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Article Excerpt: Presenting a Patient or Client to the Medical Team
by Judith P. Bradley, CSW
Editor’s Note: The following is an excerpt from an article from the Spring 2010 issue of THE NEW SOCIAL WORKER. Read the full article at:
Aside from clinical training and experience, the one skill a clinician must develop is that of communication. That sounds simple enough—talking and hearing. These abilities are not enough. Let’s look at the ability to LISTEN with purpose and SPEAK with intent. These skills will serve you and the recipient of your services well. The cornerstone of human service is the exchange of information, whether hard data or the interchange of clinical thought. I will address one area of the clinical process, and that is the presentation of a client to colleagues.
Your information must be relevant and presented in an organized and succinct manner. You must have a template, either in an agency approved written format or your own “cheat sheet.” In some cases, with years of experience, the format can be in your head. I do not recommend it. If you overlook pertinent information, it may get lost in the process. Train yourself from the beginning to be thorough. Over-confidence at any stage in your career can lead to a poor outcome. I recommend that you begin to study and learn your contact forms and use them wisely. Take your own ancillary notes if you must, but the information incorporated into your agency notes must be accurate and appropriate. This will be your guide for presentation.
The presentation itself can feel daunting. It does not have to be. Once you have your pertinent written data, you must then use the skill of speaking with intent. If you are “all over the place,” the clinical picture of your client will be lost in words. Over time, I learned to use the following format when speaking:
Objective assessment of client at initial presentation (what I see)
Client’s assessment of self and presenting problem (what I hear)
Pertinent bio/psycho/social data (information I collect)
Collateral information, if taken (from whom and in what context)
Clinical impression, if appropriate in agency (what I determine thus far)
Initial disposition of client, including colleagues consulted (what I did)
The content of the above likely does not include exact information you need to present, unless you are in the behavioral health setting. Nonetheless, there will be necessary data you must impart to serve your client. You may use the above as a guide to organize and train your own mind to consistent gathering of information.
Now let us look at presentations I have heard in real clinical settings. The clients are real but, of course, with no identifying information.
Read the rest of this article at:
Additional articles from the Spring 2010 issue of THE NEW SOCIAL WORKER include:
…and more!
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BOOK EXCERPT
Gay and Gray: Lesbian, Gay, Bisexual, and Transgender Aging
by Lisa Krinsky, MSW, LICSW
I am the Director of the LGBT Aging Project in Boston, an organization whose mission is to ensure that lesbian, gay, bisexual, and transgender elders have equal access to the life-prolonging benefits, protections, services, and institutions that their heterosexual neighbors take for granted. Until our formation, there was no organized effort in Massachusetts to understand and address the needs of this invisible, isolated, understudied, and unquestionably disenfranchised population. Typically, LGBT elder activists replicate mainstream services and provide them directly to elders. While this is important work, the LGBT Aging Project has a different approach: we are a catalyst for conversation, consensus building, and change within the vast aging services infrastructure that already exists. We offer education and technical assistance to fair minded mainstream providers who are willing to serve all clients competently, equally, and sensitively—but in this case, simply don’t know how. We offer a framework for elders, their families, and caregivers who are willing to advocate for themselves.
Like many small nonprofit organizations, we are an overwhelmingly volunteer-based organization. I am the only full-time staff person, and we have recently hired a part-time outreach/education coordinator through a grant we received. I also have a great social work intern who has experience in elder care and is focusing on macro practice in gerontology. I report to our Steering Committee, which oversees the LGBT Aging Project.
So what do I do? Much of my time, I am conducting educational trainings for elder care providers, consulting with mainstream elder care organizations, giving presentations to community groups, advocating with state legislators on behalf of LGBT elders, planning events and programs, writing grants, and working with a caregiver support program. I spend a lot of time multitasking and working independently. This is really exciting, innovative work. There is no one else in the state of Massachusetts doing this kind of work, and very few others across the country.
So, a typical day in a job that has no typical days....
8 a.m.-9:30 a.m.: I get to the office about 8 a.m. The LGBT Aging Project rents office space from a mainstream elder care agency, so I have the benefit of being with other people (rather than working from home, or in an office all alone). It’s nice to have this sense of connection, rather than complete isolation. I also spend a lot of time out of the office, consulting with a variety of mainstream elder care agencies throughout the state that are working on becoming inclusive of the issues around LGBT aging. This means I also spend a lot of time in my car.
As with many jobs, a lot of my communication with our 250 members and constituents is through e-mail, so that can be time consuming. But there are two very exciting e-mails awaiting me this morning.
First, our Public Policy Committee is working with local legislators to refile the MassHealth Equality bill, and 42 of 200 state representatives and senators have signed on as sponsors. This bill proposes that Massachusetts’ Medicaid program will grant to all married same-sex couples the same responsibilities, rights, benefits, and protections guaranteed to opposite sex married couples recognized by federal law. This is particularly important here in Massachusetts, because we are currently the only state with same sex marriage. Federal law does not recognize these marriages, and Medicaid is funded through state and federal matching funds. For elders, this is a crucial matter, as they face long-term care issues and consider how to pay for a spouse’s long-term care without impoverishing the community spouse. Medicaid has regulations regarding income and home ownership in place to prevent the community spouse from impoverishment and homelessness. We believe that Massachusetts has an obligation to extend these benefits and obligations to all married couples, regardless of the state and federal split.
We have refiled this bill, since it didn’t make it through the legislative system in the last session. This has been a great way for me to learn about the legislative process.
I e-mail the Public Policy Committee that we’ll have to schedule time to visit legislators at the State House to talk with them further about our bill. I also contact an LGBT senior couple to join us. Real people help legislators “see” real issues. These two women, in their late 60s, have been together for almost 20 years and married for three years. These issues are a very worrisome reality for them.
The second exciting e-mail is from the National Gay and Lesbian Task Force. The task force is hosting the second meeting of its National Roundtable on LGBT Aging in DC in a few weeks. About 30 of us have been invited to participate in this work group to craft a national agenda on LGBT aging. I attended the first Roundtable meeting last June and RSVP that I’ll be there again. It’s great to work with other professionals who are dedicated to the issues around LGBT aging. The downside of being a leader in an innovative field is that I have few colleagues who actually do the same kind of work I do, so it’s encouraging to build a network with people in Chicago, California, DC, Wisconsin, and elsewhere throughout the country. Many of these people are also members of the American Society on Aging (ASA) and its affiliate group LGAIN (Lesbian and Gay Aging Issues Network), which issues newsletters on a regular basis and keeps us up to date on what our peers are doing.
9:30 a.m.-12:00 p.m.: I spend the next two and a half hours working on a new grant proposal. Most of our funding comes from grants. We have a very small budget (less than $150,000/year), and each grant is extremely important to maintaining and hopefully expanding our efforts. This grant proposal is for general operating expenses, so I will focus on a broad overview of our mission and our efforts. Some grants have been more program specific—we have a caregiver grant that supports our LGBT Caregiver Support Group and the LGBT Bereavement Group we hope to start soon. I am a good writer, and the only daunting parts of writing a grant proposal are finding quiet time without distractions (phone calls, e-mails, piles of other work) to concentrate on writing. Sometimes I’ll do that at home, or take my laptop to the library.
Part of preparing a grant proposal includes the financial budget information, so I am on the phone with our accountant to prepare the details of our budget for this grant proposal. She e-mails me a draft of the budget, and we review it before including it in the grant proposal.
As a small nonprofit, we don’t handle the “business” end of our work. We work with an organization whose mission is to support small nonprofits by acting as their fiscal sponsor. We operate under the fiscal sponsor’s 501(c)(3), which certifies federal tax-exempt, nonprofit status, and our organization is provided with the accounting, financial management, legal, and contract writing and signatures, human resources services, and benefits. I am officially an employee of the fiscal sponsor and receive salary and benefits through that organization. We pay the fiscal sponsor a small percentage of our operating budget for its services. This has been a great resource for the LGBT Aging Project, as my background is in clinical social work, and I don’t have the skills for that kind of accounting and financial management.
12:15 p.m.: I jump into my car and head off to a local hospital for a presentation. I leave myself enough time to find parking and the location of my presentation. My social work intern is joining me to observe this presentation, and we chat about her project on our way there. Official supervision is at the end of the week.
1 p.m.-2:30 p.m.: I am presenting “LGBT Aging 101: What You Need To Know About Lesbian, Gay, Bisexual, and Transgender Elders” for the geriatric medical team at this large teaching hospital in Boston. There are about 30 people present—staff physicians, nurses, social workers, and the interns working with them. This team provides hospital- and community-based care for the elders of Boston. I use my standard PowerPoint presentation and have distributed handouts so they can follow along. I give them an overview of our mission, and then educate them about general LGBT information before focusing on elder-specific issues—legal, financial, social, historical. One of the participants tells me, “I treat everyone the same,” and this leads to a terrific conversation about what has been unique in LGBT elders’ experiences. Having experienced institutional homophobia by medical, educational, faith, legal, housing, and employment providers, many LGBT elders learned to be invisible to avoid discrimination. That lack of trust in systems whose intentions are to be helpful means that how providers approach their clients can have a powerful impact. We focus on interviewing techniques, how to ask questions, and ways to talk about LGBT issues with elders. Some participants share their experiences working with LGBT elders and their families and learn from each other as well as from me. Evaluation forms indicate they found the presentation interesting and valuable to their work. That feels good.
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Presidential Proclamation--LGBT Pride Month
As Americans, it is our birthright that all people are created equal and deserve the same rights, privileges, and opportunities. Since our earliest days of independence, our Nation has striven to fulfill that promise. An important chapter in our great, unfinished story is the movement for fairness and equality on behalf of the lesbian, gay, bisexual, and transgender (LGBT) community. This month, as we recognize the immeasurable contributions of LGBT Americans, we renew our commitment to the struggle for equal rights for LGBT Americans and to ending prejudice and injustice wherever it exists.
LGBT Americans have enriched and strengthened the fabric of our national life. From business leaders and professors to athletes and first responders, LGBT individuals have achieved success and prominence in every discipline. They are our mothers and fathers, our sons and daughters, and our friends and neighbors. Across my Administration, openly LGBT employees are serving at every level. Thanks to those who came before us--the brave men and women who marched, stood up to injustice, and brought change through acts of compassion or defiance--we have made enormous progress and continue to strive for a more perfect union.
My Administration has advanced our journey by signing into law the Matthew Shepard and James Byrd, Jr., Hate Crimes Prevention Act, which strengthens Federal protections against crimes based on gender identity or sexual orientation. We renewed the Ryan White CARE Act, which provides life saving medical services and support to Americans living with HIV/AIDS, and finally eliminated the HIV entry ban. I also signed a Presidential Memorandum directing hospitals receiving Medicare and Medicaid funds to give LGBT patients the compassion and security they deserve in their time of need, including the ability to choose someone other than an immediate family member to visit them and make medical decisions.
In other areas, the Department of Housing and Urban Development (HUD) announced a series of proposals to ensure core housing programs are open to everyone, regardless of sexual orientation or gender identity. HUD also announced the first ever national study of discrimination against members of the LGBT community in the rental and sale of housing. Additionally, the Department of Health and Human Services has created a National Resource Center for LGBT Elders.
Much work remains to fulfill our Nation’s promise of equal justice under law for LGBT Americans. That is why we must give committed gay couples the same rights and responsibilities afforded to any married couple, and repeal the Defense of Marriage Act. We must protect the rights of LGBT families by securing their adoption rights, ending employment discrimination against LGBT Americans, and ensuring Federal employees receive equal benefits. We must create safer schools so all our children may learn in a supportive environment. I am also committed to ending "Don't Ask, Don't Tell" so patriotic LGBT Americans can serve openly in our military, and I am working with the Congress and our military leadership to accomplish that goal.
As we honor the LGBT Americans who have given so much to our Nation, let us remember that if one of us is unable to realize full equality, we all fall short of our founding principles. Our Nation draws its strength from our diversity, with each of us contributing to the greater whole. By affirming these rights and values, each American benefits from the further advancement of liberty and justice for all.
NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim June 2010 as Lesbian, Gay, Bisexual, and Transgender Pride Month. I call upon all Americans to observe this month by fighting prejudice and discrimination in their own lives and everywhere it exists.
IN WITNESS WHEREOF, I have hereunto set my hand this twenty-eighth day of May, in the year of our Lord two thousand ten, and of the Independence of the United States of America the two hundred and thirty-fourth.
BARACK OBAMA
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June is Aphasia Awareness Month
According to the National Aphasia Association, aphasia is “an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing.” It is often acquired as the result of a stroke or other brain injury. More than 100,000 Americans acquire aphasia each year. There are many different types of aphasia, affecting people of all ages, races, genders, and nationalities.
For more information about aphasia, see the National Aphasia Association Web site at http://www.aphasia.org. Here you will find an aphasia quiz, aphasia facts, communications “do”s and “don’t”s, a guide for family and friends, and more.
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