Today we talk with Jodie Sakaris, L.C.S.W., who has been a social worker for 13 years. She worked for three years at Rehab Without Walls home and community-based program and we are discussing the value of social workers on the clinical treatment team and how they help create the right psychosocial environment for rehabilitation to happen.
When is it appropriate to include a social worker on the Rehab Without Walls clinical team?
In general there are two main reasons: One is to help the patient and family with adjustment issues following an illness or injury. The other is when there are resource issues, for example, a patient who needs help connecting to government or community supports.
Let’s look at the adjustment piece first. What role does the social worker play in this?
Often there are huge adjustment issues following a brain injury, spinal cord injury, stroke or other neuro disorder. A patient’s role in the family may have changed, going perhaps from a provider to someone who needs help with the most basic personal care needs. The patient may not feel useful or purposeful, resulting in depression or suicidal thoughts. If a TBI has occurred, there may be personality changes that the family doesn’t understand. In short, life as the patient and family knew it may have radically changed. My job is to help them readjust expectations and get stress levels under control. I help them find themselves and to understand that while things will not be the same, there will be a quality of life. In addition, the patient and family may be overwhelmed with grief and loss and not know how to talk about what is going on. I help them identify feelings, communicate and move on.
What about helping the patient with resources—how does that work?
At the initial assessment, the team member who does the evaluation looks at the family resource situation and what they may need assistance with. Some patients, due to their socioeconomic status, may need help with the basics—getting food and medicines, applying for disability, applying for Medicaid and other programs. As social workers, we not only can help patients do this more easily, but we also can connect them with a wealth of community resources we’ve identified and worked with in the past. It is important to get these supports in place as quickly as possible because lack of resources can cause undue stress, and if a patient is stressed out, it tends to divert attention away from rehabilitation. This is especially true if the patient is the family’s primary breadwinner. My job is to ease the overall family stress and shift the focus back on the rehabilitation. I also help patients nearing discharge from Rehab Without Walls reintegrate themselves into the community and find support so they can continue to make progress after their formal rehabilitation has ended.
How do you work with the other members of the clinical team?
Often I’ll do a co-treatment with another team member. For example, a patient may be scared during physical therapy and say ‘I can’t do this.’ I can teach the patient relaxation techniques to remain emotionally calm so that he or she can participate in therapy. I also can work with the patient during a painful exercise session or treatment to help manage pain. Sometimes I work directly with the therapist to brainstorm on approaches to treatment that will best motivate patients and keep them on track.
How does the social work piece of the rehabilitation equation affect outcomes?
More than you would think. Often with rehabilitation, the emotional piece gets left behind. There’s a mindset that if the patient can walk he must be fine. But what we’ve learned is that emotions can shut down progress. Time and money are wasted if you only focus on the physical, which is why Rehab Without Walls looks at the bigger picture. When a patient is emotionally adjusted, motivation increases and stress decreases. This, in turn, helps keep the focus on rehabilitation. When a family has access to coping skills, the patient is better supported and can more easily return to his or her life. All of these things affect length of stay, compliance, durability of results and, of course, healthcare costs.