Social work in primary care: a demonstration student unit utilizing practice research.

A neighborhood primary health care program serving a socially and economically oppressed community, and a graduate school of social work have collaborated to create a social work student field work unit in a primary health care setting, to demonstrate emerging and innovative social work roles in an ever-increasing managed care environment. Patients with high levels of psychosocial stress make large demands on the primary care system and consume considerable laboratory and diagnostic treatment resources. Development of social services in primary care settings is a relatively new concept, however it has been clearly demonstrated that primary care physicians need the skills of social workers to handle the psychosocial and environmental aspects of illness. The principal goal was to demonstrate social work practice in a primary care health setting, utilizing practice research approaches. Validation of effectiveness was noted, as depression, anxiety, adjustment reactions (to name a few) were decreased, resulting in fewer physician visits, less somatization and improved compliance with medical and diet/nutrition regimens. The case examples and single subject data presented provide qualitative evidence, in the context of a natural experiment, for the profession to pursue this model further in both program development and research.

A Department of Social Work uses data to prove its case [corrected].

The introductions of managed care with its emphasis on cost containment has led a Department of Social Work Services at a large urban teaching center to better document and justify its roles. A concrete result was the saving of social work positions during budget cutbacks and downsizing. There is also information in these data to help clarify the differential roles of social workers and utilization review nurses in the hospital case management/discharge planning processes. The system came about because of concerns around cost containment, the need for more systematic discharge planning and the advent of the Prospective Payment System and Diagnosis Related Groups (DRG's) as a means of reimbursement to hospitals.

Practice and research: an integrated model for the education of social work interns.

The Practice Research Center is a joint endeavor between Adelphi University Graduate School of Social Work and the Department of Social Work Services at Long Island Jewish Medical Center. This paper will describe the work of the research center from 1983 to date. This collaborative effort of agency and school is focused on the students' acquiring an understanding and appreciation of a scientific/analytic approach to knowledge building for practice. Research opportunities for social work staff and students contributed to the initiation of empirical studies. The studies focused on current topics of interest that formed the delivery of social work services, enhanced programming and added to the knowledge of practice. Studies included a hunger survey; a survey of psychiatric patients' understanding of their illness following a psycho education intervention; a retrospective study to determine the extent to which breast cancer information influences a woman's surgical options of a lump-ectomy or mastectomy; a two-tier study focused on the characteristics of foster children and the delivery of social work services; a patient and family satisfaction survey of psychiatric patients and their families. The authors will discuss the educational principles related to this effort.

Research changes a health care delivery system: a biopsychosocial approach to predicting resource utilization in hospital care of the frail elderly.

The social work department of a large New York City teaching hospital has conducted practice research studies over the past five years to better improve the early identification of high risk elderly patients. A recent prospective study is presented of the relationship between functional capacity and discharge status/length of stay, the results of which directly led to a change in the inpatient delivery system. A sample of 250 randomly selected patients, 65 years or older, selected upon admission, were tested using the Katz ADL, the IADL and the Short Portable Mental Status Questionnaire (PMSQ) to distinguish those patients likely to remain hospitalized beyond medical necessity. Results of a logistic regression indicate that low functional capacity patients (IADL: Wald = 5.6; P < .02) were likely to remain beyond medical necessity. The model predicted group membership correctly 90.6% of the time. These findings have led the medical center to develop an acute care geriatric unit in cooperation with an affiliated nursing home.

Management of alternate level of care patients using a computerized database.

The term "alternate level of care" (ALC) refers to the status of hospitalized patients who are no longer acutely ill but cannot be discharged because posthospital plans are not yet in place. ALC is a major problem for patients, families, and hospitals. This article describes the experiences of an urban teaching hospital with ALC and the development of a computerized database to better manage the ALC population. Among the findings were that age, waiting for a nursing home placement, family-related discharge problems, and pending Medicaid eligibility all significantly contributed to length of stay beyond the acute phase of the illness. Using these data, the hospital developed an innovative program in which the preparation of Medicaid applications was transferred from the Department of Finance to the Department of Social Work Services.

Helping patients in the supportive milieu of a community residence program for the chronically mentally ill: conceptual model and initial evaluation.

The Community Residence Program described is sponsored by an urban teaching hospital and supported by state funds. The program uses scatter-site apartments in the community to house 120 patients in a therapeutic milieu as part of their comprehensive aftercare treatment. The program stresses teaching the skills of daily living to patients with chronic, psychiatric illnesses. The conceptual model used is based on challenges and tasks appropriate for this population. Preliminary evaluation findings suggest that the program is successful in teaching patients social skills, helping them adhere to medical regimens, perform household chores and observe fire safety regulations.