Transcript Slide 1

Overview of Supportive Social
Services for TB Patients
Paul W. Colson, PhD
EPIDEMIOLOGY
Increasingly, US-born TB cases represent the most
disadvantaged members of society*:
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Homeless: 5.7% of US cases
IDU: 2.1%
Non-IDU drug users: 8.0%
Alcohol abusers: 13.4%
• Foreign-born
cases
patients now represent 58.3% of TB
* TIMS data from Reported Tuberculosis in the United States, 2007 CDC
WHY DO THESE GROUPS
NEED SOCIAL SUPPORT
SERVICES?
• 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 IS IT IMPORTANT?
• Improve adherence and treatment
completion
• Prevent development of drug-resistant TB
• Reduce transmission of TB, including MDR
ENHANCED SOCIAL SERVICES
INTAKE - 1
• Intake for all patients vs. as-needed (selfreferral 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:
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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:
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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:
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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
CREDITS / RESOURCES
• Andrews AB, Williams H, Kinney J. Three models of social
work intervention with tuberculosis patients. Health Soc
Work 1988; 13:288-95.
• Black B, Bruce ME. Treating tuberculosis: the essential role
of social work. Soc Work Health Care 1998; 26:51-68.
• 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; 1:48-51.
• Francis J. Curry National Tuberculosis Center, TB Outreach:
Working Effectively with Hard-to-Reach Patients, 2003
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