Wednesday, June 15, 2016
It was one of the worst days ever experienced by the staff at Pediatric & Adolescent Health Partners in Midlothian. That morning, a young patient had died from an illness, and everyone was grieving. And in the evening, a parent losing custody of her children was scheduled to transfer custody to the father at the pediatrician’s office.
“The staff was dealing with the death of this child, we were trying to get all of our work done and at the same time seeing our kids in the office,” said Ted Abernathy, M.D., who founded the practice and graduated from the Virginia Commonwealth University School of Medicine. “And then a dad [in a divorce situation] walked in with a stack of medical records that was at least 2 1/2 inches high. He told us that he had concerns that his child was in danger.”
With just a few short hours before the custody transfer and with the staff preoccupied with grief, Abernathy took the stack of medical records and handed them to the practice’s two interns, Sarah Presley and Stephanie Lizama, both students at the VCU School of Social Work.
“We had a full load that day with a lot of emotions,” Abernathy recalled. “I took that stack of papers and I put it on their desk and said, ‘Ladies, I need your help. I need you to go through these records, and figure out how we’re going to help this family.’”
Presley, a second-year Master of Social Work student, and Lizama, a rising senior social work major, dug into the child’s medical records, placing a sticky note on each page to track every medical visit that might be relevant to any possible danger facing the child.
“They jumped right into it as a team,” he said. “When they were done with it, they handed it back to me and I was able to quickly go through the chart and figure out what was wrong. We now were able to report this to the authorities – and they did it all. They talked to the authorities, they talked to the lawyers, they talked to all the people involved.”
“That day, with everything being so horrible, they went to just extraordinary lengths to help these people,” he said.
Presley and Lizama interned at Pediatric & Adolescent Health Partners as part of a field education program through the School of Social Work that places social work students in internships with state agencies, assisted-living facilities, community housing organizations and social advocacy groups to put into practice the social work techniques they learn in the classroom.
Presley and Lizama are among the first to intern at a pediatrician’s office. They were embedded within the practice and tasked with developing a care coordination program.
Pediatric & Adolescent Health Partners is in the process of becoming certified as a Level 3 NCQA Patient-Centered Medical Home, which requires a certain level of care coordination – meaning the physician’s office not only provides health care, but also coordinates with agencies to ensure the patient’s medical, housing, food and other needs are met.
“You’re asking people do you have enough money, do you have enough food, do you have transportation, do you have adequate housing, do you have adequate clothes?” Abernathy said. “As a doctor asking those questions, if someone says, ‘No, doc, I don’t have enough food in the house,’ what am I going to do? [Presley and Lizama’s] job was to figure out what resources are available, and to make things work.”
After laying the foundation for the care coordination program, creating new intake and documentation processes and procedures, the students began taking on a handful of cases recommended by the physicians.
It's our goal for our patients to have the best living circumstances they can.
“Once we started helping patients, we had the opportunity to meet with them and to get to know them. We wanted to find ways to help families who do not have any support,” Lizama said. “Once we found what their goals were, we would do everything in our power to help them get the resources they needed. It's our goal for our patients to have the best living circumstances they can.”
Once they began working on a few cases, Presley said, it quickly became clear that the needs of an individual patient can be far more complex than anticipated.
“In our assessment with patients, we aim to talk to both the guardian and the child if old enough to gain a holistic perspective of their strengths and concerns (much like a biopsychosocial spiritual assessment),” Presley said. “After we gain a better understanding of their needs, we work to analyze the systems that influence both their strengths and weaknesses. Then we collaborate with the patients and their families to identify and establish goals to improve areas within their lives that impact their health.”
As part of their work, the students have met with patients in the community, advocated on their behalf to obtain services from agencies, connected patients with other health care providers and provided several cases to child protective services.
“I am grateful that our team has been able to improve the lives of some of our patients and their families by following through and asking questions that physicians and nurses simply do not have time to cover,” Presley said.
‘So many people that can be helped’
In one case, the office was contacted by the father of a patient who had been discharged from a local psychiatric facility after attempting suicide, and now refused to get off the couch.
“The dad is frantic because his son won’t get off the couch, he’s terribly depressed, and he’s having all sorts of issues with school. I said, just bring him in to the office, I’ll see him and we’ll try to figure out what’s going on,” Abernathy said. “Stephanie and I saw him, and she sat in with me on the interview. Basically this child was depressed. It was obvious that he needed medication; however, he also needed to go to school and at that point in time he was medically not able to attend school.”
Abernathy prescribed the patient medication, and asked Lizama to contact the school system to arrange for temporary homeschooling.
“She took care of the whole thing. She got in touch with the school and the homeschool coordinator,” Abernathy said. “Within a day, we had him on medication, his mood was improving because issues affecting him were being resolved and mostly because somebody was helping. He was more comfortable, and he was able to get a temporary homeschool education so he wouldn’t fall behind in school, which was his greatest fear. He couldn’t emotionally go to school, but the fact that he was going to fall behind was causing him to have acute anxiety.”
Both Presley and Lizama will be returning to Pediatric & Adolescent Health Partners in the fall to continue their field placement work.
“The patients and their well-being led me to want to go back,” Lizama said. “A care coordination program in a pediatrician's office that includes embedded social workers is unheard of. Knowing that we only want the best for our patients, the parents loved the idea. This field placement has only inspired me. I cannot wait to go back. There is so much to learn, there are so many people that can be helped.”
Part of the PAHP family
Shanza A. Isom, interim director of field education and an assistant professor in teaching at the School of Social Work, said the internship with Pediatric & Adolescent Health Partners has been a valuable and exciting opportunity for Presley and Lizama.
Isom, who developed the placement last year, said she was impressed by the work done in the practice and the enthusiasm the practice had in partnering with the School of Social Work to embed social workers.
“I knew … that this would be an exceptional and quality learning opportunity for our students,” she said. “For our students to have the chance to be a part of such growth and to do so with their voices at the table in an interdisciplinary environment, and also being in a space where they can demonstrate the value of the social work profession in this setting is momentous. I am very appreciative of Dr. Abernathy and his team for allowing our students to be a part of their PAHP family.”
For his part, Abernathy said Presley and Lizama have become integral parts of Pediatric & Adolescent Health Partners.
“My training is medicine. Their training is social, psychological, emotional,” he said. “Without them, we would have told our patients, ‘You need to contact a social worker’ or we would have called and made an appointment with a mental health professional. There would have been no coordination between me and the social workers.”
“It’s like when you’re building something and you’re doing a pretty good job, but somebody comes up and hands you a new tool,” he added. “And you realize, ‘This is great. This is exactly what I needed to do a better job.’”
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