Oncology Social Work –Helping Patients and Caregivers Along the Continuum January 20, 2016 Penny Damaskos, PhD, LCSW, OSW-C Oncology Social Work—Helping patients and caregivers along the continuum www.MSKCC.org

Talk Outline Review the role of oncology social work Review of social work interventions along the disease continuum Society funds Overview of programs offered

Role of Oncology Social Work Primary function is to assist patients and families in coping with the psycho-social issues that result from a cancer diagnosis Emotional adjustment to the diagnosis Assist with practical issues to help patients through the diagnosis Assist family members and support system Assess strengths in all systems to provide support as needed

Role of Oncology Social Work We provide resources Within the hospital Patient Financial Services Philanthropy assessment and distribution Community settings Temporary housing Help them to mobiles resources around employment issues Disability FMLA Other entitlements

Role of Oncology Social Work Collaborate with Medical/surgical teams, nurses, patient representative, psychiatry, chaplain, Integrative Medicine Service, PFS Case management for discharge planning Home care assistance Hospice care Skilled nursing facilities—physical rehab

Role of Oncology Social Work We work with adult and pediatric populations all along the disease continuum In both inpatient and ambulatory settings We help patients and families communicate with Medical team Families, friends and caregivers

Oncology Social Work Interventions Along the Disease Continuum Oncology Social workers intervene to assist patients and family members at every stage of the disease Each stage can present a new crisis for the patient and/or family Important to have understanding of cancer diagnosis and treatment plan Important part of our clinical assessment is to explore the patient’s understanding and thinking about their diagnosis

Stages of the Cancer Experience Diagnosis Initiation of Treatment Effects of Treatment End of Treatment Survivorship Recurrence- living with metastatic disease End of Life

Self referrals from patients and caregivers Additional staff How We Get Referrals From medical team In person—through Interdisciplinary team meetings/rounds Electronic referrals Adult Health Screen and Distress Screening Self referrals from patients and caregivers Additional staff

Crisis Intervention Model (CIM) and Cognitive Behavioral Therapy (CBT) Primarily use both CI M and CBT approaches to help cancer patients Crisis Intervention Model: Addresses the perception that the event is threatening which triggers a response that is characterized by disequilibrium disorganization in thinking, behavior and perceptions

Crisis Intervention and CBT In oncology social work, crisis intervention is used to help individuals regain equilibrium after a cancer diagnosis and the treatment is cognitive behavioral therapy Through cognitive behavioral approaches patients are able to change their behavior and thinking about the crisis Both approaches help the patient move from destabilization to stability in a short period of time

Crisis Intervention in the Oncology Setting Equilibrium is achieved through: Individual counseling Problem solving, task oriented Psycho-educational support groups Family/couple counseling

Cognitive Behavioral Therapy C BT increases awareness of inaccurate or destructive thinking Helps in understanding of difficult situations and to respond to them in a more effective way Emphasis is on the present “here and now” Guidance/directive role of the therapist Rachman (1997)

Financial Support/Emotional Support The connection between financial support and emotional support: When some of the practical stressors are addressed, especially at the start of treatment or at progression of disease, this can allow patients to address the emotional impact the diagnosis has on their lives. The level and type of support we offer is unique to NYC area hospitals and other cancer centers

Financial Support With the financial assistance provided by the Society, oncology social workers are able to facilitate financial support to adult and pediatric patients that helps them sustain access to treatment Transportation/parking Housing Emergency funds

Support to Patients: What is the Process? Financial need is assessed through the Patient Financial Assistance office (PFS) Social Work provides paperwork and PFS determines financial need according to established criteria Generous guidelines take into account the impact cancer has on multiple areas of life and that life has on cancer “Double whammy” factor Super storm Sandy, global financial crisis, increasing unemployment AND Cancer

Support to Patients Once financial assessment is completed and it is determined that the patient is eligible for funds The social worker and medical team evaluates the patients most pressing needs and allocates the funds The top three areas are transportation, housing and parking assistance

MSK Society Funds Provided to Patients 2014 Individual Patients/ Quarter* Total Funds Q1 311 125,372 Q2 313 129,885 Q3 305 118,463 Q4 309 117,569 TOTAL 1,238 491,289 * Incl both peds and adults

MSK Society Funds Provided to Patients 2015 Individual Patients/ Quarter* Total Funds Q1 335 134,097 Q2 317 129,222 Q3 324 141,039 Q4 370 159,785 TOTAL 1,346 564,143* * Incl both peds and adults * 14.8% increase over 2014

MSK Society Funds Provided to Patients Individual Patients/ Quarter* AVG Funds/ Individual 2014 1,238 $400 2015 1,346 $419 * Incl both peds and adults

Social Work Programs and Groups Multiple programs offered through Social Work Department Collaborate with nursing, physical therapists, nutritionists On treatment, survivorship, chronic cancer, bereavement In person, on line (virtual) Specific populations: geriatric, young adults, Spanish speaking, childhood cancer survivors

Groups--General Disease specific breast, prostate, lymphoma, etc Population specific caregivers, children, young adults At point of diagnosis Post-surgery (breast group) On treatment (inpt, outpt) Post-treatment– Resources for Life after Cancer Advanced disease

Counseling, resources, workshops, online support group Kids Express Program Help adults talk with children about cancer at every phase of the continuum Counseling, resources, workshops, online support group CLIMB program specifically for children to be able to express their feelings in a weekly meeting with art and discussion Separate group for adults

Educational meetings several times a year Spanish and in English Caregivers program On line support groups Several times a month Educational meetings several times a year Spanish and in English Caregivers newsletter

Educational panels/meetings “Drop in” monthly group Bereavement Program Educational panels/meetings “Drop in” monthly group Time-limited support groups Spouses Young adult spouses Adult children Parents who have lost children

65+ programs Bi-monthly series of educational lectures specifically geared for geriatric populations Cognitive functioning Stamina Nutrition Meditation

Post Treatment Resources for Life After Cancer Ongoing informational programs Specific topics that address long standing side effects Highlights resources here through integrative medicine, chaplaincy, psychiatry/behavioral psych, physical therapy, nutrition, sexual health Support groups Individual counseling

Social work provide support to staff inpatient and out patient Staff Support Social work provide support to staff inpatient and out patient Groups, informational meetings The Schwartz Center Rounds Building Resilience program Clinical, patient-oriented programs are sometimes attended by staff

The Society has provided support to key programs over the years Programmatic Support The Society has provided support to key programs over the years Pediatric programs Kids Express Social Work student fellows 57 fellows trained since inception in 1997 11 fellows hired by MSK; 7 of them hired in the last 6 years Dream Team Social work liaison to this program On treatment and in survivorship

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