Cognitive Neurology
The Cognitive Neurology Social Work Team provides a broad range of integrated clinical interventions in neurology ambulatory settings. Patients served by this Team all have underlying neurologic disease or syndromes; many patients also have psychiatric illness and/or neuro-cognitive deficits. Outpatient mental health services are offered through the Cognitive Neurology Unit (CNU) for patients with diagnoses such as: dementia, attention deficit disorder, ALS, MS, Asperger’s Syndrome, epilepsy, stroke and head injury. The interdisciplinary CNU Team includes neurologists, neuropsychiatrists, and neuropsychologists. Outpatient mental health services are also provided for specialty clinics including multiple sclerosis, ALS, and Women’s Health, and Epilepsy. The DriveWise Program is a creative and innovative program developed and managed by senior staff social workers. CNU staff has organized educational packets for newly diagnosed dementia patients which are a valuable supplement to our clinical work. The Cognitive Neurology Social Work Team views family involvement as integral to the care of the neurologic patient. Often the family caregiver is "the hidden patient" and becomes the focus for social work intervention.
Direct Patient Care
A team of clinical social workers provides mental health services for patients with neurologic illness through the Cognitive Neurology Unit (CNU). These mental health services are billed to the patient's insurance carrier. Social work clinicians create patient care plans that adhere to established guidelines of managed care plans. At times the at-home caregiver may be the exclusive focus of attention (i.e. if the patient is severely cognitively impaired). Referrals are especially useful for patients who may be adjusting to a new diagnosis. Social workers facilitate periodic psychoeducational groups for patients with MS, Anxiety, and ADD. Other appropriate referrals include: patients who are involved in research protocols or experimental drug trials; patients contemplating surgical intervention; patients for whom medical compliance is uncertain; patients with vocational or school problems; family stress because of illness; patients with children for whom parenting is difficult; patients with anxiety, depression or behavioral problems; patients for whom there is concern about physical abuse or neglect; identification of community resources; long term planning for patient care. Locating resources for this group of patients, with overlapping neurologic illness and neurocognitive deficits, is challenging and labor intensive. Neuropsychiatric services are also available in the Cognitive Neurology Unit. Social workers make referrals to these staff members for consultation when necessary.
Special Programs
Group Therapy
Social workers organize and lead short term psycho educational groups that are disease focused. Groups have been offered for patients with early stage dementia, newly diagnosed MS, Asperger’s Disease, and epilepsy.
A grant was given to social work that allows us to offer ALS patients the opportunity to leave loved ones with a life review video. This is an important intervention since these patients live with a terminal illness that may rob them of the ability to speak months or years before death. Social workers carefully plan with the ALS patient what they hope to say and share during this one hour video.
Alzheimer’s Disease Educational Packets
CNU staff social workers have collected educational material that health providers can give to newly diagnosed dementia patients and their caregivers. A cover letter (attached) explains the value of the articles and resource lists to assist in planning for care of patients. Articles describing the behavioral management strategies can help caregivers cope with the challenging situations that inevitably arise in caring for someone with dementia.
DriveWise was developed to objectively assess the driving safety of patients with neurologic illness and to provide support to them and their families through this process. A CNU social worker manages this unique program. Social work services are integral to the assessment process. An Advisory Board guides the programs and initiatives of DriveWise.
DriveWise was created as a collaborative program between the Division of Cognitive Neurology and Rehabilitation Services. It was evident from clinical practice that a fully integrated program was essential to meet the complex emotional and health needs of patients served by the Program. This multidisciplinary approach, which is the hallmark of DriveWise, distinguishes it from other assessment programs which have a much more limited scope. The decision about whether or not to continue driving should be based on an objective method so that an individual is not arbitrarily or prematurely stripped of the right to drive.
Driving safety is a public health issue that is paramount in the context of an aging society. The mission of DriveWise is even more timely in light of the American Medical Society’s decision (12/7/99) to change ethical guidelines to let physicians notify the Department of Motor Vehicles (in their state) when they are concerned about medical conditions that could make driving unsafe for patients they treat. Importantly, this policy makes public safety a priority over confidentiality of patients. The DriveWise assessment reassures health professionals about those patients who, despite medical problems, are safe to continue driving. It also identifies those individuals whose compromised skills make driving no longer safe.
To date, the Program has evaluated 300 patients. We have consulted to countless physicians, family members and community agencies to help resolve or to offer approaches to difficult driving dilemmas. While DriveWise was initially conceptualized to evaluate the older driver with dementia, the Program has expanded its patient population. We have evaluated patients with problems, such as; head injuries, brain tumors, seizures, multiple sclerosis, and Parkinson’s disease.
Briefly, the DriveWise evaluation begins and ends with clinical social work assessment. Decisions about driving privileges are emotionally charged and involve the patient and their family. When patients can no longer safely drive, clinical social workers address the impact of this on their psychological status and help to locate alternative transportation resources. Family members are often grateful and relieved to have this agonizing decision mediated by professionals in the driving scenario as often nobody wants to be “the bad guy.” Neuropsychological testing involves evaluation of concentration, reasoning, judgment and speed of information processing; all essential components of safe driving. This careful assessment also helps to establish a diagnosis for some patients with cognitive decline. The occupational therapist evaluates mobility, vision and brake reaction time. Actual driving performance and safety are measured by a driving instructor and an occupational therapist during an on-the-road exam, which takes place in a specially equipped car. The team’s findings are summarized in a detailed letter and are reviewed with the Program participant and family during a follow-up session with the social worker. Attached are additional materials/fliers used to publicize the program.
Staff
Five part-time MSW prepared Social Workers (licensed at the LICSW level) provide clinical services. A full-time community resource specialist (CRS) is the link between the hospital and the community for all ambulatory neurology patients. Currently, our CRS is bilingual, providing access and outreach for our Spanish-speaking patients. The CRS locates and advocates for a range of services and entitlements such as housing, insurance, pharmacy free care programs, transportation, and home services.
