Colleague :Crystal
Describe at least one common client problem, issue, or gap in services or programs at your field agency, practice, or community setting. (If you are not currently in a practice setting, you may draw on your past work or practicum experience.)
At my previous field agency, I interned at a Middle School under the Child Study Team (CST). For a student to qualify for special services or attain an IEP, they must go through a process. For instance, a referral to the CST first needs to be made. This referral could come from a parent, school administrator, pediatrician, or legal representative. A CST member then has 20 calendar days from the referral date to set up a meeting. In the meeting, the parent’s concerns are heard along with any data collection they have from specialists, interventions, evaluations, diagnoses, etc. The CST committee (LDTC, School Psychologist, and School Social Worker) decide together as a team if an evaluation is or is not warranted at this time. An evaluation might be warranted if the parent went through RTI (Response to Intervention) and the interventions put in place to address any learning needs were not sufficient or showed improvement. This means every goal set in place for the student to achieve was not enough and the student requires more intensive support like a modified curriculum. If we see that no improvements were present despite interventions and support put in place then as a team, we can decide to move forward with testing. Now if a parent assumes their child has a learning disability but has not exhausted all measures such as going through RTI first before being evaluated for testing, we might deny evaluations because we do not have enough data collection to determine if the interventions put in place for the student through RTI was enough to address any learning concerns. The gap in the services is the process to be considered for Special Services. Before a student can be considered for Special Education, they need to go through RTI first. RTI is there to avoid any learning gaps so that the student could continue to be supported and avoid falling too far behind. The problem with this is that sometimes a student has a disability but is denied Special Services because they did not go through the process first. This not only delays the student from getting the support they need but it causes the student to fall more behind than their peers causing stress, school refusal, frustration, and lack of motivation. According to the article, “Special Education is Broken”, Samuels states that policies like RTI “can be used to keep children out of special education who should qualify for it” (2019).Specifically, highlight what you see that tells you clients need something more than what the agency, practice, or community setting is offering.
In my previous agency, I witnessed an instance where we denied services to a student although there was an evident need for support. The reason for denial was that the parent did not seek support through RTI first. We notified the parent that evaluations were not warranted at the time because all measures have not been exhausted like interventions through RTI. The interventions put in place for the student would be monitored for months at a time. If the intervention goals are not working, new goals will be put in place, and they will continue to monitor the progress of data collection. This data collection will then be useful if a referral is made to the CST in the future. We denied services at the beginning of the school year which was September. The parent sent the CST another referral in February and shared that their child was too far behind, and the interventions were not supporting her through her year in Kindergarten. The mother requested the child to repeat Kindergarten as she felt her child was nowhere near ready to move on to first grade. The mother shared that she observed her child’s class and witnessed other children recalling sounds and identifying numbers and letters while their child struggled immensely causing her to cry and hate school. If there wasn’t a process to follow, we could have provided this family with Special Services sooner and their child would not be in the situation they are in now.
Identify a program that you think is necessary to address the problem, issue, or gap and explain why.
According to Dudley, “Needs assessments are particularly useful when considering a new policy or program initiative or when considering changes to or discontinuation of an existing Program” (2020). To address the gap in Special Education, the school district should have a mandated orientation for all staff to attend before starting the new school year to learn about RTI and the CST process. It is important for staff members to be aware of their students and make note of any students falling behind or struggling. Identifying a student’s need early on is important as it allows for services to be implemented now rather than later. The school should also provide professional training opportunities to help teachers develop strategies for individualized instruction. As for parents, the school must inform them of the process as well. Many parents are unaware of the CST process. When a parent has a child who is struggling academically, they go straight to the CST for Special Services because they are unaware that they must go through RTI first. So informing parents about the process could help parents save a lot of time and get the process rolling quicker instead of wasting time and prolonging the process of their child getting the support they need. This information could be sent home in a document or could be posted on the school site.
It is also important for policymakers to address systematic challenges that contribute to the achievement gap like funding for special education programs, unbalanced distributions of resources, etc.
Generate a question that you might ask about your identified need and to whom.
I would reach out to the Director of Special Services and the Superintendent of the school to discuss the importance of having staff members know the process of RTI and CST. I would also share having them notify parents of the process as well. A question I would ask is how can we make the process easier for parents to assure that their child is getting the support they need without falling too far behind. I feel that this issue is beyond what the school district could do so I could also reach out to the Office of Special Education and Rehabilitative regarding my concerns with the Special Education process and how the process delays students learning and creates a significant achievement gap between the student and their peers. I would question why students who have a significant need must go through RTI first before they can get the support they need. Addressing the students’ needs early on with proper interventions and the implementation of an IEP could assure that the student is receiving an adequate education that is tailored to their learning needs.
References
Dudley, J. R. (2020). Social work evaluation: Enhancing what we do (3rd ed.). Oxford University Press.
Office of Special Education and rehabilitative services. USAGov. (n.d.). Retrieved March 21, 2023, from https://www.usa.gov/federal-agencies/office-of-special-education-and-rehabilitative-services
Samuels, C. A. (2021, November 18). Special education is broken. Education Week. Retrieved March 21, 2023, from https://www.edweek.org/teaching-learning/special-education-is-broken/2019/01
Colleague 2 Justin
Community Gap in Services
I live on a small rural island in Hawaii. My current field agency is a clinical care coordination network that works with our hospital’s outpatient clinic. We support various post-hospitalization transitional services like mental/behavioral health integration, psychosocial support, nursing, medication management, and other care coordination services. A significant gap on my island is supporting individuals with mental and behavioral conditions. We have two psychiatrists that may fly in once a month and currently one LCSW living on the island. The need for more on-island mental health support is long overdue. The American Foundation for Suicide Prevention (2022) reports suicide is the second leading cause of death for ages 10-34 in Hawaii, and 85.78% of communities do not have enough mental health providers to support their residents. Before I began interning at my field agency, they had no on-island providers and were serving strictly through telehealth and telephone.
Additional Support
While Hawaii is considered one US state, it consists of eight major islands with vastly different resources, cultures, and population sizes. The island I live on is often called the “most Hawaiian island” due to its resistance to change from the traditional Hawaiian way of living. My full-time job is at my island’s only hospital as the Social Work Designee, and I am the only Social Services employee. So, any patient that comes through our emergency department, outpatient clinic, or women’s health clinic with a psych or social need, I am called. The patients we see who need a full psych evaluation or inpatient hospitalization must be transferred to a neighboring island hospital via air ambulance. The issue arises once the patient is discharged back to our island. The patient’s follow-up is often nonexistent, which is another gap my field agency tries to step in and assist. On other islands, they have patient navigators and social workers who visit the patient’s home to assess for safety and provide support.
Addressing the Problem
A program that is established on other islands that have shown efficacious results is an integrative, collaborative care model. Collaborative care differs from one agency to the next but typically involves multiple healthcare professionals caring for a patient through effective communication and teamwork (Ee et al., 2020). My agency utilizes LSW and LCSWs to conduct a complex psychosocial assessment with the patient or the patient’s family to identify needs. That assessment is routed to the patient’s primary care physician (PCP) and a contracted psychiatrist. The psychiatrist reviews the evaluation, recommends appropriate interventions/medications, and works with the PCP and social workers to implement the recommendations and monitor the progress. “Outcomes studies support that collaborative care models are more effective than conventional care models for treatment of depressed mood, anxiety disorders, bipolar disorder, and schizophrenia, as well as treatment of individuals with comorbid physical conditions” (Ee et al., 2020, p. 5). Upon graduating and obtaining licensure, I hope to help build this model on my island to support my community better.
Question about Identified Need
A question often asked when assessing new programs or services is, “Will it work on our island.” Building rapport is vital for our community in any setting. Changes do not come easy. My question would be to my hospital’s leadership, who have mostly lived on this island for over 40 years, have we attempted a collaborative care model or something similar in the past? Was it effective? Why did it stop? As mentioned, this model has been effective on other islands across Hawaii, but there is no guarantee it will be here. So, I would like to know if it has been implemented before. If so, what type of results did the model yield?
References
American Foundation for Suicide Prevention. (2022). Suicide data: Hawaii. https://aws-fetch.s3.us-east-1.amazonaws.com/state-fact-sheets/2022/2022-state-fact-sheets-hawaii.pdf
Ee, C., Lake, J., Firth, J., Hargraves, F., de Manincor, M., Meade, T., Marx, W., & Sarris, J. (2020). An integrative collaborative care model for people with mental illness and physical comorbidities. International Journal of Mental Health Systems, 14(1). https://doi.org/10.1186/s13033-020-00410-6Community Gap in Services
I live on a small rural island in Hawaii. My current field agency is a clinical care coordination network that works with our hospital’s outpatient clinic. We support various post-hospitalization transitional services like mental/behavioral health integration, psychosocial support, nursing, medication management, and other care coordination services. A significant gap on my island is supporting individuals with mental and behavioral conditions. We have two psychiatrists that may fly in once a month and currently one LCSW living on the island. The need for more on-island mental health support is long overdue. The American Foundation for Suicide Prevention (2022) reports suicide is the second leading cause of death for ages 10-34 in Hawaii, and 85.78% of communities do not have enough mental health providers to support their residents. Before I began interning at my field agency, they had no on-island providers and were serving strictly through telehealth and telephone.
Additional Support
While Hawaii is considered one US state, it consists of eight major islands with vastly different resources, cultures, and population sizes. The island I live on is often called the “most Hawaiian island” due to its resistance to change from the traditional Hawaiian way of living. My full-time job is at my island’s only hospital as the Social Work Designee, and I am the only Social Services employee. So, any patient that comes through our emergency department, outpatient clinic, or women’s health clinic with a psych or social need, I am called. The patients we see who need a full psych evaluation or inpatient hospitalization must be transferred to a neighboring island hospital via air ambulance. The issue arises once the patient is discharged back to our island. The patient’s follow-up is often nonexistent, which is another gap my field agency tries to step in and assist. On other islands, they have patient navigators and social workers who visit the patient’s home to assess for safety and provide support.
Addressing the Problem
A program that is established on other islands that have shown efficacious results is an integrative, collaborative care model. Collaborative care differs from one agency to the next but typically involves multiple healthcare professionals caring for a patient through effective communication and teamwork (Ee et al., 2020). My agency utilizes LSW and LCSWs to conduct a complex psychosocial assessment with the patient or the patient’s family to identify needs. That assessment is routed to the patient’s primary care physician (PCP) and a contracted psychiatrist. The psychiatrist reviews the evaluation, recommends appropriate interventions/medications, and works with the PCP and social workers to implement the recommendations and monitor the progress. “Outcomes studies support that collaborative care models are more effective than conventional care models for treatment of depressed mood, anxiety disorders, bipolar disorder, and schizophrenia, as well as treatment of individuals with comorbid physical conditions” (Ee et al., 2020, p. 5). Upon graduating and obtaining licensure, I hope to help build this model on my island to support my community better.
Question about Identified Need
A question often asked when assessing new programs or services is, “Will it work on our island.” Building rapport is vital for our community in any setting. Changes do not come easy. My question would be to my hospital’s leadership, who have mostly lived on this island for over 40 years, have we attempted a collaborative care model or something similar in the past? Was it effective? Why did it stop? As mentioned, this model has been effective on other islands across Hawaii, but there is no guarantee it will be here. So, I would like to know if it has been implemented before. If so, what type of results did the model yield?
References
American Foundation for Suicide Prevention. (2022). Suicide data: Hawaii. https://aws-fetch.s3.us-east-1.amazonaws.com/state-fact-sheets/2022/2022-state-fact-sheets-hawaii.pdf
Ee, C., Lake, J., Firth, J., Hargraves, F., de Manincor, M., Meade, T., Marx, W., & Sarris, J. (2020). An integrative collaborative care model for people with mental illness and physical comorbidities. International Journal of Mental Health Systems, 14(1). https://doi.org/10.1186/s13033-020-00410-6Community Gap in Services