This document is designed to provide health professionals, educators, and potential employers of health care providers with guidelines for social work practice for persons with rheumatologic disorders. These competencies address the range of activities that a professional social worker might be expected to perform with respect to rheumatologic care.

Social work knowledge and skills in rheumatic disease are based on the biopsychosocial model of practice, in which biological, psychological, and social factors interact to form the basis of the illness experience. By our involvement, we as health care professionals can affect individual, family, group, and community dynamics. Each person’s lifestyle is unique and requires an approach adapted to that persons special needs. The social worker and client must work together to identify problems and to determine the optimal plan of care.

Basic Knowledge

The social worker involved in the care of the individual with rheumatic disease should be able to:

• Discuss the etiology and pathogenesis of the major types of rheumatic diseases.
  1. Articular

     a. Non-inflammatory (such as osteoarthritis)

     b. Inflammatory (such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis)

  2. Non-articular

     a. Local (such as, bursitis)

     b. General (such as fibromyalgia, polymyalgia rheumatica)

• Explain the role and value of multidisciplinary principles of care.
• Explain the treatment modalities involved in the care of the patient with rheumatic disease.
  1. Diagnostic tools (laboratory tests, x-rays, clinical examination)
  2. Role of medication

     a. Purpose - control of pain and inflammation, disease modification

     b. Types - nonsteroidal anti-inflammatory drugs, steroids, disease-modifying anti rheumatic drugs

     c. Problems - side effects, allergies

  3. Role of physical therapy and occupational therapy
  4. Surgical management
• Describe the etiology, dynamics, and management of symptoms such as pain, fatigue, altered patterns of sleep, stiffness, and inflammation.
• Describe the etiology, dynamics, impact, and management of the psychological reactions to chronic disease.
• Describe ways to access community resources and entitlement benefits affecting the quality of life of people with rheumatic disease.
• Discuss relevant government legislation that may affect the individual with rheumatic disease.
• Explain the impact of ethnocultural differences in the perception of illness and treatment modalities.
• Discuss the impact of chronic disease on the individual’s social network (family, friends, and business coworkers).

Patient Evaluation

• Assess the client’s medical/surgical history, current disease activity, and experiences with treatment, including the following:
  1. Diagnosis
  2. Symptoms
  3. Course of illness
• In consultation with other members of the client’s multidisciplinary rheumatologic treatment team, assess the client’s functioning with respect to major life activities.
  1. Demographic information
  2. Family responsibilities and involvement
  3. Living arrangements and household responsibilities
  4. Employment status and financial responsibilities
  5. Leisure and recreation activities
  6. Limitations to independent activities of daily living
• Determine the client’s psychosocial history.
  1. Interpersonal characteristics

     a. Personality

     b. Self-concept

     c. Coping styles

  2. Interpersonal relationships

     a. Family and friends

     b. Formal and informal social supports

  3. Socioeconomic and cultural influences/factors
• Determine the client’s psychosocial adaptation to the diagnosis of rheumatic disease and its impact.
  1. Body image and sexuality
  2. Self-esteem
  3. Illness appraisals and illness beliefs
  4. Emotional responses (such as anger, depression, or anxiety).

Develop a Treatment Plan

• Identify client concerns and strengths.
• Prioritize goals.
• Develop a mutual contract for change.
  1. Identify concerns and strengths.
  2. Prioritize goals.
  3. Develop a mutual contract for change.

Implement a Treatment Plan

• Implement individual interventions.
  1. Supportive interventions

     a. Establish trust and rapport through active listening.

     b. Express empathy through reflection of feelings.

     c. Utilize open-ended questioning and clarification.

  2. Cognitive behavioral interventions

     a. Problem-solving strategies

     b. Stress management and relaxation methods

     c. Reframing negative thinking

     d. Role-play and behavioral rehearsal techniques

  3. Educational interventions

     a. Recognition of specific emotional and social impact of the rheumatic disease and its management

     b. Adaptation of general management principles to an individualized plan of care

• Utilize appropriate family interventions.
  1. Communication skills training regarding role disruption/changes
  2. Educational interventions related to the nature and impact of the illness
  3. Strategic interventions for more dysfunctional families
• Utilize appropriate group intervention.
  1. Professionally-led support groups
  2. Self-help groups
  3. Psychoeducational groups
  4. Therapy groups
• Access community interventions as needed.
  1. Advocacy

     a. Help client obtain services.

     b. Intervene with the political system concerning policies and programs to better meet client needs.

  2. Referral to relevant services such as:

     a. Voluntary health agency patient services programs (e.g., The Arthritis Foundation Self-Help Course)

     b. Educational and vocational rehabilitation services

     c. Entitlement programs such as public assistance, social security, and food stamps

     d. Housing

     e. Transportation

     f. In-home services (Meals on Wheels, homemaker services, chore services)

     g. Adult day care and/or socialization activities

     h. Volunteer opportunities

     i. Natural helping networks (churches, synagogues)

     j. Counseling service

• Participate in health care system interventions.
  1. Mediate on behalf of the client regarding problems such as:

     a. Inpatient and outpatient therapeutic treatment

     b. Certified home care services for skilled needs, including physical therapy, occupational therapy, social work
          services, and home health aide services

     c. Residential care facilities (e.g., rehabilitation and skilled nursing home, group home)

     d. Make positive changes within the system to improve access to care.

Research

• Demonstrate the ability to analyze and integrate research findings to help inform social work practice.
  1. Demonstrate knowledge of social work research literature related to rheumatology and client services.
  2. Evaluate social work research literature and apply relevant findings to practice.

Bibliography

NASW Committee on the Study of Competence (1968). Guidelines for the assessment of professional competence in social work. New York: NASW.

Meyer, C.H. & Mattaini, M. (1995). Foundation of social work practice: A graduate test. Annapolis JCT, Md: NASW Press.

Edwards, R.J. (ed., 1995). Encyclopedia of Social Work (19^th edition). Annapolis JCT, Md.: NASW Press.

Donnelly, J.P. (1992). A frame for defining social work in a hospital setting. Social Work in Health Care, 18(1).

Videka-Sherman, L. & Reid, W.J. (eds., 1990). Advances in Clinical Social Work Research. Annapolis JCT, Md.: NASW Press.

Mendelsohn, H.N. (1992). An author’s guide to social work journals. Annapolis JCT, Md.: NASW Press.

OCTOBER 3, 1996