Social workers identify financial, family, and community resources that allow optimal continuity of care and disposition from inpatient rehabilitation. Their psychosocial training puts social workers in the best position to provide family caregivers with a realistic emotional assessment of the burdens that will follow discharge. Along with the psychologist, they are the most likely team members to recognize substance abuse, a PTSD, suicidal thoughts, and psychopathology that may interfere with inpatient and outpatient care. From a practical view, the social worker often serves as a case manager, helping the patient and the team advocate for the disabled patient while assessing whether or not the significant others around the patient will be able and willing to provide enough support for a discharge to the home.
Adjustment to neurologic disability involves a gradual process of psychological assimilation to changes in body image, self-concept, and ability to interact with the environs.173 The social worker begins this process of assimilation. Caregivers also face adjustments. Their emotional distress may be greater than that of the patient, related to the new physical, cognitive, financial, and role-reversing demands of dis ability. Social workers inevitably intervene in solving the problems that may otherwise lead to institutionalization of a patient after inpatient rehabilitation.
Social workers use a variety of interventions. They often address familial conflicts and emotional issues with a short course of crisis intervention. Traditional psychotherapeutic theories and strategies draw upon concepts of personality and self-awareness. Behavioral therapy tries to eliminate maladaptive behaviors to disability and condition acceptable ones. Educational approaches provide accurate information that aims to reduce anxiety and misconceptions about impairments and disability. Patients and families are taught coping skills and methods to identify and resolve problems. Social workers often develop outpatient support groups that allow patients and families to exchange ideas about care and coping.
The mechanisms and outcomes of psychosocial supports and other adaptations for coping with a sudden or chronic neurologic disability require more research.174,175
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