Leaders in Building Capacity:

Advocating for the Role of BMT

Clinical Social Workers

Jane Dabney, LISW-S, OSW-C

The Cleveland Clinic Foundation

Co-Chair, SCI SW Workforce WG

Jill Randall, MSW, LCSW

National Marrow Donor Program, Be the Match

Association of Oncology Social Work

May, 21 2015

Learning Objectives

At the conclusion of this session, you will be able to:

1. Summarize the scope of the System Capacity Initiative (SCI)

2. Define aims of the SCI Social Work Workforce Group (SWWG)

3. Discover the results of the social work workforce survey

4. Formulate strategy to utilize educational factsheet on the specialty role of BMT CSWs

5. Outline future initiatives of the SWWG

2

System Capacity Initiative Background

• Analysis of the U.S. health care system’s capacity to

support the increase in patients needing transplant by

2020*

• Collaboration by representatives of all facets of BMT

• Recommendations and solutions for issues affecting the

delivery of BMT**

* Analysis by NMDP and CIBMTR estimates a need of approximately 21,000 allogeneic

transplants based on current indications in patients up to age 74.

** Also referred to as HCT.

Professional Organizations

and Stakeholder Engagement

4

SCI Organization and Participants Year 5

(2013-2014)

5

Physician

Nurse Practitioner / Physician Assistant

Nursing

Pharmacy

Social Work

Workforce Groups

National Marrow Donor Program® /Be The Match®

American Society of Blood and Marrow Transplant®

Special Interest Groups

Center for International Blood and Marrow Transplant

Professional Societies

U.S. Transplant Centers

Transplant Experts

Hospital Administrators

BMT Program Administrators

Government

Payers

Patient Advocacy Organizations

Participants

Ste

ering C

om

mitte

e

Social Work Working Group Geographic Representation

6

Social Work Working Group Aims

• Assessment of the BMT SW Workforce

• Identify care models that optimally utilize social

workers as core members of the BMT Team

• Recommend innovative solutions to meet the

psychosocial care needs of patients and families

7

Social Work Workforce Working Group

• Conduct SW Workforce

Survey and disseminate

findings

• Educate others on the

specialized role of the

BMT clinical social worker

including:

– Members of the

multidisciplinary team

– Program administrators

– Care management/social

work department leaders

• Provide

recommendations to:

– Structure care delivery

models to fully utilize

clinical social workers in

delivering patient-centered

psychosocial care to

optimize outcomes

– Enable clinical workers to

practice at the top of their

licensure

8

BMT Clinical Social Worker

Workforce Challenges Proposed Solutions

• Variation in level of integration of the SW within the core BMT team

• Care models and processes that involve the SW at key points in patient care throughout the transplant continuum

• Barriers to practice at the top of licensure e.g. time spent clerical tasks; covering non-BMT service lines

• Dedicated staff resources for clerical tasks, lodging referrals, etc.

• Dedicated SW FTEs to BMT Program

• Increasing patient caseloads with no increase in FTEs

• Recognition of the impact of psychosocial care on patient outcomes

9

Social Work Workforce Survey Aims

• Understand the structure of SW within BMT programs

• Describe the role of BMT clinical social workers

• Assess social workers’ job satisfaction and support for

their roles

• Identify the challenges that affect social workers’ ability to

meet the needs of their patients/families

• Identify the capacity and challenges in assuring adequate

SW staffing for future BMT needs

10

Discussion

• How many of you had the opportunity to participate in the survey?

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Social Work Workforce Survey Methods

• The survey was in the field for 1 month October to

November 2013

• The online survey (SurveyGizmo) was sent to 160

NMDP network BMT social workers and interested

APOSW and AOSW members

• Sent 2 follow-up emails, made 1 set of follow-up phone

calls and sent 1 final reminder

• Received 91 replies (57% response rate) from social

workers from 66 different transplant centers

12

13

Table 1. Demographics of Clinical Social Work Workforce Survey Respondents by Hospital Program N(%)†‡

TotalCare Management

and Social Work

BMT and

Hematology/

Oncology

N=88 N=58 N=30

Gender

Female 80(91) 53(91) 27(90)

Male 6(7) 3(5) 3(10)

Age (Years)

< 41 38(43) 24(41) 14(47)

41 – 50 21(24) 14(24) 7(23)

> 50 29(33) 20(34) 9(30)

Years as BMT CSW

< 6 41(47) 26(45) 15(50)

6 – 10 20(23) 15(26) 5(17)

> 10 22(25) 13(22) 9(30)

Ethnicity

Not Hispanic or Latino 79(90) 51(88) 26(87)

Hispanic or Latino 4(5) 3(5) 1(3)

Race

White 75(85) 47(81) 26(87)

Black or African American 8(9) 5(9) 3(10)

Asian 3(3) 3(5) -

†Columns may not add up to 100% because some respondents selected “decline to answer” or did not answer‡ BMT Blood and Marrow Transplant ; CSW Clinical Social Work

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†Columns may not add up to 100% because some respondents selected “decline to answer” or did not answer‡ BMT Blood and Marrow Transplant; CSW Clinical Social Work

*Column will exceed 100% due to ‘check all that apply’ option

Table 1. Continued†‡

TotalCare Management

and Social Work

BMT and

Hematology/

Oncology

N=88 N=58 N=30

Mean social work FTE (range) 1.76(0 - 6.8) 1.78(0 - 6.8) 1.23(0 - 5)

2010 BMT volume (patients)

< 50 25(28) 16(28) 9(30)

50 – 100 17(19) 10(17) 7(23)

> 100 43(49) 31(53) 12(40)

Populations served by respondents*

Pediatric inpatient 28(31) 22(38) 6(20)

Pediatric outpatient 27(30) 21(36) 6(20)

Adult inpatient 45(49) 29(50) 16(53)

Adult outpatient 60(66) 37(64) 23(77)

Time Spent Addressing Patients’/ Families’ Psychosocial Needs (N=83)

15

47%38% 35%

12% 10% 8%

22%

10%4%

7% 16%

4%

17%

12%

9%

22%

27%

11%

11%

18%

14% 28% 11%

33%

4%

5%

6%

17%22%

20%

17%

32%

13% 16%25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Referral tofinancial

assistance,entitlementprograms*

Individual,family, or

groupcounseling

Casemanagement*

Crisisintervention

Psychosocialassessment forBMT patients

Anticipatorygrief and

bereavementcounseling

Daily 4 times/week 3 times/week 2 times/week 1 time/week <1 time/week

*Non-clinical responsibilities

Question: How much do you agree or disagree with the following

statement, My clinical social work expertise is utilized to the fullest

potential (N=88)

Agree (60%)

“I am fortunate to be a part of a team that strives to enhance and utilize

all of our skills, both clinical and non-clinical. We have a supervisor that

supports enhancement of our expertise.”

Neutral (24%)

“Because I am assigned to not only [BMT] patients but other

hematology/oncology patients as well. I feel like I do not have time to

provide the adequate support to [BMT]”

Disagree (18%)

“There are many days when I need to spend too much time filling out

forms or applications. I also don't feel that my team recognizes my

clinical skills and will call in a psychiatrist or psychologist without

checking first with the social worker who usually has a thorough

knowledge of family situation.”

Top 3 Most Satisfying

Aspects of CSW Role

91

78

52

0

10

20

30

40

50

60

70

80

90

100

Ability to provide psycho-social careover the continuum of care

Opportunity to work with patientsand families in life threatening

situations

Working as a valued member of ateam

Perc

en

tage

17

Top 3 Least Satisfying

Aspects of CSW Role

49

3632

0

10

20

30

40

50

60

70

80

90

100

Insufficient time to provide clinicalsocial work services

Emtional drain of caring forchronically or critically ill and dying

patients

Insufficient salary

Perc

en

tage

18

Question: Please help us understand how workforce challenges impact your

ability to care for patients (N=88)

Prioritizing competing patient needs (59%)

“[…] I don't have enough time for routine follow-up as they proceed through

the transplant process. Prioritizing is often done on a crisis basis. I feel that if I

had more time to see my patients more regularly, these crises could sometimes

be averted...”

Uninsured or underinsured patients (41%)

“I spend so much of my time in resource management, trying to find money

for patients who do not have any […] other disciplines do not understand

that I am a trained therapist.”

Caring for patients in more than one program (40%)

“[…] I am responsible for multiple service lines e.g. pediatric oncology,

general hematology and BMT […]

Report of BMT Social Worker Shortage

20

21

Where do you expect to be in 1 to 3 years?

59

1411

73

7

0

10

20

30

40

50

60

70

80

90

100

Same institution,same potition/title

Same institution,more advanced

position/title

Differentinstitution, butsimilar or more

advancedposition/title

Retire Leave social workentirely for a

career change

Other

Perc

en

tage

Discussion

• What is your comfort level in describing your role with other non-SW team members?

• Can your BMT multidisciplinary team members accurately describe what you do?

• Do they see you as a psychosocial care expert?

22

.

What Does a Social Worker Do?

23

.

Source: Yeliab Eniahsor

BMT Center Administrator's Conference – Tandem 2014

• Engaged in dialogue with BMT Center Administrators to:

– Gain an understanding of the workforce challenges by workforce group

– Describe activities of each workforce group in the areas of recruitment and retention

– Identify opportunities for BMT Center Administrators to support solutions to address recruitment; retention; work/life balance; including supporting non-physician staff in practicing at the top of their licensure

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Table Leaders

• Physician Workforce

– Linda Burns, MD

– George Selby, MD

• Advanced Practice Professionals Workforce

– Susan M Burroughs, PA-C

– Paula Cuthrell, MSN, FNP-BC

• Social Work Workforce

– Eleanor Leary, MSW, LICSW

• Nursing Workforce

– Martha Lassiter, MSN, AOCNS

– Kim Schmit-Pokorny, RN, MSN, OCN

– D. Kate Tierney, RN, PhD

• Pharmacy Workforce

– Tippu Khan, PharmD, BCOP

– Tracey Walsh-Chocolaad, PharmD, BCOP

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Need identified by BMT Center Administrators

– Need identified “To better understand the BMT clinical social worker skill-set”

• SCI SW WG developed BMT Clinical Social Worker Role Description document

– User testing (N=28)

• Feedback from multidisciplinary team members

– Endorsement

• AOSW

• APOSW

• NMDP /Be The Match

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BMT Clinical Social Worker Role Description

• The purpose of the document is to educate health care professionals, BMT program staff, social work department leaders on the role of BMT social worker

• Describes:

– Educational background

– Core competencies

– Aims of BMT Clinical SW interventions

– Unique psychosocial care needs of BMT patients

27

Invited to come back…Tandem Meetings 2015

• BMT Center Administrators Conference

– SCI SW Workforce WG update

– Disseminated BMT Clinical SW role description

28

• Endorsement

• Role recognition

• Creating opportunities

29

Recommendations

• Ensure comprehensive psychosocial care interventions occur at key time points along the transplant continuum

– Transplant consultation

– Work-up evaluation

– Inpatient phase

– Outpatient/survivorship follow-up

– End-of-life

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Recommendations cont.

• Consistently and actively involve BMT clinical social workers in treatment planning and decision-making

• Implement care models that enable BMT social workers to practice at the top of their licensure

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Audience Discussion

• Please share some of the successes your transplant center has had with care models that optimally utilize social workers as core members of the BMT team.

– To fully utilize the skill-set of the BMT Clinical SW?

• How has the utilization of the BMT social worker’s clinical skills been promoted in your program?

• How might your transplant center utilize the BMT Clinical SW role description document?

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Ongoing and Future Initiatives

of the SW Workforce WG

• Podium presentations at national meetings

– Leaders in Building Capacity: Advocating for the Role of

BMT Clinical Social Workers

• APOSW, May 13-15, 2015

• AOSW, May 20-22, 2015

• Development of a training curriculum for new BMT social

workers

• Identify future research to better understand the impact

of social work interventions on patient outcomes

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Onboarding BMT SWTraining Topics

Module Topics

1 Overview of BMT

2 Psychosocial assessments; Caregiver Assessments; Distress Screening and/or other screening tools

3 Stages of transplant, patient/family adaptation tasks, and clinical social work interventions

4 Role of SW on BMT Team

5 End of life and bereavement

6 Psychosocial issues unique to pediatric patient populationSiblings; Sibling Donors; Siblings at end of life

7 Ethics, boundaries and self-care

8 Survivorship (should this be a stand-alone module? or woven into another module?)

9 BMT related resources

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Social Work Workforce Group Membership

• Co-Chairs

– Jane Dabney, LISW-S, OSW-C

– Marion Kalbacker, MSW, LCSW

• Members

– Nancy Barbach, MSW, LCSW

– Nancy Boyle, MSW, LCSW

– Carrie Breitwieser, LISW-S, ACHP-SW

– Eleanor Bruin, MSW, LCSW

– Erica Bryan-Wegner, LICSW

– Tiffany J. Courtnage, LICSW

– Mary Crooks, MSW, LCSW

– Sumnee Joo, MSW, MPH,

LMSW, CHES

– Jeanette Lavecchia, MSW, LCSW

(2013-2014)

– Eleanor Leary, MSW, LICSW

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– Kathy Roundtree, MSW, LCSW

– Andrea Starkschall, LCSW, OSW-C

– Anita Vargas, MSW, LSW

– Elyse (Burk) Wells, LSW, MSW, OSW-C

• NMDP Ex-Officio

– Jeffrey Chell, MD

– Elizabeth Murphy, EdD, RN

• NMDP Lead Staff

– Stacy Stickney Ferguson, MSW, LICSW

– Jill Randall, MSW, LICSW

– Nicole Heino (admin.)

• Health Services Research Staff Support

– Ellen Denzen, MS

– Viengneesee Thao, MS

Questions or Comments

Email: SystemCapacity@nmdp.org

Jane Dabney: Dabneyj@ccf.org

Jill Randall: jrandal2@nmdp.org

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