Core competencies 6-10

Presentation

By: Brittany Floyd

Core competency: #6

Engage in research-informed practice and

practice-informed research.

Generalist practice behavior: 6.1

Use practice experience to inform scientific

inquiry.
While completing my daily assessments, I have noticed
that majority of the population being admitted into the
hospital are Geriatrics. With that being said, one may
want to investigate more of why this population is at
risk. The best way to solve this issue is by using our
Chronic Care Transition Program who helps patients
prevent being readmitted after discharge.

Generalist practice behavior: 6.2

Use research evidence to inform practice.

Within this profession, research is a huge aspect
because it can help the social worker better understand
how to effectively work with the client. For example, we
have a lot of patients who come in with Congestive
Heart Failure or COPD; therefore, I have done a great
amount of research to better understand these
diseases. From the information I have found, I have
implemented those searches into my daily assessments
with patients.

Core competency: #7

Apply knowledge of human behavior and

the social environment.

Generalist practice behavior: 7.1

Utilize conceptual frameworks to guide the processes

of assessment, intervention, and evaluation.
Everyday at McLeods, I am completing adult initial
assessments with patients. These type of assessments are
conducted for discharge planning purposes. With that being
said, there are patients who may need services after
discharge. It is my responsibility to help these individuals get
the resources they need, whether its medical equipment,
home health services, or nursing home placement. This is not
only because they need and deserve these services, but it
also helps to decrease the rate of readmissions.

Generalist practice behavior: 7.2

Critique and apply knowledge to understand person and

environment.
Within the Social Work profession, it is important that one looks at
understanding the person and their environment. In this perspective it
is only accurate that one looks at the person-in-environment theory,
which solely states that individuals act/behave the way they do, due to
the way they have been brought up. This gives social workers a chance
to understand a persons biological, cultural, and psychological
development. With that being said, I have seen many individuals for
example, who have a drug abuse problem and they are unable to stop
because this is all they have known throughout their life. Therefore,
the most effective way to deal with matters such as this is to send
these individuals to rehab facilities where they can receive the help
they need.

Core competency: #8

Engage in policy practice to advance social

and economic well-being and to deliver
effective social work services.

Generalist practice behavior: 8.1

Analyze, formulate, and advocate for policies that

advance social well-being.
While interning at McLeod, there are many services offered
to help patients who are in need. In order to receive these
services, there are procedures and policies in which patients
have to go by in qualifying for these resources. For example,
in order to receive home health services or hospices,
patients have to be considered as inpatient. One of the most
difficult task here, is trying to change a patient to inpatient
because there are so many guidelines that staff members
have to follow when doing so.

Generalist practice behavior: 8.2

Collaborate with colleagues and clients for effective policy action.

When working with the case management team, we are always trying
hard to get patients the services they need. There are many times when I
am consulting with my supervisor and other staff members about
particular clients who feel they are not receiving the care they deserve.
For example, just last week I had a patient who was upset with a medical
supply company because of a DME she received that was too small. The
patient called the company to tell them her wheelchair was too small, and
the agency stated they would bring her a larger one. However, the patient
stated that it has been over a month since she heard form this agency and
has still not received her wheelchair. Therefore, I went to the case
manager to discuss this issue with her. She immediately called the
company and within the next day, they brought they exchanged
wheelchairs.

Core competency: #9

Respond to contexts that shape practice.

Generalist practice behavior: 9.1

Continuously discover, appraise, and attend to

changing locales, populations, scientific and
technological developments, and emerging societal
trends to provide relevant services.
In this profession, especially the hospital setting, it is
important to know and understand the different changes in
social problems that could have an impact on the target
population. With that being said, social workers have to
become knowledgeable to the new technology and services
that are developing so patients can be provided with the best
practices available.

Generalist practice behavior: 9.2

Provide leadership in promoting sustainable changes

in service delivery and practice to improve the quality
of social services.
Within the hospital setting, there is a petty fund to help
patients get supplies, such as medications, transportation,
and other medical supplies. Currently, there is no money to
help patients who are in need at this time. Therefore, a
colleague and I are conducting a project, which involves a
fundraiser to help bring money into this fund so that clients
will be able to get the supplies they need to improve their
well-being.

Core competency :#10

Engage, assess, intervene, and evaluate

with individuals, families, groups,
organizations, and communities.

Generalist practice Practice: 10.1

Substantively and affectively prepare for action with

individuals, families, groups, organizations, and
communities.
While interning here at McLeod, there are multiple assessments I
conduct on a daily basis. Before entering any patients room, I
prepare myself by viewing the history record of the client as well
as attending rounds to hear other information doctors have to
say that will be useful when talking with my clients. By using this
preparation method, I am able to not only understand the
patient, but to also ask any questions I have of concern in order
to help provide the best practice available.

Generalist practice behavior:

10.2
Use empathy and other interpersonal skills.
Within the hospital, I am constantly working with
chronically ill patients. Therefore, when I go to conduct
assessments on these patients, I am always using
empathy skills when communicating with these
individuals because they are facing chronic disease, and
for some, these could be their last few days here. When
it comes to all patients, it is my job to treat these
individuals with dignity and respect in understanding
their circumstances.

Generalist practice behavior:

10.3
Develop a mutually agreed-on focus of work and desired
outcomes.
The primary responsibility of the case management team is to
help patients who need services once they are discharged. While
interning here at McLeod, I have help to get patients services,
such as home health, nursing home placement, DME supplies, and
hospice care. When getting these services, I make sure to explain
to these individuals all about their services they need and what to
expect. Then, there is paperwork they have to sign, which not only
consist of which agency they chose, but it also gives us permission
to send their information to that particular agency.

Generalist practice behavior:

10.4
Collect, organize, and interpret client data.
While completing assessments on a daily
basis, I am constantly collecting and
organizing clients data. Even before I
conduct my assessment, I am
collecting/organizing their data so that I can
complete interviews with them.

Generalist practice behavior:

10.5
Assess client strengths and limitations.
When assessing patients, it is always important to notify their
strengths and limitations so that they can understand what they
need to work on in order to improve their well-being. With that
being said, I had a patient who I went to assess, and why talking
with him, I informed him that I can see he is really concerned
about his health and whats to do better for himself. However, the
limitation to this aspect was the fact that he did not have family
support to help him with his healthcare needs. He stated that he
stays stress all the time because he has family who has a negative
impact on his life. Therefore, I gave him information on ways to
reduce his stress.

Generalist practice behavior:

10.6
Develop mutually agreed-on intervention goals and objectives.
When it comes to the social work profession, we are always
partnering with clients to focus on interventions that will help
improve their health. This involves making sure the clients
understand the action they need to take in order to complete
these aspects. For example, we usually talk to patients about
taking their medications the proper way. There are some patients
who are readmitted because they do not follow through with
taking their medications as we previously agreed on. Therefore,
we have to go back through the process of helping these patients
to understand how to do this aspect all over again.

Generalist practice behavior:

10.7
Select appropriate intervention strategies.
While interning here at McLeod, there are many interventions
strategies that take place. These include: getting patients
home health, nursing home placement, DME supplies, or
hospice care. With that being said, there are many patients
who have multiple interventions; however, in this case we
have to prioritize which intervention must come first. For
example, we had one patient who need home oxygen and
home health services. Therefore, we immediately gather
information to the get home oxygen first because the patient
could not leave the hospital until this was delievered.

Generalist practice behavior:

10.8
Initiate actions to achieve organizational goals.
Within the case management team, our goals are to help
patients be able transition out of the hospital after being
discharged. This involves helping individuals who may need DME
equipment, home health services, nursing home placement, or
hospice care. In order to make sure that actions are taking place
within the agency goals, we have to call for example, home
health services to see if they are seeing our patients within the
appropriate time frame. If patients are not being seen from a
home health agency within three days after they are discharged,
then we have to report this matter to our supervisor.

Generalist practice behavior:

10.9
Implement prevention interventions that enhance client
capacities.
In McLeod Hospital, we have a Chronic Care Transitions Program
(CCTP), that helps to reduce hospital readmissions. This is an
effective prevention method to use because it has Transition
Coaches who offer post-discharge support and education.
These individuals help assist the patient with transitioning from
hospital to home or any other facility as well as directing
patients or their caregivers on ways to manage their health
care more effectively. This will help to not only improve the
health of the patient, but also their well-being in general.

Generalist practice behavior:

10.10
Help clients to resolve problems.
Within this profession, we as social workers, are all about
helping clients solve their issues. For example, there are
some clients who do not understand their medications or
are unable to afford them. This seems to be a big issue
within the hospital setting. Therefore, it is our job to
advocate and help patients find places. For example, we
have a petty fund here at the hospital that is able to help
patients who are unable to afford meds or transportation
once they leave the hospital.

Generalist practice behavior:

10.11
Negotiate, mediate, and advocate for clients.
The Social Work profession is all about advocating and negotiating
for the needs of clients. Everyday at McLeod, the case
management team and I are doing just this. There are many times,
during my assessments, where I feel patients may need further
services to help them once they are discharged. For example, I
talked with a patient who I thought would benefit from having
home health services. Therefore, I took this case to the case
management team and we negotiated on what would be best for
this client. After telling them why I thought this was an effective
solution, they stated that they would look further into this concern
to see if the patient could qualify for this service.

Generalist practice behavior:

10.12
Facilitate transitions and endings.
The purpose of what we do at McLeod is to help patients
transition from hospital to their home or other facilities. In doing
so, we focus on what the patients may need after discharge
whether that involves services or supplies to help improve their
health care abilities. For example, we help patients transition
from the hospital stay to nursing home placements. This process
requires a lot of paperwork and is time consuming, but is worth
every minute because patients are getting the services they need
to improve. We also follow up with these patients to make sure
the services are providing appropriate care for these individuals.

Generalist practice behavior:

10.13
Social workers critically analyze, monitor, and evaluate
interventions.
In this profession, social workers are constantly analyzing,
monitoring, and evaluating interventions to make sure they are
working to increase the well-being of patients. For example, the
CCTP here at McLeod, looks at patients after they are discharged
by offering support and education. These transition coaches help
patients follow through with discharge order and also helps in
directing patients on ways to manage their health care more
efficiently. By following up with these patients, these coaches are
able to monitor and see if specific interventions are being effective
in helping clients to improve their health care well-being.