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Leaders in Building Capacity:
Advocating for the Role of BMT
Clinical Social Workers
Jane Dabney, LISW-S, OSW-C
The Cleveland Clinic Foundation
Co-Chair, SCI SW Workforce WG
Jill Randall, MSW, LCSW
National Marrow Donor Program, Be the Match
Association of Oncology Social Work
May, 21 2015
Learning Objectives
At the conclusion of this session, you will be able to:
1. Summarize the scope of the System Capacity Initiative (SCI)
2. Define aims of the SCI Social Work Workforce Group (SWWG)
3. Discover the results of the social work workforce survey
4. Formulate strategy to utilize educational factsheet on the specialty role of BMT CSWs
5. Outline future initiatives of the SWWG
2
System Capacity Initiative Background
• Analysis of the U.S. health care system’s capacity to
support the increase in patients needing transplant by
2020*
• Collaboration by representatives of all facets of BMT
• Recommendations and solutions for issues affecting the
delivery of BMT**
* Analysis by NMDP and CIBMTR estimates a need of approximately 21,000 allogeneic
transplants based on current indications in patients up to age 74.
** Also referred to as HCT.
SCI Organization and Participants Year 5
(2013-2014)
5
Physician
Nurse Practitioner / Physician Assistant
Nursing
Pharmacy
Social Work
Workforce Groups
National Marrow Donor Program® /Be The Match®
American Society of Blood and Marrow Transplant®
Special Interest Groups
Center for International Blood and Marrow Transplant
Professional Societies
U.S. Transplant Centers
Transplant Experts
Hospital Administrators
BMT Program Administrators
Government
Payers
Patient Advocacy Organizations
Participants
Ste
ering C
om
mitte
e
Social Work Working Group Aims
• Assessment of the BMT SW Workforce
• Identify care models that optimally utilize social
workers as core members of the BMT Team
• Recommend innovative solutions to meet the
psychosocial care needs of patients and families
7
Social Work Workforce Working Group
• Conduct SW Workforce
Survey and disseminate
findings
• Educate others on the
specialized role of the
BMT clinical social worker
including:
– Members of the
multidisciplinary team
– Program administrators
– Care management/social
work department leaders
• Provide
recommendations to:
– Structure care delivery
models to fully utilize
clinical social workers in
delivering patient-centered
psychosocial care to
optimize outcomes
– Enable clinical workers to
practice at the top of their
licensure
8
BMT Clinical Social Worker
Workforce Challenges Proposed Solutions
• Variation in level of integration of the SW within the core BMT team
• Care models and processes that involve the SW at key points in patient care throughout the transplant continuum
• Barriers to practice at the top of licensure e.g. time spent clerical tasks; covering non-BMT service lines
• Dedicated staff resources for clerical tasks, lodging referrals, etc.
• Dedicated SW FTEs to BMT Program
• Increasing patient caseloads with no increase in FTEs
• Recognition of the impact of psychosocial care on patient outcomes
9
Social Work Workforce Survey Aims
• Understand the structure of SW within BMT programs
• Describe the role of BMT clinical social workers
• Assess social workers’ job satisfaction and support for
their roles
• Identify the challenges that affect social workers’ ability to
meet the needs of their patients/families
• Identify the capacity and challenges in assuring adequate
SW staffing for future BMT needs
10
Social Work Workforce Survey Methods
• The survey was in the field for 1 month October to
November 2013
• The online survey (SurveyGizmo) was sent to 160
NMDP network BMT social workers and interested
APOSW and AOSW members
• Sent 2 follow-up emails, made 1 set of follow-up phone
calls and sent 1 final reminder
• Received 91 replies (57% response rate) from social
workers from 66 different transplant centers
12
13
Table 1. Demographics of Clinical Social Work Workforce Survey Respondents by Hospital Program N(%)†‡
TotalCare Management
and Social Work
BMT and
Hematology/
Oncology
N=88 N=58 N=30
Gender
Female 80(91) 53(91) 27(90)
Male 6(7) 3(5) 3(10)
Age (Years)
< 41 38(43) 24(41) 14(47)
41 – 50 21(24) 14(24) 7(23)
> 50 29(33) 20(34) 9(30)
Years as BMT CSW
< 6 41(47) 26(45) 15(50)
6 – 10 20(23) 15(26) 5(17)
> 10 22(25) 13(22) 9(30)
Ethnicity
Not Hispanic or Latino 79(90) 51(88) 26(87)
Hispanic or Latino 4(5) 3(5) 1(3)
Race
White 75(85) 47(81) 26(87)
Black or African American 8(9) 5(9) 3(10)
Asian 3(3) 3(5) -
†Columns may not add up to 100% because some respondents selected “decline to answer” or did not answer‡ BMT Blood and Marrow Transplant ; CSW Clinical Social Work
14
†Columns may not add up to 100% because some respondents selected “decline to answer” or did not answer‡ BMT Blood and Marrow Transplant; CSW Clinical Social Work
*Column will exceed 100% due to ‘check all that apply’ option
Table 1. Continued†‡
TotalCare Management
and Social Work
BMT and
Hematology/
Oncology
N=88 N=58 N=30
Mean social work FTE (range) 1.76(0 - 6.8) 1.78(0 - 6.8) 1.23(0 - 5)
2010 BMT volume (patients)
< 50 25(28) 16(28) 9(30)
50 – 100 17(19) 10(17) 7(23)
> 100 43(49) 31(53) 12(40)
Populations served by respondents*
Pediatric inpatient 28(31) 22(38) 6(20)
Pediatric outpatient 27(30) 21(36) 6(20)
Adult inpatient 45(49) 29(50) 16(53)
Adult outpatient 60(66) 37(64) 23(77)
Time Spent Addressing Patients’/ Families’ Psychosocial Needs (N=83)
15
47%38% 35%
12% 10% 8%
22%
10%4%
7% 16%
4%
17%
12%
9%
22%
27%
11%
11%
18%
14% 28% 11%
33%
4%
5%
6%
17%22%
20%
17%
32%
13% 16%25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Referral tofinancial
assistance,entitlementprograms*
Individual,family, or
groupcounseling
Casemanagement*
Crisisintervention
Psychosocialassessment forBMT patients
Anticipatorygrief and
bereavementcounseling
Daily 4 times/week 3 times/week 2 times/week 1 time/week <1 time/week
*Non-clinical responsibilities
Question: How much do you agree or disagree with the following
statement, My clinical social work expertise is utilized to the fullest
potential (N=88)
Agree (60%)
“I am fortunate to be a part of a team that strives to enhance and utilize
all of our skills, both clinical and non-clinical. We have a supervisor that
supports enhancement of our expertise.”
Neutral (24%)
“Because I am assigned to not only [BMT] patients but other
hematology/oncology patients as well. I feel like I do not have time to
provide the adequate support to [BMT]”
Disagree (18%)
“There are many days when I need to spend too much time filling out
forms or applications. I also don't feel that my team recognizes my
clinical skills and will call in a psychiatrist or psychologist without
checking first with the social worker who usually has a thorough
knowledge of family situation.”
Top 3 Most Satisfying
Aspects of CSW Role
91
78
52
0
10
20
30
40
50
60
70
80
90
100
Ability to provide psycho-social careover the continuum of care
Opportunity to work with patientsand families in life threatening
situations
Working as a valued member of ateam
Perc
en
tage
17
Top 3 Least Satisfying
Aspects of CSW Role
49
3632
0
10
20
30
40
50
60
70
80
90
100
Insufficient time to provide clinicalsocial work services
Emtional drain of caring forchronically or critically ill and dying
patients
Insufficient salary
Perc
en
tage
18
Question: Please help us understand how workforce challenges impact your
ability to care for patients (N=88)
Prioritizing competing patient needs (59%)
“[…] I don't have enough time for routine follow-up as they proceed through
the transplant process. Prioritizing is often done on a crisis basis. I feel that if I
had more time to see my patients more regularly, these crises could sometimes
be averted...”
Uninsured or underinsured patients (41%)
“I spend so much of my time in resource management, trying to find money
for patients who do not have any […] other disciplines do not understand
that I am a trained therapist.”
Caring for patients in more than one program (40%)
“[…] I am responsible for multiple service lines e.g. pediatric oncology,
general hematology and BMT […]
21
Where do you expect to be in 1 to 3 years?
59
1411
73
7
0
10
20
30
40
50
60
70
80
90
100
Same institution,same potition/title
Same institution,more advanced
position/title
Differentinstitution, butsimilar or more
advancedposition/title
Retire Leave social workentirely for a
career change
Other
Perc
en
tage
Discussion
• What is your comfort level in describing your role with other non-SW team members?
• Can your BMT multidisciplinary team members accurately describe what you do?
• Do they see you as a psychosocial care expert?
22
.
BMT Center Administrator's Conference – Tandem 2014
• Engaged in dialogue with BMT Center Administrators to:
– Gain an understanding of the workforce challenges by workforce group
– Describe activities of each workforce group in the areas of recruitment and retention
– Identify opportunities for BMT Center Administrators to support solutions to address recruitment; retention; work/life balance; including supporting non-physician staff in practicing at the top of their licensure
24
Table Leaders
• Physician Workforce
– Linda Burns, MD
– George Selby, MD
• Advanced Practice Professionals Workforce
– Susan M Burroughs, PA-C
– Paula Cuthrell, MSN, FNP-BC
• Social Work Workforce
– Eleanor Leary, MSW, LICSW
• Nursing Workforce
– Martha Lassiter, MSN, AOCNS
– Kim Schmit-Pokorny, RN, MSN, OCN
– D. Kate Tierney, RN, PhD
• Pharmacy Workforce
– Tippu Khan, PharmD, BCOP
– Tracey Walsh-Chocolaad, PharmD, BCOP
25
Need identified by BMT Center Administrators
– Need identified “To better understand the BMT clinical social worker skill-set”
• SCI SW WG developed BMT Clinical Social Worker Role Description document
– User testing (N=28)
• Feedback from multidisciplinary team members
– Endorsement
• AOSW
• APOSW
• NMDP /Be The Match
26
BMT Clinical Social Worker Role Description
• The purpose of the document is to educate health care professionals, BMT program staff, social work department leaders on the role of BMT social worker
• Describes:
– Educational background
– Core competencies
– Aims of BMT Clinical SW interventions
– Unique psychosocial care needs of BMT patients
27
Invited to come back…Tandem Meetings 2015
• BMT Center Administrators Conference
– SCI SW Workforce WG update
– Disseminated BMT Clinical SW role description
28
Recommendations
• Ensure comprehensive psychosocial care interventions occur at key time points along the transplant continuum
– Transplant consultation
– Work-up evaluation
– Inpatient phase
– Outpatient/survivorship follow-up
– End-of-life
30
Recommendations cont.
• Consistently and actively involve BMT clinical social workers in treatment planning and decision-making
• Implement care models that enable BMT social workers to practice at the top of their licensure
31
Audience Discussion
• Please share some of the successes your transplant center has had with care models that optimally utilize social workers as core members of the BMT team.
– To fully utilize the skill-set of the BMT Clinical SW?
• How has the utilization of the BMT social worker’s clinical skills been promoted in your program?
• How might your transplant center utilize the BMT Clinical SW role description document?
32
Ongoing and Future Initiatives
of the SW Workforce WG
• Podium presentations at national meetings
– Leaders in Building Capacity: Advocating for the Role of
BMT Clinical Social Workers
• APOSW, May 13-15, 2015
• AOSW, May 20-22, 2015
• Development of a training curriculum for new BMT social
workers
• Identify future research to better understand the impact
of social work interventions on patient outcomes
33
Onboarding BMT SWTraining Topics
Module Topics
1 Overview of BMT
2 Psychosocial assessments; Caregiver Assessments; Distress Screening and/or other screening tools
3 Stages of transplant, patient/family adaptation tasks, and clinical social work interventions
4 Role of SW on BMT Team
5 End of life and bereavement
6 Psychosocial issues unique to pediatric patient populationSiblings; Sibling Donors; Siblings at end of life
7 Ethics, boundaries and self-care
8 Survivorship (should this be a stand-alone module? or woven into another module?)
9 BMT related resources
34
Social Work Workforce Group Membership
• Co-Chairs
– Jane Dabney, LISW-S, OSW-C
– Marion Kalbacker, MSW, LCSW
• Members
– Nancy Barbach, MSW, LCSW
– Nancy Boyle, MSW, LCSW
– Carrie Breitwieser, LISW-S, ACHP-SW
– Eleanor Bruin, MSW, LCSW
– Erica Bryan-Wegner, LICSW
– Tiffany J. Courtnage, LICSW
– Mary Crooks, MSW, LCSW
– Sumnee Joo, MSW, MPH,
LMSW, CHES
– Jeanette Lavecchia, MSW, LCSW
(2013-2014)
– Eleanor Leary, MSW, LICSW
35
– Kathy Roundtree, MSW, LCSW
– Andrea Starkschall, LCSW, OSW-C
– Anita Vargas, MSW, LSW
– Elyse (Burk) Wells, LSW, MSW, OSW-C
• NMDP Ex-Officio
– Jeffrey Chell, MD
– Elizabeth Murphy, EdD, RN
• NMDP Lead Staff
– Stacy Stickney Ferguson, MSW, LICSW
– Jill Randall, MSW, LICSW
– Nicole Heino (admin.)
• Health Services Research Staff Support
– Ellen Denzen, MS
– Viengneesee Thao, MS
Questions or Comments
Email: [email protected]
Jane Dabney: [email protected]
Jill Randall: [email protected]
36