Evaluation Report

Running head: Evaluation Report: “Georgia regional hospital” 1

Evaluation Report: “Georgia regional hospital” 11

Evaluation Report: Georgia Regional Hospital Atlanta (Psychiatric)

Shaniqua M. Burton

Whitney M. Young Jr. School of Work

Author Note

CSSW.586.01 Research II: Evaluation of Clinical Practice

Introduction  

Mr. Doe is a 22-year-old, unemployed, Black Moroccan origin male with a history of unspecified psychosis. He is a less than 30 day return and his last admission date was (07/23/2019-08/09/2019).  Mr. Doe was brought to Georgia Regional Hospital Atlanta (GRHA) on a 1013 for psychiatric stabilization from Grady Hospital ER. Per his referral documentation, the individual was brought to Grady Hospital ER following an attempted suicide by over-dosing on unknown amounts of Lorazepam, Advil, and Seroquel.

The individual reported to Grady Hospital’s assessor that his reason for being there was due to him over-thinking and taking lots of medications- (the amounts were reported as two Lorazepam and four Aspirin) which were prescribed to him. The individual was reported being paranoid, he endorsed poor sleep, and he seemed pre-occupied. Per reports, the individual stated that “People were lying on him.” Reports also indicated that the individual stated he had one suicide attempt in the past- “I ate my medication and was admitted to Dekalb Hospital”. 

The presenting problems for Mr. Doe were, “He mixes his medications to calm the voices in his head” and he feels as though he should not be hospitalized. The main treatment goal for Mr. Doe was to find him a medication regimen that would prevent him from hearing voices. His main discharge goal was to report not hearing any voices three days consecutive prior to his discharge date. It was the job of his social worker to make great observational reports documenting which medications would indeed silence the voices.

Literature review  

When it comes to being discharged, every client will tell you that they are ready to leave the hospital. It is the job of the psychiatrist to determine if that this true when looking at the client’s symptoms. However, it is the job of the social worker to have a place for the client to discharge to, the necessary resources (money, food, insurance, and transportation), and evaluating if the client is mentally ready to go. Also, when defining discharge planning, one must include the vitality of it.

According to Craig and Muskat (2013), “discharge planning is a process used to decide what a patient needs for a smooth move from one level of care to another. Only a doctor can authorize a patient’s release from the hospital, but the actual process of discharge planning can be completed by a social worker” (p.8).

Some people have the timing of discharge planning incorrect; discharge planning should start the day the client is admitted.

If the discharge planning process is not started early, the time available to prepare a plan that meets patients’ increasingly complex continuing care needs may be insufficient, leading to poor discharge outcomes that are disruptive to patients and costly to the health care system (Holland, Rhudy, Vanderboom, & Bowles, 2012).

Waiting until the day of, or close to time of discharge sets the client back. Over everything, the discharge plan should be a smooth transition. When completing a discharge plan, it is important to achieve the most effective and the safest discharge for the individual. Decisions must be made concerning where the individual is placed, transportation, services needed, and a follow-up appointment scheduled. When coordinating these services, all parties involved must be contacted and arrangements made to serve the individual. Discharging without accurately assessing the situation, without taking all factors into consideration and deciding which choices will result in not having the most favorable outcome for the individual.

In the case with Mr. Doe he has returned back to the psychiatric hospital in less than thirty days. This case shows how important the discharge planning is. Mr. Doe suffers from schizophrenia and he lacks the insight to understand that he is indeed living with a mental health diagnosis.

“Schizophrenia is a debilitating psychotic disorder that affects patients’ personality, career-related and social functioning. Patients stop medications after discharge or inpatient care, when they feel relatively recovered” (Khankeh, Rahgozar, & Ranjbar, 2011, p. 162).

Even though Mr. Doe mixes medications to eliminate his symptoms, he eventually stops taking the medications that are intended to help his symptoms when he feels like he has recovered. The importance of discharge planning is the client having an understanding of what is required of them in order to even be eligible for discharge. And more importantly, helping the client understand their diagnosis.

  Reported by Khankeh, Rahgozar and Ranjbar (2011), “discharge plan, education and follow-up care and medications at the residences of schizophrenic patients have many beneficial outcomes and not only improve patients’ abilities in cognitive and functional aspects, also makes it possible for patients to have access to proper health care services that they need” (p.169).

Methods  

The evaluation design used was Single Subject Research AB Design. The effectiveness of an intervention can be monitored by using the Single-subject research design (SSRD). This type of design focuses on an n=1, a single subject and in this case the client represents the subject. The AB represents the client at baseline (A) and the client after an intervention has been put into place (B). “SSRD involves repeatedly measuring a single client system on an important variable or outcome (Kim,2019).”

This method parallels the logic model that was created for the client. Implementation of Assertive Community Treatment (ACT), is a community provider for individuals who suffer from a Serious and Persistent Mental Illness (SPMI). According to Carey and Carey (1999), “SPMI’s include major depression, bipolar disorders, schizophrenia and borderline personality disorder” (p.345). Based on an analysis of the logic model, ACT was decomposed to its inputs and outputs, activities used to promote the service being successful, and the outcomes of the program. Georgia Regional Hospital of Atlanta (GRH/A), refers individuals, upon discharge, to ACT to ensure they are not readmitted to the hospital. This community provider bridges the gap between socioeconomic barriers and relapse. In the case of Mr. Doe, he would benefit from ACT services seeing that he is a less than thirty day readmit.

The social work intern collected the data on a weekly basis. Data collection was implemented for eight consecutive weeks. The first three weeks that the data was collected, created the baseline for the purpose of this report. During weeks one through three the intervention was not being used. The social work intern was just taking observational progress notes. Within the progress note the social work intern would document if the client was having any suicidal ideations, homicidal ideations, and hallucinations. How the client presented also was documented in the weekly progress note.

Measurement

The measurement that I would use to monitor change in the individuals would be the “Weekly Discharge Criteria Assessment (WDCA)”, this standardized form of an assessment was created by me. At GRHA, there are assessments that are used by other practitioners in different disciplinary areas, but the social workers do not have this form of accountability. By not having a standard we as social workers cannot hold ourselves accountability or even track our competences. I may ask questions that my colleagues may not and vice versa. Another example could be how I chose to document my sessions compared to others. This does not mean my way is better, but it is hard to track the consistency if everyone has a different approach.

Taking all that I mentioned into consideration, I chose to create a more formal measurement using the questions and tools that I personally use every week with my caseload. By standardizing my approach, it could potentially be implemented into the hospital amongst all the social workers or even improved with their feedback once they use it. This would also solidify the reliability of the measurement; with reliability being the consistency of understanding among different respondents (Kim, 2019, slide 6). In terms of the reliability of using the WDCA, per our PowerPoint, “a question is consistent by administering it to the same person at two different points in time” (Kim, 2019, slide 8), so if I am administering my assessment at the initial session with the individual and again a week later; those are to be considered two different points in time. Hence, validating the assessment as being consistent.

When considering the validity of the WDCA, I had to understand what I wanted to analyze before I created it. Validity is the insurance that what is being stated as being measured is doing that; it can also be related to the accuracy of a measurement (Kim, 2019, slide 15). WDCA is an assessment that will track if the individual is meeting their discharge goal/goals and give a more quantitative value to a qualitative approach. Even though this assessment has not been tested officially in the field, I do stand behind the validity of it. Its overall goal is to monitor the individuals discharge readiness; it does that through self-reports, the social workers observations, questions, and the clinical documentation of the other practitioners.

Strengths and Weakness

The WDCA has great strengths which are incorporated through what it captures in a small amount of time. The social worker will have the full picture to share with the treatment team and it allows an actual document to be presented. It also gives the individual an opportunity to express their knowledge of their recovery plan. Many times, individuals just state, “I want to be discharged”, but can not articulate why or understand what is required from them for that request to be granted. It somewhat forces the individual to look at their contributions to their own recovery and allow them to be self-sufficient. The biggest weakness of this assessment is that it has not been tested in the hospital and basically it is hypothetical at this current point. It may not be able to yield the anticipated results that it was created for. It may be used and not display a precise picture of the individuals discharge readiness. However, with all research one must test it out to see the results and I plan on conducting my own study that will document the actual reliability, validity, and usefulness of the WDCA.

Results  

The sessions were documented over the course of eight weeks. The (A) column is the sessions before the WDCA was implemented. “A period where reliable and valid data are gathered in a systematic manner in the absence of a particular intervention” (Kim, 2019). For three weeks the social worker intern took observational progress reports and noted minimal changes. The (B) column recorded the last five sessions that involved the WDCA. The implementation of the WDCA was used to clinically track the progress of the client.

The trends for baseline and intervention are increasing. The slopes are positive values, 0.5 and 1.6, respectively.

Discussion/Implication  

The interpretation of the data concluded that the implementation of the WDCA was a more accurate solution to documenting discharge readiness of a client. The baseline showed a linear trend indicating a slight positive impact. Overall, the slopes confirmed that the WDCA improved the client’s ability to work towards their discharge goals. The strengths of this research proved to be a visual interpretation along with the social workers progress notes. When the social workers go into treatment team meeting, the visual data could be shown to support reason why a client should be discharged. Limitations to the study included the client’s ability to understand their discharge criteria, the client being unable to complete the assessment due to psychosis, and the client refusing the process by not accepting they should be hospitalized.

Reflection upon the evaluation project has shifted documentation into a more research-based report. When documenting something, it will now be second nature to include research that can support the information. A greater knowledge of excel and how almost any data can be graphed to produce a visualization. In practice, it will give a multilayer approach to how data is tracked and used to assist the client. The client is the primary reason why the project was a success. Mr. Doe not only gave consent for his results and information to be used for educational purposes, but he also was very engaged in the process. Without a willing client, this project would have been a failure. SSRD requires that a measurement be measured repeatedly and consistently; Mr. Doe was very cooperative with the social work interns schedule. This type of understanding made gathering the data points fairly simple.

Every research project comes with its own set of problems, in the case of the evaluation report, the biggest problem was getting Mr. Doe close to his baseline so that he would answer the assessment with his fullest capabilities. When the assessment was first mentioned, Mr. Doe refused every kind of treatment, because he believed he did not belong in a psychiatric hospital. In retrospect, what could have been done differently to make this report better would have been using this type of assessment on various clients. To see how the trend would look and the progression of the client’s discharge readiness. Getting a greater sample size could have revealed a stronger case when presenting if this assessment actual improves the discharge readiness of clients.

 Next semester, the social work intern will have her own caseload and this assessment will be introduced at the initial meeting of each client. Taking the feedback from the professor and the supervisor will go towards making necessary adjustments to this research design. Future clients will have a more research-based assessment and will be adding their data to further the perfection of this data collection tool. These efforts instilled into this report and assessment will be expanded to all the social worker interns at GRHA. This is a great deal because it could eventually lead to a published article documenting how social workers can create the tools needed for the clients, produce data and visualizations to prove that it works. WDCA will be proven useful once the data is compared to clients who discharge without being assessed with it. The findings from this report yields equally applicable with any client, culture, gender, sexual orientation, or finical level. The WDCA is truly universal in its approach and can be applied to anyone.

Reference

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Social Workers in Urban Hospitals. Health & Social Work, 38(1), 7–16. https://doi-org.ezproxy.auctr.edu/hsw/hls064

Holland, D. E., Rhudy, L. M., Vanderboom, C. E., & Bowles, K. H. (2012). Feasibility of

Discharge Planning in Intensive Care Units: A Pilot Study. American Journal of Critical Care, 21(4), e94–e101. https://doi-org.ezproxy.auctr.edu/10.4037/ajcc2012173

Khankeh, H., Rahgozar, M., & Ranjbar, M. (2011). The effects of nursing discharge plan (post-discharge education and follow-up) on self-care ability in patients with chronic schizophrenia hospitalized in Razi psychiatric Center. Iranian journal of nursing and midwifery research, 16(2), 162–168.

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