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437 -Social Work Considerations for Addressing Chronic Conditions
Dr. Dawn-Elise Snipes
Counselor Toolbox Podcast

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~ Chronic conditions such as diabetes, arthritis, chron's disease, and depression
~ 60% of people in the US have a chronic illness
~ Many serious illnesses have a much longer course with episodes of exacerbations and remissions
~ Chronic Illness can be highly stressful for patients and families
~ Care for people with chronic illnesses is increasingly done by family in the home.
~ Untreated mood disorders in individuals with co-morbid chronic health conditions increases morbidity and mortality rates and reduces the capacity for self-management

Biopsychosocial Impact of Chronic Conditions
~ Sleep
~ Pain
~ Medication side effects
~ Fatigue
~ Circadian rhythm disruption
~ Physical changes (weight changes, ports, pumps, hair loss)
~ Loss of mobility
~ Depression
~ Anxiety
~ Anger
~ Grief/Adjustment
~ Jealousy or resentment
~ Irritability
~ Withdrawal
~ Self Esteem changes
~ Loss of social support
~ Smothering social support
~ Inability to engage in prior important activities
~ Loss of independence
~ Vocational problems
~ Financial hardships (Medical expenses, job loss, environmental modifications)
~ Access to nutritious food
~ Physical, sexual and emotional relationship problems

Goals of Chronic Care Models
~ Shift from acute, episodic treatment to one of ongoing proactive care
~ Emphasizes
~ Prevention (getting worse, developing other conditions)
~ Patient’s role in managing health with mutual goal setting and action planning (self-management)
~ The goal of self-management interventions are to:
~ Improve knowledge about the condition and intervention options
~ Increase confidence in the ability to change
~ Leverage what he or she can do to promote personal health (prevention)

Goals of Chronic Care Models
~ The goal of self-management interventions are to
~ Improve motivation and problem solving rather than simple compliance with a caregiver’s advice
~ Help the participants’ master six fundamental self-management tasks:
~ Solving problems
~ Making decisions
~ Using resources
~ Forming a patient -provider partnership
~ Making action plans for health behavior change
~ Self-tailoring
Categories of Interventions (FRAMES)
~ Self Management Support
~ Feedback
~ Develop collaborative relationships
~ Use an ask-tell-ask framework with clients and caregivers
~ Responsibility
~ Ability and motivation for self-management fluctuates. Tailor interventions appropriately (symptom exacerbations, med changes, life changes…)
~ Advice
~ Use education and scaffolding to empower clients to adjust their behaviors and take control of health self-management
~ Menu of Options depends on individual circumstances, and resource availability
~ Empathy and Encouragement
~ Self-Efficacy

“5 A’s” of Behavioral Change
~ Assess
~ Advise/engage
~ Agree/collaborate
~ Assist/identify obstacles and interventions (treatment)
~ Arrange for follow up (evaluate/review)

Categories of Interventions
~ Assess
~ Regular assessment and enhancement of motivation and readiness for self-management
~ Ongoing Biopsychosocial Assessment (including quality of life and a Health Risk Appraisal (HRA)
~ An HRA is a systematic approach to
~ Collecting information about risk factors
~ Providing individualized feedback
~ Linking the person with at least one intervention to promote health, sustain function and/or prevent disease

Categories of Interventions
~ Advise:
~ Multimodal education about the condition and treatment options
~ Teach self-monitoring for clients and caregivers
~ Families and clients are educated about
~ The illness
~ What to expect from a family member who has the illness
~ How they can best help
~ How to take care of themselves

Categories of Interventions
~ Agree and Assist (Collaborate)
~ Engage through goal directed counseling and conferences with patients, families, and support networks to
~ Motivate and empower them to take an active part in the recovery process
~ Teach them how to monitor and improve their motivation and commitment to tasks
~ Set goals, collaboratively, with clients, using templates that can be modified based on the client’s context
~ Develop tools that the client can use in the future

Categories of Interventions
~ Agree and Assist (Collaborate)
~ Engage through goal directed counseling and conferences with patients, families, and support networks to
~ Encourage the use of specific tools and templates that can be modified based on the client’s context (home, work, vacation)
~ Teach how to break down goals and tasks into small steps
~ Help clients and families integrate feelings and attitudes regarding their condition and life with a focus on issues and concerns that they have experienced since first developing signs of the problem, and how to address those problems

Categories of Interventions
~ Agree and Assist (Collaborate)
~ Crisis intervention
~ Social support facilitation
~ Interdisciplinary care planning, collaboration, referrals (i.e. Church-based support groups, local community health programs, clinic and internet based support groups)
~ Advocacy on patients’ behalf including addressing problems related to treatment options and setting transfers
~ Assistance with decision making with regard to advance directives
~ Personalized feedback and help the client learn how to ask for, receive and use feedback

Categories of Interventions
~ Arrange for Follow-Up and Step-Down
~ Build in evaluation processes to help clients measure their progress
~ Service plan reassessments
~ Discharge planning

Additional Interventions
~ Additional services
~ Assertive community treatment (ACT) programs to monitor medication and treatment plan compliance in clients with low motivation and/or low functioning
~ Assist clients in using
~ Information from self-monitoring techniques
~ Clinician extenders like mindfulness, CBT or pain management apps
~ Linkage with community support programs

Change Process
Qualities of Good Action Plans
~ Something the person wants to do
~ Avoid having to take insulin
~ Feel less pain
~ Specific and positive
~ Improve my weight, nutrition, exercise and stress levels
~ Be able to comfortably sleep and engage in meaningful activities
~ Measurable: What? How much? When? How often?
~ Reduce my weight by 5%, follow the prescribed diet, get 30 minutes of exercise 5 days a week, reduce daily stress levels from a 7/10 to a 4/10
~ Reduce my daily pain rating from a 4/5 to a 2/5, get at least 7 hours of quality sleep, be able to take my dog on 2 30-minute walks a day
~ Achievable with a high probability of success
~ Relevant
~ Time limited (3 months)—Break it down further…

~ Treatment for persons with chronic conditions requires use of many strategies outside of traditional emotion or cognition focused counseling to educate, motivate and empower clients to take charge of their condition.
~ It is beneficial to educate the client as well as the family/support system about the condition, effects of the condition, expectations for improvement and benefits and drawbacks of possible interventions.
~ Using the FRAMES approach empowers the client to take charge of self-management, provides a menu of options and support to help the client enhance self efficacy