psychosocial barriers and tb treatment...5 steps • step 1 - identify the root cause of tb • step...

TB Nurse Case ManagementSan Antonio, Texas

April 30 – May 02, 2019

Psychosocial Barriers and TB Treatment

Michelle Hale, LMSW, CDP, NFA

Michelle Hale, LMSW, CDP, NFAhas the following disclosures to make:

•No conflict of interests

•No relevant financial relationships with any commercial companies pertaining to this educational activity

PSYCHOSOCIAL BARRIERS AND TB

TREATMENTBY: MICHELLE HALE, LMSW, CDP, NFA

SOCIAL WORKER

TEXAS CENTER FOR INFECTIOUS DISEASE

5 STEPS

• Step 1 - Identify the root cause of TB

• Step 2 – Identify psychosocial barriers for persons on TB therapy

• Step 3 – Identify resources and supportive services to address barriers

• Step 4 – Identify interpersonal techniques to minimize barriers

• Step 5 – Ask Questions!

STEP 1 - IDENTIFY THE ROOT CAUSE OF TB

• Immune System

• Environment

• Socio-Economic Status

• Hygiene

• Lack of Education

• Legal History

• Homelessness

STEP 2 – IDENTIFY PSYCHOSOCIAL BARRIERS FOR PERSONS ON TB THERAPY

• Intra-Personal Factors

• Mental Health

• Motivation

• Helplessness / Hopelessness

• Perceived Susceptibility to Negative Consequences

STEP 2 – IDENTIFY PSYCHOSOCIAL BARRIERS FOR PERSONS ON TB THERAPY

• Inter-Personal (Social) Factors

• Alcohol & Substance Abuse

• Social Exclusion & Stigma

• Use of Traditional Healing Systems

• Family Engagement / Experience with TB Treatment

STEP 2 – IDENTIFY PSYCHOSOCIAL BARRIERS FOR PERSONS ON TB THERAPY

• Provider Factors

• Experience

• Language Matching

• Location of Service Delivery

• Quality of Relationship

• Provider’s Health

• Communication Style / Openness

STEP 2 – IDENTIFY PSYCHOSOCIAL BARRIERS FOR PERSONS ON TB THERAPY

• Systemic Factors

• Poverty

• Policies

• Inadequate Housing

• Pharmacological Barriers

STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS

• Health Promotion Activities

• Household visits

• Referral for mental health

• Ensure continuity of care

STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS

• Socioeconomic Support

• Community Workshops

• Financial Counseling

• Psychological Counseling

• Time and medication Management

STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS

• Cross-Cutting outputs

• Empowerment

• Advocacy

• Equity

STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS

• Hierarchical Support

• Housing

• Food

• Poverty Improvement

STEP 4 – IDENTIFY INTERPERSONAL TECHNIQUES TO MINIMIZE BARRIERS

• Unconditional Positive Regard

• Based on Carl Rogers work from 1961

• Three Elements: Warmth, Empathy, Genuineness

STEP 4 – IDENTIFY INTERPERSONAL TECHNIQUES TO MINIMIZE BARRIERS

• Education and Preparation

• Focus on Process and Outcome

• Do not set false expectations

• Always clarify for understanding and answer questions

• Identify preferred communication

STEP 4 – IDENTIFY INTERPERSONAL TECHNIQUES TO MINIMIZE BARRIERS

• Engaging Patients Own Motivation in Treatment

• Motivational Interviewing

• Roll with resistance, active listening, etc

• Transtheoretical Model of Change

• Pre-Contemplation

• Contemplation

• Preparation

• Action

• Maintenance

• Relapse

STEP 4 – IDENTIFY INTERPERSONAL TECHNIQUES TO MINIMIZE BARRIERS

• Self-Care and Self-Awareness

• Take care of yourself

• Avoid Burnout

• If you are not well, you will not perform well!

REFERENCES

STEP 5 – ASK QUESTIONS!

• Michelle Hale, LMSW, CDP, NFA

• Michelle.Hale@dshs.texas.gov

• Office #: 210-531-4547