Illinois Study Brings Social Workers to Physician Offices
"Holistic biopsychosocial care is the only care that makes sense for older people," said Sanford I. Finkel, director of the Geriatric Institute, Council for Jewish Elderly (CJE), in Chicago. He discussed CJE's Partners in Care (PIC) project, which tests the effectiveness of social work interventions that are conducted in different kinds of primary care settings around Illinois. The aim, he said, has been to integrate social work interventions into the clinical practice for patients who screen positively for depression, cognitive impairment or difficulties-such as medication compliance, falls and sleep problems-that might signal depression.
Finkel said, "We know that many older people with cognitive impairment who show up at the primary care physician's office live alone. Many need help with such things as bill-paying, transportation and personal care in order to remain in the community for as long as possible. We know that people who are depressed also sometimes don't get out. They are often too depressed even to go shopping, are pessimistic about their future, don't eat well, develop secondary nutritional problems and are particularly at high risk for falls. So we tried to look at those issues."
The four-year initiative, begun in early 2000, involved a range of research partners, including private managed care systems, Cook County Hospital and Northwestern University. Phase I of the study, being completed this fall, involved 2,150 patients who were screened at eleven physicians' offices (seven involved in social work interventions and four control offices). In the first 16 months alone, the PIC assisted 1,350 patients with mental and physical health interventions, financial and health insurance, and personal care at home.
Elders enrolled in the study spanned ages 65 to 100, with an average age of 76, and 25% were ethnic or racial minorities. Elders came from inner-city areas, upper-middle-class communities, suburbs, and urban and rural areas throughout Illinois. Interviews were conducted in English, Spanish and Russian.
Using a range of tests, including the Mini-Mental State Examination and an assessment of each patient's capacity for performing activities of daily living (bathing, eating and so on), the program identified 581 elders for detailed followup-including two interviews conducted one year apart-by the PIC project's social workers.
Intervention clients particularly included those who have few friends, were especially lonely or whose families lived far away, Finkel said. Those most apt to see a social worker were African American, widowed, living in supportive housing, unmarried, and had higher depression scores or a greater indication of cognitive impairment. They were people who were older and had less education.
"We particularly looked at what we call signal cases," Finkel said. …