METRIC TOOLS of the TRADE Using Self-assessment Data

METRIC TOOLS of the TRADE Using Self-assessment Data to Complement Social Work Assessment and Intervention Jane Stretton MSW, RSW Cathie Percival MSW, RSW 7 th International Conference on Social Work in Health and Mental Health: Pathways to Client-Centered Care June 24, 2013

TORONTO REHAB Toronto Rehab is a multi-site hospital providing inter-disciplinary care in rehabilitation and complex care; two years ago, we joined the University Health Network which provides acute and cancer care in three Toronto hospitals Lengths of stay in rehabilitation are typically timelimited, based on national standards All disciplines work within a program management structure

TORONTO REHAB (2) Our 33 social workers are College regulated and Master’s prepared There also three community resource workers also College regulated and two discharge planners Provide service to a wide variety of patients

METRIC TOOLS of the TRADE An ongoing practice development project with resource to fund release time of about five hours a week for one social worker to develop and implement the project To encourage social workers to integrate behavioural observation and practice wisdom with data from self- assessment tests (SATS) to inform assessment, contracting, intervention and discharge planning across all programs at Toronto Rehab

Purposes ENHANCE PATIENT-CENTRED CARE A way to reflect respect for patient selfknowledge related to their recovery and enhance empowerment Enhance “buy-in” to clinical plan as test results reflect the patient’s view of themselves Therapeutic relationship is strengthened when patients self identify clinical issues (externalization of negative judgement)

Purposes (2) Organizational Pressures Growing awareness of the need to incorporate outcome evaluation tools to reflect evidencebased practice Consistent with both the patient and hospital goal -setting approach Effective way to demonstrate the ways in which emotional and psychosocial functioning impacts the hospital mission of improving rehabilitation optimizing quality of life

Purposes (3) ENHANCE PROFESSIONAL GROWTH Facilitates speaking the language of the dominant culture Highlights strengths as well as problems, a fit with social work values Allows social work staff to reflect on their professional strengths thus reduce burnout and identify areas where enhanced professional learning is indicated

PHASE ONE Extensive work was done to establish a common target for social work intervention at Toronto Rehab Target established - Coping style Three tests* were selected measured it. All social workers were expected to try at least one measure over the following year Education was provided around test design and administration for the three tests *Brief Cope, CISS, WCQ

PHASE ONE (2) At the end of the trial period there appeared to be limited “buy-in” and most social workers chose not to trial any of the three measures saying that it didn’t seem appropriate for their population Given the voluntary nature of participation and apparent reluctance to utilize the coping measures, more consultations were done with all social workers

EVALUATION Barriers that emerged : – belief that was being done was effective and didn’t need evaluation or modification – potential to use data to evaluate social workers’ performance – the art of counselling would be lost – time concerns – difficulty explaining the purpose of SATS to patients – not knowing how to link results to practice – math phobia

REDIRECTION A new focus was chosen to reflect the concerns of social work staff Reassurances were provided to address the concerns that such data might appear in performance evaluations New CPD lead with extensive experience in use of SATS was recruited

REDIRECTION (2) Further education was done around both the gains for practice as well as the SATS limitations Learning needs were sought and extensive program-specific consultations were done to address particular concerns and customize the use of SATS

PHASE TWO SATS were expanded to include any selfassessment tool that the social worker thought appropriate for the target patient population and interventions Education provided around limitations of SATS ( culture bias and exclusionary criteria)

PHASE TWO (2) All social workers were encouraged to evaluate what they target for change in their intervention plans and to seek measures that matched those elements All social workers were expected to include at least 1 SATS in their assessments. When such testing was not clinically appropriate then evidence-based reasons would be documented

PHASE TWO (3) Training and mentoring was provided on how to choose and administer SATS After 3 years SATS were included as part of the documentation audit done through peer review Program specific SATS summary sheets were developed to facilitate documentation and written communication with patients

PHASE TWO (4) A toolkit was created and distributed to all programs which provided information including – utility of screening/assessment tests – choosing appropriate tests and where to access such tests – how to provide patient feedback – recording and storage of tests – inventory of all self-assessment tests used at Toronto Rehab and the names of the social workers using each test

ANECDOTAL RESULTS The majority of social workers have integrated SATS into their practice Some staff have not yet seen the value of this new approach (perhaps because of previously mentioned barriers) Patients and team members report enhanced understanding of psychosocial functioning, social work role, positive impact on therapeutic relationship and discharge plans

ANECDOTAL RESULTS (2) Social workers report reduced “ compassion fatigue" and improved resilience because of enhanced awareness of patient strengths, improved therapeutic relationship and the efficacy of the interventions they provide Students report enhanced confidence as SATS provided focus and structure in initial interviews

FUTURE DIRECTIONS Field instructors at Toronto Rehab will mentor students around the use of SATS The student seminar series will continue to contain a SATS introduction Experienced staff will mentor new staff around use of SATS will remain a part of the documentation audit

FUTURE DIRECTIONS (2) On-line toolkit and training DVD in development Possible research initiatives/ quality improvement projects to evaluate : -the impact of the use of SATS on therapeutic relationship -how to establish parameters of reliable change for SATS -how to provide tools to group data obtained through SATS

Questions?

Thank you for your interest and attention

OUR PROFESSIONAL BACKGROUNDS Jane Stretton MSW, RSW Research Associate, 1971 -1974 In and Out-patient Social Worker, 1980 -present ( neuro rehabacquired brain injury and MS, chronic pain, orthopedic, slow stream rehab, palliative care and special projects) SW Corporate Professional Leader , 1999 -2007 Adjunct Lecturer, Factor. Inwentash Faculty of Social Work, University of Toronto 1999 -2007 CPD Lead: 2010 -2013 Cathie Percival, MSW, RSW In-Patient Social Worker: 1986 present- neuro-rehabilitation SW Corporate Professional Leader: 2007 -2012 Adjunct Lecturer, Factor-Inwentash Faculty of Social Work, University of Toronto: 2006 -2011