The Scheme takes place in two phases: Befriending and Outreach, and Direct Assistance. The Befriending and Outreach phase consists of home visits to patients for preliminary information-gathering, building rapport and trust, allowing the patients to gain familiarity and comfort with MKAC’s caseworkers and services. Direct Assistance consists of intense and focused support from MKAC to address critical needs which have fallen through the cracks of currently available services.
Privacy and Comfort for Kidney Patients:
Patients may not be able or willing to adequately and accurately share about their situations when conducting a case interview in MKAC premises. MKAC has observed a difference in the quality of information-sharing when interacting with the volunteers in the comfort of their own homes. The privacy and dedicated attention provided to each individual patient (rather than in an open group setting) help in the quality of sharing and improve counseling of patient condition.
Build Sustainable Future:
While it remains important to consider long-term solutions for patient welfare, some patients face immediate and critical threats to their basic health, shelter and physical well-being. Some are “borderline” cases that were either not qualified to receive vital support from available services. The urgent need of these families at risk may not be apparent based on current evaluation reports from existing services, but become clearly critical when an in-person home visit is made.
If the families do not break out of these immediate risk areas, they are trapped in a vicious cycle of poverty and distress. This trap has led to ill-health, starvation, bankruptcy, homelessness and even risk of death when treatment for chronic illnesses is not obtained. Focused and targeted assistance is urgently needed to relieve these immediate risk areas. Patients and families will then no longer be under duress, giving them a stable starting point to explore sustainable and viable solutions to other challenges.
The two-phased approach for VBS is implemented in a systematic manner outlined below:
Befriending and Outreach
Volunteer Befrienders (VBs) are briefed regarding the patients whom they are visiting, prepared with prior case reports and a timetable for the day. Patients would have given their permission before home visits are conducted.
MKAC sends 2 VBs to each household. During each visit, which lasts between 1-3 hours, VBs interact with the patient, main caretaker(s) and other family members if present. They make both visual and cognitive observations, paying attention to family dynamics, basic security and living conditions, income and education.
VBs close the visit by inviting the patients’ family to MKAC’s programmes. Families are given tokens from MKAC in thanks, and updated literature on MKAC programmes and services.
MKAC staff and VBs debrief after they discuss the observations about each family and evaluate which families should receive Direct Assistance. Each VB pair updates the case reports for each family visited.
An agenda of a typical Befriending and Outreach day is provided in Exhibit 1. Also attached as Exhibit 2, are the Guiding Principles for Volunteer Befrienders, which govern how VBs conduct themselves during home visits.
After the first home-visits, MKAC identifies families who should receive further support from Direct Assistance. Caseworkers are now assigned to the identified families.
Caseworkers analyze the financial, social and psychological situation of each patient based on the principle that all available resources that can be mobilized within the timeframes applicable. Please see Exhibit 4 for a tabular framework of the Direct Assistance analysis.
Caseworkers clearly document the actions taken and individuals/ organizations interacted with, to ensure continuity through each case report. These case reports are the cases on which MKAC and other organizations evaluate the effectiveness of actions taken, to ensure that patients’ and families’ welfare has definitely and sustainably improved.
The MKAC Volunteer Befrienders Scheme (“VHBS”) was launched in 2006 to provide a direct form of quality sustainable assistance to kidney patients and their families. Since then, it has evolved from a home-visit programme to a systematic and targeted approach of providing critically-needed support to supplement the assistance from other sources. The programme is now called Family Case Management Project.
Reasons for distress may stem from psycho-social, health or financial conditions surrounding not only he patient but its family members. Home visits allow volunteers/caseworkers to interact with other members of the family. Living conditions and family dynamics are observed not just verbally but also visually first-hand. As signs of trouble may not be apparent when patients are not at home, this improved information-gathering process provides better context and deeper understanding for all factors that contribute to a patient’s condition – and more importantly, reveals opportunities for MKAC to identify and address the root causes.
The above observations have helped us focus the efforts of the VHBS, leading to the development of today’s 2-phased approach to productively utilize caseworkers’ and volunteers’ time.
MKAC has targeted the following beneficiaries for each of the phases in the programme:
- Befriending and Outreach: Kidney patients/families in MKAC’s database, compiled from referrals by fellow organizations, or from MKAC’s other programmes. MKAC’s database identifies over 300 such families in MKAC’s database.
- Direct Assistance: 30 families who have been identified by either MKAC or referral organizations as critically in need of assistance.
The VHBS’s operations have evolved over the past 2-3 years to better meet the needs of the patients and their families. VHBS aims to achieve the following programme goals:
- Break the vicious cycle of poverty, illness and distress that inhibits independence and basic welfare of patients and their families.
- Provide immediate support for critical issues affecting basic health, safety and welfare of patients and families and families to live under humane conditions with basic dignity.
- Assist patients and families to achieve stability in order to find sustainable and viable options for their future.
- Advocate for and obtain patients’ rightful benefits with the help of other organizations and individuals.
- Identify and build constructive relationships with other organizations and individuals that can help address issues that affect patient welfare.
- Report objectively and transparently on the assistance rendered to patients and resources expended for such assistance.
- Effectively and transparently use provided budget to offer best assistance in the most direct way possible for the patients’ benefit.
- Establish rapport and gain the trust of patients and their families in their own homes.
Since 2006, the VHBS has visited over 100 families. The increase in the number of families who subsequently participate in MKAC programmes over the past 2 years is proof of success in our outreach activities.
Since late 2008 we have refocused our resources on Direct Assistance to a priority list of families that need critical assistance. So far assistance has been provided in the form of direct financial aid, liaising with government officers, assisting patients in court appearances, advocating with homes/care centres, case discussions with other agencies, family counseling, liaising with hospitals and doctors, sourcing for home-help and cleaning services, replacing/ replenishing necessary household items, etc.
Our work is still continuing, but we have seen indications of success in these areas:
- Improves living conditions or home care for those medically unfit to care for themselves
- Obtained financial assistance from various agencies for families that were previously unsuccessful in their applications
- Successfully placed patients in jobs after immediate at-risk areas of medication and shelter were resolved
- Demonstrated improvement in family income due to job placement
- Returned patients’ children to education with adequate pocket-money and supervision
Following the two-phased approach, VHBS has set the following targets:
Befriending and Outreach
- Visit 50 families in MKAC’s database
- Increase recruitment of volunteers to provide sufficient support for the visit target
- Update home visit checklist/report requirements to be reflective of current challenges
- Update status of case reports of families visited