Introduction
The Hospice Social Work Toolkit Project began as an idea to enhance the therapeutic care provided to hospice patients and their families by Adoration Hospice of SweetWater. The goal was to create a portable toolkit with evidence based therapeutic interventions, coping skills, and assessment tools specific to the common mental health needs of hospice patients and their families. Throughout the course of the project’s development, it became clear that the toolkit needed to be more comprehensive to include additional resources to address social justice issues related to poverty, disability, patient rights, and health equity. What resulted was a large binder, as well as a backup copy, filled with comprehensive clinical and community resources that can be used by the agencies medical social worker to assist any patient and their family as they navigate end of life. This project took the majority of my field hours to complete, however I was able to utilize it for the last two weeks of my practicum, and it continues to be used by my field instructor and the agencies medical social worker.
Social Issue Addressed
The need for this project was first initiated by Ashley Pelham, the Medical Social Worker at the agency and my field instructor. When we were brainstorming ways that I could improve the social work department at the agency, she explained the need for a resource binder she could bring with her to home visits. This binder would need to provide her with clinical resources that would help her meet the mental health needs of the hospice population. Social workers on the hospice team have the unique role of assisting patients and families through the dying process by providing mental health care, care coordination, crisis intervention, insurance assistance, and case management. When conducting home visits, it can be unpredictable as to what needs will arise. The Hospice Social Work Toolkit allows for the social worker to have readily available clinical interventions and resources.
When I first began developing the toolkit, I wanted to assess the patients’ needs for mental health support. To do this, I received permission from the agency to pull patient care plans, diagnosis lists, and medication lists to look for in mental health needs. Out of the 32 patients under Hospice care at the time of this research, 24 were care planned for coping and anticipatory grief services, which means that they have a need for mental health and emotional support. Out of this group of 24 patients, 20 of them had an official diagnosis of a mental illness with Anxiety being the most common diagnosis. This established the need for more intentional therapeutic resources to provide competent mental health support.
During the development of the Hospice Social Work Toolkit, it became apparent that it needed to include more than just mental health resources. Adoration Hospice of SweetWater is in East Tennessee and many of the patients are on low-fixed incomes often impacted by age, race, education, and socioeconomic status. Many patients needed assistance paying their electricity bill, getting food, or having basic needs met in the home. Another issue I observed was patients and their families not being able to afford end of life care that aligned with patient’s wishes. For some, this was having care to be able to pass in their own homes, for others it was being able to access care at a long-term care facility. I wanted the binder to reflect the role hospice social workers can play in advocating for human rights and promoting healthcare equity. To meet this need, the binder was expanded to include materials like community based resources and applications for assistance programs.
Intervention
The mission of Hospice Social Work Toolkit Project is to enhance the work of the Adoration Hospice social work services with the goal of supporting the patient and family’s quality of life. The intervention was developing a binder of comprehensive resources, that social workers at the agency can take with them while completing home visits. In rural areas, internet connection can be lacking, so having hard copies of suicide risk assessments and other crisis management tools is important. Additionally, having applications for programs to help meet basic needs or provide healthcare options, such as CHOICES will make visits more efficient. This intervention is supported by the idea that social work interventions in hospice should be equitable and holistic to meet psychological and physical needs in a timely manner as the window of opportunity is likely short (Moon & McDermott, 2021).
The mental health resources included in the binder are evidence based and catered to this population’s needs. They include a variety of resources for therapeutic approaches supported by research such as Dignity Therapy (Patinadan, et.al, 2022). This is accompanied by a variety of handouts on coping skills for grief and anxiety, like mindfulness exercises, deep breathing, and imagery. Mindfulness exercises have been shown to be helpful in minimizing anxiety (Schanche, et al. 2020). These tools can even be used with family members, as research has shown that providing counseling to terminally ill patients and their families helps to reduce anxiety (Jung, et.al, 2021). Lastly, the binder includes a variety of tools so that social workers can implement strategies that can be applied to diverse populations.
The theories used to inform this project are person-in-environment theory and family systems theory. Person-in-environment perspective acknowledges all elements of the environment a person lives in and provides holistic context when addressing needs. Interventions included will be developed keeping in mind the environmental context of a hospice patient. Family Systems theory explains the complex dynamics of family relationships and how they impact each other. The family is often involved as caregivers are under hospice care as well. Resources were included that could be used in a family context or with caregivers.
Results
After the Hospice Social Work Toolkit was complete, I was able to bring the binder with me on my visits. It was very beneficial as I was able to assist two families to fill out applications for community service programs, and one family with advanced directive paperwork. I also provided psycho education to several patients and was able to hand out copies of coping mechanisms. To evaluate if this project fulfilled its goals, I created a survey to be filled out by the the agency’s social worker. The resource binder was found to have been very helpful to the agency and is still being used. The results of this survey can be found below under competency 9.
Conclusion
Creating this project provided me with the opportunity to deepen my understanding of the needs of this community and ways to support patients and families on hospice. The toolkit is something that will not only help the agency and patients, but myself as I begin my MSW journey. One of the biggest limitations for this project was time. It was very time consuming to analyze research for best practices on this scale and to collect all the resources needed. Even after completing my internship, I had more ideas of resources I could have included, and I would have if I had more time. The second limitation was not being able to evaluate the special project from the patient or families’ perspective. This would have been very difficult to accomplish as I had no control over the visitation schedule, and often only interacted with a patient or family on one occasion.
Resources
Moon, F., & McDermott, F. (2020). Social work end-of-life care interventions for patients and their families in hospital. Australian Social Work, 74(3), 276–293. https://doi.org/10.1080/0312407x.2020.1717561
Jung, Y., Yeom, H.-E., & Lee, N.-R. (2021). The effects of counseling about death and dying on perceptions, preparedness, and anxiety regarding death among family caregivers caring for hospice patients: A pilot study. The Korean Journal of Hospice and Palliative Care, 24(1), 46–55. https://doi.org/10.14475/jhpc.2021.24.1.46
Patinadan, P. V., Tan-Ho, G., Choo, P. Y., & Ho, A. H. Y. (2022). Resolving anticipatory grief and enhancing dignity at the end-of life: A systematic review of palliative interventions. Death Studies, 46(2), 337–350. https://doi-org.ezproxy.southern.edu/10.1080/07481187.2020.1728426
Schanche, E., Vøllestad, J., Binder, P.-E., Hjeltnes, A., Dundas, I., & Nielsen, G. H. (2020). Participant experiences of change in mindfulness-based stress reduction for anxiety disorders. International Journal of Qualitative Studies on Health and Well-Being, 15(1), 1776094. https://doi.org/10.1080/17482631.2020.1776094
Competencies
Competency 1- This project required be to collaborate professionally with others. An example of this is that I created a price guide for cremation services to assist patients and families to make informed decisions. In order to collect this information, I called all the funeral homes in the service area and spoke with representatives on behalf of Adoration of Sweetwater. Here is the East Tennessee Funeral Home Pricing Information sheet I created.
Competency 2- The Hospice Social Work Toolkit includes resources such as CHOICES, SNAP, Meals on Wheels, and LIHEAP applications. Upon assessment of clients needs, I was able to use the binder to have applications readily available to fill out then and there.
Competency 3- Included in Hospice Social Work Toolkit is a cognitive assessment tool called the Mini Mental State Examination (MMSE). A factor to consider when assessing cognitive status is education level. I was able to find and include an evidence based scoring system that provides accurate score adjustments for patients that did not complete grade school, high-school, or college. Here is the copy of the MMSE with the adjusted scoring system.
Competency 4- In order to establish the need for mental health resources in the Hospice Social Work Toolkit, I analyzed patient data from care plans, diagnosis lists, and medication lists. From the results, I was able to determine that there was a need for this special project.
Competency 5- The binder can assist social workers navigate policy for access to services as it contains several applications and eligibility information. This also helps to inform any gaps in services to from the basis for future advocacy efforts.
Competency 6- I examined best practices for social work interventions by reviewing research on therapeutic tools and consulting with my field supervisor. I also utilized resources such as the McKee Library and Google Scholar to identify credible information.
Competency 7- I included a variety of assessment tools, including bereavement assessments cognitive assessments, caregiver burnout, and suicide risk assessments. While I did not myself get a chance to use these from the binder, they will assist the agency is assessing patients going forward.
Competency 8- I was able to actually utilize some of the the coping skill handouts and psychoeduation tools to use in a session with clients. I included a variety of coping materials in the toolkit to meet the diverse needs of clients.
Competency 9- I developed a survey to evaluate the effectiveness of Hospice Social Work Toolkit. It was administered to the social worker at Adoration Hospice Sweetwater after my hours were completed. Here you can find the survey results.