psychosocial barriers and tb treatment...5 steps • step 1 - identify the root cause of tb • step...
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TB Nurse Case ManagementSan Antonio, Texas
April 30 – May 02, 2019
Psychosocial Barriers and TB Treatment
Michelle Hale, LMSW, CDP, NFA
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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
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PSYCHOSOCIAL BARRIERS AND TB
TREATMENTBY: MICHELLE HALE, LMSW, CDP, NFA
SOCIAL WORKER
TEXAS CENTER FOR INFECTIOUS DISEASE
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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!
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STEP 1 - IDENTIFY THE ROOT CAUSE OF TB
• Immune System
• Environment
• Socio-Economic Status
• Hygiene
• Lack of Education
• Legal History
• Homelessness
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STEP 2 – IDENTIFY PSYCHOSOCIAL BARRIERS FOR PERSONS ON TB THERAPY
• Intra-Personal Factors
• Mental Health
• Motivation
• Helplessness / Hopelessness
• Perceived Susceptibility to Negative Consequences
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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
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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
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STEP 2 – IDENTIFY PSYCHOSOCIAL BARRIERS FOR PERSONS ON TB THERAPY
• Systemic Factors
• Poverty
• Policies
• Inadequate Housing
• Pharmacological Barriers
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STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS
• Health Promotion Activities
• Household visits
• Referral for mental health
• Ensure continuity of care
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STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS
• Socioeconomic Support
• Community Workshops
• Financial Counseling
• Psychological Counseling
• Time and medication Management
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STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS
• Cross-Cutting outputs
• Empowerment
• Advocacy
• Equity
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STEP 3 – IDENTIFY RESOURCES AND SUPPORTIVE SERVICES TO ADDRESS BARRIERS
• Hierarchical Support
• Housing
• Food
• Poverty Improvement
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STEP 4 – IDENTIFY INTERPERSONAL TECHNIQUES TO MINIMIZE BARRIERS
• Unconditional Positive Regard
• Based on Carl Rogers work from 1961
• Three Elements: Warmth, Empathy, Genuineness
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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
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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
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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!
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REFERENCES
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STEP 5 – ASK QUESTIONS!
• Michelle Hale, LMSW, CDP, NFA
• Office #: 210-531-4547