579 Benefits of Licensed Clinical Social Worker Utilization in an Adult Burn Clinic: More Than Just Checking the Box

Introduction Our burn institution cares for critically ill burn patients and provides post-acute care for a large referral base. The clinic is staffed by a wound certified physical therapist, an advanced practice registered nurse and a licensed clinical social worker (LCSW), with consult access to Trauma/Burn Surgeons. The incidence of acute stress symptoms after burn injury is noted in up to 35% to 40% of patients. Therefore, it is important to identify symptoms of anxiety and depression early and begin symptom management. Burn patients have access to a multi-disciplinary team, and a licensed therapist, that can identify symptoms of acute stress and make recommendations for appropriate treatment in concert with the medical staff. This project seeks to determine the prevalence of acute stress in post-acute burn patients seen in an adult burn clinic and the benefits of utilizing a Licensed Clinical Social Worker to perform screening. Methods For a one-year period all burn patients in the burn clinic were screened by the LCSW. The subjects underwent initial screenings for depression, anxiety, and suicide risk at their first clinic visit. The PHQ-2 and PHQ-9 were utilized to assess depression, the GAD-7 for anxiety and the Columbia Suicide scale to assess suicide risk. Patients were initiated into multi-modal therapies based on specific scoring. These intervention strategies were based on the Depression Screening Protocol which included education on depression, and/or anxiety, with or without participation in a Trauma/Burn Peer Support Group. Patients were prescribed medication per provider discretion, and/or connected to community resources such as, counseling, and psychiatric mental health services. Results During the one-year assessment period screening compliance was >90%. During this period, >50% of patient’s scores were clinically significant for acute stress. Over half of those that screened positive were connected to community resources of counseling services or psychiatric care. 100% of those that screened positive were given education and connection to peer support services. An incidental correlation was noted between increased total body surface area involvement and work-related accidents with increased symptomology. Conclusions The inclusion of an LCSW in the burn clinic has improved the overall care of the burn injured patient. The assessment of depression and anxiety related to the burn injury has led to an increase in peer support participation and an increase in referrals to counseling and/or psychiatric services.

The Influence of Clinical Supervision of Therapists in the Therapeutic Alliance Between Patient and Therapist

The therapeutic alliance between patient and Clinical Social Worker/Therapist is directly influenced by clinical supervision that therapists receive. This article will bring awareness to Clinical Supervisors’ abilities to correct and adjust to how they are providing Clinical Supervision or how Clinical Social Workers are receiving supervision.

Palliative care pharmacists as advocates to conduct advance care planning.

73 Background: Advance care planning (ACP) is a process whereby individuals consider their end-of-life (EoL) treatment preferences and make them known to caregivers and clinicians in the event of decisional incapacity. We previously reported a focused ACP intervention led by a clinical social worker (J Palliat Med 2016). Based on this trial’s initial success, we aimed to evaluate this approach when led by a pharmacist. To date, no data exists regarding pharmacist-led ACP discussions. Methods: Advanced stage cancer patients were screened at a single, academic oncology palliative care clinic. Training of the pharmacist included observation of ACP interventions conducted by the clinical social worker, didactic lectures, and role playing. Subjects engaged in a 1-hour ACP intervention with a palliative care pharmacist within 4 weeks of consent. Details of the ACP intervention were documented in the electronic medical record and AD/POLST completion was encouraged but not required. The study outcome was the identification of an informed proxy. After the patient’s death, proxies were contacted to determine if EoL wishes were achieved. Descriptive analyzes were performed. Results: Patient demographics were 22 patients, who were mostly woman (n = 13), Caucasian (n = 17), married (n = 14), with a mean age ± SD of 60.3 ± 10.5 years and with gastrointestinal (n = 5) and genitourinary (n = 5) as the most common primary cancers. After the ACP intervention by the pharmacist, 21 of 22 patients identified an informed proxy. The most commonly identified proxy was a spouse (n = 13). Fourteen (64%) subjects completed an AD/POLST after the ACP intervention. As of October 2016, 27% (6/22) of patients have died. Four out of 6 patients died in a setting consistent with their EoL wishes. Mean time to death from ACP intervention was 133±132 days. Sixteen subjects remain in surveillance. Conclusions: Preliminary results suggest that a pharmacist can conduct ACP discussions to identify an informed HCP. To date, the majority of patients achieved a death concordant with their EoL wishes.