with depression, 14 (67%) had a health condition that was
examined in this study. Eight moms screened negative on the PHQ-2
but were diagnosed with depression. Of the 8 women that had a
negative PHQ2 screen, but had a documented depression diagnosis
100% (8) were current or former smokers, 5/8 had co-morbidities
such as (Hypertension, Pre-Eclampsia, Gestational Diabetes,
Substance Use), and for some patients there is a disconnect between
the ICC screening and diagnosis. Racial breakdowns and showed
that 32.42% of moms of color and 69.23% of white moms were
diagnosed with depression during pregnancy or postpartum; this
severe variance of diagnoses could be related to cultural beliefs of
mental illness and the decisions to seek help, and/or racial bias in
providers.
Limitations
Physicians documenting diagnoses differently in Electronic Medical
Record charts which may have led to incomplete or inconsistent data.
The data collected from IMPLICIT Network ICC spreadsheets and
Epic Systems was not always identical which created uncertainty in
collecting data.
Recommendation: Latterman FHC should review depression
screening workflow and create a PDSA cycle to improve workflow
for identifying women with depression risk.
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Analysis of Teletherapy Use Within Primary Care During the COVID-19 Pandemic
UPMC St. Margaret Health Centers
Dana Duncombe & Emily Halicek
Background
The provision of behavioral health services through telephone or video calls – teletherapy - is an effective means of supporting diverse populations and people living with mental health disorders, such as PTSD, depression, anxiety, ADHD, and eating disorders. It works well as means of providing care to underserved communities by addressing issues associated with transportation, limited available providers, and stigma or concerns for privacy. Until 2020, many insurances limited coverage for telemedicine services to geographic areas and to specific services. However, many states, including Pennsylvania, have yet to amend telemedicine regulations to ensure ongoing coverage after the COVID-19 public health emergency. This study examines the socio-demographics of teletherapy service use at the UPMC St. Margaret Lawrenceville Family Health Center between April 2020 and June 2020.
Methods
Performance reports for full-time behavioral health clinicians were generated for April-June 2020 via UPMC’s electronic health record. All completed appointments and related information (i.e. format, date, type of appointment) were included in a de-identified datasheet. Format trends for patients were coded as “video only,” “telephone only,” “mixed teletherapy,” “in-person only,” and “mixed in-person and teletherapy.” “No shows” and patients from other clinics were excluded. A total of 443 appointments were included, representative of 124 patients. Chart reviews provided sociodemographic information: age (as of 12/2020), racial identity, gender identity, zip code, behavioral health diagnosis, and insurance payor. Frequency distributions and cross-tabulations measured associations between sociodemographic identities and appointment format.
Findings
White and Black patients represented 67% and 27% respectively of the clinic’s 2019 medical appointments. 2020 saw an overrepresentation of White patients (81%) completing teletherapy behavioral health appointments. Black patients (63.2%) used telephone only for their appointments twice as much as White patients (30%), who were more likely to use a mix of telephone, in-person, and video. 26% of White patients had only video appointments versus 5.3% of Black patients (only 1 patient). White patients had more repeat appointments (4+) than Black and other patients of color (recognizing that many factors impact return rates). Older adults (65+) exclusively used telephonic services more than other formats within their age group (41.7%) but at a similar rate when compared across age groups. Older adults used video the least (0%) compared to other age groups.
Discussion & Limitations
While the findings cannot be generalized beyond the sample, it provides a glimpse into outpatient behavioral healthcare and emergent issues surrounding teletherapy access. The leveling-out across appointment formats suggests that while teletherapy filled an important gap during stay-at-home orders, a demand for in-person appointments continued. Findings may indicate that sociodemographic factors, particularly race and age, influence type of service utilization. This study is limited by its scope and data source (i.e. medical charts). This study was only able to capture patients who completed appointments, thereby missing patients who never established care, even if they sought behavioral health services before the pandemic.
9
�ANALYSISOFTELETHERAPYUTILIZATIONWITHINPRIMARYCAREDURINGTHECOVID-19PANDEMIC DanaDuncombe,MSWc&EmilyHalicek,MSWcEdithM.BakerIntegratedHealthcareFellowship
METHODS• Performancereportsforfull-timebehavioralhealthclinicianswere
generatedforApril-June2020viaUPMC’selectronichealthrecord.• Duetoresourcelimitations,thestudyonlyexaminedthe
LawrencevilleFamilyHealthCenter.• Allcompletedappointmentsandrelatedinformation(i.e.format,
date,typeofappointment)wereincludedinade-identifieddatasheet.“Noshows”andpatientsfromotherclinicsloggedatLawrencevillewereexcluded.
• 443appointmentswereincluded,representativeof124patients.• In-depthchartreviewsofthe124patientsprovidedinformation
pertainingtothefollowingsociodemographicfactors:age(asofDecember2020),racialidentity,genderidentity,zipcode,behavioralhealthdiagnosis,andinsurancepayor.
FINDINGS
Acknowledgements:ThisfellowshipissupportedbytheHealthResourcesandServicesAdministration(HRSA)oftheU.S.DepartmentofHealthandHumanServices(HHS)undergrantnumber,M01HP31376,BehavioralHealthWorkforceEducationandTraining(BHWET)Program.Thisinformationorcontentandconclusionsarethoseoftheauthorandshouldnotbeconstruedastheofficialpositionorpolicyof,norshouldanyendorsementsbeinferredbyHRSA,HHSortheU.S.Government.TheauthorswouldalsoliketothanktheUPMCFamilyHealthCenterstaff,patients,andresidentswhoinspiredtheprojectandcontinuedtoprovidemeaningfulhealthcareservicesandsupportthroughouttheCOVID-19publichealthemergency.
BACKGROUND• Thisstudycontributestopre-existingliteratureonteletherapyin
urbansettingsbycomparingpopulationtrendsofbehavioralhealthserviceutilizationattheUPMCSt.MargaretFamilyHealthCentersbetweenApril2020andJune2020toexplorequestionsaroundteletherapyaccessibilityacrosssociodemographicfactors.
• Teletherapy,theprovisionofmentalhealthservicesthroughlivetwo-wayplatforms,hasproveneffectiveinsupportingdiversepopulationsandpeoplelivingwithmentalhealthdisorders,suchasPTSD,depression,anxiety,ADHD,andeatingdisorders.1,2,3
• Teletherapyhasbecomeanalternativemeanstoprovidementalhealthcaretounderservedcommunitiesbyaddressingissuesassociatedwithtransportation,limitedprovidersinagivenarea,andstigmaorconcernsforprivacy.2,4
• Until2020,manyinsurancepayorslimitedcoveragefortelemedicineservicestospecificgeographicareasandservices.Asofthisstudy’spublication,amajorityofstates,includingPennsylvania,hadyettopermanentlyamendtelemedicineregulationstoensureongoingcoverageaftertheCOVID-19publichealthemergency.
SOCIALWORKCOMPETENCIES• CulturalCompetence&Adaptation:Examinedisparitiesin
teletherapyaccessibilityinregardstosociodemographicfactors.• Practice-BasedLearning&QualityImprovement:Measurepatient
utilizationofteletherapyduringtheCOVID-19pandemictoinformserviceimprovementinitiativestoensurethecontinuedprovisionofqualitybehavioralhealthcare.
• Informatics:Quantitativeanalysisofteletherapyplatforms(i.e.Video,Telephone)togenerateexploratoryfindingstobettercontextualizefuturestudiesonpatientpreferencesandbarriersconcerningappointmentformats.
DISCUSSION• Thelevelingoutacrossappointmentformatssuggeststhatwhile
teletherapyfilledanimportantgapduringstay-at-homeorders,ademandforin-personappointmentscontinued.
• Theincreaseinvideoappointmentsmaybeexplainedbyincreasedpatientandprovidercomfortinusingvideos.
• Generalizationscannotbeextrapolatedfromfindings.Yet,resultsmayindicatethatutilizationofservicesisinfluencedbysociodemographicfactors,particularlyraceandage.Futurequalitativeandquantitativestudiesarenecessary.
• Permanentinsuranceparityforteletherapyisanethicalnecessitymovingforward.Withoutfederalandstatepolicychanges,accesstoteletherapymaybecomeafinanciallystratifiedcommodity.
• Thereisanimmediateneedtoincreasetelemedicinetrainingamongstmentalhealthcliniciansandtointegraterelatedcourseworkintomaster’sprograms.
REFERENCES1. Trombello,S.(2020).Twotrajectoriesofdepressivesymptomreductionthroughoutbehavioralactivation
teletherapyamongunderserved,ethnicallydiverse,primarycarepatients:Avitalsign6report.BehaviorTherapy,51(6),958–971.https://doi.org/10.1016/j.beth.2020.01.002
2. Turvey,F.(2017).Theuseoftelemedicineandmobiletechnologytopromotepopulationhealthandpopulationmanagementforpsychiatricdisorders.CurrentPsychiatryReports,19(11),1–8.https://doi.org/10.1007/s11920-017-0844-0
3. Waller,P.(2020).Cognitive-behavioraltherapyinthetimeofcoronavirus:Cliniciantipsforworkingwitheatingdisordersviatelehealthwhenface-to-facemeetingsarenotpossible.TheInternationalJournalofEatingDisorders,53(7),1132–1141.https://doi.org/10.1002/eat.23289
4. Morland,M.(2015).Telemedicineversusin-persondeliveryofcognitiveprocessingtherapyforwomenwithposttraumaticstressdisorder:Arandomizednoninferioritytrial.DepressionandAnxiety,32(11),811–820.https://doi.org/10.1002/da.22397
2 2
48
110100
47
28 32
74
0
20
40
60
80
100
120
Apr May Jun
AppointmentFormatsfor2020In-PersonTelephoneVideo
18%
5%
16%
18%
17%
36%
40%
34%
32%
42%
27%
30%
26%
9%
18%
13%
16%
14%
17%
13%
8%
27%
25%
0% 20% 40% 60% 80% 100%
19-25
26-34
35-54
55-64
65+
AppointmentFormatbyAgeGroup
In-PersonOnly
TelephoneOnly
VideoOnly
MixedTelemedicineMixedIn-Person&Telemedicine
• WhiteandBlackpatientsmadeup67%and27%respectivelyoftheclinic’s2019medicalappointments.2020sawanoverrepresentationofWhitepatients(81%)completingbehavioralhealthappointments.
• Blackpatients(63.2%)used‘telephoneonly’twiceasmuchasWhitepatients(30%).26%ofWhitepatientsused‘videoonly’versus5.3%ofBlackpatients(only1patient).
• Whencontrolledforrace,olderadults(65+)used‘telephoneonly’morethanotherformatswithintheiragegroup(41.7%)butatasimilarratewhencomparedtootheragegroups.Theyusedvideoformatstheleastcomparedtootheragegroups(0%).
• Whitepatientshadmorerepeatappointments(4+)thanpatientsofcolor,acknowledgingthatmanyfactorsimpactreturnrates.
61%Ofpatientsused
apublicinsuranceoption
81%OfpatientswereWhite
Top3MentalHealthDiagnoses
AnxietyDisorders28.2%
MoodDisorders28.2%
SubstanceUse
Disorders13.7%
61%ofallpatientshad1-3appointments.84%ofBlackpatientshad1-3appointments.57%ofWhitepatientshad1-3appointments.
10
Substance Use Resources: From the Emergency Room to the
Medical Observation Unit
Jefferson Hospital-Emergency Room & Medical Observation
Unit
Brandon Thomas
Background
Those who have been diagnosed with Substance Use Disorders
(SUDS) and Mental Health Disorders (MH) face challenges
including socio-economic challenges, homelessness,
stigma/bias, access to care through lack of insurance,
transportation, or remote geographic location.
Research Question
Are SUDS and MH patients presenting at the Emergency
Room or admitted to the Medical Observation Unit being
offered outside resources for follow-up treatment?
The hypothesis is that these patients are not consistently being
offered outside resources. The question is, is this due to
comfortability of working with the patient or is this lack of
education on outside resources such as AA/NA meetings,
outpatient treatment, intensive outpatient treatment, inpatient
rehabilitation facility, or inpatient medically managed
detoxification unit?
Method
This social work intern used a blind survey method in which a
combination of 54 ER nurses and Medical Observation Nurses
were asked questions surrounding comfortability around
SUDS/MH and education on aftercare resources.
Results
The results were 50% of nurses felt neutral when working with
SUDS and 31.5% felt comfortable. As far as comfort with
providing education resources 55.6% felt comfortable while
33.3% did not.
The idea of this project was to determine if patients were being
offered resources for after care and if not was this due to the
comfortability of working with SUDS/MH or was this due to
not having the proper training on resources.
Limitations
The data did not come in on time to determine how many
patients were offered resources, but the data that was collected
showed nurses were about 50% comfortable with both
SUDS/MH patients and in providing education on resources.
Ideally, I would like to have collected data on patients and
compared all the data together to see if not receiving resources
was a nursing issue or a hospital system issue.
11
Substance Use Resources:From the Emergency Room to the Medical Observation Unit
Brandon Thomas, Edith M. Baker FellowshipPurpose of the Research: The purpose is to determine whether patients are being offered substance use disorder (SUD) treatment in the ED. To determine if the patient is admitted to medical observation unit, is the offer for substance use disorders still being discussed after admission to observation unit.Research Question? (1) Are Patients who present to the Emergency Department (ED) with Substance Use Disorders being offered further treatment? (2) Are patient admitted to the medical observation floor, continued to be offered further services by nurses? 3) What are the attitudes of both the ED nurses and the medical observation nurses, about treating patients with substance use disorders?
Methods: A survey was distributed to Emergency Room nurses and Observation unit nurses, 3 questions 1) Comfortability caring for physical illness, 2) Comfortability caring for Suds/Mental Health, and 3) Your knowledge of SUDS/Mental Health aftercare resources.
Competencies/How they apply:• Collaboration and Teamwork• Care Planning and Care Coordination• Intervention• Practice-Based Learning and Quality Improvement• Cultural Competence and Adaptation
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government
Relevancy/Implications for Social work Practice: The relevancy of this research question is to determine if Jefferson Hospital is offering enough services which could potentially increase patients receiving care from treatment centers who specialize in substance use disorders and decrease the number of re-admissions.
The implications of Social Work practice hold social workers to the value of service which compels us to help those in need and address social justice issues. We look at the dignity and worth of a person, which can point us to the idea that all patients deserve the best care that can be offered. Importance of Human Relationships, this would allow social work and nurses to form a partnership with this population (NASW, 2017.).
12
Importance and Prevalence of Advanced Directives for
Patients with Chronic Illness
Allegheny General Hospital
Alexa Harms
Background
Patients with chronic illness are not always able to make
medical decisions for themselves or be active participants in
their own care. Per PA Act 169, medical decision makers on
behalf of the patient are a spouse, an adult child, a parent, an
adult sibling, or an adult grandchild when there is not a
completed advance directive (AD) or designated medical
power of attorney (MPOA). Through completing an AD and
designating an MPOA, patients and designated medical
decision makers have clear instructions on what life-sustaining
measures to take or reject. An AD or MPOA allows patients
and medical decision makers to focus on what is most
important at end-of-life rather than facing the stress and
difficulty of making these decisions under pressure. AD and
MPOA directives ensure that patients remain active
participants in their own medical care.
Research Question
How many patients at AHN with chronic illness have an
Advance Directive or designated Medical Power of Attorney?
Method
The current study aimed to examine the number of patients
with chronic illnesses including Chronic Obstructive
Pulmonary Disease (COPD), Congestive Heart Failure (CHF),
and cancer (designated terminal) who have completed ADs and
designated MPOAs. Data collection consisted of 85 chart
reviews of patients ranging in ages 65-90. Gender and race
information was also collected. Patient charts were chosen by
filtering out chronic illness care paths and through review it
was noted whether or not the patient has a completed AD or
designated MPOA.
Results
Of the 85 medical charts reviewed, 31.76% of patients have a
completed AD or designated MPOA while 68.24% do not.
Broken down by diagnosis, the following percentage of
patients did not have a completed AD or designated MPOA:
76.92% of patients with COPD, 69.23% of patients with CHF,
and 69.23% of patients with cancer. There was no significant
difference within gender and the majority of patients are White,
so this research could not conclude if race might influence
results.
Social Work Implications
Based on the current study, a large majority of patients with
chronic illness at Allegheny General Hospital do not have
completed ADs or designated MPOAs. Within the hospital
setting, social workers are often the staff to initiate discussion
around ADs and MPOAs. They provide patients and family
with education on the benefits of completing the documents.
Patient wishes and desires are then recorded and patients
remain active participants in their own medical decision
making. Social workers have the right skills to assist families
in preparing documents that may ease the difficulty of end-of-
life decision making.
13
Importance and Prevalence of Advanced Directives for Patients with Chronic Illness
Allegheny General Hospital (AGH)
Allegheny General Hospital is located in the North Side of Pittsburgh, PA and has been operating since 1886. AGH is a 576-bed quaternary care and educational hospital, seeing 24,000 inpatient admissions, 23,000 surgeries, and nearly 56,000 emergency department visits each year. AGH is a national leader in cancer, cardiovascular, and neuroscience care.
Introduction
Patients with chronic illness are not always able to make medical decisions for themselves or be active participants in their own care. Per PA Act 169, medical decision makers on behalf of a patient would be a spouse, an adult child, a parent, an adult sibling, or an adult grandchild when there is not a completed advance directive (AD) or designated medical power of attorney (MPOA). These individuals may not always have the knowledge of a patient’s preference or values and may not be able to assess how the patient would make healthcare decisions. Completing an advanced directive provides health care providers, patients, and family/loved ones control over desired care at end-of-life and allow those involved to focus on what is important at end-of-life (Elorreaga, 2017). This also allows patients to remain active participants in their own medical care.
Allegheny General Hospital
Research Question and Methodology
This study examines the number of patients with chronic illnesses including chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and cancer (designated terminal) who have completed ADs and designated MPOAs. Data collection consisted of 85 chart reviews of patients ranging in ages 65-90. Gender and race information will also be collected. Patient charts were chosen by filtering chronic illness and through review it was noted whether or not the patient has a completed AD or designated MPOA.
Research Findings
Results The breakdown of results are shown as above. Of the 85 medical charts reviewed, 30.59% were patients with Cancer, 38.82% have CHF, and 30.59% have COPD. Percentage of those with and without MPOAs/Advanced Directives are shown above. Overall, 31.76% of patients have a completed MPOA/AD while 68.24% do not. There was no significant difference within gender and the majority of patients are White, so this research could not conclude if race might influence results
Social Work ImplicationsSocial workers are able to provide patients with ADS and MPOA forms to complete. They are also able to educate patients on the necessity and benefits of having these completed forms. Social workers can work with patients and loved ones to complete these forms and make sure the wishes of the patient are known and at the forefront of medical decision making. Based on the results of the current study, many patients with chronic illness do not have completed ADs or designated MPOAs. Social workers can have these conversations with patients and their loved ones to bridge this gap within healthcare treatment.
Integrated Healthcare Competencies• Interpersonal Communication • Collaboration and Teamwork• Screening and Assessment• Care Planning and Care Coordination
AcknowledgementsElorreaga, N., Allred, D., Ortiz, G., McNeill, C., Scholand, M. B., & Frech, T. M. (2017). Implementation of an advance directive focus in a Chronic Multi-Organ Rare Disease Clinic. Annals of palliative medicine, 6(Suppl 2), S206–S208. https://doi.org/10.21037/apm.2017.08.06Facts on Act 169 (Advance Directives). N.d., from https://www.pamedsoc.org/detail/article/Act-169-factsThis fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Alexa Harms, Edith M. Baker Integrated Healthcare Fellowship
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Cancer CHF COPD
Percen
tage
Chronic Condition
Demographic InformationMale
Female
White
Black/AfricanAmerican
30.77%
39.39%
23.08%
Percentage of Patients With MPOA/Advance Directives
Cancer CHF COPD
69.23%
60.61%
76.92%
Percentage of Patients Without MPOA/Advance Directives
Cancer CHF COPD
14
The Underlying Effects of COVID-19 on Hospital Social
Workers
UPMC Children’s Hospital of Pittsburgh (CHP)
Samantha Yule, Maggie Schmitt, Julianna Giannantonio,
and Hope Lowry
Background
The COVID-19 pandemic has affected large populations of
individuals across the world resulting in global shutdowns,
stay-at-home orders, and restrictions on day-to-day
functioning. To date, there have been more than 30.1 million
recorded cases of COVID-19 in the United States, and over
546,000 of those cases resulting in death (John Hopkins
University, 2021). Essential healthcare workers including
hospital social workers play a key role in responding to
psychosocial needs of patients and families.
Research Question
How has COVID-19 affected the role of hospital social
workers between March 30, 2020 and December 31, 2020?
Methodology
An online survey with five short-answer questions and fifteen
scaled questions was distributed to every CHP social worker in
the department via email. The responses were collected
anonymously over the period of several weeks. Two reminder
emails were sent to encourage the entire department to
participate.
Results
Our results indicate that many social workers at CHP
experienced increased symptoms of burnout during this period.
Overall, social workers reported that their roles did not
drastically change despite the pandemic however, social
workers noted that other healthcare professionals became more
aware of how hospital social workers can contribute to the care
of patients and families. While other healthcare professionals
seemed to recognize the contributions of hospital social
workers, our results show that hospital social workers’ and
their safety was not prioritized leaving many of them without
proper resources and equipment for months into the pandemic.
Limitation
This data was collected out of convenience from UPMC
Children’s Hospital social workers therefore, this data cannot
be generalized to all hospital social workers.
Implications for Social Work
Healthcare social workers have had to adapt to new guidelines,
adjust their roles, and how to deliver services to patients and
families (Daphna-Tekoah et al., 2020). Our findings suggest
that social workers must continue to educate other professions
about their roles and the importance that they have in the the
lives of patients and families.
15
The Effects of COVID-19 on Hospital Social WorkersJulianna Giannantonio, Hope Lowry, Maggie Schmitt, Samantha Yule
UPMC Children’s Hospital of PittsburghUPMC Children’s Hospital of Pittsburgh (CHP) is located in the Lawrenceville area of Pittsburgh and is comprised of 313-beds, including 46-bed emergency department and trauma center, and 124-bed critical care unit. CHP is the only Level-1 pediatrictrauma center in western Pennsylvania.
IntroductionThe COVID-19 pandemic is an unprecedented, challenging, and uncertain event that has drastically impacted everyone’s personal and professional lives. Healthcare professionals and other essential workers have arguably been impacted the most by the pandemic from the beginning.
Project Goals● Identify & understand the overall impact of
COVID-19 on medical social workers specifically:○ Social workers’ responsibilities○ Performance○ Work environment○ Delivery of services
● Analyze results & utilize information to preparehospital social workers for future crisis events
● Improve the level of services delivered to patientsand families
Research QuestionHow has COVID-19 affected the role of integrated hospital social workers between March 30, 2020 and December 31, 2020?
Integrated Healthcare Core CompetenciesInterpersonal Communication: Social workers communicating with patients and families.
Collaboration and Teamwork: Integrated healthcare professionals working as a team to effectively communicate on behalf of patients and families
Cultural Competence and Adaptation: Social workers utilize translation technologies (Cryacom/bluephones) services to communicate between the medical team and families
System Oriented Practice: Staff members ability to function effectively within organizational and financial structures
Informatics: The ability to navigate delivering services in utilizing telehealth applications
Implications for Social Work PracticeThe COVID-19 pandemic has shown to have affected many individuals and their families. Healthcare social workers have had to adapt to new guidelines, adjust their roles, and how to deliver services to patients and families (Daphna-Tekoah et al., 2020) Our findings suggest that social workers must continue to educate other professions about their roles and the importance that they play in not only their multidisciplinary teams, but also the lives of patients and families. Also, noticing gaps in resources and equipment available can help inform responses to future crisis.
References and AcknowledgmentsDaphna-Tekoah, S., Megadasi Brikman, T., Scheier, E., & Balla, U. (2020). Listening to Hospital Personnel’s Narratives during theCOVID-19 Outbreak. International Journal of EnvironmentalResearch and Public Health, 17(17), 6413. MDPI AG. Retrievedfrom http://dx.doi.org/10.3390/ijerph17176413
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. This study was made possible by participating UPMC staff members.
Edith M. Baker Integrated Healthcare Fellowship
Results
LimitationsUnfortunately, this research was limited by time constraints as well as a small sample population that prevent the data from being generalized beyond the participants in the project.
Methodology ● Survey emailed to 35 participants● 15 Likert scaled questions & 5 open-ended
questions starting on January 30th and ending onFebruary 17th, 2021
UPMC Children’s Hospital of Pittsburgh4401 Penn Ave, Pittsburgh, PA 15224
16
Addressing Social Determinants of Health in Primary Care Setting
Primary Care Institute; Allegheny General Hospital Internal
Medicine
Emmanuela Abraham
Background/Problem
Many studies have found that Social Determinants of Health such as
transportation, finances and food security impact individuals’ ability to
access care, afford medications, and overall wellbeing. According to
the American Hospital Association, the physical environment, social
determinants and behavioral factors drive 80 percent of health
outcomes. With this in mind, Allegheny Health Network has made it
their mission to address not only the physical needs of their patients,
but also their social needs. Allegheny Health Network formulated a
Social Determinants of Health Assessment (SDOH) to be implemented
in their hospitals and primary care offices. Within the past 1 ½ years,
the network’s primary care offices have gone through a transformation
and trainings to implement this assessment. Unfortunately, many
offices such as Allegheny General Hospital Internal Medicine have not
been receiving a steady flow of referrals.
Research Question
What factors impact the social work referral process and what barriers
exist to patients disclosing information on a SDOH assessment?
Methods
Participants were selected through a chart audit of SDOH assessments
completed during new patient and annual wellness visits for the month
of February. Patients who were not asked Social connections section
were excluded with a total of 24 participants. The researcher
formulated a survey that was conducted over the phone. A two-call
limit was set, and voicemails were left with each missed call. Out of
24, 12 patients participated in the interview.
Results/Recommendations
Results found that many patients are not aware of what the Social
Determinants of Health Assessment is and why it is conducted. It was
also found that patients are do not have a solid understanding of what
information we are seeking when these questions are asked. For the
questions of focus in this study, each participant produced various
interpretations. This in turn can affect patient responses. Several
participants expressed that they felt like some questions were redundant
and unnecessary. This study has shown that how the question is asked
is just as important as what is being asked.
Based on the results, I recommend that the assessment be shifted from
being asked exactly as stated to turning it into a conversation. With that
being said, new training should be implemented focused on
interviewing skills. I also recommend that each office create incentives
to encourage the medical assistants to complete the assessments.
Limitations
Limitation involved with this study are the lack of completed
assessments and participants not picking up the phone or refusing to
take part in the assessment.
Implications for Social Work Practice
This study is relevant because addressing the social needs of patients
in healthcare settings impacts their health and overall, well-being. It is
important to have effective programs and strong collaborations to
make this possible.
17
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program.This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Alleghany General Hospital Internal Medicine
Method/Design(How, Where , When)
Results/Recommendations
Social WorkCompetencies
References & Acknowledgements
Alleghany General Hospital Internal Medicine (AGHIM) is a primary care office in downtown Pittsburgh that specializes in internal medicine. This location serves primarily adult patients from 18 years and older.
AGHIM is in an area where residents are known to face many social determinants compared to other cities in Pennsylvania. Unfortunately, the onsite social worker has not been receiving a steady flow of referrals.
This has led management/social work team to question: What factors impact the social work referral process and what barriers exist to patients disclosing information on a SDOH assessment?
The researcher believes that some possible factors to the lack of referrals are patient understanding of assessment questions and patient interactions with the medical assistants.
Participants were selected through a chart audit of SDOH assessments completed during new patient and annual wellness visits for the month of February. Patients who were not asked Social connections section were excluded with a total of 24 participants.
The researcher formulated a survey that was conducted over the phone. A two-call limit was set, and voicemails were left with each missed call. Out of 24, 12 patients participated in the interview.
Sample Question: During the assessment, did the medical assistant make you feel like he/she cared about your concerns?
Results of the survey concluded that patients are not aware of what the Social Determinants of Health Assessment is or why it is conducted. It was also found that patients do not have a solid understanding of what information we are seeking when these questions are asked. Each participant produced various interpretations of questions. This in turn can affect patient responses. Another factor affecting patient responses is asking the questions exactly as written. One patient stated, “ These are straight forward, and straightforward questions get straight forward answers”. This is very important to consider as one patient has many social concerns come up while conducting the survey that were not flagged or mentioned during the assessment.
Based on results, I recommend that new training be implemented in interviewing skills for all staff. I also recommend office managers implement incentives such as gift cards to encourage assessment.
• Cultural Competence and Adaptation• Screening and Assessment• Practice-Based Learning and Quality
Improvement • Interpersonal Communication
Alleghany General Hospital Internal Medicine
Issue/ Research Question
Addressing Social Determinants of Health in Primary Care Settings Emmanuela Abraham, Edith Baker Integrated Healthcare Fellowship
Site NameSite Logo Here
Background
Social Determinants of Health (SDOH) are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life-risks and outcomes (Center for Disease Control and Prevention, 2021). These include items such as food security, socioeconomic status, education, transportation and housing. These factors can affect resident’s ability to access care, ability to afford medications and overall wellbeing. In the 2019 Kaiser Permanente Social Needs in America survey, researchers found that 68% of Americans had at least one unmet social need in the past year and more than 25% stated that an unmet social need was a barrier to health (Molis, 2020). In order to address these concerns and improve healthcare outcomes and access for all, Alleghany Health Network formulated a Social Determinants of Health assessment and implemented them in their hospitals and primary care offices across the state of Pennsylvania.
75%
8.30%
16.70%
Do you think this question (How often do you lack companionship)
could have been asked better?
Yes
No
The term "companionshipcan cause confusion
18
The Relationship Between Patient Demographics and Drug
Testing
West Penn Hospital
Mary Ackourey and Kelly Polosky
Background
West Penn Hospital, like many other Pennsylvania hospitals,
lacks a drug screening policy. Without a written protocol to
follow, physicians can order drug screens for patients
arbitrarily. The problem with this method of screening is the
possible inclusion of systematic bias. Studies have found
significant bias among healthcare professionals with regard to
race/ethnicity, gender, and socio-economic status. Identifying
and eliminating bias is of great importance as biases can
correlate to poor quality of care for patients (FitzGerald &
Hurst, 2017).
Research Question:
Does a patient’s demographic information have any correlation
with whether a patient is drug tested upon admission to the
hospital?
Method
This project was designed to identify possible bias among the
current drug screening methods of patients. The project period
lasted from December of 2020 until March of 2021. During
this time, data was collected by reviewing 500 patient charts.
Of the 500 inpatient charts reviewed, 140 patients were found
to have been given a drug screen upon admission to the
hospital. Information on the patient's race/ethnicity, age,
gender, and insurance was then collected and compared to the
hospital's yearly patient demographic data.
Results
After the data was collected, there was no bias with regard to
patient gender, as the sample population was consistent
compared to the hospital's yearly patient demographics.
However, it was found that patients identifying as black or
African American were drug tested at a higher rate than
patients of other races. It was also found that patients were less
likely to be given a drug screen if they were aged 65 or older
when compared to other age groups. These findings provide an
affirmative answer for the research question: Yes, a patient’s
demographic information is correlated with an order for a drug
test.
19
The Relationship between Patient Demographics and Drug Testing
Mary Ackourey and Kelly Polosky
Research QuestionThis research aims to uncover whether a patient’s
demographic information has any correlation with whether a patient is drug tested upon admission to the hospital.
Findings1. Men and women are drug tested proportionately
to hospital demographics.2. Patients identifying as Black or African American
are drug tested in a higher proportion to yearly demographics.
3. Patients aged 65 years and over are tested at a lower rate than other age groups, especially when
controlling for testing based on altered mental status diagnoses.
Methods and DesignData was collected from 140 patients through review of 500 inpatient charts between December 2020 and March 2021. Demographic information was collected only from patient
charts that indicated a drug test was given.
Social Work ImplicationsAddressing WPH drug testing practices is relevant
because the inconsistencies violate the social work competencies and ethical codes. The lack of a uniform
policy allows medical providers to uphold a lack of cultural competence in drug testing practices. Having
more standard drug testing procedures is best practice when considering patient safety and self-
determination. Patients should be afforded the option to use services related to substance use, should they
need or want those services.IHC Competencies
1. Cultural Competence and Adaptation2. Practice-Based Learning and Quality Improvement
3. Informatics
Acknowledgement: This fellowship is supported by the Health Resources and Services
Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)
under grant number M01HP31376, Behavioral Health Workforce Education and
Training (BHWET) Program. The information or content and conclusions are those of
the authors and should not be construed as the official position or policy of, nor should
any endorsements be inferred by HRSA, HHS, or the U.S. Government.
BackgroundWest Penn Hospital is in Bloomfield, Pa, and has been
serving the Pittsburgh community since 1848. West Penn is proudly part of the Allegheny Health Network. The network
values working as an integrated system to improve Pittsburgh communities' health and wellbeing. Guided by these values, West Penn has received national recognition
for patient care and outstanding medical services. With these recognitions, it's no wonder the hospital is
recommended for burn care, oncology, pregnancy, and newborn services, and so much more.
20
COVID-19 Impact on Therapy Warm-Referral Availability
Center for Adolescent and Young Adult Medicine Clinic,
UPMC Children’s Hospital
Srinidhi Alur, Jonathan Peitzman, and Ryan Martin
Background
Research suggests that telemedicine is effective for psychiatric
medication management and counseling in a young adult
population. Our clinic has behavioral health providers
supporting adolescent patients with mild to moderate
depression or anxiety. Observational data during the pandemic
described increased wait times and inability to take new clients.
Adolescents can be a difficult population to engage in care.
One study found that of all the adolescent patients referred to
mental health treatment, only 18% ever initiated care. Our
study intended to explore how our clinic could be more helpful
with increased obstacles in a population known for low
motivation and responsiveness.
Research Question
How has COVID-19 impacted the experience of adolescent
patients and their families when given a referral to an outside
mental health provider?
Method
Data was collected during 1-2 week follow-up phone calls
from referral date. For consistency, we looked at patients who
were provided referrals in Allegheny County. We used a
questionnaire we developed to standardize the process. The
questionnaire assessed the reason patients came to the clinic, if
they followed up with referrals, and if so what their experience
was like. We asked specifically about wait times for referrals
and patients’ satisfaction with the process. If patients didn’t
contact referrals, we asked why they didn’t contact the
referrals.
Results
We found it extremely difficult to reach patients for follow-up
if at all. We called patients once a week for two weeks and left
a voicemail if given the option. If patients had access to
MyUPMC, we also sent a message with our contact
information.
Limitations
We reached out to 35 participants and heard from 10 on
accessing resources.
Conclusion
This study demonstrated benefits and barriers to the integrative
care model and availability of services. For instance, patients
were assessed for level of care and multiple resources were
given to them by social work interns. It was during follow up
with 35 participants in the next 1-2 weeks where challenges
were met in reaching patients. Social work interns offered
additional support but had less than one-third utilize ongoing
services. We believe that future studies should focus on
developing interventions to improve follow-up with this patient
population.
21
BackgroundPrevious research on telemedicine, or telemental health,
has proven to be effective with youth and adolescents both with psychiatric medication management and
mental health therapy interventions. In the context of our clinic, we utilize warm referrals for patients whose
level of care exceeds a moderate anxiety or depression. What remains to be fully explored are the effects of the deluge of demand on mental health clinics. The influx in demand for mental health services has increased both
wait times and acceptance of new patients. Further research will be able to analyze this fully in the coming
years as COVID-19 decreases its global impact.
Research QuestionsAre the wait times for referrals outside of the clinic that
are regularly referred to by CAYAH (Center for Adolescent and Young Adult Health) inaccessible? Are referrals to therapy outside of the clinic impacted negatively by
COVID? Referrals given to adolescents and young adults must be outpatient therapeutic referrals within
Allegheny County.
IHC CompetenciesCompetency #4 Engage in Practice-informed Research and Research-informed PracticeImplement research to see if individuals are getting access to therapeutic resources or accessing therapeutic resources after their visit to the clinic for an in person/telemedicine appointment with a provider.Competency #6: Engage with Individuals, Families, and Small GroupsEngage with individuals about access to therapeutic resources outside of the clinic, including how they have reached out to resources, wait time from referral source and other explanations given for access or barriers in accessing resources (insurance, location, etc.).Competency #7: Assess Individuals, Families, and Small GroupsLook at the process with a holistic lens in accessing resources outside of the clinic. We will account for willingness to start therapy, barriers around creating an appointment outside of the clinic, and addressing wait time for outside referrals.
Methods•Baker Fellows followed-up with patients 1-2 weeks after they have been givenoutside mental health referrals.•For consistency, we limited our contact to patients who had been referred toresources in Allegheny County•All questions were asked from a questionnaire developed to standardizethe process:
•Baker Fellows obtained demographic information (age, gender, race)•Assessed reason for warm referral, whether patients was able to reach out tothese referrals (yes or no), and if they came to the clinic for mental health reasons.•For patients who didn't reach out to referrals (no):
•we assessed if there was any reason they didn't contact referral•For patients who have reached out to referrals (yes):
•we assessed how many they called, how soon they called after the referral• to what degree were they able to access therapeutic resources
•outcome of their call, if it was difficult to contact someone toschedule with, how long did they wait for first appointment, werethey satisfied with telemed format.
•We also assessed for quality of referral process:•Did you find the referral process easy to understand, Were you satisfiedwith the information/direction provided, any additional supports thatwould have helped the process.
DiscussionFor the future, an intervention that could be considered in gaining
feedback from patients could be a virtual system. Some adolescents and young adults do not call back after leaving the office. Including
a virtual messaging system for social workers, adolescents andyoung adults can enhance communication about accessing
therapeutic resources after warm referrals.Limitations: Currently, given the climate of Covid-19, there are limitations to the study including seeing patients for in person
referrals. Working remotely has impacted answering phone calls from patients. If social work interns would like to hear from
patients, they must leave a voicemail, which does not always occur. It has been difficult to reach and follow up with patients.
Implications for Social WorkPatients should have access to mental/behavioral health
resources when the patient seeks out services. There is limited research on what access to therapeutic resources may look like
during COVID-19.As Social Workers in Integrated Healthcare settings, it is our duty to improve access to resources for our patients and clients. Given
the current climate, there is an increased need for therapeutic resources. As mental health advocates in this setting, it is
important to be aware of the availability of outsidereferral resources to ensure accessibility for patient
needs outside of the clinic. It is also crucial to connect with patients on accessing referrals outside of the integrative health
model and recognizing how to reach patients.
Acknowledgements This fellowship is supported by the Health resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and
conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S Government. We would like to thank Kara Peters LCSW, Sarah London MSW, and Alex Ley LSW and the Division of Adolescent and Young Adult Medicine for their
guidance and support with this project.
COVID-19 Impact on Therapy Warm-Referral AvailabilitySrinidhi Alur, Jonathan Peitzman, and Ryan MartinEdith M. Baker Integrated Healthcare Fellowship
Division of Adolescent and Young Adult Medicine
ResultsIn total, there were 35 patients involved in data collection after implementing our
exclusion criteria. Of these 35 patients, we were able to reach 10 patients. 6 patients reported that they attempted to contact resources.
Wait times for the referrals patients contacted varied drastically. Wait times ranged from 2.5 weeks to 2 months. Some locations stated that their waitlists were closed due to high
demand.
ConclusionQuantitative data was collected from 10 participants, on reaching
therapeutic resources. Two higher level of care facilities had wait times consisting of months or were not accepting patients, one higher level of care facility had wait times for 1-2 weeks and varying input consisted of
individual psychologists accepting patients (1 participant) and two individual psychologists not accepting patients (1 participant). One
participant did not hear back from the facility after leaving a voicemail. It is important to look at demand for mental health resources, availability and participants who are reaching out to referrals. It was indicated by
several participants that they did not reach out to the referrals provided. Either patients were successful in getting connected to
therapeutic services, the patient had difficulty in getting connected and did not get connected or the patient did not reach out. Given the
difficulty in reaching patients, we believe that future studies should focus on developing interventions to improve follow-up with this patient
population. As part of an integrated healthcare setting, we must ensure that we are able to connect our patients with resources.
22
Combatting Hunger and Assessing the COVID-19 Pandemic
Impact on Food Access and Affordability
UPMC Matilda H. Theiss Health Center
Aubrey Masters
Background Food insecurity is a complex problem closely associated with poverty. Those who are food insecure are at an increased risk for negative health outcomes and health disparities. The Theiss Health Center receives federal funds from the Health Resources & Services Administration (HRSA) Health Center Program to provide primary care services in underserved communities where food insecurity and poverty are common barriers that the patients face. A 2018 Pittsburgh study identified West Oakland and Terrace Village as food desert locations. The study identified that one-third to one-half of residents in those areas experience food insecurity. These are the communities and people that our health center cares for, making it essential to address food barriers known to disproportionately impact people of color and those of low socioeconomic status (Culgan & Deppen, 2018).
Research Question
Is food insecurity a significant barrier to accessing healthcare?
Method This project was designed to assess food insecurity in our patients and how the pandemic impacts their access and ability to afford food. During the data collection period (January 18, 2021 – February 17, 2021), the Social Work Intern contacted patients from Theiss via phone calls, Survey Monkey, and in-person surveying prior or after appointments. Eighty-six patients of Theiss were surveyed, with a standardized 6-
question hunger vital screening with additional questions specific to the COVID-19 pandemic’s impact on their food accessibility and affordability. The survey had a total of 9 questions asking about their worrying, affording, and access of food over the last month, six months, and a year. Those who scored a 5 or 6 on the first 6 questions were offered immediate relief through Thrive Boxes and adding them to our monthly food donation call list.
Results In January, 42% worried about money and food and 27% ran out before they could get more. These numbers increased as the time scope of the question extended further back. At 6 months, 57% were worried and 47% physically ran out of food and money. These numbers are even higher spanning back a year at 63% worried about food and money and 57% physically ran out of food before they had the funds to buy more. Food insecurity is a significant barrier among Theiss patients and others of low socioeconomic status.
Limitations First, the patients at Theiss can be transient at times and often change their phone numbers or provers. Second, lack of transportation and snowy weather conditions of January and February in Pittsburgh provided more challenges. Patients scheduled to show were often unable to make it due to lack of transportation with the snow only exacerbating the issues. Third, the pandemic and telehealth eliminated the possibility for the Social Work intern to survey those in the office.
Recommendation: Addressing food insecurity can prevent health disparities and complications in the future.
23
• Usefulness of integrated team approach• Addressing food insecurity breaks down barriers and helps underserved
communities• Preventing more health disparities and adversities in the future• More research needed to better address food insecurity• Theiss Implications
• 21 new additions to donation list and 16 Thrive Boxes• More support is needed for our patients in the pandemic• Follow-up research to ask how we can better address food need
86 total patients surveyed• 42% worried about money and food in the past month and 27%
physcially ran out before they could get more• % worried and running out of food increased as time scope expanded
from 1 month, 6 months, and 1 year• 63% worried about money and food in the past year and 57% physically
ran out before they could get more• Immediate relief offered to those who scored a 5 or higher on first 6
questions• THRIVE Boxes, 412 Food Rescue
COVID-19 Impact• 54% stated COVID-19 made their ability to afford and access food worse• Only 9% said pandemic has made it better
• Attributed to increased benefits, less need for transportation,greater utilization of food banks, more cooking at home
• 77% have a moderate to high worry about food and money in COVID-19
Combatting Hunger and Assessing the COVID-19 Pandemic Impact on Food Access and Affordability
Aubrey Masters, Edith M. Baker Integrated Healthcare Fellowship
UPMC Matilda H. Theiss Health Center
UPMC provides community-based health care services in Pittsburghneighborhoods. UPMC Matilda H. Theiss Health Center is located in upperOakland. It is the only federally qualified health center within UPMCmeaning it receives funds from the HRSA Health Center Program to provideprimary care services in underserved communities.
Social Issue & Research QuestionIn what ways does hunger and food insecurity impact Theiss patients andhow has COVID-19 impacted food accessibility and affordability?
Those who are food insecure are at an increased risk for negative healthoutcomes and health disparities. Focusing on food insecurity can preventhealth problems. Food insecurity disproportionately impacts individuals ofcolor and those living with disabilities. It is important to resolve foodinsecurity for the health and well-being of individuals and communities andto alleviate disparities. In 2018, a study was conducted to locate fooddeserts within Pittsburgh. This identified West Oakland and Terrace Village(Matilda Theiss location) as food deserts. These areas showed that foodinsecurity impacts between one-third to one-half of all residents. Bridgingthe gap for the patients at Theiss is important (Culgan & Deppen, 2018).
Research Design and MethodologyI surveyed 86 patients primarily utilizing phone calls. Survey Monkey wasalso emailed to those who approved email contact and were inaccessible byphone; however, Survey Monkey did not yield many responses.
Data collection was through subjective surveys consisting of 9 questions.The first 6 questions are “Yes/No” responses asking about affording andaccessing food over the last month, six months, and year. The 7th and 8th
questions are scaling questions about COVID-19 impact on their foodaccessibility and affordability and to what extent the pandemic hasincreased their worry about food and money and running out of thosethings. For a score of 5 or more on the first 6 questions, immediate reliefwill be offered. Lastly, if the patient chooses, they may leave their name andnumber to be added to our monthly food donation call list.
Integrated Healthcare Competencies
• Collaboration and Teamwork• Interprofessional teamwork
• System Oriented Practice• Assessing internal and external barriers
• Intervention• Immediate food relief after survey with
Thrive Boxes and monthly donation list; referred to dietician at Theiss
Findings
Implications for Social Work Practice
ReferencesCulgan, R. & Deppen, C. (2018). Fresh Divide: Inside Pittsburgh’s food deserts, where buying milk or veggies is impossible. TheIncline. Retrieved from: https://archive.theincline.com/2018/10/15/fresh-divide-inside-pittsburghs-food-deserts-where-buying-milk-or-veggies-is-impossible/
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Healthand Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training(BHWET) Program. This information or content and conclusions are those of the author and should not be construed as theofficial position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
24
Implementing Social Determinants of Health Screening in an
IBD Clinic
UPMC Total Care – Inflammatory Bowel Disease (IBD)
Echo Eggebrecht
Background
The World Health Organization (2008) defines the social
determinants of health (SDOH) as the daily conditions in
which people live, as well as the wider set of systems shaping
those conditions, that influence individual and group health
outcomes. The evidence base for the relationship between
health outcomes and levels of support for social factors such as
income, housing, and personal safety is strong, and there is
increasing recognition of the need for health workers at the
clinical level to incorporate screening for SDOH to better
ensure overall patient success (Andermann, 2018). The
correlation between decreases in patients social and economic
status and increases in negative health outcomes is referred to
as the social gradient. Gaining a better understanding of what
social factors patients with IBD most frequently report as
requiring attention will better enable the clinic to identify
appropriate interventions and develop a network for referrals.
Research Question
What are the areas of highest need that an SDOH Screener can
identify among the patients receiving care through UPMC
Total Care?
Method
Through close collaboration with Total Care team members
and outside experts in screening for SDOH, the Social Work
Intern developed a screening tool appropriate for use with the
clinic’s patient population. The tool consists of nine questions
addressing social factors identified as affecting health, well-
being, and quality of life: health insurance status, medication
affordability, employment, housing, food access, personal
safety, transportation, utilities/technology, and childcare. The
Social Work team administered the tool to a systemically
randomized sample of patients over the phone and during
telehealth sessions.
Results
Screening revealed that the area of social concern most
common to the sample of patients concerned employment, with
70% of patients reporting that they were unemployed.
References
Andermann, A. (2018). Screening for social determinants of
health in clinical care: moving from the margins to the
mainstream. Public Health Reviews, 39(1), 19–19.
https://doi.org/10.1186/s40985-018-0094-7
World Health Organization. (2008). Closing the gap in a
generation: Health equity through action on the social
determinants of health: Commission on Social Determinants of
Health final report. Geneva.
25
Implementing Social Determinants of Health Screening in an IBD ClinicEcho Eggebrecht, Edith Baker Integrated Healthcare Fellowship
BackgroundInflammatory bowel disease (IBD) affects nearly one million people nationwide. UPMC Total Care is the nation’s first Patient-Centered Medical Home (PCMH) for IBD patients, offering patients coordinated access to care addressing the full spectrum of their health needs.
Research Issue and Question
Implementing social determinants of health (SDOH) screening within a clinic’s practice can enable a team of providers to better target the needs of patients through an improved awareness of the social, economic, and environmental issues affecting patients (Bernstein et al., 2020). This project asks: What are the areas of highest need that an SDOH Screener can identify among the patients receiving care through UPMC’s PCMH for IBD patients?
Screener Design & Implementation
Patients scheduled for telemedicine appointments with a Total Care provider were randomly selected to complete the SDOH screener via a phone call in advance of their appointment. The screener was developed through collaboration with Total Care team members and external experts in SDOH screening The screener addresses 8 domain identified as affecting patients’ health, well-being, and quality of life: health insurance status, medication affordability, employment, housing, food access, personal safety, transportation, and utilities. This is a pilot project to explore the potential for future use of SDOH screening in the clinic’s assessment of patients.
Results: Areas Indicating Greatest Need
Social Work ImplicationsImplementing SDOH screening into clinical practice will better enable social worker to fulfill the principle of addressing social problems and helping patients in need. SDOH screening can help social workers to observe how social inequity contributes to negative health outcomes and to identify interventions that will help patients access services. Improved data collection and interpretation will strengthen the clinic’s capacity to meet patients’ needs (Andermann, 2018).
IHC Core Competencies
Interpersonal Communication: Communicating effectively with participants contributes to the successful collection of data and aids patients inunderstanding the purpose of the research.Screening and Assessment: This project centers on how use of SDOH screening can contribute to patient assessment in the clinical setting.Informatics: Data collected from SDOH screening is included in patients’ electronic health records, enabling team members to gain a more complete understanding of patient needs.Acknowledgement
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government
ReferencesAndermann A. (2018). Screening for social determinants of health in clinical care: moving from the margins to the mainstream. Public health reviews, 39, 19. https://doi.org/10.1186/s40985-018-0094-7Bernstein, C., Walld, R., & Marrie, R. (2020). Social Determinants of Outcomes in Inflammatory Bowel Disease. The American Journal of Gastroenterology, 115(12), 2036–2046. https://doi.org/10.14309/ajg.00000000000007
26
Dementia and Skilled Nursing Facility Barriers
UPMC Passavant McCandless
Amanda Bricker
Background
Dementia patients often face unique and challenging barriers
that extend or prevent placement in a skilled nursing facility.
One barrier is that some patients with dementia may require a
tailored behavioral or social care plan prior to transfer
(Gilmore-Bykovskyi, Roberts, King, Kennelty, & Kind, 2017).
Barriers such as behavioral and psychiatric symptoms, patients
with no acute illness, and economic and systemic disincentives
for nursing homes can present as problems (Sachs, Shega, &
Cox-Hayley, 2004). Another barrier is Medicare policy
denying Medicare part A hospice care for patients receiving
skilled nursing care (Miller, Lima, Looze, & Mitchell, 2012).
These barriers can have an impact on discharge planning for
social workers when discharging these patients to skilled
nursing facilities.
Research Question
What are the barriers to placement in a skilled nursing facility
for individuals with dementia?
Method
For this study, a systematic review of medical records of
patients with a diagnosis of dementia and a skilled nursing
facility placement that was met with a barrier. Barriers were
identified by reading the social work notes on each patient. The
social work intern reviewed 25 medical records of dementia
patients. These patients were identified through reviewing
social work chart notes from past patients and current patients.
The social work intern created a list of the top five barriers that
prevented placement in a skilled nursing facility for individuals
with dementia.
Results
The findings show that the biggest barrier to discharging
dementia patients to skilled nursing facilities is the presence of
behavioral and psychiatric symptoms while in the hospital,
followed by the category “other” which included a patient’s
issues with alertness, a patient being transitioned to comfort
measures only (CMO), a facility requiring 24 hours without
restraints, medically delayed discharge, no bed availability,
Covid-19 positivity, and staffing issues at the facility. The next
biggest barrier was that there was no acute illness present upon
admission to the hospital.
The other barriers, including economic and systemic
disincentives, behavioral and social care plan, and Medicare
policy, were found to be minimally impactful to skilled nursing
facility placement for dementia patients.
27
Dementia and Skilled Nursing Facility BarriersAmanda Bricker
Edith M. Baker Integrated Healthcare Fellowship
Introduction
Research Question
MethodsFor this study, a systematic review of medical records of patients with dementia in which the outcome was placement in a skilled nursing facility was conducted. I utilized a survey instrument with five questions created from previous literature while conducting the review. I looked for barriers that are similar to previous literature and will also note any new barriers. These barriers were identified by reading social work notes on each patient. For this study, I reviewed 25 medical records of dementia patients. These patients were identified through reviewing options paperwork from past patients as well as reviewing chart notes of current patients. Inclusion criteria included a diagnosis of dementia and a skilled nursing facility placement that was met with a barrier. I created a list of the top five barriers that prevented placement in a skilled nursing facility for individuals with dementia.
What are the barriers to placement in a skilled nursing facility for individuals with dementia?
Competencies• Screening and Assessment• System-oriented practice• Informatics
References
Findings Implications for Social WorkAt UPMC Passavant, there is a high number of elderly patients with dementia that require placement at skilled nursing facilities. There are often problems that arise surrounding the discharge of these patients due to their dementia diagnoses. With these barriers identified, social workers can plan ahead to make the transition from the hospital to the skilled nursing facility an easier process. This would improve the overall care for patients because they would not have to spend unnecessary days in the hospital. Spending extra time in the hospital puts them at an increased risk for being exposed to hospital-acquired infections.
UPMC Passavant McCandless
Dementia patients often face unique and challenging barriers that extend or prevent placement in a skilled nursing facility. As shown in previous literature there are a number of barriers that can prolong discharge from the hospital. During the data collection process, a number of other barriers were identified. One barrier is that some patients with dementia may require unique transition needs, such as a tailored behavioral or social care plan prior to transfer (Gilmore-Bykovskyi, Roberts, King, Kennelty, & Kind, 2017). Barriers such as behavioral and psychiatric symptoms, patients with no acute illness, and economic and systemic disincentives for nursing homes can present as problems (Sachs, Shega, & Cox-Hayley, 2004). Another barrier found is Medicare policy denying Medicare part A hospice care for patients receiving skilled nursing care (Miller, Lima, Looze, & Mitchell, 2012). These barriers can have an impact on discharge planning for social workers when discharging these patients to skilled nursing facilities.
With this study, the findings show that the biggest barrier to discharging dementia patients to skilled nursing facilities is the presence of behavioral and psychiatric symptoms while in the hospital. The next greatest barrier was other, which included patient’s issues with alertness, a patient being transitioned to comfort measures only (CMO), a facility requiring 24 hours without restraints, medically delayed discharge, no bed availability, issues with being Covid-19 positive, and staffing issues at the facility. The next biggest barrier was that there was no acute illness present upon admission to the hospital. The other barriers, including economic and systemic disincentives, behavioral and social care plan, and Medicare policy, were found to be minimally impactful to skilled nursing facility placement for dementia patients.
Gilmore-Bykovskyi, A. L., Roberts, T. J., King, B. J., Kennelty, K. A., & Kind, A. J. H. (2017). Transitions from hospitals to skilled nursing facilities for persons with dementia: A challenging convergence of patient and system-level needs. The Gerontologist, 57(5), 867-879.Miller, S. C., Lima, J. C., Looze, J., & Mitchell, S. L. (2012). Dying in US nursing homes with advanced dementia: How does health care use differ for residents with, versus without, end-of-life medicare skilled nursing facility care?. Journal of Palliative Medicine, 15(1), 43-50.Sachs, G. A., Shega, J. W., & Cox-Hayley, D. (2004). Barriers to excellent end-of-life care for patients with dementia. Journal of General Internal Medicine, 19(10), 1057-1063.
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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Understanding Urban and Rural Trauma Patients: Comparing Injuries and Health Outcomes Facility Not Disclosed Due to Confidentiality Alexandra Winter & Cole Rapso Background Traumatic injuries are one of the leading causes of death and disability in the U.S. Though trauma impacts all populations, level one trauma centers are primarily located in urban areas. This specialty care is not always feasible or accessible for trauma patients from rural areas due to finances, transportation, and other barriers. Previous studies have demonstrated poorer health outcomes for rural patients, as these populations do not have the ability to receive rapid and adequate care. Research Question To what extent are injuries and health outcomes different for trauma patients from rural areas compared to those from urban areas? Method We reviewed de-identified data on all trauma patients brought to the emergency room of a level one Pennsylvania urban trauma center from January 2019 – December 2020. We used the Centers for Medicare & Medicaid Services definitions of urban and rural zip codes. Rural injury patients comprised 561 of total cases while 3,522 cases were patients injured in urban areas. We defined “poorer” health outcomes to include longer hospital stays, discharge to a medical facility instead of home, and patient death.
Results Our findings indicate that, overall, urban and rural patients sustained similar types of injuries with similar mortality rates. Urban patients were more likely to sustain firearm-related injuries, while rural patients were more likely to be injured via machinery. Rural patients were also more likely to present with head injuries. Urban and rural patients had similar lengths of stay, but rural patients died earlier, on average. Urban patients were more likely to discharge to a sub-acute level of care, whereas rural patients were more likely to discharge home. Conclusion Future studies should encompass regional data, including lower-level local trauma centers, smaller rural hospitals, and EMS reports. Unfortunately, rural trauma patients are more likely to die on scene before ever reaching a hospital, leading to a data gap in our analysis. For this reason, social workers engaging in policy practice, public health, and/or social planning who are looking to improve rural patient health outcomes should advocate to strengthen rural EMS, including increased funding to increase the number of crews available, improve providers’ wages, and offer more advanced training. Medical social workers should also be aware of these disparities when approaching rural patients with regard to advance directive planning. Given that rural trauma patients are more likely to die in the field or within fewer days after an injury, upstream interventions are necessary to proactively and accurately record rural patients’ preferred medical decision makers, next-of-kin, and wishes for medical treatment. We hope our research informs social workers in practice at both the individual and institutional levels to anticipate and address the disparities that rural populations face in accessing trauma care.
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Understanding Urban and Rural Trauma Patients:
Comparing Injuries and Health OutcomesAlexandra Winter & Cole Rapso
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the
author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Implications for Social Work Practice
Social Issue and Research Question Findings
Research Design and Methodology
Cultural Competence & AdaptationIdentifying disparities in healthcare access and quality
System-Oriented PracticeRecommendations for adjusting delivery of care
Practice-Based Learning & Quality ImprovementMeasuring healthcare outcomes and collaborating with other team members on service improvement
Centers for Medicare & Medicaid Services. (2020, November 13). Ambulance fee schedule. U.S. Department of Health and Human Services.https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ AmbulanceFeeSchedule
Newgard, C. D., Fu, R., Bulger, E., Hedges, J. R., Mann, N. C., Wright, D. A., Lehrfeld, D. P., Shields, C., Hoskins, G., Warden, C., Wittwer, L., Cook, J. N., Verkest, M., Conway, W., Somerville, S., & Hansen, M. (2017). Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services. JAMA surgery, 152(1), 11–18. https://doi.org/10.1001/jamasurg.2016.3329
Traumatic injuries are one of the leading causes of death and disability in the U.S. Though trauma can impact all populations, level one trauma centers tend to be located in urban areas. Previous studies have demonstrated poorer health outcomes for rural patients sustaining traumatic injuries due to delays in care and lack of access to specialized services (Newgard et al., 2017).
To what extent are injuries and health outcomes different for trauma patients from rural areas compared to those from urban areas?
Application of Integrated Healthcare Competencies
We reviewed de-identified data on all trauma patients brought to the emergency room of a level one urban trauma center in Pennsylvania from January 2019 – December 2020. Of the total 6611 cases, we identified 4083 cases with known mechanism of injury, Injury Severity Scores, Glasgow Coma Scale scores, injury zip codes, total hospital days, discharge destinations, and discharge status.
We utilized the Centers for Medicare & Medicaid Services (2020) definitions of urban and rural zip codes. Rural injury patients comprised 561 cases and 3522 cases were patients injured in urban areas. We defined severe injury based on ISS and GCS scores. We defined “poorer” health outcomes to include longer hospital stays, being discharged to another medical facility instead of home, and patient death.
Overall, urban and rural patients sustained similar types of injuries with a few exceptions: urban patients were more likely to sustain firearm-related injuries while rural patients were more likely to be injured via machinery or forms of land transport other than motor vehicles. Rural patients were also more likely to present with head injuries.
Urban and rural patients had similar lengths of stay except that rural patients died earlier, on average.
Urban patients were more likely to discharge to a skilled nursing facility or rehabilitation center, whereas rural patients were more likely to discharge home.
Though patients from rural areas were more likely to be profoundly or severely injured according to injury severity scores (23% of rural patients vs. 16% of urban patients), mortality rates were similar across patients coming from urban areas (3.7%) and rural areas (3.6%).
• Further research needed to include all trauma centers ingreater area, as well as emergency medical services data
• Macro-level social workers should advocate to strengthenEMS services to improve rural patient outcomes
• Medical social workers should be aware of thesedisparities to anticipate rural and urban patients’ needs,specifically around advance directive planning
References
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Impact of “Discharge Planning Huddle” on Family Satisfaction
UPMC Montefiore Inpatient Rehabilitation Facility
Livia Slabodkin
Background
Discharge after a stay in rehabilitation can be a stressful time for patients and families. The Discharge Planning Huddle was created to review the Interdisciplinary Discharge Readiness Checklist with the patient, chosen family member, attending physician and therapist. During the huddle, the patient’s team meets with the patient and their family in preparation for in-home care. The interdisciplinary discharge readiness checklist includes topics such as: caregiver support for discharge, functional mobility and self-care, discharge needs, medications, follow-up appointments, and testing. The goal of the discharge planning huddle is to support the patient and their family in feeling prepared for discharge by providing necessary education.
Purpose
The Discharge Planning Huddle has only been implemented since fall of 2021 and it is unclear if it is benefitting the families in relation to preparedness for discharge and overall care satisfaction. To evaluate the effectiveness of the discharge planning huddle, an interview based study was implemented to evaluate patient and family participation and satisfaction.
Findings
My findings indicate that most families feel that the Discharge Planning Huddle aids in feeling prepared for discharge and is a beneficial part of the discharge process. Clear announcement of the beginning and start time of the Discharge Planning Huddle are significant barriers to the family’s satisfaction.
Discussion & Implications for Social Work
Discharge planning is an essential role of social workers in hospital settings. On UPMC Montefiore’s rehabilitation unit, care managers are in charge of educating families on the Discharge Planning Huddle and setting up their participation. The Discharge Planning Huddle’s success is important because family involvement is key to the patient experience and recovery being a success.
Limitations
There are possible limitations for this study in regard to sample size. A larger sample size would have allotted more precise statistical analysis. More research must be done to accurately and effectively establish how the Discharge Planning Huddle is affecting family satisfaction.
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Impact of “Discharge Planning Huddle” on Family SatisfactionLivia Slabodkin, Edith M. Baker Integrated Healthcare Fellow
UPMC Montefiore Inpatient Rehabilitation Facility
Interpersonal Communication
Collaboration and Teamwork
Care Planning and Care
Coordination
System Oriented Practice
This fellowship is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number, M01HP31376, Behavioral Health Workforce Education and Training (BHWET) Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Integrated Healthcare Competencies
• The Discharge Planning Huddle was created todiffuse patient and family anxiety, questions orconcerns at discharge.
• DPH is conducted two days prior to discharge• Care managers schedule the meeting with families.• During DPH, the patient's attending doctor
and therapists meet with the patient and their pointperson to review DPH checklist
• The DPH has only been in effect since the fall and itis unclear if the DPH has benefited families inrelation to patient satisfaction.
• I wanted to find out: What changes could beimplemented to the DPH to increase familysatisfaction at discharge?
Family and patient interviews were conducted on day of discharge. Interviews included 5 questions:(1)Who was present at the huddle?(2)Was the DPH announced?(3) What time did the DPH begin?(4) Did the DPH aid in day of dischargepreparedness?(5) Was there a topic you wish had beendiscussed during the DPH, that wasn't?14 participants were interviewed on day of discharge: 7 patients and 7 family members.Inclusion/ Exclusion Criteria: Family memberswere only interviewed on day of discharge if they participated in DPH by phone or in unit.
4. Research Design & Methodology
Results:• Among my small participant pool, all participants
answered "yes" to my 4th question, "Did the DPHaid in day of discharge preparedness?".
• Unclear announcement of the Discharge PlanningHuddle caused some participants to not knowthey had actually participated in DPH.
Conclusions:• The Discharge Planning Huddle is impactful, if the
information Social Work communicates to familiesis compatible with the reality. Family frustration atdischarge can be mitigated if their perception ofDPH is aligned with reality.
• Clear communication to patients and families ofthe Discharge Planning Huddle beginning willindicate meeting importance
• In the future, interviewing more participantswould grant more reliable data.
5. Findings
• 20-bed facility in an acute care hospitalwith the latest technology and access totop rehabilitation professionals
• UPMC Rehabilitation Institute patientsreceive comprehensive rehabilitative carethrough specialized programs andfacilities that include in-unit therapygyms for daily exercise
1. UPMC Rehabilitation Institute
2. Issue & Research Objective
3. Discharge Planning Huddle Checklist
• Discharge planning is essential role ofSocial Workers in hospital settings. Onour rehab unit- care managers are incharge of setting up families withDPH.
• Family involvement is key tothe patient experience and recoverybeing a success.
• Case managementinvolves understanding theclient’s micro and mezzo systems,and family is a significant component .
Relevancy & Implications for Social Work Practice
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Evaluating Mental health/Substance usage Concerns in Braddock Borough AHN Braddock Family Medicine
Alexandria Hickman Background The town of Braddock was once a thriving community filled with store fronts and a flourishing population. However, as the steel mill closed it took many businesses and community members with it. Subsequently, Braddock has experienced a shortage of resources including those related to mental health and substance abuse. However, Allegheny Health Network (AHN) Braddock Family Medicine has recently implemented an integrated health care model, including a behavioral health consultant on their team to address the mental health concerns of their patients. Looking to expand their work and address the entire Braddock community, AHN created a Community Strengths & Needs Assessment funded through a grant provided by the Staunton Farm Foundation. Research Question Are mental health concerns recognized and treated within the community? Hypothesis
Many community members and organizations are unaware of mental health/substance abuse services within the area; and barriers to care prevent community members from accessing resources.
Method We created and conducted the community intervention plan based on suggestions from the Center for Disease Control CHI intervention model. We decided that a survey method would be the best approach for this community. We conducted several community organization and community member interviews to gain a deeper understanding of the resources and gaps in mental health care in Braddock. We reached out to 20 community organizations around Braddock and interviewed 15 out of those 20 including organizations such as MAYA, Healthy Start, and Family Care Connections. Along with those community organization interviews we surveyed 62 community members and interviewed 3 out of those 62 members for more in-depth examinations. The results showed that 84% of community members found the issue of mental health and substance abuse treatment to be important and 16% found it to be unimportant. We compared these numbers to the results of the community member’s satisfaction of Braddock Borough efforts to address the issue which showed 59% of community members were unsatisfied vs 41% of community members who were satisfied. Result & Recommendation There is a greater percentage of community members who recognize the value of mental health care and who feel more effort is needed to provide such care to residents. The next step will be to gather leaders from within the community to create an advisory board who will collaborate with AHN to support their need for better access to mental health & substance abuse services.
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Evaluating Mental Health/Substance usage
Concerns in Braddock BoroughBy Alexandria Hickman: Edith Baker Fellow 2020-21
AHN Braddock Family Medicine
Presenting Problem
Methods/Future Plans Impact On The Community
Integrated healthcare Competencies
Braddock Family Medicine Is a Primary Care facility that opened in Braddock Borough back in January 2020. The facility has been operating for over a year now and has been working to help address mental health concerns within their community. Doing so by first addressing the concerns seen in their own patients by introducing an Integrated HealthCare Model into their facility.
The town of Braddock was once a thriving community with a growing population, until they faced a rapid decline when the steel mills shut down taking much if the population and business with it. Since, they have dealt with minimal resources within the area especially those related to mental health. AHN has sought out to address the concerns of lack of mental health resources through creating a Community Needs Assessment.
My role as an intern for AHN Braddock Family Medicine was to help conduct a formal Community Needs assessment for Braddock Bourgh. Creating a survey with a series of questions concerning different social
determinates of health along with evaluating if a lack of mental health/substance usage resources is a concern of the community.During the surveying period we reached ;15 local organizations to
interview
Graphs/results
❑ Offer BHC seminars to Community organizations❑ Make research findings available to the public
❑ Create an advisory board❑ Plan effective program implementations for the community
based on research findings❑ Begin action plan within Braddock Borough
❑Build awareness of mental health withinthe community❑Provide Organizations with a better
understanding on how to utilizemindfulness and proper coping skills withtheir members❑Decrease Mental Health/Substance
usage concerns within the Braddockcommunity❑ Provide education on MAT subscribers
1.Practice based Learning & QualityImprovement
2.Intervention3.Collaboration & Teamwork
Social Work Competencies
References
1.Research2.Intervention3.Human Behavior and Social
Enviromint
Making the case for collaborative chi - chi nav -cdc. (2016, March 10). Retrieved February 25,2021, fromhttps://www.cdc.gov/chinav/case/index.htmlAbout Braddock. (n.d.). Retrieved February 25,2021, fromhttps://www.braddockborough.com/about#:~:text=The%20borough%20was%20incorporated%20on,the%20Bessemer%20process%20in%20America.
This project is being funded partly by a private agency, funding being provided by the Staunton Farm Foundation.
Importance of the issue: Community Satisfaction:
Presenting Question: Does the community of Braddock Borough feel Mental health concerns are recognized and treated within the community?
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