The effectiveness of case work treatment in a team approach to rehabilitation of rheumatoid arthritis patients : (Rheumatic Diseases Project, Rheumatoid Arthritis series, Canadian Arthritis and Rheumatism Society, British Columbia Division

The Canadian Arthritis and Rheumatism Society, British Columbia Division has envisaged research as an important and integral part of its objectives and in February 1951 embarked upon an intensive study of the usefulness of cortisone in long-term medical treatment of the rheumatic diseases, including a series on Rheumatoid Arthritis. A comprehensive program of medical treatment has been put into effect, including the services of social workers. It is essentially a team approach to the aim of physical rehabilitation and a return to gainful employment. The present study is directed to the evaluation of the case work treatment offered to those patients selected to participate in the Rheumatic Diseases Project, Rheumatoid Arthritis Series on Cortisone Therapy. Within a predominantly medical setting the function of the case worker has been considered from the viewpoint of what is expected of her by the medical profession and what might be expected from her as a professional social worker. Two methods of assessment were employed both based on evaluation of each case according to selected case work criteria and the premise that effectiveness of treatment depends upon the appropriate use of skills in relation to the degree of treatability of the patient. The first approach made use of the available case records as far as possible. The second was the device of a Rating Scale devised for the purpose and completed by a group of social workers for each patient worked with. The goals aimed at by the Medical Committee responsible for the project were stated as "physical rehabilitation and a return to gainful employment". Medically the cortisone therapy was successful in effecting enough physical improvement for a patient to become potentially employable. Socially results were discouraging because emotional difficulties and the non-availability of suitable positions prevented the actual return of many patients to gainful employment. The Long-standing personality problems, characterizing this group of patients, precluded the use of intensive case work techniques in roughly 75% of the cases. The evidence is that face-to-face interviewing involving the skilled use of relationship is not appropriate and that supportive technigues designed to prevent further deterioration, alone are relevant for the majority. Sound social diagnostic evaluations with the use of appropriate treatment methods are essential. It is suggested the reality of the team approach should he made available, and that more use should be made of social work skills in the selective screening of applicants for rehabilitation, and that the contributions of social work in the total team plan merits deeper exploration.Arts, Faculty ofSocial Work, School ofGraduat