Clinical social workers and the science of caring

Christina Cabanillas
Christina Cabanillas, L.C.S.W.
Cancer attacks more than just a body — it can affect every aspect of a patient’s life, causing stress and depression as well as family, work and social issues. City of Hope understands that addressing a spectrum of factors with holistic, science-based interventions is the key to managing treatment for the best possible outcome. 
That’s where clinical social workers come in, essential members of the Department of Supportive Care Medicine who serve as partners throughout the entire journey. The 31 social workers at City of Hope are a hub, of sorts, in a network of services and caregivers that patients can access all in one place, said Christina Cabanillas, L.C.S.W., manager in the Division of Clinical Social Work.
The DSCM is a multidisciplinary team of experts who have a shared vision and mission to focus on a whole-person and patient-centered approach to care,” she said. “It has experts in the areas of social work, supportive medicine, spiritual care, psychiatry and psychology. There are Child Life specialists, patient navigators and educators. And clinical social workers are central partners within this health care team.”
Clinical social workers identify sources of distress and teach coping skills to manage the challenges that come with treatment, using evidence-based methods to improve lives and outcomes. They also connect patients to community resources for mental health services and support groups, as well as financial and transportation assistance.
We collaborate closely with medical teams to improve the patient and family’s experience, serving a wide range of patients and situations,” Cabanillas said. “There are social workers dedicated to understanding the needs of couples coping with breast cancer, as well as supporting patients and their caregivers prior to and following transplant treatment.”

Science and soul

Battling cancer can seem overwhelming at times, and City of Hope social workers are trained to help by providing science-based psychosocial therapies that take the entire experience into account, said Courtney Bitz, M.S.W., L.C.S.W., director of the Division of Clinical Social Work.
Courtney Bitz, manager of clinical social work, City of Hope
Courtney Bitz, M.S.W., L.C.S.W.
One of the most recent advances is psycho-oncology, an interdisciplinary approach that’s being widely incorporated into routine oncologic care. Simply put, it treats the psychological factors that patients and families face when dealing with the biological, social and behavioral aspects of cancer treatment.
Might sound dry and scientific, but psycho-oncology is really all from the heart.  
“Psychosocial oncology represents the very best of the science of caring,” Bitz said. Social support is consistently cited as one of the most influential variables in quality and length of life. Patients cannot judge the quality of our cutting-edge medical treatments, but they certainly know when our interventions are rooted in their values, include their loved ones, and maximize their strengths and internal resources.”    
The team at City of Hope also incorporates cognitive behavioral therapy to help manage persistent negative thoughts and replace them with a more helpful, positive mindset.
“CBT interventions have been shown to reduce symptoms of depression and anxiety, as well as reduce cancer-specific physical symptoms such as pain and improve quality of life for cancer patients,” Bitz said.
Negative thoughts can overwhelm the mind of a cancer patient at times — and they’re very often extreme and unrealistic. Cognitive behavioral therapy can reframe a patient’s outlook to help them see their situation in a more balanced, realistic light.   
Mindfulness, or meditation, also can be an excellent tool for coping with stress and fear. By quieting the mind, increasing inner awareness and calming the body, mindfulness has proven to be an effective tool, and one that can be combined with other therapies.

A team effort

Coordinating palliative care for patients facing the most advanced stages of disease — one of the most challenging aspects of social work — is the mission behind City of Hope’s integrated care services team. This multidisciplinary unit deals with complex and emotionally difficult issues for end-of-life patients and their loved ones.
I support my patients, their families and caregivers using evidence-based interventions that have been researched in the field of palliative and hospice care,” said Lucia Kinsey, a clinical social worker for integrated care services. “They have proven to produce positive results.”
The interventions are based on the individual needs of each patient and family, she said. For the most part, Kinsey uses proven therapies including mindfulness, cognitive behavioral therapy and supportive psychotherapy.  
“I meet with all of our integrated care service patients and families and conduct a biopsychosocial assessment to identify their needs, strengths and goals,” she said. “Then I provide psychosocial education about palliative care and the hospice medical philosophy. I also provide counseling to address anticipatory grief and bereavement.” 
The integrated care service transdisciplinary team includes a supportive medicine physician, nurse practitioner, clinical social worker, chaplain and hospice liaison. Having such a range of caregivers available in one place can help provide some peace of mind during the final stages of a disease, Kinsey said.
“We’re currently able to accept a total of eight patients at a time,” Kinsey said. “And given the specialty of our service, continuity of care and team approach, we are allowing patients to feel known, heard and cared for.”