Productive Aging During COVID-19 - Lessons from WH SeniorLink

Introduction: According to the National Academies of Science, Medicine, and Engineering, even before the pandemic, 24% of Americans 65+ were considered socially isolated, and 43% of adults 60+ were lonely. Both experiences are associated with serious physical and mental health problems, including increased risks of dementia, stroke, depression, and suicidal ideation. As older adults engage in stricter social distancing to protect themselves from COVID-19, their risk of social isolation and loneliness is heightened. According to research by the Kaiser Family Foundation, 46% of adults 65+ reported that the worry and stress caused by pandemic has had a negative impact on their mental health. In order to combat this unique challenge, we must employ innovative, flexible solutions that adapt to the shifting circumstances and an uncertain future. Method(s): WH SeniorLink has developed an innovative program for integrating friendly visiting, mutual aid, needs assessment and case management, all delivered remotely by trained volunteers. The program was conceived, developed and executed since the beginning of COVID-19 restrictions and has grown to become a fully fledged 501(c)(3) organization, and is a model of flexible service delivery during this unusual time. The program operates through a volunteerism-mutual aid model. Volunteers are trained using online modules and quizzes and supervised by a licensed social worker, including training on needs and risk assessment. Volunteers are then matched with an older adult with similar interests and language preferences to provide friendly weekly phone calls, care packages and letters. Older adults with higher needs are referred to WH SeniorLink's service navigation program which operates using the online platform, Apricot, and is staffed by masters level social work interns and supervised by licensed social workers. Service navigation involves conducting comprehensive assessments and identifying resources and referrals. Older adults who express interest are also paired with each other to provide social support. Barriers to program development have included identifying consistent funding sources and volunteer attrition. Result(s): Data shows 169% growth in contacts made with older adults between May and October, with 2.5 times more older adults served in November than in May. Initial responses to the Dejong Gierveld Loneliness Scale and qualitative data collection reflect that older adults continue to feel lonely and isolated in the midst of the pandemic, but that WH SeniorLink is helping. By placing emphasis on empowering older adults to form sustained relationships with volunteers and their peers, WH SeniorLink encourages reciprocal relationships through which older adult participants are valued for their experiences and contributions. Conclusion(s): The mission of WH SeniorLink is to strengthen community ties and improve health outcomes among older New Yorkers by providing social-emotional support and connection to essential services. WH SeniorLink was founded during the COVID-19 pandemic, in response to the myriad of new challenges faced by older adults including greater risk of social isolation and increased disconnection from essential services. However, we recognize that the pandemic has only exacerbated a problem that began long before, and older adults are at risk of being left behind in the coming months and beyond. Funding(s): WH SeniorLink is funded by a starter grant from Columbia School of Social Work and subsequent crowdfunded donations.Copyright © 2021

Can You Spare 100 Days? The Allogeneic Hematopoietic Cell Transplant Caregiver Requirement

Allogeneic hematopoietic cell transplantation (alloHCT) is a potentially curative treatment for patients diagnosed with blood cancers (such as acute myeloid leukemia) and blood disorders (such as sickle cell disease). It is a resource-intensive treatment that generally requires a long hospital stay and recovery period. If continuous caregiver support is not available, alloHCT likely will not be a treatment option. To learn more about caregiver requirements and perspectives on those requirements, we conducted web-based focus groups with alloHCT social workers who worked with adult patients at United States (US) transplant centers (TCs) from May-July 2022. Web-based interviews with adult alloHCT recipients,caregivers of adult alloHCT recipients, and physicians/advanced practice professionals will also be conducted. Twenty-two social workers from TCs across the US (Midwest [n=8];West [n=5];Northeast: [n=5];South, [n=4]) and with varying volumes (median: 97 alloHCTs performed/year) participated. All noted their TC required a caregiver to proceed to alloHCT. However, there was variation across TCs in the length of time a recipient was required to have a caregiver, the distance/time needed to stay near the TC post-alloHCT, and COVID-19 vaccination requirements. The majority of participants also noted variance among the transplant team in allowing exceptions for caregiver requirements. All participants noted it would be helpful to have a 'gold standard' of requirements across TCs, though there was discussion about what such a standard would include, as well as the need for flexibility to account for different patient and TC needs. Social workers were also asked to identify patient barriers to meeting the caregiver requirement;common barriers included patients feeling they did not have anyone to ask to be a caregiver, the need to relocate closer to the TC, and financial barriers. The impact of the COVID-19 pandemic was also noted (e.g., vaccination requirements, and increased telework allowing more flexibility for caregivers). In analysis of the first of four populations interviewed in this study, social workers reported variation in caregiver requirements across TCs. Finding a caregiver is one of many barriers patients face in accessing alloHCT. Though this variation may allow for some flexibility, it may also contribute to access barriers. This study focused on those who received an alloHCT, but further research is needed to learn about barriers faced by those unable to access alloHCT. Results from this and other cohorts will describe current practices related to caregiver requirements and help inform the development of new programs to reduce caregiver-related barriers to alloHCT.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Using real-time data to improve patient no-shows and late cancellations

Background: The Cystic Fibrosis Foundation (CFF) advises that all persons with cystic fibrosis (PwCF) visit a cystic fibrosis (CF) care center every 3 months for evaluation, treatment, surveillance, counseling, and education [1]. In March 2020, our clinic went into modified operations in response to the COVID-19 pandemic, necessitating a temporary change in our ability to conduct routine face-to-face visits. Within 1 month, we operationalized virtual visits in addition to face-to-face visits. During the pandemic, staff noticed a drop in clinic attendance, and we implemented a quality improvement (QI) plan to study and address this trend. Method(s): Our QI team is a multidisciplinary group that is part of the Cystic Fibrosis Learning Network (CFLN). We defined the clinic fill rate (CFR) as the number of people seen over the number of available clinic slots. Each week, we determined the number of PwCF scheduled the following week and compared that number with no-shows and cancellations that occurred during that 7-day period. We also determined the number of PwCF scheduled 1 month ahead to compare it with weekly data. We used a key driver diagram to help focus our interventions (change ideas). Using run charts, we analyzed data each week to identify trends and variances. We used plan-do-study-act cycles and implemented initial interventions centered on publicizing CFF follow-up guidelines in town hall meetings, emails, and newsletters. We later identified PwCF who had a no-show history, and before clinics, our social worker communicated with each family (telephone or text) to remind them of the upcoming visit and identify any barriers to attending. During our study, Oregon experienced a surge in COVID-19 cases from the omicron variant, andwe overlaid our data with a graph of cases. Result(s): CFR was measured in 598 encounters over 28 weeks. CFR 1 month in advancewas 79%. In theweek before clinic, CFRwas 84%. After theweek, overall CFR was 66% (68% for face-to-face visits, 58% for virtual visits). Fifteen percent of our cancellations were COVID-related (increasing to 21% during the surge), but CFR did not change during the surge. After our intervention, those contacted in advance came to clinic 93% of the time, and our CFR improved to 74.8%. Conclusion(s): An 84% CFR, measured 1 week ahead of clinic, was dropping to an average of 66% because of late cancellations and no-shows, and widespread education about clinic attendance guidelines did not increase the rate. Having our social worker communicate directly with PwCF increased the overall CFR closer to our advance numbers, and 93% came to clinic. These communications also served as an additional patient interaction during which other social work needs were identified. Overall reduced clinic attendance may be related to the indirect impact of the pandemic and benefits of modulator therapy.We need to gather more postimplementation data and to consider different approaches to partnering with PwCF to achieve ideal follow-up.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

National assessment of school resources in cystic fibrosis care centers

Background: Assessment of the prevalence and correlates of educational risk and school support needs of children with cystic fibrosis (CF) is limited. Educational support for people with CF has become even more pressing with the onset of COVID-19 and the dramatic changes seen in the education system nationally. Method(s): A cross-sectional needs assessment survey for pediatric and adult CF center care team members across the United States was distributed to assess student and family school needs, resources, services offered, and current processes for identification of concerns and intervention. Care teams were asked to complete the survey as a group or specify respondents who routinely provide school support. Result(s): The survey was sent to 3684 individuals within the CF care center network, on April 1, 2022, with a closure date of April 22, 2022. Preliminary results at time of this submission include 56 survey responses, completed primarily by social workers (40%) and physicians (23%), representing approximately 20% of all centers. Thirty-eight percent of respondents reported that their center administered a screening tool to assess general school functioning routinely or as needed. Specific school topics most widely assessed included need for CF care (treatments and medications) to occur at school (73%), concerns about emotional and behavioral functioning in the school setting (70%), CF daily care burden affecting school attendance and performance (63%), and CF-specific needs in university settings (63%). According to the care team report, families most often asked for help with school accommodations related to ability to carry enzymes (74%), carrying awater bottle (50%), additional bathroom passes (43%), and ability to step out of the classroom as needed for gastrointestinal problems (50%). Nurses, program coordinators, and social workers are the team members addressing school needs most often (55%, 42%, and 90%, respectively). Sixty-two percent of respondents reported having access to a hospital-based teacher for education support during inpatient stays, 10% had access to school services or educational support, and 5% had access to someone with a background or training in education or teaching (other than hospital-based teacher) for ambulatory care. Upon closure of the survey, the above data will be updated, and more complete identification of current resources and future needs will be described at the 2022 North American Cystic Fibrosis Conference. Conclusion(s): This survey will be the most comprehensive assessment to date of ongoing school services at CF centers nationally. Results will be used to identify specific areas of need to guide development of a roadmap addressing proactive monitoring of school functioning and resources in the CF care modelCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Formation of a virtual cystic fibrosis support group: Connecting with Other Parents' Experiences

Background: Before the COVID-19 pandemic, families at a large pediatric cystic fibrosis (CF) center expressed interest in participating in support groups through informal oral feedback during CF clinic visits. Many barriers existed related to CF guidelines restricting in-person contact, traveling to the hospital to attend, feasibility of attending groups regularly, and lack of technology. The COVID-19 pandemic drastically improved the availability of telecommunication, which expanded options for support. This project involved development and implementation of a formal virtual support group for caregivers of children recently diagnosed with CF. Method(s): The psychosocial team (2 licensed clinical social workers, 2 psychologists,1psychology trainee)developedacurriculumwiththemesand discussion topics for each session that included processing and sharing diagnosis story, mobilizing support, treatment fears and frustrations, and celebrating milestones and successes. Eligible group members were caregivers of babies diagnosed with CF who were in their first year of life. All eligible caregivers were emailed to assess interest and collect feedback that was used to inform implementation of the group. A total of 12 families were eligible for the first round of Connecting with Other Parents' Experiences (COPE) group sessions and 14 families for the second round. The first cohort met biweekly in for six 90-minute sessions. After the initial group, adjustments were made based on feedback and participation. The second cohort met weekly for four 1-hour sessions. All participants were scheduled onthelicensedclinicalsocialworkers orpsychologyscheduleandjoinedeach session via the institution's HIPPA-secure virtual platform(Vidyo). Result(s): The first COPE group sessions were held from July to September 2020. Sixty-seven percent of eligible families expressed interest in participating (n = 8). Fifty percent of families who expressed interest in the group attended at least one session (n = 4). Each group session ranged from one to four families. The second COPE group sessions were held in October 2021. Sixty-four percent of eligible families expressed interest in participating (n = 9). Forty-four percent of families who expressed interest in the group attended at least one session (n = 4). Anecdotal evidence from the parent support groups has been overwhelmingly positive. Parents reported appreciating the social support and have begun to connect with each other outside of the group for ongoing support. Conclusion(s): COVID-19 and the increase in telemedicine expanded our ability to provide support to caregivers in away that had not been feasible previously. Caregivers were engaged and reported experiencing less isolation and normalization of emotions and challenges related to having a baby with CF. Several barriers to offering support groups exist, such as determining times that work for most families and interest in regular participationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Towards digitally mediated social work – the impact of the COVID-19 pandemic on encountering clients in social work

In the spring of 2020, the COVID-19 pandemic spread around the globe. The viral outbreak was followed by rapid changes in people's everyday and working lives. Because of the wide-scale societal restrictions that took place to prevent the pandemic, social work was forced to take a digital leap. In this article, we examine Finnish social workers' experiences of extending the use of digitally mediated social work (DMSW) in working with clients during the first wave of the pandemic, the spring of 2020. The data consist of 33 social workers' personal diaries, which are analysed using a qualitative theory-based content analysis. Henri Lefebvre's theory of spatial triad will be utilised in theorising how social workers represent DMSW through three dimensions of space, that is, how they perceive, conceive and live digital spaces when encountering their clients and how physical, mental and social spaces are embodied in the representations. The results suggest that the three dimensions of space 1) basis of, 2) conceived and 3) lived DMSW intertwine closely together. The results reveal how the physical space, including IT infrastructure, its functionality and applicability, along with the organisational contexts, form a bedrock for the social workers' DMSW practice and had a decisive impact on their experiences. Second, the conceived space consists of workers' cognitive and emotional elements, such as competencies, preconceptions and attitudes towards ICT. Finally, the third dimension of spatiality concludes with the social and relational aspects of the user experiences and encounters between clients and social workers.

Social worker to therapist: Adaptation of role while addressing inequities in mental health care

Background: 2020 was a year of transformation in cystic fibrosis (CF) care. Many adults with CF started elexacaftor/tezacaftor/ivacaftor while COVID- 19 was unfolding. Occurring almost simultaneously, these two events created a dramatic shift in the disease landscape. Hospital admissions plummeted, and physical health improved. Clinic appointments turned virtual, and people with CF sheltered at home for months. These changes created opportunities for CF team members to adapt roles to meet evolving needs. Social work hours devoted to inpatient care, end of life, and discharge planning could be reallocated to other areas. Although many patients improved from a physical standpoint, mental health problems increased. Between 2020 and 2022, demand for mental health services increased exponentially, creating a national mental health crisis, but inequities in insurance coverage existed between physical and mental health care. Finding a mental health provider became an almost impossible task. This author sought to address insurance inequity and increased demand for mental health services by offering cognitive behavioral therapy (CBT) sessions to adults with CF to optimize their health andwellbeing. CBT is considered an evidence-based approach for most mental health problems. Method(s): Eight adults at the Stanford Adult CF Center were referred for CBT with social work from August 2021 to April 2022. Referrals were based on mental health crisis, mental health screenings, insurance barriers, and availability of mental health providers. Therapy sessions were offered via telehealth as part of the multidisciplinary care at the CF center. Patients were not billed for the sessions. The number of sessions was variable, with a mean of 10.5 sessions per patient. The frequency and content of sessions were tailored to patients' unique needs. Referrals were accepted on a continuous basis, space available. Mental health problems included anxiety, depression, alcohol use disorder, trauma, and gender dysphoria Results: All eight patients receiving CBT demonstrated significant improvement in mental health symptoms, as evidenced by a mean reduction in Patient Health Questionnaire-9 score of 3 and General Anxiety Disorder-7 score of 3.3. (Six of 8 patients were screened before and after therapy.) Other measures of improvement were patient selfreport as documented in therapy notes, sessions being tapered or discontinued as goals were met, and reduction in or stoppage of psychotropic medications. Conclusion(s): Mental health is a vital component of health and should be properly addressed as part of CF care. Although mental health care in CF has come a long way, patients continue to lack proper access to trained providers, especially those with expertise in CBT and CF. Given the current mental health crisis and shortage of therapists to meet newdemands, there are serious implications for long-term health outcomes for people with CF. As more studies are published demonstrating the effectiveness of CBT and other forms of therapy in the CF population, CF providers can adapt roles to implement new interventions in addressing mental health problems as part of CF care rather than referring patients to community providers who often are poorly positioned to meet their needs. The Stanford CF program will continue to use social work role to provide mental health servicesCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Development of an overdue outreach program to improve adherence to PKU management

Background: Phenylketonuria (PKU) is an inherited autosomal recessive disorder caused by variants in the PAH gene which encodes for phenylalanine hydroxylase (PAH). PKU, left untreated, can cause intellectual disability, psychiatric symptoms, and behavioral abnormalities. Lifelong management of PKU is challenging, and many adult patients become lost to follow-up, despite recommendations for lifelong management. Method(s): The PKU clinic team is a multidisciplinary team consisting of an APN Director, physician, dieticians, diet tech, genetic counselor, registered nurse, and social worker. After establishing formal guidelines, algorithms were created to determine thresholds for initiating patient outreach based on both age and type of PKU treatment. EMRbased data collection is used to track adherence to both clinic visits and consistent submission of Phe levels. Data was collected and analyzed for roughly 250 PKU patients. Baseline levels for adherence to clinic visits and filter card submission were collected at time of implementation. Data was then reviewed after 18 months, and has been further analyzed for a second 18 months (which correlates with the start of the COVID-19 pandemic) Results: Overall baseline adherence across the population for annual clinic visitswas 72% (144/200). Clinic visit adherence increased to 88% at 18 months, and then was similar at 86% through COVID-19 pandemic. In the adult population, 54% (57/106) were adherent at baseline with clinic follow-up. With implementation compliance increased to 80% initially and was then reported to be 74% during the pandemic. Baseline for all PKU patients showed 81% (161/200) filter card submission within the last 12 months. Submission increased to 91% after 18 months of overdue outreach, and as of October 2021, 85% of all patients had submitted a filter card within the last calendar year. Adult patients specifically showed an increase, with 53% at baseline to 69% after implementation. Conclusion(s): Implementation of an overdue outreach program is successful in re-engaging patients with the PKU clinic and improving adherence to treatment recommendations. We have seen increased patient adherence across all domains and have maintained this improved adherence despite the global COVID-19 pandemic.Copyright © 2022 Elsevier Inc. All rights reserved.

Addressing the unmet social needs of gynecologic oncology patients as identified by a universal screening tool in a safety net hospital

Objectives: To identify the unmet, actionable social needs of gynecologic oncology patients using a self-administered social needs assessment tool and quantify the interventions subsequently provided to our patients. Method(s): This is a study of data collected in an ongoing performance improvement initiative in a gynecologic oncology clinic at a safety net hospital and was determined to be exempt from review by the institutional IRB. Eligible patients completed the social needs screening tool from October 2021 to March 2022. The following social needs domains were assessed: food insecurity, utility insecurity, housing insecurity, transportation insecurity, need for childcare, exposure to violence, lack of companionship, difficulty reading, or difficulty accessing medical care due to fear of losing job. Patients were asked if they desired to speak with a social worker and if any needs were urgent. Data from the screening tool was collected and supplemented by data from the EMR. Univariate descriptive statistics were used to report the patient demographic information, prevalence of social needs, and referral rates for social needs identified. Result(s): There were 475 patients seen in the gynecologic oncology clinic since October 2021. 286 (60%) patients completed the screening tool. 139 (49%) screened positive for at least 1 social need;of those 98 (70%) were Hispanic with a median age of 56 years. 27 (6%) patients were receiving treatment for a gynecologic malignancy, of whom 19 (70%) had at least 1 social need. 25 (92%) patients were insured through Medi-Cal. 12 (44%) patients were being treated for endometrial cancer, followed by ovarian (7, 26%) and cervical (4, 15%). The social needs identified in all patients and in patients actively receiving cancer treatment are summarized in Fig. 1. Patients reporting lack of companionship were referred to mental health or cancer support groups through the American Cancer Society or the Los Angeles County Department of Public Health. Those needing transportation or utility services were linked with services available through their insurance or LA County, ride share vouchers, low-income energy assistance programs, COVID rent/mortgage relief programs. Patients with food and housing insecurity were assisted in applying for public housing or food stamps;local food banks were provided. Patients were assisted with applying for disability insurance as needed. To date, all actively treated patients reporting lack of companionship, need for transportation, avoiding medical care for fear of losing their job, and utility insecurity were provided resources;80% received resources for food insecurity. Conclusion(s): Universal screening for social needs in gynecologic cancer patients identifies a high rate of unmet needs within a safety net hospital. Cancer care navigators can successfully provide these patients community-based resources tailored to their individual social needs. Our next steps will be to determine if and how these resources impact our patients' experiences and treatment outcomes.[Formula presented]Copyright © 2022 Elsevier Inc.

"People Need to Know They Matter to Somebody": Interdisciplinary Staff Perceptions of Compassionate Care Visits for Seriously Ill Residents in Nursing Homes During the COVID-19 Pandemic (Sci206)

Outcomes: 1. Articulate the risk, benefits, and outcomes of compassionate care visits during restricted visitation in nursing homes as they pertain to psychological, social, and spiritual domains of care. 2. Explore potential approaches to improve care for people living with serious illness in nursing homes while balancing risk/benefit and equitable access to resources for safety precautions during restricted visitation. During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services announced strict guidance for compassionate care visitation (CCV) in nursing homes (NHs) to protect residents and facilities from outbreak yet permit residents' visitors at the end of life. As a result, seriously ill NH residents, not imminently dying, experienced enormously high rates of social and physical isolation, and staff were left to interpret guidance and manage who could and could not have CCV. This qualitative descriptive study intended to illustrate NH staffs' understanding, use, and perception of risk around CCVs for residents experiencing serious illness during the COVID-19 pandemic. We conducted semi-structured interviews and analyzed data using directed content analysis to assess staffs' definition of CCVs, their facilities' use of CCVs, and staffs' perceptions of the risks and benefits of CCVs. Participants (N=24) included licensed and unlicensed nursing staff (eg, RN, LPN, CNA), social workers, and activities directors;were mostly female (88%) and White (79%);and had more than 3 years of experience working in NHs (79%). Results indicate the definition and use of CCVs simultaneously expanded over time supported by three themes: visits for those imminently dying, visits to support psychosocial needs, and visits to alleviate family concern. Throughout the themes, we found: 1) the benefits of CCVs-improved physical and emotional well-being-outweighed the risk of COVID-19 transmission and 2) the risks of CCVs were perceived as minimal when adequate safety precautions (e.g., screening, personal protective equipment, and vaccination) were available and used as risk mitigation strategies. The findings highlight the need to consider the physical and psychosocial consequences of social isolation of NH residents while expediently assessing the risk/benefit profile of CCVs and viral transmission and ensuring equitable access to safety precautions in NHs during public health crises.Copyright © 2023

Creative arts intervention to reduce burnout and decrease psychological distress in healthcare professionals: A qualitative analysis

Creative arts therapy (CAT) can potentially mitigate the unprecedented levels of healthcare professional (HCP) burnout that have been exacerbated by the COVID-19 pandemic. However, empirical evidence about the impact of CAT programs is lacking. We conducted focus groups with HCPs (N = 20) who participated in a 12-week CAT clinical trial to enhance the understanding of the effectiveness of the intervention. For HCPs experiencing burnout and psychological distress, our CAT program supported healing and resiliency through building a sense of community. Participants reported that several programmatic components contributed to this sense of community including: 1) diversity of participants' disciplines, roles, and geographic locations;2) physical separation between the conduct of the CAT program and their primary place of employment;3) facilitator skill;4) collectively contributing to a group project;and 5) being pushed out of their "comfort zone" through the creative activity. Although participants described the particular need for the CAT program in light of additional stressors induced by the COVID-19 pandemic, they believed that this program would have been beneficial pre-pandemic and in the future. To build long-term resiliency, participants suggested that CAT interventions should continue after the 12-week program.Copyright © 2023 Elsevier Ltd

Alcohol use trends in Dallas County during the COVID-19 pandemic

Alcohol (ethanol) is the most widely detected drug in forensic toxicology casework and an increase in consumption of alcohol was reported during the COVID-19 pandemic. The increase in consumption could be attributed to rising stress levels and social isolation. To determine whether the pandemic had an impact on ethanol positivity and concentrations in cases analyzed by the Dallas County Southwestern Institute of Forensic Sciences, blood ethanol results were evaluated from January 1, 2019, through December 31, 2021. This time frame captured ethanol prevalence and concentrations before, during, and immediately following the pandemic for comparison. The average ethanol concentration in postmortem casework over the three years for each quarter ranged from 0.116 g/100 mL to 0.142 g/100 mL while the average concentration in driving while intoxicated (DWI) was higher, ranging from 0.173 g/100 mL to 0.188 g/100 mL. The ethanol positivity rate for postmortem casework remained relatively the same at approximately 20% during the time frame, while there was a decrease in ethanol positivity rate for DWI casework during the pandemic in April - June (Q2) 2020. However, the positivity rate returned to pre-pandemic levels by the end of 2020. Despite the self-reported surveys of increased alcohol consumption during the pandemic, a corresponding increase in average ethanol concentrations was not observed in Dallas County and the surrounding area.Copyright © 2023

Experiences of patients at high risk of opioid overdose accessing emergency department and behavioral health interventions: a qualitative analysis in an urban emergency department.

BACKGROUND: Emergency Departments (EDs) have become critical 'touchpoints' for the identification and early engagement of patients at risk of overdose or who have an opioid use disorder (OUD). Our objectives were to examine patients' ED experiences, identify barriers and facilitators of service uptake in ED settings, and explore patients' experiences with ED staff. METHODS: This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants' ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization. RESULTS: Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care. CONCLUSIONS: While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose. TRIAL REGISTRATION: Clinical trial registration: NCT03684681.

Working Conditions and Well-Being across the COVID Pandemic in UK Social (Care) Workers

Prior to the COVID-19 pandemic, social work and social care practitioners had some the worst working conditions of any sector in the UK. During the pandemic, data revealed that social care occupations had higher COVID infection and mortality rates than the general population. The article reports the changing working conditions (measured via the Work-Related Quality of Life scale) and well-being (measured via the Short Warwich–Edinburgh Mental Well-being Scale) of UK social care and social workers across three timepoints between May 2020 and July 2021 through an online cross-sectional survey of working conditions and well-being. Analysis of variance demonstrated that both well-being and working conditions were significantly poorer in July 2021 (phase 3 [ n  = 1,606]) than the previous two phases (n  = 2,523 and n  = 2,424, respectively), suggesting that both working conditions and well-being worsened within the social care and social work workforce across the pandemic. Furthermore, each of career satisfaction, working conditions, control, general well-being and home–work interface predicted poorer well-being at Time 3. Whilst chronically poor working conditions can lead to poorer individual psychological and physiological health outcomes, our findings highlight continually poor conditions in this sector, with potential further impacts on organisations and the service users that social care workers support. It is therefore important that individuals, organisations and government develop mechanisms to support these critical workers during and following the pandemic.

'How shall we handle this situation?' Social workers' discussions about risks during the COVID-19 pandemic in Swedish elder care

Within a context where New Public Management [NPM] has become increasingly influential in shaping everyday working practices, social workers often handle risks in their everyday work using formalised bureaucratic procedures, among other strategies. As the COVID-19 pandemic progressed, rapid changes occurred in Swedish elder care that social workers were required to address in their everyday work. Intra-professional case conferences amongst social workers provide one opportunity to discuss individual viewpoints and obtain suggestions from colleagues on how to proceed with a case. These discussions have so far received little scholarly attention. In this study we used a data set consisting of 39 audio-recorded case conferences to analyse social workers' intra-professional discussions about risks during the COVID-19 pandemic. In the case conferences, social workers discussed the risks that were accentuated by the pandemic, such as the risk of spreading COVID-19 to clients, the risk of unmet care needs amongst clients, risks related to accountability, and the risks pertaining to blurred boundaries between different organisations. The collegial discussions in case conferences included opportunities for social workers to use their collective professional experience and competency to establish creative solutions 'on the go' and to discuss various ways of handling and balancing different risks while continuing to carry out their work in the changing and unknown situation. Our findings highlight the importance of collegial support in social work in dealing with accentuated risks during the pandemic.Copyright © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

'Masks and Social Distancing -You Still Want to Add That Human Element': Impact of Covid-19 Changes on Children and Families

Background Despite lower rates of illness, morbidity and mortality associated with SARS-CoV-2 infection in children during the pandemic, their health and wellbeing has been significantly impacted. Emerging evidence indicates that this includes experiences of hospital-based care for them and their families. As part of a series of multi-site research studies to undertake a rapid appraisal of healthcare workers' perceptions of working during the pandemic, our study focussed on clinical and non-clinical staff perceptions of the impact of COVID-19 on aspects of care delivery, preparedness and staffing which were specific to a specialist children's hospital. Methods This was a qualitative study. Hospital staff were invited to take part in a single telephone interview. Researchers used a qualitative rapid appraisal design. This included a semi-structured interview guide, RREAL Rapid Assessment Procedure (RAP) sheet to share data, audio recording and transcription of interviews, with a framework approach to analysis. Results Thirty-six staff participated representing a wide range of roles within the hospital: 19 (53%) nurses, seven (19%) medical staff, 10 (28%) other staff groups (including radiographers, managers, play staff, schoolteachers, domestic and portering staff, social workers). Three themes related to the impact on children and families were identified: Same Hospital but Different for Everyone, Families Paid the Price and The Digital World. Conclusion Providing care and treatment for children and families changed profoundly during the pandemic, particularly during lockdowns periods. Adaptations to deliver clinical care, play, schooling, and other therapies online were rapidly put into action, however benefits were not universal or always inclusive. The disruption to a central principle of children's hospital care-the presence and involvement of families-was of critical concern to staff. We present perceptions of staff on how changes to the organisation of care delivery within Great Ormond Street Hospital impacted upon children and families.

Family caregivers in palliative care: Social work roles and responsibilities

This chapter highlights the key concepts in palliative social work, including caregiver assessment that addresses roles, tasks, coping, unmet needs, and caregiver support along the continuum of illness, including the COVID-19 pandemic. It outlines the key social work skills, with a view toward strengthening and expanding the role for social workers with caregivers. The National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care describe core concepts, structures, and processes necessary for quality palliative care, including eight domains of practice. It is generally best to conduct the caregiver assessment as early as possible so caregiver concerns can be communicated with the entire palliative care team and integrated into the plan of care. A comprehensive caregiver assessment provides a useful roadmap for identifying the role of culture in the beliefs, values, and everyday life of patients and caregivers. The Advanced Palliative Hospice Social Worker Certification, established social work fellowships, and the competency-based training for Educating Social Workers in Palliative and End-of-Life Care hold the promise of creating a stronger palliative social work educational framework/foundation similar to that of other disciplines. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Providing Comprehensive Services to Treat Patients and the Inpatient Psychiatric Bed Crisis

Objectives: A growing mental health crisis and a shortage of inpatient psychiatric beds have resulted in a surge of patients' boarded' in emergency departments awaiting acute inpatient psychiatric placement. This delays care and causes a further burden on already stressed emergency services. In June 2020, the Centers for Disease Control and Prevention (CDC) reported an increased incidence of anxiety and depressive disorders since March of 2020, in comparison to pre-pandemic data. This has further exacerbated the shortage of psychiatric beds nationwide. In addition, staff shortages at state psychiatric hospitals in the Commonwealth of Virginia led to temporary closures to admissions. State facilities in VA provide care for our most vulnerable population, including (involuntary) patients on a temporary detention order (TDO). Carilion Clinic implemented the Comprehensive Psychiatric Emergency Program (CPEP) in August 2020 with the goal of early identification and robust treatment of psychiatric patients while in the ED. Since implementation of the CPEP, providers have been able to redirect patients away from burdened state psychiatric facilities by rapid stabilization of patients in the ED. Patients were able to step down to a less restrictive environment, often no longer meeting criteria for TDO. This study aims to assess the rate of TDO releases pre- and postimplementation of the CPEP at Carilion Clinic. Method(s): A pilot program was launched in August 2020 at Carilion Roanoke Memorial Hospital through a collaboration of the Departments of Emergency Medicine and Psychiatry. The staff was comprised of a psychiatrist, a psychiatric nurse practitioner, and a social worker. Data was collected from May 2020 to June 2021 from the Epic electronic medical record and included all patients in the ED on a TDO, ages six and above. Patients who no longer met criteria for a TDO were released from involuntary status and either redirected as a voluntary patient to an inpatient psychiatric unit or discharged to the community. The rate of TDO releases three months prior to CPEP implementation was assessed and compared to the TDO release rate post-CPEP implementation. Result(s): Prior to CPEP implementation, the TDO release rate was 7%, amounting to four patients released from a TDO per month. After implementation of CPEP, the TDO release rate increased to 19%, equating to thirteen patients released from a TDO per month during the pilot period. This led to a decrease in the number of patients that would have previously been admitted to a state psychiatric facility. Patients who benefitted from implementation of the CPEP were those with conditions in the following categories: chronic mental illness (32%), individual/family crisis (24%), neurocognitive disorders (20%), substance use disorder (18%), autism spectrum disorders and intellectual/developmental disabilities (6%). Conclusion/Implications: Implementation of the Comprehensive Psychiatric Emergency Program (CPEP) in Carilion Clinic' Emergency Department was successful in reducing the number of state psychiatric admissions by redirecting 11% more involuntary patients to voluntary status. The results of this study highlight the benefits of having in-house psychiatry teams dedicated to early triage, rapid treatment, and comprehensive case management for psychiatric patients in the emergency department. References- CDC, National Center for Health Statistics. Indicators of anxiety or depression based on reported frequency of symptoms during the last 7 days. Household Pulse Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics;2020. https:// www.cdc.gov/nchs/covid19/pulse/mental-health.htm.

Changing English Local Authority Duties by the Adoption of Easements in the COVID-19 Pandemic, Findings from an Interview-Based Study

This article reports findings from a study on the effect of the adjustments or 'easements' that were made to the 2014 Care Act when measures to manage the impact of COVID-19 were introduced in England in 2020. Only eight local authorities (LAs) implemented the changes permitted. The experiences of five are explored in this article. Data were collected in 2021 through interviews with Directors of Adult Social Services and other senior managers in these LAs and analysed using a thematic approach. Participants referred to the challenges under which they were working pre-pandemic, including resource pressures and problems recruiting and retaining staff. Despite the conditions attached to adopting easements these LAs had done so because of the uncertainties they were facing. All ceased to use them within a short time because they could manage without them. They had been shocked by the concerted opposition to easements and the time necessitated in responding to this. They contrasted their experiences with the apparent ease with which NHS colleagues had been able to change their practices. The experiences of these LAs may contribute to planning for the continuity of social care in any future emergency.