Ov erview of Supportive Social Services for TB Patients

1. Overview of Supportive Social Services for TB Patients Paul W. Colson, PhD

2. EPIDEMIOLOGY • Increasingly, US-born TB cases represent the most disadvantaged members of society*: • Homeless: 5.7% of US cases • IDU: 2.1% • Non-IDU drug users: 8.0% • Alcohol abusers: 13.4% • Foreign-born patients now represent 58.3% of TB cases * TIMS data from Reported Tuberculosis in the United States, 2007 CDC

3. 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

4. WHY IS IT IMPORTANT? • Improve adherence and treatment completion • Prevent development of drug-resistant TB • Reduce transmission of TB, including MDR

5. ENHANCED SOCIAL SERVICES

6. INTAKE - 1 • Intake for all patients vs. as-needed (self-referral 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)

7. INTAKE - 2 • Biopsychosocial assessment: • Patient information • Reason for referral • Psychosocial history • Current living situation & functioning • Assessment: • Subjective • Objective • Plan: • Short-term goals • Long-term goals

8. 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

9. CASE MANAGEMENT - 2 • Case management meetings may discuss: • 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

10. REFERRALS • After assessment, provide referrals to: • 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!

11. OTHER SERVICES • Targeted health education • Support groups • Counseling

12. 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

13. CASE STUDY – Mr. A • Hard to reach/volatile • Problems with Neighbors/Fear of Intruders • Psychiatric Diagnosis • Other problems: dental, medical bills • Jury Duty

14. CASE STUDY – DISCUSSION • Establishing rapport • Tolerance • Psychiatric diagnosis • Tangible assistance • Persistence • Relationship