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===Social Work Consultation Guidelines===

*Consult Social Work early if you anticipate any issues so they can get things during business hours and get to families before they leave.  Consult by placing a social work order in Orchid (documents consult time). 
*  Refer also to [[Harbor:Social_EM_resources|Social EM Resources]]
*  When discharging Homeless patients but still waiting for Social Work:
** ED Provider discharges patient, and fill out the Homeless Discharge Form in the depart process (offered a meal, Hep A or COVID vaccines, weather appropriate clothing, outpatient medical and/or mental health resources, prescriptions, etc.) 
** ED RN: discharges and departs patient off the track, places a patient sticker on a paper log at the Router Desk for SW/HTF
** SW/HTF will assess patient, explore placement opportunities and give resources as available for patient. 

====1. SW Order Indications====

Choose the indication that best fits your clinical need/question. Special instructions are helpful.

=====Lack of Resources=====

Those who need help connecting with resources (financial, placement, housing, food, transportation, etc)
*"Community resources" - food banks, gov benefits
*"Disability" - how to apply for disability (not for filling out application itself)
*'''Discharge planning/placement''' - when a patient needs placement to a facility of lower acuity than an acute care hospital (not to be used if homeless)
*"'''Homeless'''" - for housing/resources. If patient has chronic physical and mental health problems, ask for patient to be signed up for Housing for Health.
*"Hospice" - still need to place a [[https://wikem.org/wiki/Harbor:Home_Health| home-health order]] (only if going home on hospice, not a care facility)
*[[https://www.wikem.org/wiki/Transportation_Needs| Transportation Needs]]
*'''Crisis/Trauma''' - SW is consulted automatically for all TTAs. Consider also consult order for referral to Trauma Recovery Center and Violence Intervention Prevention program if victim of violent crime (shooting/stabbing, etc.)

====Poor judgement/Substance Abuse====

*"Behavioral issues"
*'''EtOH related trauma''' - SW provides a screening & brief intervention
*Non-compliance 
*Poor communication 
*'''Positive toxicology screen''' - mainly used in peds
*Refusal of treatment 
*'''Substance abuse''' - SW will provide screening & brief intervention

====Psychosocial Support====

This category has a lot of overlap with psychiatry.

*"'''Adjustment to illness'''" - for psychosocial assessment by SW, help provide coping skill
*"Anxiety"
*"Crisis/trauma" - see above
*"Depression"
*"'''End-of-life issues'''" - for family or patient, help with GOC discussions
*"Family conflict"
*"'''Grief/bereavement'''"
*'''Mental health''' - SW can provide more resources than just the DMH list, provide full assessment of patient's financial abilities and other social factors
*'''High risk pregnancy or Teenage pregnancy''' - provide resources & support

====Regulatory/Legal Issues====

*Adoption
*Advanced directive
*AMA
*'''Domestic Violence''' 
*'''Reportable pressure ulcer''' - Stage 3+ ulcers upon presentation. SW will contact adult protective services (if coming from home) or ombudsman (if coming from a health care facility).
*'''Suspect child abuse'''
*'''Suspect elder/dependent elder abuse'''
*'''Unidentified person'''
** [[Harbor: Identifying Jane/John Doe, finding next of kin tips]]


==== Other Social Determinants of Health Resources====

* '''Re-entry''' (released from prison <6 months with medical, mental health, substance abuse, or social needs) 

* '''Medically Complex''' Transitions of care (includes 3 visits to  ED in past year) 
** ORCHID Message/Call/Text Rosario Aliviado - Social Work Supervisor.  Please include MRN, pt phone number, and reason for referral. 
*** 21x.294.8908.  She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.

* '''Mental Health'''
** Residential & Bridging Care (transition from mental health institution to community)  213.738.4775
** Intensive Service Recipients  (mental health with 2 or more admissions in year, recent DC from psych hospital)  844.804.5200

====2. Transportation home:====
[[Harbor:Main#Transportation_Needs|Harbor Transportation Needs]]

====3. Patient who are homeless:====

a. Homeless Task Force - p1735 
*looking for patients with chronic illness (HTN, diabetes, psych, etc) who have had 2+ visits.  
*Put in s/w consult and choose "Homeless" under reason for consult, NOT "Discharge planning/placement".  
*If eligible - they will help sign up the patient - however, they may be on a waitlist for days to months. 

b. Can be given packet of resources by clerk's station or with SW discussion

====4. Patients whom family is no longer able to take care of====

Please page social work asap - before family leaves - s/w will work with them to see if:

a. IN HOME SUPPORT SERVICES (IHSS) - Medi-Cal program - can either be started or have hours increased (to help with supervision, cooking, bathing, grocery shopping, other ADLs)

b. other community resources are available 

c. consider [https://www.wikem.org/wiki/Harbor:Home_Health home health] referral

d. if family dumps patient and doesn't respond, s/w may file an adult protective services report

e. if the patient truly needs to be placed, run Interqual, try to transfer/admit to obs/short stay for placement

====5. Pt/family not happy with current skilled nursing facility (SNF)====

a. generally, this is not an appropriate use of the ED - the family needs to work with the SNF s/w to facilitate transfer to another SNF, exception point c. below

b. if actual abuse, s/w at Harbor can help with ombudsman report

c. APPROPRIATE if pt needs a HIGHER level of care b/c of medical needs - then s/w at Harbor can help  

====6. Clothing rack / clothing for patients====

Nursing and social work have access ('Harbor Rack' outside in ambulance entrance)

====7. Patients who need PT/OT for placement====

a. Admit patient to obs/short stay for placement and PT/OT evaluation 
b. In rare circumstances, may need to order PT/OT to be done in the ED.

==References==
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