Phone Call

Calling a referred patient was nothing unusual for Perelman School of Medicine student Bianca Nfonoyim. As part of her social work elective during her final semester of medical school this spring, she received referrals of people needing assistance through a COVID-19 hotline. One call, however, stood out. A man, who was COVID-19 positive and in self-quarantine, explained how he only had one or two pills left for his blood pressure medication and urgently needed more. Understanding his distress, Nfonoyim felt determined to help him if she could. Calling community resources and connecting with other hotline team members for advice, she coordinated to get the man an emergency one-month prescription, which one of his friends was able to pick up and deliver.

Nfonoyim was part of the COVID-19 Social Needs Response Team, which serves to assist people experiencing distress, having safety concerns for themselves or others, or seeking immediate social needs such as where to find community resources for housing, transportation, or food security. For example, the team has been able to quickly secure temporary housing for many patients diagnosed with COVID-19 without a safe place to quarantine. Multiple referral sources contact the team, including clinical providers, testing sites, and Penn Medicine’s COVID-19 ChatBot. The program was developed by Penn Medicine’s Center for Health Equity Advancement in partnership with the Department of Case Management and Social Work.

Shortly after the program’s initial launch in April, Jaya Aysola, MD, DTMH, MPH, founder and executive director of the Penn Center for Health Equity Advancement, had the idea to recruit medical students to work alongside the social workers, to not only receive elective credit, but also to gain a better understanding of the work other team members contribute to the health care system.

“The program allows students to work alongside and learn from social workers in an interprofessional virtual team to assist people with their most pressing social needs during this crisis,” Aysola said. “Such a program helps to fulfill both a service mission and an educational mission during this unprecedented time.” Having medical students on the team provided an “undeniable” benefit for the service mission, Aysola added. “Their comfort with technology, abilities to navigate this virtual landscape, and dedication to serve are key strengths that enhanced our program and helped our health system better care for our patients.”

Amid the uncertainties of the last semester of medical school for Nfonoyim and her roommate, Joy Obayemi, among other classmates — the pandemic cancelled their clinical rotations and in-person courses — the opportunity to join the team not only allowed them to gain elective credit, but it also sparked a newfound interest in their career path.

“For me, one of the biggest highlights of this program was really understanding what social workers do, learning all the resources that they’re able to provide and their varied job descriptions,” Nfonoyim said. “That’s something we didn’t get a lot of exposure to throughout medical school.”

Obayemi agreed. “I always thought of social workers as magicians of the hospital,” she said. “If a patient needed something, social work would somehow find a way to make it happen and I always wondered what the process looked like.”

Medical students joined the team remotely on April 13. In each virtual orientation session, two to three students worked with a social work supervisor. A leadership team comprising Aysola, Deborah Lowenstein, LCSW; Preeti Advani, MSW, LSW; Patricia Meehan, LSW; Rosemary Thomas, MPH, CHES; and Heather Klusaritz, PhD, MSW, familiarized the students with the protocols for patient interaction and how to navigate the technical aspects of the program. The students learned about crisis intervention theory and empathetic inquiry, how to compassionately communicate with patients over the phone, and how to best connect them to resources. Even after the orientation, the social workers continued to provide support and were just a phone call away if a student needed assistance with a case. And despite only having virtual contact with them (never face to face), the students’ dedication to the team and their willingness to help the community endeared them to the social workers.

“The medical students were passionate, and they were all in,” Lowenstein said. “It wasn’t about being a medical student; it’s ‘I’m helping the community. I’m all in and you teach me what I need to learn.’”

“One patient said to a student, ‘This phone conversation is a miracle happening in my life right now. This is the most actively that I’ve been taken care of by a health care system in my entire life,’” said Advani, who is informatics manager for Case Management and Social Work. Another patient said, “You are heaven on earth as far as I’m concerned.”

Finding Hard-to-Reach Patients

The team has emerged as a resource the Health System turns to when there is a need to find hard-to-reach patients. “It’s like being a detective,” Aysola said. When a patient’s test result is COVID-19 positive, a case report is first filed with the Department of Health. There are some instances, however, when a patient is difficult to find, making them unable to learn their test results. This can be due to the patient not having stable housing or access to a phone. The team first reaches out to any emergency contacts the individual has provided or tries to find updated contact information from any health care providers the patient may have seen. The next step would be to reach out to local shelters and other community resources, and if still no sign of the patient, then a case is closed with the Department of Health. However, the team is able to find nearly half of these patients.

“It was an unexpected and challenging part of the role, but a lot of learning came from that,” Nfonoyim said. “Those moments when we could find patients were very rewarding.”

With the success of the program, helping more than 300 individuals so far, the program was expanded to include Penn Nursing students, and there are hopes to possibly implement the program at other institutions.

“Interprofessional education is such an important part of medical student training. We welcome any opportunity for our medical students to partner with social workers as early as possible,” said hospitalist Nadia Bennett, MD, MSEd, associate dean of Undergraduate Medical Education Clinical and Health Systems Sciences Curriculum. “They can learn from and work alongside these professionals early on to provide excellent patient care while also making a meaningful difference in the community.”

After graduating from PSOM and beginning their residencies, Obayemi (now at the University of Michigan for General Surgery) and Nfonoyim (Children’s Hospital of Philadelphia for Pediatrics) are continuing their training with a newfound appreciation for social work .

“I feel more confident going into residency thinking about the different needs that my patient will have and things I can specifically ask social work for,” Nfonoyim said. “Just having these resources in the back of my mind will help me develop more specific plans for my patients.”

“I was amazed by how confusing things were, and if I’m confused — someone who has relative knowledge of the medical system — then how do we expect patients to navigate resources on their own?” Obayemi said. “The fire this program has lit in me will impact my future patients. I’ll work to make sure they have their needs met.”

TO CONTACT THE COVID-19 SOCIAL NEEDS RESPONSE TEAM, call the hotline at 267.785.2019, Monday-Friday, 8am-8pm or connect via the Epic pool titled “COVID-19 SOCIAL NEEDS.”

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