NASW continues to partner with other health organizations in developing and promoting toolkits that assist clients with transitions of care between health care settings and practitioners.
In October, the National Transitions of Care Coalition, of which NASW is an Advisory Task Force member, announced the release of Spanish and French translations of the client/caregiver tools "Taking Care of My Health" and "My Medicine List." NASW assisted in developing the English version of the tools, which became available to the public in 2008.
The translated versions serve as a proactive step toward meeting the needs of the growing diversity in the United States, according to NTOCC.
"French and Spanish are the two most requested translations in our tools portfolios," said Cheri Lattimer, executive director of the Case Management Society of America and project director of the NTOCC.
Chris Herman, senior practice associate at NASW, said the guides help consumers monitor and maintain control of their health care. Such tools can help ease transitions of care among health and behavioral health settings and providers, she said.
"Tracking health information is especially critical for older adults and other people who may have multiple chronic conditions or who see several providers," Herman said.
She stressed, though, that the tools are beneficial for people of all ages and health conditions. "They can be helpful whenever you might be in an emergency situation or whenever you have to answer a long list of questions for a health care provider," she said.
Dyan Bryson, national director of Community Health Partnership at Sanofi-Aventis U.S., a global pharmaceutical company that sponsors NTOCC, said the translated tools will be a major step in providing much-needed health care information in Spanish-speaking communities.
"They will provide patients and their family caregivers valuable help in their native language and in a format which they can understand, put into practice and use to communicate through translators in hospitals and clinics," Bryson said.
NTOCC has also assisted in developing the Consumers Advancing Patient Safety toolkit, "Taking Charge of Your Health Care: Your Path to Being an Empowered Patient," which health care professionals can use to help clients prepare for hospital discharges. The toolkit includes five documents for clients and caregivers, including tips for communicating with the health care team, a glossary of commonly used health care terms and a form to guide post-discharge care. It also includes links to other resources, such as NASW's consumer Web site www.HelpStartsHere.org, and tips to help clinicians communicate effectively with patients during hospital discharges.
NASW, represented by member Mary Freeman, also teamed up with the Centers for Medicare and Medicaid Services to develop the "Planning for Your Discharge" checklist for patients and caregivers preparing to leave the hospital, nursing home or other health care setting.
The 16-item checklist, which highlights the role of social work in helping clients clarify benefit coverage and obtain community resources, includes toll-free phone numbers and Web links to publicly funded agencies
Herman said in addition to helping clients prepare for and cope with transitions of care, one goal of the NTOCC, CAPS and CMS tools — and part of social workers' role — is to prevent unnecessary transitions by enhancing communication among professionals and between clients and professionals.
"For example, a home health patient may not need to go to the hospital if the home care team can coordinate care with the physician to address the problem at home," Herman said.
The same is often true in nursing homes. NASW member Shelley Schneider represented NASW in evaluating components of a toolkit called "Interventions to Reduce Acute Care Transfers" or INTERACT II. This toolkit provides tools to enhance communication among nursing home staff, and between staff, residents and family caregivers about resident status. Nursing home social workers can use the toolkit to aid them in conversations with residents and families about a resident's condition, including what sort of medical care the resident wishes to receive or not receive, Herman said.
"Such communication, when documented appropriately, clarifies the resident or, if appropriate, the family's wishes, thereby preventing unnecessary transitions," she said.