Celebrating Diversity Within the Sickle Cell Community: Commitment, Innovation, Practice
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Friday, October 12 • 4:15pm - 4:30pm
The Importance of Social Work In Complex SCD Care: A Model For Clinical Intervention

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Prof. Teresa Works- New England Sickle Cell Institute, UCONN Health

Teresa Works, LCSW, ACSW, Ph.D. Candidate, New England Sickle Cell Institute, UCONN Health:
Objective: To understand the importance of the role of social worker as part of a multidisciplinary SCD team to improve SCD care while reducing inpatient length of stay, 30 day re-admissions and improving financial solvency of institutions providing SCD care as well as the financial burden of chronic disease on patients.
Methods: Sickle cell disease (SCD) is a common genetic blood disorder in the United States. It is estimated to affect approximately 100,000 African Americans and other people of color in the U.S. SCD causes the oxygen carrying hemoglobin to have an irregular “sickled” shape, which occludes small blood vessels and organs and reduces oxygen supply to cells, organs and bones. These acute vaso-occlusive episodes result in chronic anemia, organ dysfunction and causes unpredictable acute painful crisis which are the primary causes of hospitalizations in persons with SCD. Many SCD patients develop chronic pain and complex co-morbidities requiring specialized and expensive medical care. “The estimated cost of medical care for the individuals with sickle cell disease in the US exceeds $1.1 billion at about $16,000 annually or $1,341 per patient per month. This figure does not include the impact on reduced quality of life, lost productivity, un-compensated care and premature mortality. If these were included the full economic costs of SCD are likely to be much higher”. [1]
A retrospective analysis of the implementation and outcomes of the New England sickle Cell Institute was performed as it relates to several national benchmarks of care was performed for the period of 2012-2017. In 2012, UCONN Health developed the New England Sickle Cell Institute (NESCI): a comprehensive, multidisciplinary team to navigate patient care across both inpatient and outpatient settings. Integral to this team, was the designated, full time licensed clinical social worker (LCSW). The role of the social worker at the NESCI is unique, in that it covers SCD patients in both inpatient and outpatient settings providing a variety of clinical services focused on the unique needs of each SCD patient. The role includes daily rounding with the inpatient multidisciplinary team on the SCD inpatients and facilitating discharge planning, NESCI follow up, and coordination of aftercare. The social worker works within the NESCI clinic having scheduled (and unscheduled) outpatient appointments with SCD patients to provide psychosocial and behavioral health services. In addition, the social worker assists SCD patients with transportation, medical protection for utilities, insurance and entitlements, grant funding for patient unpaid medical bills, referral for employment services, housing and a myriad of other needs. These psychosocial, discharge planning and concrete service needs, if unmet, can cause non-adherence with treatment, longer inpatient lengths of stay, difficulty accessing needed medical care, as well as protracted illness, pain and suffering.
Results:  Over a 5 year period, the use of reporting such as (30) day readmission reports, inpatient length of stay (LOS), Emergency department utilization, and financial reporting assisted in clinical and programmatic developments to improve NESCI SCD care and demonstrate improved patient care and programmatic financial solvency. Clinical and programmatic goals were established and implemented over this period corresponding with the development of the multidisciplinary NESCI team including the LCSW. The social workers unique role proved invaluable in terms of reducing inpatient bed days, average length of stay and (30) days re-admissions. UCONN NESCI demonstrated that by expanding multidisciplinary SCD services, they were able to improve quality clinical care and generate revenue, while decreasing inpatient LOS and (30) day readmissions. These changes saved the institution significant financial savings, more than covering the cost of the clinical social worker’s salary and fringe, while improving patient access to social work clinical and behavioral health services, which decreased the financial burden of chronic SCD care to the patients as well.
Conclusion: SCD is a complex and expensive disease to treat and manage. Social workers, with their unique training in a “person in environment” approach, have a distinct and beneficial role with all chronic diseases, including SCD. Utilization of a dedicated SCD social worker can improve health care outcomes, reduce institutional costs and financial burdens to patients. Through these multidisciplinary interventions, SCD patients can receive improved quality clinical care, while simultaneously reducing the institutional costs of providing SCD care as demonstrated in the 5 year retrospective analysis at the NESCI at UCONN Health. These changes can be implemented systematically at adult SCD comprehensive centers across the country to expand access to SCD care and reduce financial burdens to institutions and patients.

avatar for Teresa Works, MSW, LCSW

Teresa Works, MSW, LCSW

Clinical Social Worker, Property Management, Psychotherapist, UCONN Health
Teresa Works, LCSW, ACSW is a social worker with 25 years experience in medical and behavioral health settings. She is a doctoral candidate in social work research at the UCONN School of Social Work, where she also is an adjunct faculty member.  Teresa has been employed full time... Read More →

Friday October 12, 2018 4:15pm - 4:30pm EDT
Constellation D