Harbor:Social work: Difference between revisions
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===Social Work Consultation Guidelines===
===Social Work Consultation Guidelines===


Generally, please call Social Work early if you anticipate any issues so they can get things during business hours and get to families before they leave.  Consult by placing a social work order in Orchid (documents consult time).  
*Consult Social Work early if you anticipate any issues so they can get things during business hours and get to families before they leave.  Consult by placing a social work order in Orchid (documents consult time).
*  Refer also to [[Harbor:Social_EM_resources|Social EM Resources]]
*  When discharging Homeless patients but still waiting for Social Work:
** ED Provider discharges patient, and fill out the Homeless Discharge Form in the depart process (offered a meal, Hep A or COVID vaccines, weather appropriate clothing, outpatient medical and/or mental health resources, prescriptions, etc.)
** ED RN: discharges and departs patient off the track, places a patient sticker on a paper log at the Router Desk for SW/HTF
** SW/HTF will assess patient, explore placement opportunities and give resources as available for patient.  


====1. SW Order Indications====
====1. SW Order Indications====
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Choose the indication that best fits your clinical need/question. Special instructions are helpful.
Choose the indication that best fits your clinical need/question. Special instructions are helpful.


======Lack of Resources======
=====Lack of Resources=====


Those who need help connecting with resources (financial, placement, housing, food, transportation, etc)
Those who need help connecting with resources (financial, placement, housing, food, transportation, etc)
*Community resources - food banks, gov benefits
*"Community resources" - food banks, gov benefits
*Disability - how to apply for disability (not for filling out application itself)
*"Disability" - how to apply for disability (not for filling out application itself)
*'''Discharge planning/placement''' - when a patient needs placement to a facility of lower acuity than an acute care hospital (not to be used if homeless)
*'''Discharge planning/placement''' - when a patient needs placement to a facility of lower acuity than an acute care hospital (not to be used if homeless)
*'''Homeless''' - for housing/resources. If patient has chronic physical and mental health problems, ask for patient to be signed up for Housing for Health.
*"'''Homeless'''" - for housing/resources. If patient has chronic physical and mental health problems, ask for patient to be signed up for Housing for Health.
*Hospice - still need to place a home-health order (only if going home on hospice, not a care facility)
*"Hospice" - still need to place a [[https://wikem.org/wiki/Harbor:Home_Health| home-health order]] (only if going home on hospice, not a care facility)
*Transportation - transportation home or to appointments, see section 1.2
*[[https://www.wikem.org/wiki/Transportation_Needs| Transportation Needs]]
*'''Crisis/Trauma''' - SW is consulted automatically for all TTAs. Ask for referral to Violence Prevention program if victim of violent crime (shooting/stabbing, etc)
*'''Crisis/Trauma''' - SW is consulted automatically for all TTAs. Consider also consult order for referral to Trauma Recovery Center and Violence Intervention Prevention program if victim of violent crime (shooting/stabbing, etc.)


======Poor judgement/Substance Abuse======
====Poor judgement/Substance Abuse====


*Behavioral issues
*"Behavioral issues"
*'''EtOH related trauma''' - SW provides a screening & brief intervention
*'''EtOH related trauma''' - SW provides a screening & brief intervention
*Non-compliance  
*Non-compliance  
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*'''Substance abuse''' - SW will provide screening & brief intervention
*'''Substance abuse''' - SW will provide screening & brief intervention


======Psychosocial Support======
====Psychosocial Support====


This category has a lot of overlap with psychiatry.
This category has a lot of overlap with psychiatry.


*'''Adjustment to illness''' - for psychosocial assessment by SW, help provide coping skill
*"'''Adjustment to illness'''" - for psychosocial assessment by SW, help provide coping skill
*Anxiety
*"Anxiety"
*Crisis/trauma - see above
*"Crisis/trauma" - see above
*Depression
*"Depression"
*'''End-of-life issues''' - for family or patient, help with GOC discussions
*"'''End-of-life issues'''" - for family or patient, help with GOC discussions
*Family conflict
*"Family conflict"
*'''Grief/bereavement'''
*"'''Grief/bereavement'''"
*HI
*'''Mental health''' - SW can provide more resources than just the DMH list, provide full assessment of patient's financial abilities and other social factors
*'''Mental health''' - SW can provide more resources than just the DMH list, provide full assessment of patient's financial abilities and other social factors
*New diagnosis - overlaps with Adjustment to Illness
*'''High risk pregnancy or Teenage pregnancy''' - provide resources & support
*Poor coping
*SI
*'''Teenage pregnancy''' - provide resources & support


======Regulatory/Legal Issues======
====Regulatory/Legal Issues====


*Adoption
*Adoption
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*'''Suspect elder/dependent elder abuse'''
*'''Suspect elder/dependent elder abuse'''
*'''Unidentified person'''
*'''Unidentified person'''
** [[Harbor: Identifying Jane/John Doe, finding next of kin tips]]


======Nonspecific======


*Other
==== Other Social Determinants of Health Resources====
*Assessment


J Singh 7/7/17
* '''Re-entry''' (released from prison <6 months with medical, mental health, substance abuse, or social needs)


====2. Transportation home:====
* '''Medically Complex''' Transitions of care (includes 3 visits to  ED in past year)
** ORCHID Message/Call/Text Rosario Aliviado - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral.
*** 21x.294.8908.  She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.


* BUS:
* '''Mental Health'''
**8a-5p - send to Social Work Office
** Residential & Bridging Care (transition from mental health institution to community)  213.738.4775
**nights/weekends/holidays - ED RN can get from the property office in the ED (behind triage)
** Intensive Service Recipients  (mental health with 2 or more admissions in year, recent DC from psych hospital) 844.804.5200


* TAXI:
====2. Transportation home:====
** Daytime - call Social Work to facilitate
[[Harbor:Main#Transportation_Needs|Harbor Transportation Needs]]
** Night/Weekend/Holidays - call house supervisor x65620 or spectra 23721 who will deliver the voucher to the ED
*** RN calls taxi - must notify taxi if needs wheelchair accessibility (Yellow Cab @ 310-533-6800)
*** RN takes the patient to the hospital nursing office; taxi driver comes to nursing office to sign paperwork and pick up the patient
 
* AMBULANCE: for patients that have a medical necessity (cannot ambulate, here w/o wheel chair, etc) and medically cannot take a taxi
* ED RN & area clerk to coordinate with insurance (if applicable)
* If patient is UNINSURED (including restricted Medi-cal) - use county transport to get an ambulance home
** UR & SW can get involved if issues
** If patient lives outside of LA County, call nursing supervisor or SW as they may need further authorization
*** Joy Lagrone can authorize county transport as a last resort
 
Chappell 9/2020
 
*kids without car seats: For kids who arrive (usually by ambulance) w/o a car seat, we do not have car seats available.  however, options are:
# take the bus home (no need for car seat)
# have someone bring a car seat and pick them up or go home in a taxi with the car seat that is brought
# if a. or b. will not work, can try arranging for ambulance (see section above)


====3. Patient who are homeless:====
====3. Patient who are homeless:====


a. Homeless Task Force - looking for patients with chronic illness (HTN, diabetes, psych, etc) who have had 2+ visits.  Put in s/w consult and choose "Homeless" under reason for consult, NOT "Discharge planning/placement".  If eligible - they will help sign up the patient - however, they may be on a waitlist for days to months. If an potentially eligible patient is stable for discharge, you may refer them to contact the Homeless Task Force with the following number: 310-848-3325.
a. Homeless Task Force - p1735
 
*looking for patients with chronic illness (HTN, diabetes, psych, etc) who have had 2+ visits.   
b. Patients discharged overnight who are not safe to go out into the night CANNOT wait in the ED lobby.  However, they can wait in the main hospital lobby in front of the social work offices to speak with social work for resources on housing in the AM. However, please try to consult SW during the ED visit if possible as there is overnight staff available.
*Put in s/w consult and choose "Homeless" under reason for consult, NOT "Discharge planning/placement".   
*If eligible - they will help sign up the patient - however, they may be on a waitlist for days to months.  


J Singh 7/15/17
b. Can be given packet of resources by clerk's station or with SW discussion


====5. Patients whom family is no longer able to take care of====
====4. Patients whom family is no longer able to take care of====


Please page social work asap - before family leaves - s/w will work with them to see if:
Please page social work asap - before family leaves - s/w will work with them to see if:
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b. other community resources are available  
b. other community resources are available  


c. help family brainstorm other ideas
c. consider [https://www.wikem.org/wiki/Harbor:Home_Health home health] referral


d. if family dumps patient and doesn't respond, s/w may file an adult protective services report
d. if family dumps patient and doesn't respond, s/w may file an adult protective services report


e. if the patient truly needs to be placed and resources and strategies of a/b/c do not work, per Dr. Wu, please place in obs and the inpatient team will work on placement from there
e. if the patient truly needs to be placed, run Interqual, try to transfer/admit to obs/short stay for placement


====6. Pt/family not happy with current skilled nursing facility (SNF)====
====5. Pt/family not happy with current skilled nursing facility (SNF)====


a. generally, this is not an appropriate use of the ED - the family needs to work with the SNF s/w to facilitate transfer to another SNF, exception point c. below
a. generally, this is not an appropriate use of the ED - the family needs to work with the SNF s/w to facilitate transfer to another SNF, exception point c. below
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c. APPROPRIATE if pt needs a HIGHER level of care b/c of medical needs - then s/w at Harbor can help   
c. APPROPRIATE if pt needs a HIGHER level of care b/c of medical needs - then s/w at Harbor can help   


d. Different levels of care are outlined in slides (attached) - shelter vs respite vs board and care vs SNF vs ?
====6. Clothing rack / clothing for patients====
 
====7. Clothing rack / clothing for patients====
 
a. s/w has a small stash in ED - consult/page to get access
*Located behind double doors in ambulance bay. NA-7 key for access.
 
b. volunteers office has another stash but only open 8-5 M-F
 
ED stash is in need of donations for men's pants, flip flops, sweat pants, sweat shirts
 
J Singh 5/9/17
 
====8. Patients who need PT/OT for placement====


a. place the patient in obs for placement and PT/OT evaluation - this way the hospitalist can then admit the patient from obs if they cannot get PT/OT (which they more likely than not cannot) - this is needed to document the need for PT/OT so we can get resources (it shows how many avoidable admissions there can be as the ED hospitalists are collecting this data manually).
Nursing and social work have access ('Harbor Rack' outside in ambulance entrance)


====7. Patients who need PT/OT for placement====


==See Also==
a. Admit patient to obs/short stay for placement and PT/OT evaluation
*[[Harbor:Main]]
b. In rare circumstances, may need to order PT/OT to be done in the ED.
*[[Harbor:Whole person care]]


==References==
==References==

Latest revision as of 06:11, 5 March 2022

Social Work Consultation Guidelines

  • Consult Social Work early if you anticipate any issues so they can get things during business hours and get to families before they leave. Consult by placing a social work order in Orchid (documents consult time).
  • Refer also to Social EM Resources
  • When discharging Homeless patients but still waiting for Social Work:
    • ED Provider discharges patient, and fill out the Homeless Discharge Form in the depart process (offered a meal, Hep A or COVID vaccines, weather appropriate clothing, outpatient medical and/or mental health resources, prescriptions, etc.)
    • ED RN: discharges and departs patient off the track, places a patient sticker on a paper log at the Router Desk for SW/HTF
    • SW/HTF will assess patient, explore placement opportunities and give resources as available for patient.

1. SW Order Indications

Choose the indication that best fits your clinical need/question. Special instructions are helpful.

Lack of Resources

Those who need help connecting with resources (financial, placement, housing, food, transportation, etc)

  • "Community resources" - food banks, gov benefits
  • "Disability" - how to apply for disability (not for filling out application itself)
  • Discharge planning/placement - when a patient needs placement to a facility of lower acuity than an acute care hospital (not to be used if homeless)
  • "Homeless" - for housing/resources. If patient has chronic physical and mental health problems, ask for patient to be signed up for Housing for Health.
  • "Hospice" - still need to place a [home-health order] (only if going home on hospice, not a care facility)
  • [Transportation Needs]
  • Crisis/Trauma - SW is consulted automatically for all TTAs. Consider also consult order for referral to Trauma Recovery Center and Violence Intervention Prevention program if victim of violent crime (shooting/stabbing, etc.)

Poor judgement/Substance Abuse

  • "Behavioral issues"
  • EtOH related trauma - SW provides a screening & brief intervention
  • Non-compliance
  • Poor communication
  • Positive toxicology screen - mainly used in peds
  • Refusal of treatment
  • Substance abuse - SW will provide screening & brief intervention

Psychosocial Support

This category has a lot of overlap with psychiatry.

  • "Adjustment to illness" - for psychosocial assessment by SW, help provide coping skill
  • "Anxiety"
  • "Crisis/trauma" - see above
  • "Depression"
  • "End-of-life issues" - for family or patient, help with GOC discussions
  • "Family conflict"
  • "Grief/bereavement"
  • Mental health - SW can provide more resources than just the DMH list, provide full assessment of patient's financial abilities and other social factors
  • High risk pregnancy or Teenage pregnancy - provide resources & support

Regulatory/Legal Issues

  • Adoption
  • Advanced directive
  • AMA
  • Domestic Violence
  • Reportable pressure ulcer - Stage 3+ ulcers upon presentation. SW will contact adult protective services (if coming from home) or ombudsman (if coming from a health care facility).
  • Suspect child abuse
  • Suspect elder/dependent elder abuse
  • Unidentified person


Other Social Determinants of Health Resources

  • Re-entry (released from prison <6 months with medical, mental health, substance abuse, or social needs)
  • Medically Complex Transitions of care (includes 3 visits to ED in past year)
    • ORCHID Message/Call/Text Rosario Aliviado - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral.
      • 21x.294.8908. She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
  • Mental Health
    • Residential & Bridging Care (transition from mental health institution to community) 213.738.4775
    • Intensive Service Recipients (mental health with 2 or more admissions in year, recent DC from psych hospital) 844.804.5200

2. Transportation home:

Harbor Transportation Needs

3. Patient who are homeless:

a. Homeless Task Force - p1735

  • looking for patients with chronic illness (HTN, diabetes, psych, etc) who have had 2+ visits.
  • Put in s/w consult and choose "Homeless" under reason for consult, NOT "Discharge planning/placement".
  • If eligible - they will help sign up the patient - however, they may be on a waitlist for days to months.

b. Can be given packet of resources by clerk's station or with SW discussion

4. Patients whom family is no longer able to take care of

Please page social work asap - before family leaves - s/w will work with them to see if:

a. IN HOME SUPPORT SERVICES (IHSS) - Medi-Cal program - can either be started or have hours increased (to help with supervision, cooking, bathing, grocery shopping, other ADLs)

b. other community resources are available

c. consider home health referral

d. if family dumps patient and doesn't respond, s/w may file an adult protective services report

e. if the patient truly needs to be placed, run Interqual, try to transfer/admit to obs/short stay for placement

5. Pt/family not happy with current skilled nursing facility (SNF)

a. generally, this is not an appropriate use of the ED - the family needs to work with the SNF s/w to facilitate transfer to another SNF, exception point c. below

b. if actual abuse, s/w at Harbor can help with ombudsman report

c. APPROPRIATE if pt needs a HIGHER level of care b/c of medical needs - then s/w at Harbor can help

6. Clothing rack / clothing for patients

Nursing and social work have access ('Harbor Rack' outside in ambulance entrance)

7. Patients who need PT/OT for placement

a. Admit patient to obs/short stay for placement and PT/OT evaluation b. In rare circumstances, may need to order PT/OT to be done in the ED.

References

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