Social Work 564 -Advanced Practice in Health Care II: Chronic Illness and Disability

Winter, 2002

Gunnar Almgren

Class Times: Thursdays 1:30-4:20, SSW B14

Office Hours/Location: 12:30-1:30 Tuesdays SW 127L or by Appt.

Phone 685-4077, e-mail mukboy@u.washington.edu

Case Discussion

General Course Description: This course is the second course in a two-quarter sequence that prepares social workers for practice in institutional and community health care contexts. Consistent with the findings and recommendations of The New York Academy of Medicine's Social Work Education for Practice in Health Care (New York Academy of Medicine: 2000) this course places a large emphasis on working with populations affected by chronic illness and disability, as well as addressing the core issues that arise in family care systems. This course is primarily organized around the family system and draws heavily on family life cycle theories found in the literatures of social work, developmental psychology, and sociology. A central theme of this course is the need for social workers in health care to view chronic illness and disability at multiple levels (individual, family, organizational, and societal) in order to engage in effective multi-level professional practice.

Course Objectives:

1. Chronic illness and disability will be viewed as a universal aspect of human diversity, and students will have some knowledge of how the societal response to chronic illness and disability affects the everyday lives of individuals and families.
2. Students will have some general knowledge of how chronic illness and disability are defined, measured, and estimated in terms of prevalence.
3. Students will have knowledge of particular public policies that have large influence upon the degree to which chronically ill and disabled persons and their families can access systems of education, employment, recreation, and health care.
4. Students will be conversant in family life cycle theory, and the relationship between the essential features of chronic illness and disability and the adaptive response of the family system over the family life cycle.
5. Students will have a basic understanding of how disabled persons and their partners seek to find and sustain what might be considered the core challenge and achievement of human existence: relationship commitment and intimacy.
6. Students will be achieve some basic level of understanding of the individual and family processes of fear, uncertaintly, and grief in the context of childhood illness and death -as well as the social work interventions that enable couples and families to better adapt to severe emotional trauma and loss.
7. Students will have a foundation knowledge of bioethics and the primary bioethical conflicts that arise in the context of chronic illness and disability.
8. Students will have the essential professional knowledge that enables them to effectively support and advocate for caregivers and caregiving family systems.

Course Format Class sessions will be roughly and equal mixture of lecture and discussion, with some guest lectures and problem-based learning assignments that will call for small group discussion.

Course Materials There will be one book assigned in the course, Arthur Kleinman's The Illness Narratives: Suffering, Healing and the Human Condition (BasicBooks: 1989). The cost of the book is just under $20.00 in softcover and is available at University Bookstore. This book is 267 pages in length and is to be read over the first five weeks of class. The other assigned readings are on 4 hour reserve in the library. Students may make a single copy of individual articles for their own use. Readings that are recommended, but optional are marked with an asterisk.

Assignments There are two course assignments. The first involves a problem-based learning analysis on four case vignettes assigned by the instructor over the course of the quarter. Each vignette will come with a set of instructions and students may collaborate with one another on their responses. The problem based learning assignments collectively will be worth 30% of the course grade. The second assignment will be a case study of a chronic illness or disability, selected by the student. This assignment will require the student to consider the intersect between the nature of the illness or disability, the social and developmental history of the patient, the patient's system of care, and the formal system of care. Students will be expected to incorporate explicit theories of development and adaptation in to their case study. This assignment will comprise 50% of the course grade. The remainder of the course grade will be based on attendance and classroom participation.

The due date of the case vignettes will be 2 weeks after they are assigned and the case study will be due Wednesday, March 20^th.

Week I January 10th The Social Context of Chronic Illness and Disability	Learning Resources
Foundation Knowledge The Definition and Measurement of Chronic Illness and Disability Prevalence The Experience of Disability Self Identity and Stigma The Sociology of Disability and Chronic Illness: Disability and Illness as Deviance	Kleinman. pp. 1-55 Thorne, S. Normalcy and Visibility. In Thorne, Negotiating Health Care: The Social Context of Chronic Illness. Newbury Park, Calif.: Sage, 1993. :56-77. Schneider JW and Conrad P. The medical control of deviance: Contests and consequences. In Julius Roth (Ed), Research in the Sociology of Health Care, vol 1, Pp. 1-53, Greenwich Conn: JAI Press, Inc.: 1980. *Goffman E. Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall, Englewood Cliffs, N.J.: 1963. *Mechanic D. Health, disease, and deviant behavior. In Medical Sociology: A Selective View, Pp. 15-48, New York: Free Press, 1968.
Practice Methods	Applying standard measures of health and disability

 

Week II January 17th The Public Policy Dimensions of Chronic Illness and Disability	Learning Resources The latter four citations listed have been recommended by the School of Social Work's Disability Committee on the basis of a detailed review by second year MSW student Liz Arjun.
Foundation Knowledge The civil rights of disabled persons Access to health care finance and income maintenance programs for disabled and chronically ill populations	Kleinman pp. 56-99 Priestly, M. 1999. Disabling Values: Disabling Policies. In Disability Politics and Community Care: London, England: Jessica Kingsley Ltd.: 27-54 Johnson, W. 1997. The Future of Disability Policy: Benefit Payments or Civil Rights?. The Annals of the American Academy of Political and Social Science. Vol. 549: 160-172. *Drake, R. 1999. Contemporary British Policy in the International Context. In Understanding Disability Policies. London, England: Macmillan Press: 93-109. Scotch, R.K. and Schriner, K. 1997. Disability as Human Variation: Implications for Policy. The Annals of the American Academy of Political and Social Science. Vol. 549: 148-159. *The Americans for Disabilities Act Homepage. U.S. Department of Justice: http:// Www.usdoj.gov/crt/ada/adahom1.htm
Practice Methods	Advocacy in the the Public Policy Domain

  

Week III January 24th The Conceptual Framework for Social Work Practice in Chronic Illness and Disability	Learning Resources
Foundation Knowledge A Psychosocial Typology of Illness Chronic Illness, Disability, and the Family Life-Cycle Cultural Context, Family Belief Systems, and the Reframing of Family Identity	Kleinman. pp. 100-145 McDaniel, Hepworth and Doherty. 1992. The Challenges of Chronic Illness. In Medical Family Therapy. New York: BasicBooks. Rolland. 1994. The Psychosocial Typology of Illness. In Families, Illness, and Disability: An Integrative Treatment Model. New York: BasicBooks.
Practice Methods	Family system assessment in the context of chronic illness

   

Week IV January 31ST The Early Family Lifecycle: The Disabled Child	Learning Resources
Foundation Knowledge Assisting families to negotiate grief and loss. Issues if stigma and family identity. Advocacy without bitterness. Common sibling dynamics. Building a family support network.	Kleinman, pp. 145-194 Solnit, A. 1989. Preparing for Uncertainty: Family Reactions to a Seriously Impaired Child. In Heller, Fisher and Zegans (Eds.) Psychosocial Interventions with Physically Disabled People. Harcourt-Brace Publishers. Oppenheimer-J-R; Rucker-R-W. 1980 The effect of parental relationships on the management of cystic fibrosis and guidelines for social work intervention. Social Work in Health Care. 5(4): 409-19. Rolland, J. 1994. Treatment Issues with Families. Families, Illness, and Disability: An Integrative Treatment Model. New York: BasicBooks *Freeman and Hagan. 1990. Effects of Childhood Chronic Illness on Families. Social Work in Health Care 14 (3): 37-53.
Practice Methods	Brief couples and family therapy

   

Week V February 7th The Early-Middle Family Lifecycle: Chronic Illness and Disability in Adolescence	Learning Resources
Foundation Knowledge Developmental Models of Adolescence and Family Processes Issues in the Negotiation of Developmental Goals, The Experience of Illness and Disability, and Medical Care	Lock. 1998. Psychosexual Development in Adolescents with Chronic Medical Diseases. Psychosomatics 39: 340-349. Abraham, Silber, and Lyon. 1999. Psychosocial Aspects of Chronic Illness in Adolescence. Indian Journal of Pediatrics 66: 447-453. Burke and Elliot, 1999. Depression in Pediatric Chronic Illness: A Diathesis-Stress Model. Psychosomatics 40 (1): 5-17. Rosen. Between Two Worlds: Bridging the Cultures of Child Health and Adult Medicine. 1995. Journal of Adolescent Health 17: 10-16. Green. 1999. Treatment Strategies for Adolescents with Hemophilia: Opportunities to Enhance Development. Adolescent Medicine 10 (3): 369-376. Cepeda, Allen, Cepeda and Yang. 2000. Physical Growth, Sexual Maturation, Body Image and Sickle Cell Disease. Journal of the National Medical Association. 92 (1): 10-14. Nasr. 2000. Cystic Fibrosis in Adolescents and Young Adults. Adolescent Medicine 11 (3): 589-603
Practice Methods	Assessing the developmental needs of adolescents Engaging the adolescent in the helping process Helping the adolescent negotiate boundaries of autonomy and dependence

 

Week VI February 14th The Middle Family Life Cycle: Chronic Illness and Disability in Young and Middle Adulthood	Learning Resources
Foundation Knowledge Achieving Economic Independence Relationship Commitment, Intimacy and Adaptive Sexuality Transition and Commitment to a New Family System Intergenerational Commitments	Sidell-N.L. 1997. Adult adjustment to chronic illness: a review of the literature. Health-and-Social-Work. 22(1): 5-11. Beder J.. 1999. Evaluation Research of Social Work Intervention on Dialysis Patients: The First Three Months. Social Work and Health Care 30 (1): 15-31.
Practice Methods	Individual counseling with young adults.

     

Week VII February 21ST The Later Family Life Cycle: Chronic Illness and Disability in Old Age	Learning Resources
Foundation Knowledge Variability in cognitive deficits and implications for interpersonal psychotherapy methods Alternative conceptions of meaning in old age. Social work practice in institutional long term care settings.	Fabiano L (1991). Social work practice with institutionalized frail elderly. In MJ Holosko. Social Work Practice with the Elderly. Toronto: Canadian Scholars Press. Payne B ( 1990). Research and theoretical approaches to spirituality and aging. Generations (Fall):11-14. Brody, C. (1993). Reminiscence groups with women in a nursing home (13-29). In Strategies for Therapy with the Elderly: Living with Hope and Meaning. NY: Springer. Beaver M. (1992). Tertiary intervention: Institutionalized elderly. (199-235). In Clinical Social Work Practice with the Elderly: Primary Secondary and Tertiary Intervention. Belmont CA: Wadsworth Publishing Co. Silver M. (1995). Memories and meaning: Life review in old age (57-73). Journal of Geriatric Psychiatry. 28(1). Watson J. (1986). Suffering and the Quest for Meaning. Social Work. Fall.
Practice Methods	Assessment of cognitive capacity  Life review therapy

 

 

Week VIII February 28th Chronic Illness and Disability: The Bioethical Dimensions	Learning Resources
Foundation Knowledge Bioethical analysis frameworks Inter-team dynamics Assessing the capacity to consent to and direct care.	Foster Let al. (1993). Bioethics: Social work's response and training needs. Social Work in Health Care. 19(1). 15-38. Forsberg R. (1995). Rationality and allocating scarce medical resources. Journal of Medicine and Philosophy 1995:20:25-42. Jecker N, Pearlman R. (1992) An ethical framework for rationing health care. Journal of Medicine and Philosophy. 17:79-96. Proctor E, Morrow-Howell N, and Lott, C. (1993). Classification and correlates of ethical dilemmas in hospital social work. Social Work 38(2). 166-177. *Zawacki B, Robb J (1984). Decision-making in the ICU: The ethical perspective . From Life Support Systems in Intensive Care/ Year Book Medical Publishers, Inc. *Kumar S (et al). (1990) Orthotopic liver transplantation for alcoholic liver disease. Hepatology 11(2) 159-164. Cummings, S. and C. Cockerham.(1997) Ethical Dilemmas in Discharge Planning for Patients with Alzeimer's Disease. Health and Social Work 22 (2): 101-108.
Practice Methods	Conducting a clinical bioethic analysis

 

Week IX March 7th Living with Chronic Illness and Disability: Couples Issues	Learning Resources
Foundation Knowledge   Adaptive for HIV Affected Couples   Sexual Intimacy in Serodiscordant in Gay and Heterocouples   Couples Management of Chronic Illness	Greene R.R; Kropf N.P; MacNair N. A family therapy model for working with persons with AIDS. Journal of Family Psychotherapy. 5(1): 1-20, 1994. Serovich JM; Greene K. Perceptions of family boundaries: the case of disclosure of HIV testing information. Family Relations. 42(2): 193-97, Apr. 1993. Palmer, Robert; Bor, Robert. The challenges to intimacy and sexual relationships for gay men in HIV serodiscordant relationships: A pilot study. Journal of Marital and Family Therapy. 2001 Oct; Vol 27(4): 419-431 De Vincenzi,-Isabelle. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. New England Journal of Medicine. 1994 Aug; Vol 331(6): 341-346 VanDevanter, Nancy; Thacker, A Stuart; Bass, G; Arnold, M Heterosexual couples confronting the challenges of HIV infection. AIDS Care. 1999 Apr; Vol 11(2): 181-193
Practice Methods	Family and Couples Therapy

 

Week X March 14th Social Work Practice with Caregivers: Perspectives, Clinical Issues, and Interventions	Learning Resources
Foundation Knowledge Balancing the strengths perspective with the psychological consequences of chronic fatigue and stress. Systems of support for caregivers. Common dynamics in the negotiation of intergenerational support.	Ponder and Pomeroy. 1996. The Grief of Caregivers: How Pervasive Is It? Journal of Gerontological Social Work. 27 (1/2) 3-21. Hinrichsen. 1997. Interpersonal Psychotherapy for Depressed Older Adults. Journal of Geriatric Psychiatry 30 (2): 239-257. Sanchez-Ayendez. 1998. Middle-Aged Puerto Rican Women as Primary Caregivers to the Elderly: A Qualitative Analysis of Everyday Dynamics. 1998. Journal of Gerontological Social Work. 30: 75-97. Cummings. 1996. Caregivers of Early Stage Alzeimers's Patients: A Psychoeducational Support Group Model.Journal of Gerontological Social Work 26 (3/4): 83-98. *Berenbaum and Zweibach. 1996. Young Adults with Down Syndrome as Caregivers for the Elderly with Dementia: A Intergenerational Project. Journal of Gerontological Social Work 26 (3/4): 159-170
Practice Methods	Counseling and support group interventions in older adults. Family therapy in older family systems.

 

Supplementary Topic The Early Family Lifecycle: The Seriously Ill Child and Coping with Child Loss	Learning Resources
Foundation Knowledge Processes of parental and family grief   When children die: secondary traumatic stress among health care personnel	Kleinman 195-267 Gilliland B. (1997). Person loss: Bereavement and Grief. Crisis Intervention Strategies. Pacific Grove, CA. Brooks Cole Publishing Co. 416-464. Baker J., Sedney MA, and Gross, E. 1992. Psychological Tasks for Bereaved Children. American Journal of Orthopsychiatry. 62(1): 105-117. Parry J. (1994). Death Review: An important component of grief resolution. Social Work in Health Care. 20(2):97-107. Spitzer, W. and Laurie Burke. 1993. A Critical-Incident Stress Debriefing Program for Hospital-Based Health Care Personnel. Health and Social Work 18 (2): 149-156.
Practice Methods	Critical incident debriefing Techniques of bereavement counseling