Comprehensive Rehabilitation Assessment in Multiple Sclerosis Social Work Perspective By Judy Soderb

1
Comprehensive Rehabilitation Assessmentin
Multiple SclerosisSocial Work PerspectiveBy
Judy Soderberg,MSW, LISW
2

• Different types of Social Workers
• (In Minnesota may differ in various states
  and countries.) All are licensed by State.
• A. Licensed Bachelor of Science in Social Work,
  BSW
• B. Licensed Social Worker, MSW
• C. Licensed Clinical Social Worker, MSW
• D. Licensed Ph.D. Social Worker

3

• Social Workers work in a variety of settings and
  have various assessment and functions depending
  on setting and type of licensure.
• Intake for various program, i.e., MSAC, Courage
  Center, Long
• Term Care
• B. Intake and follow for various
  county/state programs

4

• C. Discharge planning
• D. Intake/follow up for home care
  services
• E. Information/referral services at
  local M.S. Societies
• F. Attached to Comprehensive M.S.
  program

5

• Because of the variability of M.S., and the
  length of time people/families will deal with it,
  social workers from various settings and
  different licenses can be involved over time.
• Tendency to be more involved with social workers
  as disease progresses particularly social workers
  who work in program of all types and in hospitals
  and home care. These are generally BS MSW
  licensed social workers.

6

• Global assessments done by programs, hospitals
  and home care. Depending on information gathered
  in global assessment, other types of assessments
  may be requested.

7

• Sample
• of
• Global Assessment

8

• Ability to express thoughts/needs/feelings
• ___Expresses thoughts/feeling/needs without
• difficulty
• ___Requires extra time or cuing
• ___Speech limited to single words
• ___Uses only gestures (eye blinking/eye or head
  movement/pointing)
• ___Unable to express thoughts/feelings/needs
• (speech unintelligible or inappropriate)
• ___Unresponsive

9

• Patients living arrangement/care setting
• ___Patients own home/residence
• ___Home of family member/friend
• ___Boarding home
• ___Assisted living facility/retirement center
• ___Hospital/Acute care facility
• ___Skilled nursing facility
• ___Long term care facility/Nursing Home
• ___Other (specify)__________________

10

• Patients Relationship Status
• _Single
• _Married
• _Divorced
• _Domestic partner
• _Widow/Widower
• _Common law
• _Separated
• _Unknown

11

• If in a relationship, name of partner/spouse
• _________________________________
• Age_________________
• Duration of relationship_____________
• Anniversary date_____________

12

• Relationship of Primary Caregiver
• __No primary caregiver available
• __Spouse/significant other
• __Natural child
• __Step child
• __Sibling
• __Parent
• __Friend/Neighbor
• __Community/Church volunteer
• __Paid Help
• __Other (specify)_______________________

13

• Does the Caregiver Appear to Have any
  Limitations?
• __Vision
• __Hearing
• __Speech
• __Mobility/Endurance
• __Emotionally unstable
• __Alcohol/Substance abuse
• __Conflict with patient

14

• __Concurrent treatment of own illness
• __Inability to cope with potential loss
• __Difficulty with own ADLs
• __Lack of time
• __Resistant to performing medical tasks
• Family Members/Significant Others Not a Member
  of the Household
• ________________________________
• ________________________________

15

• Social Support Systems (select one best
  description)
• _Excellent social support system which
• includes three or more willing family
• members or friends
• _Good social support system which
• includes two or less willing family members
• or friends
• _Fair social support which includes one
• willing family member or friend
• _Poor social support no willing family
• members or friends basically ALONE

16

• Patients Description of Illness/Current Health
  Status___________________
• _______________________________
• __Patient unable/unwilling to discuss
• __Knowledge/Understanding of Disease
• Process
• __Burden of Care

17

• Risk Factors
• _Alcohol abuse
• _Financial resources inadequate to meet
• basic needs (food/house/etc.)
• _Financial resources inadequate to meet
• health care needs
• (supplies/equipment/medications)
• _Food/Nutrition resources inadequate
• _Home environment unsafe/inadequate for
• home care
• _Homicidal risk

18

• Risk Factors
• _Lives alone or without concerned relatives
• _Multiple medications/complex schedule
• _Physical limitations increase likelihood of
• falls
• _Plan of care/treatments complicated
• _Substance use/abuse
• _Visual impairment threatens safety/ability
• to perform self-care
• _Other (specify)__________________

19

• Abuse/Neglect (actual/potential risks)
• _No signs of abuse/neglect
• _Physical _Sexual
• _History of abuse/neglect
• _History of domestic violence
• _Lacks adequate physical care
• _Lacks emotional nurturing/support
• _Lacks appropriate
• stimulation/cognitive experiences
• _Left alone inappropriately

20

• _Lacks necessary supervision
• _Inadequate or delayed medical care
• _Unsafe environment (I.e. guns/drug
• use/history of violence in the
• home/etc.)
• _Bruising or other physical signs of
• injury present
• _Other (specify)_________________

21

• _Refer to child/adult protective services
• _Other (specify)_________________
• Mental Status
• _Alert Oriented to
• _Person _Place _Time
• _Comatose responds to
• _Verbal Stimuli _Tactile stimuli
• _Painful stimuli

22

• _Forgetful
• _Disoriented/Confused
• _Lethargic
• _Agitated
• Other (specify)___________________

23

• Emotional Status (mark all that apply)
• _Angry _Euphoric
• _Anxious _Fearful
• _Apprehensive _Flat affect
• _Avoidant _Helpless
• _Clinging _Hostile
• _Depressed _Impulsive
• _Distraught _Irritable
• _Elated _Labile

24

• Emotional Status (continued)
• _Manic _Restless
• _Sad _Suspicious
• _Tearful _Withdrawn

25

• Cognitive Functioning
• _No signs of impairment
• _Impaired decision making
• _Does not understand nature of health
• condition on lifestyle
• _Non-compliant with medical regimen
• _Non-compliant with assistance
• _Other (specify)_____________________

26

• Functional limitations
• _Amputation
• _Bowel/Bladder incontinence
• _Contracture
• _Hearing
• _Paralysis
• _Endurance
• _Ambulation
• _Speech

27

• Functional limitations (continued)
• _Legally blind
• _Dypsnea with minimal exertion
• _Other (specify)________________

28

• Current Sources of Stress in Addition to Current
  Illness
• _None reported
• _Bills/Dept
• _Career/Job change
• _Child care (short term)
• _Child care (long term)
• _Death of a child (recent)
• _Death of a parent (recent)

29

• Current sources of Stress in Addition to Current
  Illness (continued)
• _Death of a spouse (recent)
• _Employment status changed
• _Family discord
• _Financial loss/Inadequate income
• _Job loss
• _Legal issues unresolved
• -Lifestyle change

30

• Current sources of Stress in Addition to Current
  Illness (continued)
• _Marital discord
• _Marriage within the last year
• _Paperwork (insurance/legal,etc.)
• overwhelming
• _Separation/Divorce
• _Other (specify)__________________

31

• Patients Income Level (per year)
• _Less than 8,000
• _8,001-14,000
• _14,001-25,000
• _25,001-40,000
• _Greater than 40,000
• _Patient refuses to provide information
• Current source (s) of income____________
• ___

32

• Handling Finances
• _Independent Manages financial affairs
• without assistance
• _Minimal Assistance Needs prompting
• (cuing/repetition/reminders to pay
• bills/make deposits/cash checks or
• manage financial accounts)
• _Moderate Assistance Needs supervision of
  all financial tasks

33

• Handling Finances (continued)
• _Total assistance Unable to manage
• her/his own financial affairs
• _Financial matters handled by family/friend
• Financial Concerns Expressed by
  Patients/Spouse____________________
• __________________________________

34

• Current Community Resources Being Utilized
  (list)
• _________________________________
• _________________________________
• _________________________________

35

• Interventions/Plan of Care
• _Assess social and emotion factors
• _Counseling for long range planning and
• decision-making
• _Short term therapy
• _Community resource planning/referral
• _Other (specify)____________________

36

• Community Resources Planning/Referrals
• _Child care
• _Financial management/counseling
• _Final arrangements
• _Food/Nutrition support
• _Home maintenance/repairs/handyman
• services
• _Homemaker services

37

• Community Resources Planning/Referrals
• (continued)
• _In-Home grooming services
• _Legal assistance
• _Mental health referral
• _Protective services
• _Relocation to different care setting
• _Transportation
• _Other (specify)

38

• The global assessment gives information that
  could suggest a more targeted intervention. At
  this point a referral could be made to a clinical
  social worker to work with the person on their
  individual issues.
• Referral from a team member if part of
  comprehensive MS Center
• Self referral

39

• VII. Individual Assessment Clinical S.W.
• A. Social Workers would assess social and
  emotional factors related to the impact of M.S.
  and the disability caused by it on the total life
  of the individual, their family, and the other
  social memberships, i.e., work, recreation
  interests, larger community.

40

• VIII. Areas to be addressed in targeted
  assessment In no special order.
• A. Life style of individual who they
  are as they define themselves
• 1. Family/home
• 2. Characteristics coping style
• 3. Work
• 4. Recreation/interests
• 5. Other

41

• B. Perception of how MS has affected
  their life style
• C. What are the stresses in their life?
• D. Specific areas of concern
• 1. Physical changes
• 2. Cognitive changes
• 3. Fatigue
• 4. Depression
• 5. Relationship Issues (partner,
• parenting)
• 6. Work ?
• 7. Other

42

• E. Risk Factors Alcohol abuse, social
  risk,finances, abuse.
• F. Impact of MS on various parts of
  their life
• G. Perception of things that need to
  be modified or changed
• H. Grief/loss issues
• I. What is issue that brought them to
  you.
• J. Future focus

43

• Development of plan based on individual
  perception of problem
• -Many different options
• -Individual counseling
• -Couples counseling
• -Family counseling
• -Information or support group offered
• by M.S. Society

44

• -Community Resources
• -OT/PT Speech referral
• -Referral for specific services offered
  by physician, I.e., symptom management,
  depression management
• -HUGA Program
• -Volunteer opportunities
• County/programs

45

• Assessment by Social Worker and
• patient to ascertain whether goals were
  met decision point
• -End point
• _Additional referrals/services