Ov erview of Supportive Social Services for TB Patients Paul W. Colson, PhD

Increasingly, US-born TB cases represent the most disadvantaged members of society*: Homeless: 5.7% of US cases IDU: 2.1% Non-IDU drug users: 8.0% Alcohol abusers: 13.4% Foreign-born patients now represent 58.3% of TB cases * TIMS data from Reported Tuberculosis in the United States, 2007 CDC EPIDEMIOLOGY

Language/cultural barriers TB treatment may be low priority Poor adherence due to differing beliefs, life circumstances (e.g., homelessness, substance use) Multitude of needs Lack of resources WHY DO THESE GROUPS NEED SOCIAL SUPPORT SERVICES?

Improve adherence and treatment completion Prevent development of drug-resistant TB Reduce transmission of TB, including MDR WHY IS IT IMPORTANT?

ENHANCED SOCIAL SERVICES

INTAKE - 1 Intake for all patients vs. as-needed (self- referral or referral from medical provider) Should be conducted in private setting Establishing a therapeutic alliance Confidentiality must be maintained Start with client’s definition of problem (e.g., housing) but may have to deal with issues client denies (e.g., substance abuse)

INTAKE - 2 Biopsychosocial assessment: –Patient information –Reason for referral –Psychosocial history –Current living situation & functioning –Assessment: Subjective Objective –Plan: Short-term goals Long-term goals

CASE MANAGEMENT – 1 Case management is an interdisciplinary approach to patient care –“Case management” is a term used for different purposes –Managed care companies use “case management” to limit services Includes physicians, nurses, social workers, health educators, outreach workers, etc. Requires meetings where information is shared and insights from different disciplines is offered

CASE MANAGEMENT - 2 Case management meetings may discuss: –A newly diagnosed client –Significant new problems –Change in medication –Treatment completion Process: –Share information –Share opinions from perspective of discipline –Identify goals and action steps

REFERRALS After assessment, provide referrals to: –Public assistance –Shelters or other housing programs –Food programs –Clothing and other tangible goods –Substance abuse treatment –Agencies assisting immigrants, particularly the undocumented Accompany client or follow-up with agency to make sure referral worked!

OTHER SERVICES Targeted health education Support groups Counseling

Andrews AB, Williams H, Kinney J. Three models of social work intervention with tuberculosis patients. Health Soc Work 1988; 13: Black B, Bruce ME. Treating tuberculosis: the essential role of social work. Soc Work Health Care 1998; 26: Charles P. Felton National Tuberculosis Center, Social Support Services for Tuberculosis Clients, 1999 El-Sadr W, Medard F, Dickerson M. The Harlem family model: a unique approach to the treatment of tuberculosis. J Public Health Manag Pract 1995; 1: Francis J. Curry National Tuberculosis Center, TB Outreach: Working Effectively with Hard-to-Reach Patients, 2003 CREDITS / RESOURCES

CASE STUDY – Mr. A  Hard to reach/volatile  Problems with Neighbors/Fear of Intruders  Psychiatric Diagnosis  Other problems: dental, medical bills  Jury Duty

CASE STUDY – DISCUSSION  Establishing rapport  Tolerance  Psychiatric diagnosis  Tangible assistance  Persistence  Relationship