Volume 20, 2000
Table of Contents
Increasing Access to Transplantation for the Working Poor: Social Workers as Advocates.
Charlie Thomas, ACSW, CISW, Samaritan Transplant Services, Phoenix, AZ
Legacies, Liars and Those Alone: Lived Experiences of End Stage Renal Disease Revealed Through Group Work
Rebecca S. Sloan, RNCS, PhD, Indiana University School of Nursing, Indianapolis, IN; Sally Rice, MSSW, University of Louisville Kidney Disease Program, Louisville, KY
Infants, Families and End Stage Renal Disease: Strategies for Addressing Psychosocial Needs in the First Two Years of Life
Debbie Kagan Brady, LCSW, ACSW, Arkansas Children's Hospital, Little Rock, AR; Kathleen Lawry, LISW, ACSW, NKF of Ohio, Cleveland, OH
The Complexity of Social Work Practice With Dialysis Patients: Risk and Resiliency Factors, Interventions and Health-Related Outcomes
Judith Dobrof, DSW; Arlene Dolinko, CSW; Elena Lichtiger, CSW; Jaime Uribarri, MD; all of the Mount Sinai Hospital, New York, NY; and Irwin Epstein, PhD, Hunter College School of Social Work, New York, NY
Health Quality of Life Among Female Caregivers of Male Hemodialysis Patients
Robert A. Schneider, PhD, LISW, University of Northern Iowa, Cedar Rapids, IA
The Need to Remind Ourselves Who We Are
Joan Beder, DSW, Yeshiva University, Wurzweiler School of Social Work, New York, NY
"How Does That Make You Feel?": Rediscovering Clinical Social Work and Psychological Principles for Social Work Leaders
Sheila B. Weiner, MSW, LSW, National Kidney Foundation, New York
Winning an HMO Appeal's Case Study in Social Work Advocacy
Steve Bogatz, MBA, MSW, LCSW, Central Connecticut Dialysis Center, Meriden, CT
Abstracts From Original Articles
Increasing Access to Transplantation for the Working Poor: Social Workers as Advocates.
Charlie Thomas, ACSW, CISW, Samaritan Transplant Services, Phoenix, AZ
The Arizona Medicaid program was developed as a managed care alternative to traditional "fee-for-service" Medicaid in 1982. The program covered cornea and kidney transplantation from its inception. However, coverage of the life-saving heart, heart-lung, lung, liver and bone marrow transplants was limited to only those individuals receiving Supplemental Security Income (SSI) or Aid to Families with Dependent Children (AFDC/TANF). The working poor and low-income Social Security Disability Beneficiaries (SSDB) might be eligible and enrolled in Medicaid, but they were not eligible for a life-saving transplant. This policy excluded the working poor and other middle class individuals who "fell into the safety net." Over 50 people died as a result of this policy. This article demonstrates how social workers utilized group work and community organization theory and skills with patients to change the Medicaid policy that prevented the working poor in Arizona from receiving life-saving transplants.
Key Words: Medicaid, working poor, transplants, advocacy, group work, community organization, public policy
Legacies, Liars and Those Alone: Lived Experiences of End Stage Renal Disease Revealed Through Group Work
Rebecca S. Sloan, RNCS, PhD, Indiana University School of Nursing, Indianapolis, IN; Sally Rice, MSSW, University of Louisville Kidney Disease Program, Louisville, KY
Based on our shared social work and nursing interests in quality of life, an interdisciplinary research study was conducted using group work to understand the concerns and successes of end stage renal disease (ESRD) patients related to 1) the effect of role changes, 2) cognitive changes, 3) sleep disruption, and 4) burdens of renal disease. Not only did these group work sessions identify specific concerns, they stimulated conversation between ESRD patients and an interdisciplinary health research team which revealed patient concerns going much deeper than one might anticipate. Three themes were identified by hermeneutic analysis of transcripts of the group work sessions: leaving a legacy, becoming a liar, and being alone. Generated from traditional group work activities, this information will support both social work and nursing interventions in meeting the needs of ESRD patients.
Key Words: quality of life, end stage renal disease, burdens of renal disease, interdisciplinary health care team, group work
Infants, Families and End Stage Renal Disease: Strategies for Addressing Psychosocial Needs in the First Two Years of Life
Debbie Kagan Brady, LCSW, ACSW, Arkansas Children's Hospital, Little Rock, AR; Kathleen Lawry, LISW, ACSW, NKF of Ohio, Cleveland, OH
The birth of a child with a congenital defect that results in immediate renal failure turns a joyous event into a crisis. Families are instantly asked to make life and death decisions about their infant's care. Furthermore, if they elect to go forward with treatment, they must incorporate into their parenting routine home dialysis, nutritional supplements (NG or G-tube feedings) and infant stimulation. The pediatric renal social worker's role on the medical team is multifaceted. The social worker must not only assess the family's coping strategies, support network, learning styles and abilities and financial situation but communicate this information to the healthcare team and identify intervention strategies that will provide the family with comprehensive care for their medical and psychosocial needs.
Key Words: pediatrics, infants, congenital renal disease, coping
The Complexity of Social Work Practice With Dialysis Patients: Risk and Resiliency Factors, Interventions and Health-Related Outcomes
Judith Dobrof, DSW; Arlene Dolinko, CSW; Elena Lichtiger, CSW; Jaime Uribarri, MD; all of the Mount Sinai Hospital, New York, NY; and Irwin Epstein, PhD, Hunter College School of Social Work, New York, NY
A demonstration project designed to explore psychosocial risk and resiliency factors, social work interventions and health-related outcomes with dialysis patients is described. The study is unique in focusing on an urban, low-income, minority population; in employing an interdisciplinary team to guide the research process; in retrospectively reviewing available medical record data; and in focusing on interventions and outcomes over time rather than at one point in patients' treatment histories. It illustrates the complexity of practice with dialysis patients and the critical role for social workers in enhancing patient outcomes. Secondary benefits of employing this methodology and implications for social work practice and research are discussed.
Health Quality of Life Among Female Caregivers of Male Hemodialysis Patients
Robert A. Schneider, PhD, LISW, University of Northern Iowa, Cedar Rapids, IA
The purpose of the study was to assess the quality of life (QOL) of female caregivers of male hemodialy-sis patients. Forty-five spouses or first-degree female caregivers of male hemodialysis patients in northern Iowa were administered the Rhoten Fatigue Scale, the CES-D, and two single-item perceived health quality of life (QOL) questions. The two single-item perceived QOL measures were associated with outcomes of depression and fatigue. Results showed that perceived QOL was an important factor in depression but not in fatigue among the sample. The nephrology community may benefit from the availability of short instruments to assess depression and fatigue among caregivers of dialysis patients. Limitations of generalization are addressed.
Key Words: dialysis, caregiver, quality of life, fatigue, depression
The Need to Remind Ourselves Who We Are
Joan Beder, DSW, Yeshiva University, Wurzweiler School of Social Work, New York, NY
Nephrology social workers are often stressed to the limit with patient care, paperwork and the constraints and worries of managed care. Sometimes we lose sight of our original mandate with all these competing situations. This article traces the history of medical social work as it began in England and truly became institutionalized in the United States. Sometimes when we look back it enables us to look forward. It is the intention of this article to remind social workers of our tradition and focus and to bring insight and vision to the present.
Key Words: Social work, social work history
"How Does That Make You Feel?": Rediscovering Clinical Social Work and Psychological Principles for Social Work Leaders
Sheila B. Weiner, MSW, LSW, National Kidney Foundation, New York
Every social worker is at least conscious of an ample body of information that exists to coach us through the frequently muddy waters of even the most challenging clinical situations. The very basics that we learned in school, and have carried ever since we left the safe refuge of the classroom, may have more significance in our everyday professional lives than one would ever imagine.
Winning an HMO Appeal's Case Study in Social Work Advocacy
Steve Bogatz, MBA, MSW, LCSW, Central Connecticut Dialysis Center, Meriden, CT
Nephrology social workers provide a multitude of services to renal patients and their families, which typically fit under the umbrella of education, counseling, and advocacy. Different patients may require any or all of the above depending on the patient's adjustment to his or her illness and the outside world's response to the patient. In my practice, I recently played an instrumental role in assisting a patient fight a managed care organization to receive critical funding for a successful kidney transplant. My work as an advocate for this patient not only assisted in justice being served but was one of the most rewarding professional experiences I have yet had.