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To improve participation in outpatient programs, social workers can identify and address client barriers to keeping appointments, such as inadequate transportation, non-cooperative employers or family members, limited financial or child care resources, or even poor client motivation. Pairing newly diagnosed patients with "diabetic sponsors" -- individuals who are experienced and successful at managing their diabetes -- also may enhance attendance. Rather than relying on clients to come to clinics, social workers may need to bring the clinics to clients by organizing diabetic health fairs, outreach, or training programs in work settings, church facilities, or community centers. It is related that: "For people with Type 2 diabetes, Medical Nutritional Therapy (MNT) is often the "first-line therapy of choice" (Lipkin, 1999). The goal of MNT is to maintain near-normal glucose levels by matching dietary consumption with actual caloric (energy) needs, necessitating that the right foods in correct proportions be eaten at prescribed times for many MNT may include a secondary goal -- weight loss. Nutritional self-management or compliance with a prescribed diet can be handicapped by many of the same factors that impede self-care knowledge and skill mastery. In MNT, food assumes an almost medicinal quality, and many may resist altering long-held consumption patterns, inasmuch as food plays a part in their cultural heritage or serves as a source of pleasure; therefore, dietary changes are interpreted as loss of either function. For some patients, making these lifestyle changes may require assistance with concrete resources. As resource brokers, social workers can assess needs and link clients with community agencies for nutritional assistance, fitness training, additional diabetic education (professionals or material), medical care, health insurance, insulin and glucose monitoring supplies, prescription assistance, transportation, and counseling or support groups" (Lipkin, 1999)
VII. RESOURCE-BROKERING and COLLABORATION AMONG PROFESSIONALS
The social worker is also experienced in 'resource brokering' and as related by Lipkins (1999): "As a therapist, the social worker may practice independently or in conjunction with other professionals (such as psychiatrists and psychologists) to treat more serious mental health issues inhibiting the management of diabetes. In this role a social work practitioner may screen and treat illnesses with high rates of comorbidity among diabetes patients, such as major depression or eating and anxiety disorders. The social worker also may ensure the management of preexisting chronic mental illnesses like schizophrenia, bipolar disorder, and alcohol or substance abuse." (Lipkin, 1999) the social worker also has the capacity to: "...coordinate a comprehensive assessment, treatment plan, and intervention, striving for an optimal level of collaboration among professionals, patients, and families. Financially, social work case management can effectively and efficiently use community resources, creating an optimal environment that promotes glycemic control to delay complications and reduce hospitalizations."
