Author: Eve Escalante, LCSW
This month we celebrate Social Work Month, and I have been fortunate to have had the opportunity to have multiple spaces to reflect on the value of the work that this discipline provides, how my role has shifted since I began my social work career two decades ago, and how social work has been called to rise to the occasion to an evolving and ever-more-complex political and national system.
An ongoing opportunity of reflection for me is my clinical work, the care management and care navigation support I provide to a small group of patients and community members. Although this remains a small percentage of my time and role, it has helped me stay attuned to front-line challenges of the day-to-day work so that I feel more equipped to support staff, develop education and training, and speak to larger policy needs.
As part of a number of programs provided via the Department of Social Work and Community Health at Rush, the Community Practice Team provides safety net care management and community navigation support to the communities surrounding Rush, and target populations are those who are utilizing care in non-traditional ways (high emergency room or hospital use, for example), or those who live very close but are “flying under the radar” with unmet social and healthcare needs.
This fall, I had the opportunity to begin work with a mother who was identified at a community event where Rush Community Health Workers were proactively outreaching to community members.
When I was first connected to this young mother, she was trying to move through a web of intersecting crises: unstable housing, food insecurity, unemployment and caring for a young daughter who couldn’t start fourth grade because the family had no permanent address.
She expressed overwhelm and described feeling “paralyzed” by overlapping needs and priorities. Her temporary housing situation that provided a physical roof over their heads felt toxic, adding to her chronic stress. Finding employment was incredibly difficult without dependable childcare and enrolling her daughter in school depends on where you live, and she didn’t know how long they could stay where they were.
There was no social safety net for her and she voiced a deep sense of shame. She was in survival mode and so put her physical and mental health on the backburner.
Once we were connected, we worked together to find first what mattered most to her and then to identify the resources and support she needed to meet her most pressing needs. I helped mom understand the local school system’s support for unhoused families and the right to education regardless of housing status. Within a few days, her daughter was enrolled at the local school, which gave her the time she needed to apply for employment assistance and other benefit programs.
Once we were connected, we worked together to find first what mattered most to her and then to identify the resources and support she needed to meet her most pressing needs.
Alongside addressing her immediate needs, I found it equally important to reaffirm her that the failures of our system were not a reflection of her as a person or a parent. Psychoeducation became a key intervention in our work, as it is with so many clients we see in health care settings. We spent time identifying physical changes she observed in her body, how those changes correlated with moments of interpersonal stress and/or trauma, which helped her develop insight into how chronic systemic stress feeds into the mind/body connection. We discussed the stigma associated with seeking mental health care in her community and were able to explore what possible benefits of regular psychotherapy may be for her.
Through months of work, dozens of phone calls and her unrelenting determination, she has since found a full-time job. She has steady income and her daughter is back at school, thriving in a classroom environment. Our weekly calls now focus on finding permanent housing, management of interpersonal stress as a bridge to long term psychotherapy, and connection to primary care. I vision the work lasting for quite some time, I am not optimistic that the systems she faces will transform overnight, but I am certainly relieved we will navigate it together.
When we consider this case example, not much of this work happened inside the four walls of a hospital or clinic. Mom and I did meet face to face several times but most of this work occurred in the context of mom’s life, in her time, and on her terms. And, this is still the heart of healthcare social work. Because health happens in the community, at home (or in this case, where mom lays her head), and where people work and play.
I am proud to be part of a team that is not only able to provide this kind of care as part of our team’s offerings at Rush using the CHaSCI Care Model — but also working via CHaSCI to expand healthcare to more regularly include these kinds of personalized supports that take time and do not fit neatly into traditional medical models of healthcare, yet are often the glue to people’s engagement in care and associated with real impacts on people’s health and the system.
Transforming the system in this way takes uplifting patient impact stories and defending the values and competencies we bring to our work. We invite you to join us in this effort at www.socialworkandhealth.org or by reaching out to info@chasci.org.