Critical Analysis and Masters of Social Work Interview, Essay Example

Critical Analysis

Twin City Pediatrics is located in Winston-Salem, in the state of North Carolina. It started out as Forsyth Pediatrics at Medical Park for children in 2003. Their practice grew steadily and quickly and by the summer of 2008, they needed extra room. They moved into the new office at 2821 Maplewood Avenue. The name Forsyth pediatrics was changed to Twin City Pediatrics in October 2008. Through the years, they had exciting changes, but one thing that remained clear is the goal held by the health care organization of providing personal service and excellent care in a child-friendly environment(Alcalde, 2012). The provider type for the hospital is pediatric practices in three locations. The patients served within and without the state are approximately five thousand on an annual basis. This number covers in-patient, outpatient, and referral cases to the health care provider.

The philosophy in children pediatrics at Twin City Pediatric involves excellent care. This is ensured through a well-trained medical staff with certification and necessary experience for high quality care provision. The hospital pays special attention to children with server behavioral issues especially attention deficit hyperactivity disorder (ADHD) (Schweitzer & Cummins et al., 2001). The staff understands that caring for a child with mental illness or special needs presents many new challenges especially for parents. The frustrating health care experience for such parents in managing medication regimen and complex care plans, coordinating across multiple health care providers, as well as dealing with lack of support systems and educational resources are challenges dealt with at Twin City Pediatrics.

The team of competent care providers has endeavored to create a positive experience for children, caregivers, and parents in a patient-centered medical home environment. The focus from the initial set-up of the mental health department was to put a professional team in place, as well as identification of proper skill sets and roles to accommodate mental health needs and primary care of patients. In line with this, they have a care coordinator whose work is directly linked to ADHD and other conditions that have to do with behavioral health (Faraone & Sergeant et al., 2003). The care coordinator works with caregivers and parents directly to assist with medication plans and prescription fulfillment, as well as scheduling of appointments. In line with their personal care philosophy, the coordinator also reviews and signs forms required by schools and provide advice on specialty visits and therapy.

Twin City also works closely with families and parents in aligning care plans for ADHD patients with critical points on the school year calendar (Campbell, 2000). For instance, ADHD patients are advised to make sure they visit with their care team at least three times every year for well visits. Summer visits have their focus on modifying and reviewing medication plans for an upcoming school year. Visits during fall occur four to six weeks after the beginning of the school year with an aim of checking on effectiveness and progress while a spring visit is for checking-in before testing at the end of the year. The ADHD care plan at Twin City Pediatrics also monitors metrics such as percentage of patients with new diagnosis seen for follow-up within a month of beginning medication and those with established diagnosis seen more than once in nine months.

Overall, the primary care system at Twin City is strong. The other aspect that helps in maintaining quality service provision is the strong health IT infrastructure that enhances connections between community organizations and traditional health care providers. This has been instrumental in offering a network of support for families and patients to improve their care experience and gain better understanding of the impact of integrating community support, social, and medical services. The care model at Twin City is labor-intensive and requires maintenance of a large staff base. This additional expense is taken as a long-term investment, which results in high patient satisfaction recommendations and feedback. The organization anticipates benefiting from forthcoming payment reforms aimed at rewarding behavioral health and medical home competencies as part of enhancement to their return on investment. It is a fact that future payment reform and care delivery innovations’ alignment will continue strengthening Twin City’s role as a valuable partner in the medical neighborhood.

Masters of Social Work Interview

Linda: How did you become interested in working with children with psychological behaviors?
Karen: I completed a master of social work degree at the Grand Valley State University an enjoyed the behavioral side of mental disorders as well as working with children. I joined family outreach after my internship training. My interest in ADHD and behavioral disorders became apparent through this experience while in training through the number of ADHD patients that I was seeing. The majority of my time is spent completing assessments, making sure the individual is assign to some type of medication management, supervision, teaching, and educating teen parents.

Linda: How are patients referred to family Outreach Services?

Karen: We receive approximately 50 to 60 referrals each month. Most of the referrals that we receive come from the health organizations such as network 180, human services, schools, private patients, family doctors, and from pediatricians or mental health care providers.

Linda: What is the most common disorder you have observed in children?

Karen: Attention deficit/hyperactivity disorder is the most common behavioral disorder of childhood. Children with ADHD exhibit symptoms of inattention, hyperactivity, and impulsivity, and as a result, they frequently experience school problems, have difficulty with peers and family members, and show poor psychosocial development. They are at a higher risk for teen pregnancy, substance abuse, and other co morbid conditions, and they are more likely to drop out of school at an early age. Nearly all children with ADHD suffer from low self-esteem. ADHD is a chronic health condition, and early identification and treatment of the disorder increase the child’s chance for academic, emotional, and social success. If we let an ADHD child go untreated, we may well be handing that child a life sentence of academic and social failure.

Linda: How do you conduct an ADHD assessment?

Karen: ADHD assessments require a considerable amount of time and effort. At the center, we plan about four hours for an initial assessment. The diagnosis of ADHD requires that a child meet the criteria set forth in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). A complete assessment includes the following:

1. A complete history from the child’s parent or caretaker, including information about the child’s inattention, hyperactivity, and impulsivity, the age of onset of the symptoms, and the extent of the child’s academic and social impairment;
2. Behavior and academic reports, including report cards and samples of schoolwork, from the child’s school. It is also helpful to gather information from other collateral resources such as counselors, day care providers, or coaches if they have significant contact with the child.
3. Use of ADHD-specific behavior rating scales and questionnaires. Scales are used in an attempt to quantify the level of the child’s impairment. All kids have some characteristics of ADHD. However, if a child has ADHD, the symptoms will be clinically significant for longer than 6 months and will manifest themselves in at least two environments, typically at home and at school. The scales also assist us in establishing a baseline so that once the condition is treated; we have something against which we can measure improvement. A complete physical examination, including a neurological examination if indicated, to determine if there is a physical reason for the problem, such as a visual or hearing impairment or a genetic disorder;
4. An interview with the child separate from the physical examination;
5. An assessment for co-existing conditions. There are a number of look-alike and/or co-occurring disorders associated with ADHD – depression, anxiety, substance abuse, learning disorders, conduct disorder, oppositional defiant disorder (ODD), and Tourette syndrome to name a few.

Linda: Is the evaluation and treatment for boys different than for girls?

Karen: The assessment and the treatment are the same. However, if the patient is a hyperactive, impulsive child, that child will require more intervention. And, since boys tend to be more hyperactive than girls, boys will often require more intense intervention than girls.

Linda: Describe how you treat a child with ADHD.

Karen: Once the diagnosis is made, we develop a child-specific treatment plan that includes goals, methods of treatment, patient education, a system for monitoring progress, and plans for follow-up.

Linda: Are there areas that still need improvement?

Karen: Continuous improvement is always needed. As you stated earlier in this interview your research paper for your master’s program concerns psychological support for teen moms, which also includes a need in developing a better understanding of ADHD in girls, is an excellent place to start this research. Further research needs to be done with regard to the diagnosis and treatment of ADHD in adolescents. However, there is very little information in the literature on ADHD and multicultural issues as well, as I hope to see some day new research generated in this particular area.

Linda: Thank you for taking the time to share your masters of social work knowledge and experience with me in this interview.

References

Alcalde, G. (2012). Integrating Care for Better Health. The British Journal of Psychiatry, 200 (6), pp. 442–443.

Campbell, S. B. (2000). Attention-deficit/hyperactivity disorder. Springer, pp. 383–401.

Faraone, S. V., Sergeant, J., Gillberg, C. & Biederman, J. (2003). The worldwide prevalence of ADHD: is it an American condition? World Psychiatry, 2 (2), p. 104.

Schweitzer, J. B., Cummins, T. K., & Kant, C. A. (2001). Attention-deficit/hyperactivity disorder. Medical Clinics of North America, 85 (3), pp. 757–777.