Over the past several years, the primary focus of inpatient psychiatric treatment has moved to a model of brief treatment and shortened length of stay. There have been many factors driving this, including the advent of managed care. The main goal of inpatient treatment has become rapid assessment and psychiatric stabilization. Whereas once deeper psychological issues were treated on inpatient units, the current focus is on treating acute symptoms and returning patients to the community, where they may work on longer term problems in outpatient settings. As a result, patients and families as well as inpatient and outpatient providers have had to adjust their expectations during inpatient stays. At NewYork-Presbyterian Hospital, where “We Put Patients First,” these changes were the driving force in identifying the need to assist Social Work staff in developing increased competencies and new tools tailored to meet the needs of the current healthcare environment.
At NewYork-Presbyterian/Westchester Division, approximately 40 Licensed Social Workers provide treatment to individuals, families and groups on 12 inpatient units. Our Social Work Department has a long-established continuing education program. As patient lengths of stay decreased, it became evident that we needed to provide Social Workers with clinical training targeting the evolving needs of our patient populations, while simultaneously enhancing Social Workers’ competence, confidence and job satisfaction. In our annual staff satisfaction survey, Social Work staff told us that it was important to them to do meaningful clinical work with patients during their brief stays, and expressed an interest in trainings that would help them maintain their roles and professional identities as clinicians in a changing environment.
In order to address the needs identified by the Social Work staff, our Social Work Education Committee, comprised of senior clinical staff, considered skill sets required for care of patients during brief hospitalizations. The Committee felt strongly that providing brief treatment requires a high degree of proficiency in the use of our best practice clinical skills for assessment and intervention regardless of length of stay. We initiated a literature review on clinical Social Work in brief inpatient treatment and discovered that there were few articles. In fact, there seemed to be little written on the impact of shortened lengths of stay on outcomes, patient satisfaction, and follow-up in general. Similarly, there was little literature on the impact on the practice of clinical Social Work, including the development of curriculum that focuses on clinical skills in brief treatment settings. One relevant article, “Everybody Puts A Lot into It! Single Session Contacts in Hospital Social Work” by Jill Gibbons, PhD, and Debbie Plath, PhD from the School of Social Sciences, University of Newcastle, Australia, explored Social Workers’ experiences of brief treatment in a hospital setting and supported our thinking that the best way to identify training needs and clinical best practices was to elicit this information from the staff themselves.
The Social Work Education Committee conducted focus groups with the Social Work staff that identified the skills that were useful in providing brief treatment sessions with their patients and what theoretical frameworks they used in their work. Additionally, the questions helped the staff to look more closely at their own attitudes and potential biases regarding the brief treatment model. They were also asked to identify what might be valuable for the patients using such a model and to examine what attitudes, behaviors, and skills can facilitate rapid alliance building and effective outcomes. In addition, we wanted staff input regarding realistic expectations as to what constitutes effective outcomes in a brief treatment setting.
From these focus groups, we learned that some staff were concerned that brief treatment would utilize less clinical skills than in longer term care. Overwhelmingly, however, the information gathered from both staff and supervisors supported our hypothesis that brief therapy actually utilizes the same important skills in caring for both patient and family. The difference is that our patients’ critical areas of need have to be prioritized and conceptualized earlier in the treatment and implemented with a well-defined focus. Additionally, Social Workers need to be able to help patients and families establish clear expectations about the treatment outcomes from a brief inpatient stay. It became evident that to be able to effectively provide brief treatment, we had to adjust our mindset and embrace what we are able to accomplish within shorter lengths of stay.
The Committee gathered and synthesized the information from the Focus Groups, which was then incorporated and expanded upon in the development of a curriculum to be used for the first academic year of this initiative entitled: “Brief Inpatient Psychiatric Treatment: Clinical Social Work Practice.” The curriculum presented a clinically clear framework for brief treatment Social Work practice which focused on ten key competencies over sixteen training seminars. These included process skills that would help Social Work staff use time and organization skills to maximize efficiency in service of high-quality care. Another process skill reinforced was the critical importance of always engaging in active listening toward the goal of rapport building with patients and families. Our curriculum focused on case conceptualization and treatment contracting over five seminars, allowing for teaching of theory, discussion and practice sessions. We also focused on such issues as managing expectations, goal setting and benchmarking progress – all skills that reinforce interactive processes with patients and family members. Other topics included how to engage families and build bridges into the community after discharge, as well as concepts related to empowerment and recovery. In one of our final seminars, we focused on the importance of keeping a good work/life balance so that Social Work staff would be able to sustain their level of professional commitment and engagement in patient care and to minimize the risk of burnout.
Our Social Work Education Program was enthusiastically received by the staff. Program evaluations collected after each seminar indicated that the seminars had a high degree of relevance for daily social work practice and that they were supporting the need for the continuous identification of highly proficient clinical skills. These evaluations also indicated that staff were eager for ongoing educational programs that targeted the development of ever evolving skills that would effectively address the needs of our patients and their families, while recognizing the impact of the brief treatment model of care both for inpatient stays and for outpatient after care.
Since the inception of this “Brief Inpatient Psychiatric Treatment: Clinical Social Work Practice,” our Social Work Department and the Education Committee continue to work together annually to develop curricula relevant to the needs of patients and families and to identify staff training needs that will ensure our practice skills will always be commensurate with those needs. In subsequent training years, we have addressed topics related to “Group Work in Brief Inpatient Psychiatric Treatment,” and “Working with Families in Brief Inpatient Psychiatric Treatment.” We believe that these efforts allow our Social Work staff to function optimally and to always honor that “We Put Patients First.”
Catherine Bookless, LCSW, is Program Coordinator of the Co-occurring Disorders Program; Andrew Bloch, LCSW, is Program Coordinator of the Second Chance Program; Michael Cavallaro, LCSW, is a Social Work Supervisor; Kathleen Friedman, LCSW-R, CSC, is Director of the Deaf and Hard of Hearing Program; Melodee Morrison, LCSW, is a Social Work Supervisor; Arabelle Rowe, LCSW, is a Social Work Supervisor; Michelle Sardone, LCSW, is a Social Work Supervisor; and Barbara Waltman, LCSW-R, is the Director of Social Work at NewYork-Presbyterian/Westchester Division.
For further information, please contact Barbara Waltman, Director of Social Work at bwaltman@nyp.org.
