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A typical day on the child and adolescent hospital units at Spring Harbor begins with the assignment of patients who were admitted to the hospital overnight. Patient treatment needs are then evaluated during interviews with the individual and family members. The results of this evaluation are discussed with various members of the treatment team - psychiatrists, nurses, program managers, and occupational therapists and discharge planners, as necessary. Together with patients and families, a customized treatment plan for each individual is created.
The day is filled with meetings with individual patients and their family members, many of which are therapeutic in nature. Collateral work includes phone calls to families, schools, and other mental health agencies, and of course documentation of the treatment provided to patients and their daily recovery progress.
The social workers and clinical counselors at Spring Harbor see themselves as advocates for child and adolescent patients and their families. They interact with the community at large, as well.
Ultimately, social workers and clinical counselors on the child and adolescent treatment units provide patients and families with skills and information that helps them begin the healing process and prepare for discharge and improved functioning at home, school, and in the community.
In the Child and Adolescent Outpatient Psychiatry Clinic at Maine Medical Center, the day begins with reviewing the charts of patients to be seen that day by each therapist. Individual therapy sessions with children and teens make up the majority of the day, as well as treatment sessions with their parents and families. Each social worker / clinical counselor sees between seven and ten patients and families per day.
Between appointments, therapists place phone calls to parents, schools, probation officers, and other outside caregivers and contacts to follow up with patient treatment plans. Occasionally conference calls or face-to-face meetings are held with insurance companies to provide details about the treatment progress of particular clients or families. Time is also allocated to writing treatment progress notes on patients and consulting with physicians and other clinicians.
The role includes the challenge of treating patients and families who are in pain, but also the reward and satisfaction of hearing stories of survival, celebration, and growth. For many, this part of the job is the most meaningful, and the very reason why they joined a psychiatric practice in the first place.
PIER Program Services
Through early intervention, the Portland Identification & Early Referral (PIER) team seeks to stem the progression of serious mental illness, resulting in healthier children and adolescents, healthier families, and healthier Maine communities. The program's social workers and clinical counselors work as part of a team to stem the progression of serious mental illness in young people. They spend part of their time conducting individual therapy sessions with children and adolescents - some of it planned, and some unplanned, due to crisis situations. They also meet individually with families and hold orientation sessions and multi-family meetings to assess and discuss symptoms that could signify possible mental illness. Gathering family histories, providing an overview of the PIER model, and reviewing the consent and assent process for the PIER clinical and research program are additional responsibilities.
Twice per week, multidisciplinary team meetings are held to review current clients, discuss new patients and consult on urgent cases. Each day involves making notes of client progress and communicating with appropriate treatment and community contacts.
Following a review of recent admissions and the assignment of new patients to their caseloads, social workers and clinical counselors on the hospital's adult units meet with the patient treatment teams, which include psychiatrists, nurses, occupational therapists, and others. In the treatment team setting, they review the progress and current status of all patients. They then interview patients with a psychiatrist also participating. In the afternoon, social workers and clinical counselors meet with patients individually and with their families to discuss treatment goals and plans for discharge from the hospital.
Adult inpatient social workers and clinical counselors who work with adults also perform psychosocial assessments, attend network meetings, facilitate meetings with community agencies and/or family members, and work with discharge planners to create appropriate plans for patients who will need additional assistance once on their own. Much of this work is completed via phone and email between patient meetings and treatment sessions.
In this fast-paced role, social workers and clinical counselors work hard to meet the current treatment needs of patients and families while also helping build bridges of care and support for them once they leave the hospital. Providing the highest quality, most efficient yet respectful and individualized care is a special talent of this group of caregivers.
Social workers and clinical counselors in the Adult Outpatient Mental Health Clinic at Maine Medical Center offer both individual and group therapy sessions. Sessions range from high-acuity individual therapy to groups for cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), anger management, transsexual therapy, and co-occurring disorders. Social workers and clinical counselors work in teams with psychologists, nurses, psychiatrists, and residents to formulate and refine treatment plans for patients and groups on a daily basis.
Between sessions, therapists respond to calls, consult with other members of the team, and complete necessary treatment documentation. Those employed by the Partial Hospital Program spend much of their time on case management, advocacy, and crisis management, since their clients typically have more intensive treatment needs.
Many therapists in the clinic teach, both formally and informally. In addition to providing education to therapy groups and clients' family members, they also teach psychiatry residents, medical students, nurse practitioners, and social work interns in CBT, DBT, group therapy, and family and couples counseling.
Most therapists in this setting say the day simply flies by. The role is challenging, sometimes exhausting, but always very interesting and filled with opportunities to help individuals who need it most.
Days on "P6" - the geriatric/medical psychiatry unit at Maine Medical Center - begin with a staff meeting. Here, newly admitted patients are assigned to multi-disciplinary treatment teams, patients being discharged from the hospital are announced, and any medical/psychiatric/behavioral issues from the night before are reviewed and discussed. Next, the social worker, attending psychiatrist, occupational therapist, registered nurse, care coordinator, and other treatment team members hold patient rounds to review and discuss treatment plans and formulate care plans for new patients. The social worker reviews all treatment and discharge plans with patients and/or families and guardians.
In the afternoon, the social workers hold family and patient discharge meetings. As the main contact with family members, social workers lead family meetings, field questions, provide psychiatric education, and offer information about community resources. They also coordinate aftercare services to help ensure successful transitions from the hospital. This is also the time for individual therapy sessions, phone calls and emails, and the writing of progress notes concerning each patient in their care.
Social workers on P6 know that their communication with families, outpatient treatment providers, and aftercare facilities is an essential ingredient in the smooth transition of patients from the hospital back into the community. Ensuring the best care, both in and outside the hospital, is always top of mind in this role.
There is no "typical" day in the delivery of acute psychiatric care within an emergency room setting. This is what some of the social workers in this treatment area like best about their work. They are flexible and ready for anything. In the same day, they may see a suicidal teen, an elderly person with dementia, a woman experiencing flashbacks from a trauma, and an intoxicated homeless man in despair.
These scenarios are common to social workers within the "East Wing" of the Maine Medical Center Emergency Department, where a 6-bed secure area exists for the treatment of patients who arrive with a complaint that is primarily psychiatric in nature. The area is staffed around the clock by a social worker and registered nurse, with an attending psychiatrist, psychiatric resident, or physician assistant available for consultation and backup at all times.
The social worker's main role is to quickly assess the level of care that is appropriate for each patient who arrives in psychiatric crisis. Sometimes the social worker provides an intervention - such as brief, supportive therapy and a referral to outpatient care - to those with less severe symptoms. For those with the most intensive treatment needs, social workers will arrange for admission to a psychiatric hospital unit. As needed, they also provide psychiatric consults to medical patients receiving treatment in the main emergency room.
Professionals in this role are experts in helping patients and family members cope with and understand psychiatric crises. In addition to rapid psychiatric assessment, they provide a calm and supportive presence that can make all the difference to a patient or family in crisis.