Social Work Helps

Religion and spirituality

2011-09-21T20:12:00.000-07:00

So one of the volunteers I work with mentioned the other day that I am “just not religious enough to be a good social worker.” Terrific.

I have two problems with this statement: A) Since when is religiosity (or even spirituality) a prerequisite for success as a social worker? And B) Since when am I not religious?

We are planning a memorial service for hospice families that have lost loved ones in the last year. It is taking place in a local church. We were discussing the order of programs and it was mentioned that we need an opening and closing prayer. I offered to say the closing prayer. One of the volunteers looked at me and said, “Um, we are looking for someone to pray who has more, um, traditional beliefs. You know, beliefs that go along with the majority of the people in this area.” That was what he said, but what he meant, if you are not a Baptist preacher or preacher’s wife, you are not qualified to pray in public.

Never mind the fact that this is a non-denominational memorial service meant for members of any/all/no religion.

During the same conversation, my boss commented to me "you are so unchurched it is ridiculous." Which is actually not true, given that I am a weekly participant in church services, pray several times a day, attend scripture study weekly, and volunteer much of my time each week to my church.

As eye opening as it has been spending this time in the south, I struggle with this a great deal. I grow weary of people assuming that religiosity equals worth in a person. I have had hospice volunteers who have refused to go into the home of a patient who is not religious, and volunteers who have all but insisted that their own minister meet with a non-religious patient to make sure that patient is all right before Jesus before death.

Although intentions may be sincere, this creates challenges as a social worker to train volunteers and staff members to protect the patient’s own right to determine what he/she needs from a spiritual point of view.

Social workers are trained to work in a very inclusive fashion, and to accept the realities of other people’s lives without judgment. This applies to religious beliefs and practices as well. While I don’t personally mind being the religious minority, I do wish that there was a little bit more open mindedness about that in my area.

How do religion and spirituality and social work relate? I feel like in some lines of work, it is a very fine line that separates them. What has your experience been? If you find it to be a fine line, how do you navigate it?

By the way, this is a fascinating project that is attempting to better understand and bring together world religions. If you are interested in getting a better understanding of world religions- either for yourself or to better understand your clients- check out: Project Conversion. And follow it on Facebook here.

Let the Job Search Begin

2011-09-18T07:01:00.000-07:00

Today marks exactly 90 days until I graduate with my MSW.

Not that I am counting or anything.

I was planning on waiting until I was a month or so away from graduation to start applying for full-time jobs. I was recently reading some articles that reminded me what a bad economy we live in and that it generally takes people several months longer than they think it will to actually find a job (and that’s assuming people find jobs at all).

So I decided I’d start sending out my resume now. This has a potential to pose logistical challenges only if I get offered a full-time job very quickly and they want me to start right away and are unable to wait for me to finish classes and field (I graduate in December). But judging from how long it typically takes employers to actually make hiring decisions, I’m not terribly concerned. Indeed, if my biggest problem is that I get offered a job before I am ready to take it, I’m in pretty good shape.

My fear is that the opposite will happen: That I will send out a bazillion resumes and not be able to find a job.

I am a “macro” social worker. My work in hospice has been an exciting combination of clinical work and community outreach, but I have a feeling that if I pursue the hospice social work track in an area that is not small and rural, it will be mostly clinical. My emphasis in grad school has been management and community practice, and although I have some clinical interest, my passion has always been the macro stuff. This makes the job search more… interesting.

Direct practice social work jobs are generally pretty cut and dry. They typically require a degree, a license of some sort, supervision, etc. And they are usually in the areas of mental health, medicine, or case management. When it comes to job hunting, direct practice social workers can go to great websites like The Social Work Job Bank, find their dream job, submit their resume and voila! (Okay, it’s that easy to APPLY for direct practice social work jobs; actually GETTING one is another story).

There is no real job bank for macro social workers (that I know of). There are sites offering guidance. One such that I have recently found is The Macro Social Work Blog, which is a great read but unfortunately not updated all that often. A macro social worker’s job description might not say “social work” anywhere in it. Macro social workers might be community organizers, or volunteer coordinators, or program assistants, or a combination of any number of interesting job titles.

Employers of direct practice social workers typically know what a social worker’s job is (although as any social worker knows, we are frequently used inappropriately). Macro social workers often have to explain what their skills are to potential employers. In the last two weeks, I have heard the following quotes from people:

“Social Workers do something other than hand out food stamps? Really?” (From a random person at Wal-Mart

“If you don’t want to work for the Department of Social Services, why did you get a degree in social work?” (From my roommate)

“I did not know that there was such a thing as ‘macro social work.’ What exactly is the point of that?” (This one was actually a month or two ago, at a job interview, from a potential employer)

Feeling like I have to explain my passion for social work and why I went into this field despite not really being interested in mental health or social services is draining. I can’t honestly say that I am looking forward to explaining my skills and qualifications to future employers who don’t know what the point of macro social work is.

But the hardest part, I think, will be narrowing down my own pool of interests until I can settle on some options that would be good for me. Ideally, I would like to work for a large non-profit organization doing community outreach. One of the things that the Macro Social Work Blog mentions is that a lot of social work jobs don’t require a master’s degree, and some don’t even require a bachelor’s degree. This means two things for me:

1) I have to teach myself that it is okay to seek this kind of a job even though it may be viewed as “less important” than the licensure-track positions that my classmates are pursuing.

2) I have to learn to put into words the feelings I have about the importance of my education and how it relates to what I do. This is helpful both in order to accomplish number 1, and also to explain why my experience will be valuable to a company.

I’ll tell you what I want. I want to find a job that will give me opportunities for community outreach and advocacy. I want to live in an urban area that has a low enough cost of living that I can afford to live at least relatively close to the downtown area. I’m open to living in a foreign country if such a place needs social workers.

I want to make enough money to be able to put gasoline in my car, feed myself on a regular basis, avoid the homeless shelter (avoid living in them; I’d be open to working in one), and eventually pay back those pesky student loans. Unless an anonymous benefactor decides that I am terrific enough that I deserve complete forgiveness on those loans. In which case I’d happily accept such an offer. And if any of you social workers out there are reading this blog-post and have a lead on a job for me, I’d happily accept such an offer from you too (did I mention that I am willing to move just about anywhere, provided that a reasonably sized city is somewhat close?)

So, with all that said: Let it be known to the world that the job search has officially begun. May the Full-Time-Job-Gods be on my side. May the We-Live-In-A-Crappy-Economy-And-Most-People-Are-Grateful-To-Be-Using-Their-Masters-Degrees-To-Sling-Burgers-Gods be curiously distracted.

Elders and racism

2011-08-28T19:54:00.000-07:00

I got a scholarship for working with the elderly. It’s funny, because I went into social work because I wanted to work with children and issues of poverty, but I continue to find myself drawn to the aging people.

When I moved to the rural south, I learned how prevalent issues of race and racism still remain in our country. Coming from the west, where people's skin color is relatively non-diverse, and the absence of racial minorities creates a pretense of the an absence of racism, this discovery was rather surprising to me.

I visited a patient the other day, and she spent an hour telling me that she is “not racist, but I just think white people should stay with white people and black people should stay with black people. I’m not racist, but that ‘s just the way it is.” I encounter this type of old fashioned racism a lot among the elderly people I work with in the south. I’m never entirely sure what to do about it. A part of me wants to correct this type of thinking, but a part of me wonders what the point in attempting to do so with a dying person is. What do you think?

Performance Evaluation

2011-01-27T16:17:00.000-08:00

Just when I start to think that I am doing well in life, I get some sort of reminder about all of my vast areas for improvement. This time it came in the form of a performance evaluation at work. Not that it was anything really bad (I do enjoy my job, for the most part); it was just a reminder of how far I have to go. More of the same old… I need to organize my stuff better, document better, etc. Blah. I just want to be the world’s most perfect social worker now, dang it!

Honestly, I don’t know about this whole “being an adult” thing. It’s hard sometimes. I think I chose a tough field to get involved with given the fact that it has such a high burnout rate. If I can just survive this year, which is extra tough because I am studying social work in school, working as a social worker, and doing a social work field placement. I think that when I have time to think about things other than social work, I will be okay. Until then, I just need to pray for better organization skills and find a couple of good social work mentors.

An Interesting Request

2011-01-25T04:44:00.000-08:00

So I went to visit one of our new hospice patients last week. This was a really nice patient and we had a great visit. As we were nearing the end of our conversation, I asked her if she had any goals for her time as a hospice patient. Her response: “I’d love to ride with Mark Martin.”

Now, I had no idea who Mark Martin was, but I guess he’s some kind of NASCAR driver (I don’t follow racing, but everyone in my town loves it). She was half-joking, and the race does not come here for another couple of months so I don’t know if it would be possible anyway. Still, I thought to myself, it’d sure be super cool to make her dream come true.

I've always kind of thought that one of the jobs of a social worker is to help make people's dreams come true, and that idea was one of the reasons I pursued social work. That desire so frequently gets lost in all of the other obligations of Social Workers, but it is still there in the back of my mind. I can't stop thinking about this patient and her goal. I really want to see it happen, but I don't know how.I wonder how I get in touch with a race car driver?

First Day of School!

2011-01-13T17:17:00.000-08:00

So, it's only been three months since my last post on this blog. That's not so bad, is it?

When I started this social work blog, it was my attempt to have a "professional" blog that would be kept separate from my "personal" blog. I wanted a place where I could write about work and school and the things that I am learning in an arena that is separate from the place where I talk about my family and friends and other more personal aspects of my life. It is a good idea in theory.

What I have discovered over the last semester is that when you are working on an MSW, working as a hospice social worker, AND doing a field placement in child/adolescent mental health, there is not a lot of room for "other more personal aspects of my life" to write about. Social work has become my life, personally, academically, and professionally. This has made it difficult to separate the two blogs, and so most of what I've written these last few months has ended up on my personal blog, even though it has related to what I am doing in social work.

My goal for the year is to change that. I like this blog, I like writing, and I have a goal to sit down 2 times a week and write about something that is social work related. My hope is for blog to be a record and a resource to me of the things that I have learned while in the beginning stages of my social work career. Tomorrow is the first day of school, and in 11 months, I will have that elusive masters degree. And I want this blog to be a record of the things I have done and the experiences I have had along the way. This is to say... I am back. And I am determined to succeed.

Wish me luck!

Educational Experiences

2010-10-10T17:01:00.000-07:00

I’ve had some interesting educational opportunities this week. First of all, I had the privilege of hearing Larry Churchill lecture on the healing power of relationships. Mr. Churchill is a professor of Medical Ethics at Vanderbilt University. The lecture was, for all intents and purposes, absolutely fascinating. Seriously, it was. I mean really.

Mr. Churchill and some colleagues did a qualitative study on medial clinicians who have received peer reports indicating that they are very good at building rapport with patients. The intent of the study was to help us develop some understanding of common practices that are used in building relationships. Mr. Churchill and his colleagues identified some common practices. As a side note, I took copious notes on the lecture, and I was actually complimented on my note taking skills, which is a first for me. Note taking is not normally my strength).

He instructed us to take the time to be present, personalize the relationship with the patient, utilize common courtesies, and do things that remind the patient that you are human too.

He also reminded us to be present and listen. When seeking to engage clients, there should be NO MULTI-TASKING (I am the worst at this. I feel like being present is one of my biggest weaknesses as a social worker). Patients and their families deserve our undivided attention when they are with us.

Ultimately, Dr Churchill told us that clinicians need to live out humility. We should be “worthy to serve the suffering.” This means that we live good lives, we carry ourselves in such a way that suffering people will feel safe with us.

I think one of the most interesting ideas that Dr. Churchill shared with us is that healing is not something that flows from the clinician to the client, but it is a feature of the interaction.

I was also privileged to attend a Q&A session with Elie Wiesel, distinguished professor, Nobel Laureate, holocaust survivor, and political activist. It was a very intimate conversation; only me and a handful of other students. The students asked Dr. Wiesel how he felt about various issues the world is facing, including the wars in Iraq and Afghanistan, the conflicts in Israel and Palestine, the recent suicides of homosexuals, and many other things. He shared with us his mantra: Whatever we do in life, we need to think higher and feel deeper. He encouraged those of us who want to be lifelong servants and humanitarians to remember to enjoy our own lives, but consistently be thinking about those who are unable to enjoy it.

Dr. Wiesel also made a comment about God that resonated with me. A student asked him if he felt that God was indifferent to the suffering in the world. Dr. Wiesel pointed out that the world’s definition of injustice may be different from God’s definition of injustice, due to the fact that God may have a different perspective than those of us on earth. It’s an idea that has been rolling around in my head for a few months now, but he managed to put it into words that make sense other people as well as me.

I’m so grateful for the educational opportunities I have received. I love being able to learn from great people. Great clinicians, great activists, just plain and simple great people. My goodness, I love Social Work!

Nursing Home Placements

2010-09-27T11:57:00.001-07:00

Since I started working in hospice, my opinion about nursing homes has evolved a bit. I used to think of nursing homes as sad, lonely, pathetic places where people go when no one else wants them. Sort of like an orphanage for the elderly. Surely the only people who were placed in nursing homes were those with no other family. When I started working for hospice, I realized that that is not always the case. Sometimes, nursing homes are wonderful places.

Our hospice is very small and does not have any contracts with nursing homes, so when a patient or family chooses nursing home care, they also choose to revoke hospice (some of our competitors have contracts with the nursing homes our patients typically choose, so they are not without hospice care completely). For our hospice this is unfortunate from a business perspective, but it is obviously better for the patient to be able to get around the clock care needed.

We have had several patients who have not identified a primary care-giver, either because there is none available or because they do not feel they need one. In those situations, when the time comes that the patient is no longer able to care for him/herself at home, part of my responsibility is to help the patient identify an acceptable nursing home placement. I’ve found this to be a difficult task; very few patients admit that they are no longer able to care for themselves, and the notion of having to leave one’s home for the final days or weeks of life is understandably unpleasant. These are the situations I’ve struggled with. What is the best way to help a patient see the writing on the wall? If the patient cannot safely be in their home, how can I explain this to the patient, who came into hospice knowing that the mission of hospice is to help patients remain at home?

A couple of months ago, we had a lovely patient Mrs. G. Mrs. G. is a very sweet lady who somehow managed to capture the heart of everyone who came into her small apartment. She was mostly bed bound, did not have any family in the state, and relied on hospice care and four hours a day personal care from her Medicaid benefits. One day, after her personal care aid left, Mrs. G. decided to make herself some stew. She took her oxygen off, turned her crock-pot on dumped the stew in the pot, turned around to answer the phone, and fell over. Since she had chosen not to wear her lifeline, she had no way of reaching anyone. From 1:00pm until 8:00 the next morning, Mrs. G lay on the floor, a hot crock-pot on the counter 6 feet away from her.

When her personal care aide arrived the next morning, she found Mrs. G on the floor, helped her get up, cleaned, and back into bed, then promptly notified hospice. Mrs. G was adamant that she would not go to a nursing home, but gradually relented when the nurse, the chaplain, and I spoke to her and gently encouraged her to reconsider. Luckily, Adult Protective Services did not have to become involved, and Mrs. G headed off to the nursing home, only a little bit sad. Two days later, I stopped by the nursing home to say hello. Mrs. G was a different woman. Although she was of course still terminally ill, her eyes and her face were so much brighter. She reported more energy, and more happiness, which she attributed to finally receiving the care that she needed. She had lots of positive social interaction with the other people in the nursing home, and she could not remember why she had been so adamant about staying in her apartment.

Experiences like this have helped my opinion on nursing homes to evolve. I know that nursing homes are not without problems, but I love the care they’ve been able to give our former patients. Responsible adults who do not wish or are not able to be the main caregiver to their elderly parents do them a large disservice by keeping them at home without providing the highest quality of care. If being the caregiver is not in the cards, the most responsible choice for the family to make is to work to locate the best possible long-term care facility. And visit regularly, of course.

Signs of a Sleep Deprived Grad Student

2010-09-18T16:18:00.001-07:00

Full-time work, seminary teaching, graduate school, and part-time interning are starting to their toll on me. I’m a lot punchier than I usually am when I’m not sleep deprived. See, I’m generally the quintessential night owl. I like to go to bed around two or three am and sleep until ten am. Lazy? Nah, just bound and determined to get eight hours of sleep a night.

Since school, early-morning seminary, and my internship all started the same week, I’ve been waking up around 5 am and trying to go to bed by about 10 pm. So far, it hasn’t worked out well for me.

Anyway, I generally know when I am sleep deprived by the fact that I find the world considerably funnier. Case in point:

I was sitting in class yesterday, thinking about my errands I needed to run after class. I remembered I need to pick up a part for my computer (a Mac book). I don’t live in the area where I go to school, and I am unfamiliar with the city. I turn to my classmate who lives in Winston-Salem and I ask, “Do you know if there is an Apple Store anywhere in town?”

“An apple store?” he says. “I think there’s some fruit stands around.”

At that point I burst into uncontrollable giggles and pointed to my computer. My classmate laughed too. Here is where the sleep deprivation comes in. Instead of giggling at our miscommunication and then refocusing my attention on my professor’s lecture, I giggled uncontrollably (albeit quietly) for ten minutes while my classmates and professor stared at me in confusion. Even after we explained the joke to the class, no one could quite understand my uncontrollable laughter.

“ANYWAY…” my professor said, and resumed her lecture, and the class went on while I struggled to regain my composure.

See, even as you read it, I’m sure it’s not all that funny. I have countless examples of laughing hysterically over nothing when I am tired.

This is why the majority of us social workers need to sleep more. When those hours are going to come, I’m not entirely sure. Probably not for the next 15 months while I get through this program. Do you think if we put together a petition and got 10,000 signatures, we could successful convince God to give us longer days?

Changes in the Air

2010-09-12T15:26:00.000-07:00

I finally secured a field placement for the duration of my MSW program. Incidentally, did you know that “MSW” says the same thing when you turn the word upside down? I discovered that in moment of boredom at a church meeting and immediately had to text all of my MSW friends.

Anyway, I will be doing my field placement at a day treatment center in another rural town not far from me. My new boss at the hospice is being nice enough to let me work some crazy hours in my feeble attempt to be superwoman for the next year. So these days my day begins with early morning seminary (a religion class that I teach for high schoolers) at 6:30am and ends when I have completed 4 hours of internship and 7 hours of work. But then I have to make lesson plans and prepare for the next day.

Crazy? Yes. Is the elusive MSW degree worth it? I sure hope so. Will I find time to do my homework? I sure hope so. Can I do hard things? I think so. Will I slack off on writing this blog? Probably. Will I slack off on nearly every other aspect of my life that isn’t directly related to either my eternal salvation and/or my social working aspirations? Probably.

I’ve been wanting a dog lately, but something tells me that now is not the time due to the fact that I am never home. I didn’t see my turtle (Fluffy) all week. Good thing he is fairly low maintenance. I can’t handle a dog right now. Maybe I could get a fish. And another turtle.

So I am adjusting my hours at work to accommodate my field placement, but my caseload and other responsibilities will remain the same. Currently, our hospice program is small enough that it will be manageable, but as it picks up, it will definitely be very difficult. My boss who quit a few weeks ago decided to stay on in a different capacity. She will be our clinical coordinator (we’ve never had one before) and the director will be someone else. That “someone else” is thus far quite nice, reasonable, approachable, and fair. Most people are one or two of those qualities, but very few are all four. I’m excited about that.

Our hospice has been through a lot in the past few years. We’ve been through a lot in the few short months I’ve been a part of it. There have been a lot of trials and changes that we have weathered. We are still grieving the loss of some great people. Hopefully the changes we are making now will be positive.

When I was first deciding to move across the country, one of my friends asked me if I was really ready to be a professional. She said: “if you take a job like that, you will be a professional. Being a professional isn’t all it’s cracked up to be. You have to deal with way more politics and other things that you might not want.” I thought she was probably right, but that I was ready for the challenge. Being that this is my first post-college job, this is my first time really dealing with office politics and such. It’s difficult. I’m not always a fan of being a grown-up. But I suppose that’s just the way is.

I’m curious about what office politics are like in other people’s jobs and lives. What other styles of officehood are out there?

Here's where I've been

2010-08-27T05:50:00.000-07:00

So, when I started this blog, my hope was to post once or twice a week with my thoughts and experiences as a young social worker working in a rural hospice. The last month has just gotten away from me and I must admit, I haven't found too much that I really want to write about. Life is just hard right now. Our hospice program is understaffed, and I found myself handling volunteer coordination, bereavement efforts, hospice social work patient care, and home health social work patient care. In other words, trying to do about four people's jobs while going to graduate school. So making the time and the clarity of mind to sit down and write a blog post has not been high on my priority list.

Here's what has been on my priority list: I found out that my out-of-state tuition will be higher than what the program advertised. Instead of $6,000 a semester (expensive, but reasonable... it's only for 3.5 semesters and I'm willing to shell out 20 grand for this program), it will be $10,000 a semester (outrageous, and somewhat unreasonable... there's a big difference between going into debt $20,000 for school and going into debt $40,000 for school). Crap. One of the reasons I chose this program, despite the fact that it is an awesome program at a great university, was because of its reasonable out of state tuition rates. So much for that plan.

I have been trying to locate a field placement that will allow me to continue to work at my job. On top of all of that, my job has continued in it's tumultuous pattern. Last week our director and one of our nurses resigned within hours of each other (for unrelated reasons). Now we are short two staff members and they have already told us that they will likely not be hiring to replace them. It's not been the most pleasant work environment these past few weeks.

So I have to come up with an unplanned 20 thousand dollars, and at the same time I will also most likely have to cut back on my hours at work (or find another job altogether...a hospice in a neighboring town contacted me last week for a part time position, so we'll see what happens there) to do my field placement. Oh, and I found a field placement that I would like to do... I just need to figure out the logistic of it. If I were to do this particular placement, I would be working in a day treatment center for children and adolescents. Then this blog would likely become a combination of hospice social work/child and adolescent mental health/MSW program blog. I can handle that. Lots of things to think about.

Oh well. I'd say life is still good. I'm counting my blessings and am grateful for the fact that I have a job. A job, by the way, that I am falling in love with. I never, not even for one second, wanted to do medical social work. When I went into social work, I imagined working for a non-profit organization doing macro-level social work and community development in some urban neighborhood. But can I just say, I love the hospice program? I really do. I love holding patients' hands and talking with them about life after death. I love that this is a field where I can be open about my faith and my belief in God without feeling like I am stepping on toes (I moved here from Utah, and discussing religion in a public way is a no-no there, so it is very refreshing). Ultimately, I love the fact that families are willing to allow me to be a part of their lives during a time in their lives that is so sacred, and when they are so vulnerable.

Oh, and I started teaching an early morning religion class at my church. I meet three teenage boys every morning at 6:30 am to study the scriptures. It's good times. No, really, it is. But it does occupy much of my time and mental energy that I once channelled toward blogging.

All of that said, the new semester of school begins in t-minus three hours. Now that it is costing me almost twice as much as I budgeted for, I am feeling slightly more motivated to succeed. And the new semester will give me even more interesting things to write about. I will put forth every effort to not go for this long without posting ever again.

"Fix her for me, will you?"

2010-07-13T19:02:00.002-07:00

Source

It seems like the general public’s perception of the social work profession is that we are around to solve everyone’s problems. I can’t tell you how many times a nurse has wandered into my office, handed me a patient’s file, rattled off a list of problems, and wandered back out. I don’t mean to be critical of nurses or of anyone else in these helping professions; Heaven knows we are all overworked and exhausted. But I am getting tired of the idea that I am the resident problem solver. This guy needs Medicaid, get it for him; this lady needs to stop spending her money on cat food and start spending it on medicine, make her do that (and get her the drugs she needs in the meantime); this family needs to pay their mortgage, get them the money. And be sure you do it by today because they might be dead by tomorrow.

I love the concept of Social Work. I love the idea of helping people acquire the resources they need to improve themselves. What I can’t figure out is how to navigate between coworkers expectations of “help” and a client’s idea of “help.” They are two different things.

Many people seem to think that a social worker is not doing a good job if a client still has a messy house, still lives alone, still has denial issues, still has an unpaid mortgage, etc, even whilst working with a social worker. What is not taken into account is the will of the person. I’ll happily help a client make arrangements for a housekeeper or a sitter, or I’ll help a client apply for financial assistance or Medicaid if they would like. But I can’t just go into their home and wave my magic wand and solve their problems for them. And even if I could, there is no section of the Social Work Code of Ethics that give us permission to use magical powers. If no one is in immediate danger, there is not reason to solve problems that clients don’t care about. On the contrary, social workers “enhance clients’ capacity and opportunity to change and to address their own needs.” (NASW Code of Ethics)

“Address their own needs.” Not address the needs that the nurses, the chaplain, or even the social worker think are important. But the client/family’s own needs. What has the client identified as important? What does she need help with? And what effort is she willing to make to get there? If I give her the resources and the support, can she give the effort? Those are some of the questions I ask myself when I am assessing a client.

Empowerment. Sometimes we forget this concept. Or maybe sometimes we think that to empower someone is to make them like us. To introduce them into our culture and our reality. To make them give high priority to the same things that we give high priority.

That doesn’t seem terribly effective.

Boundaries- Cross at your own risk

2010-07-02T19:04:00.000-07:00

I've been wondering about boundaries that as social workers are generally hammered into our heads. Do other disciplines and other helping professions receive the same boundary awareness training that we social workers receive? I can't quite figure it out.

A therapist brings his wife and children to a patient's house to clean it for her.
A chaplain adds a patient's adult daughter as a friend on Facebook
A professor sleeps with a student.
A doctor sleep with a resident.
A (fill in the blank) sleeps with a (fill in the blank)
A nurse buys groceries for a patient because his fridge is empty.
An aide invites a patient who got kicked out of his home to come and stay at her place.
A volunteer spends the night at a patient's house because "I just felt like she needed me to be there."
A nurse notices a patient's mattress springs are poking out of a patient's bed, so she purchases a new mattress for her and delivers it personally.
A volunteer gives a patient a suppository. ("I just decided that I was his friend for a few minutes and not his volunteer").
A social worker sleeps with a client. ("I just decided that I was his lover for an hour and not his social worker").

In some agencies, this type of work is lauded and considered very praiseworthy. It is even expected. To me (and hopefully any professionally trained social worker), it screams "INAPPROPRIATE!" Seriously. We are taught from day one not to get too involved, and to maintain professional boundaries. On a personal level, I struggle with this. I become very invested in the lives of my friends and family members. It is a weakness most of the time. But on a professional level, I have no problem (thus far in my career) with maintaining boundaries.
In my opinion, the majority of people who choose to do the actions listed above (all of them made up. Any similarities to actual persons, living or dead, is purely coincidental) do it not to meet the need of the patient or client, but to meet their own needs. In an agency where things like that are expected and even encouraged, the need might be to seek after praise or recognition, or to combat the fear of losing one's job in the uncertain economy. Those who choose to respect professional boundaries may be seen as callous or jaded or out of touch with what the client "really" needs. I think what most clients need are professional, kind people who know how to get them in touch with their needed resources.
When I worked in foster care, I met kids and families that I just wanted to take home with me. Heck, when I taught swimming lessons, I met kids and families that I just wanted to take home with me. Why didn't I? Well, aside from the fact that I would not survive as a foster parent at the moment... duh.. boundaries. I'm sure we've all met people who we love and want to do anything for. But in these cases, it is best to keep our professional distance.
Boundaries protect us. Just like boundaries in our personal lives protect us (choosing not to drink alcohol protects me from drunkenness; choosing to wait until marriage for sex protects me from STDs; choosing to fasten my seat belt protects me from many injuries). We draw our own boundaries in our personal lives. In our professional lives they are drawn for us. At least I thought so.

Give a man a fish

2010-06-20T19:08:00.000-07:00

An old (I believe it's Chinese) proverb of some sort says something to the effect of “give a man a fish, feed him for a day. Teach a man to fish, feed him for the rest of his life.” Or something like that.

We’ve all heard it a whole lot of times. I was helping a friend write a paper a month or so ago. I’m kind of anal when it comes to spelling and grammar and punctuation errors in writing, so after I basically picked his whole paper apart with a fine tooth comb and corrected all his errors, I sent it back to him. He texted me saying something to the effect of “wow, you’re feeding me; I’m not fishing,” in reference to that proverb. A week or two later, I was sitting in class and one of my classmates referenced the same proverb and how it relates to social work: that one of the purposes of social work is to teach people how to fish so that we do not have to do all their fishing for them.

I don’t know about you, but I know that I am in the best place to learn right after a good healthy breakfast while my belly is full. If I am hungry, I have a hard time focusing on the tasks of the day. I don’t disagree with the concept of proverbially teaching people how to fish. But I’ve often wondered if we occasionally allow someone to starve to death while they are learning. Case in point: I had a patient who refused to get medications that she needed because she couldn’t afford the $4 that her insurance didn’t cover. This was a little frustrating because the woman is spending probably a good $20 a week on gourmet cat food and kitty litter. I pondered bringing in some information on creating a budget and helping the women figure out where she could cut back. Problem was that helping an old women create a balanced budget wouldn’t make any difference if she didn’t get the medications that would keep her alive and healthy through the weekend.

As annoying as it is to me that people choose to put luxuries for their pets before necessities for themselves, teaching this woman how to prioritize financial resources and allocations (teaching her how to fish) needed to take a back burner to securing her needed prescriptions (giving her a fish).

I think that we do that at times. We spend so much energy focusing on the long range goals that we forget to make a plan for short term needs. Short term needs are important. They are what keep people around long enough to accomplish their long term goals. Maybe I shouldn’t have spent so much time fixing my friend’s paper. Maybe I should have sent him a grammar book and made him fix it himself. But if a good grade on a paper or two will give him the boost he needs to continue to progress in school, I feel it is worth it. Maybe I shouldn’t have helped that patient get her medications. But I feel it is necessary to keep patients alive first, and give them financial advice second.

Hmm… It gives me something to think about. Do I teach a starving man, or do I feed him first, then teach him while his belly is full?

First official day of graduate school

2010-05-15T19:14:00.000-07:00

After two weeks of orientation, on Friday May 14, 2010, I celebrated my first official day of my MSW program. I will now bring your attention to the first page of notes I have taken as a graduate student...

Drumroll please...

Looks like my note-taking skills... um... leave something to be desired.

Oh well... I'm working on it. When I moved out here three months ago, I spent a lot of time wondering if I was big enough for all the responsibilities I was given. As the only social worker in an already floundering hospice, I consistently find myself bombarded with any project that is even vaguely "social worky." It is demanding, yes, but I am learning new things every day.

Now that I have officially started graduate school, I feel the same way. Am I really "big enough" to be a graduate student? In 1.5 years, will I really be "big enough" to be an MSW? So many questions on my mind. But for now, I have to get to work writing my paper and about twenty case notes in preparation for the coming week.

loss

2010-05-10T19:16:00.000-07:00

I think I want to name my firstborn daughter Elisabeth. Not after me (my middle name is Elizabeth, and I very commonly go by Liz), or the several dozen people I know with that name, but after Elisabeth Kubler Ross. I just finished "On Death and Dying" and that experience has changed the way that I feel about the grieving process.

All people experience loss in their lives. Only a small number of the losses we experience are related to death. More commonly we experience loss of a relationship, loss of a job, loss of an expectation, loss of a friendship, loss of innocence, or loss of trust. It is unfortunate that we are conditioned to only grieve loss when it comes to us in the form of physical death. As a result, a lot of the losses we feel are not mourned in a healthy way.

Today, I conducted a volunteer support meeting for our wonderful hospice volunteers. Hospice in our area was once a very strong program, but in the last few years it has dwindled into a very small organization. Many people don't even realize we exist. As I spoke to the volunteers, who have been with this program through to good times and the bad ones, tears were shed as they spoke of the program they once knew. They are mourning the loss of hospice they once knew. As a way of moving forward, they are sticking with the program while we continue in our "building" phase.

We have all experienced loss in our lives. I am finally beginning to understand that we are allowed to feel loss regardless of how insignificant the experience seems to others. I remember a time last year when I was feeling down. I remember wishing more than anything that something outwardly painful would actually happen so I could have an excuse for feeling the way I felt. I think that might be why depressed people resort to cutting, and maybe it's why somatoform disorders exist.

But back to my starting point. I hope that I can learn how to truly grieve when faced with losses. I hate comparing challenges among people. Some of the most unintentionally hurtful comments I've ever been on the receiving end of have come from people who assume that because I choose not to talk about it, I don't know what it is like to feel pain. I imagine I'm not alone in that. I may not have dealt with the death of a loved one, but I know what pain feels like. I know what it is like to lose friends, family members, innocence, faith, trust, and even jobs. To me, some of those losses feel even more painful than death, because at least death offers an element of closure. I know how to experience pain. What I am still learning is how to grieve those losses, and give those experiences the validity they deserve.

So how? How do we validate our grief, our losses, and our individual bereavement without letting them consume us? That, once again, is always the question.

In the beginning

2010-04-29T19:19:00.000-07:00

I still remember the exact moment that I realized that social work was the profession for me. I was 20 years old, had just finished my second year of college (as an English major). I was spending the summer in Fishkill, NY, working for an organization called the Fresh Air Fund, a non-profit organization that provides a summer camp to children who are living at or below the poverty level in New York City.

I was standing on the boating dock, supervising a small group of 12-year-old boys in the lake. Generally, 12-year-old boys from New York City have not had much experience in boating and swimming, so the sight was rather comical.

As I stood there trying not to laugh at these beautiful children as they attempted to do something that was a slight foreign concept to them, I started to think about how amazing these experiences must be from the perspective of the children experiencing them. Watching these children explore this new world made me rethink my professional goals. I love English. I am passionate about reading and writing, but I had known for awhile that a profession in English wasn’t really for me. I knew who I wanted to be. I knew that I wanted to be in a profession of service. What I couldn’t figure out was the educational path I should take to that profession of service.

From behind, me, I heard the voice of someone calling to me. It was the camp’s assistant director, Kish coming down for a visit. Kish was the first Social Worker I ever knew. I’d always been impressed the gentle softness that existed within her as she interacted with our boys (did I mention that this was a camp for boys ages 9-12? That’s kind of a stressful time for some people…) The conversation we had on that boating dock would change my life (ironically, 5 years later, that same boating dock would be the site of another life-altering experience). Kish introduced me to the field of social work, and invited me to give it a try. I’ll always be grateful for that.

After that day, Kish and I had a number of conversations about the field of Social Work, and about the diverse opportunities that exist in that field. For the first time, I realized that Social Work essentially put a label on all of the things I hoped to accomplish in my life. Social Work is more to me than a program of study; it is a representation of what I want to become in every aspect of my life, not just in my career. I began to view Social Work as something of a calling in my life; something that I know I have the right strengths and experiences needed to be successful.

Six years later, I have a BSW, am working in a hospice (which is a field of social work I never even CONSIDERED entering), and have my first official day of graduate school in t-minus 12 hours. Sweet.

I've always been curious what makes people choose their fields of work. Are you like me and view it as a calling? What are some of the other reasons people choose their fields?

What is this language you speak?

2010-04-17T19:23:00.000-07:00

I just got out of new employee orientation at the hospice. Once again, I am wishing I knew more about medicine.

All through my school experience, I never thought even for a millisecond that I would eventually become a medical social worker. It wasn’t even remotely appealing to me. I really wanted to work for a non-profit of some kind doing some kind of something. As you can see, I am a very driven person who knows exactly what she wants in this life.

After graduation, the economy’s downward tide has made medical social work considerably more appealing. I was hired for the position I have now as a hospice social worker despite the fact that I haven’t yet obtained my MSW, despite the fact that I only recently graduated with my BSW, despite the fact that I have no experience as a social worker in any capacity, and despite the fact that my knowledge of anything even remotely medical can fit on the head of a pin.

I think it was an act of Deity.

So even though I had no idea whether or not I would find success or happiness in this branch of social work, I packed my bags and headed across the country; from northern Utah to southern Virginia. From the land of the Mormons to the land of the Southern Baptists. From the land of funeral potatoes and green Jello to the land of biscuits and gravy and grits. I think it’s safe to say I needed a change of pace anyway.

The change of pace has been nice. But challenging. Very challenging. See, I’m not medically trained. At all. On my first day on the job, I was reading a patient’s chart and I came across the acronym “S.O.B.” The context: “Patient was sitting up in bed talking and friendly, but noticeably SOB.” I thought to myself, ‘SOB? Hmm… that can’t possibly mean what I think it means…. But what does it mean?’ I can’t honestly say that I am much of a question asker (it’s something I’m working on), and so I just sat there for awhile trying to figure out what S.O.B. meant. I could have asked my boss and that would have been the end of it.

A couple of days later after reading it in about 20 other charts, it finally dawned on me that S.O.B must stand for short of breath. I mentioned this confusion to my medically trained sister and she laughed really hard. A couple of days later she and the physical therapist presented me with a list of commonly used medical acronyms.

It’s proved very helpful.

Tis a puzzlement

2010-03-31T19:21:00.000-07:00

So, here's an interesting tidbit. A patient of mine "Sally," was recently released from the nursing home rehab center after having surgery on her back. After her surgery, her family, which consists of a sister and some nieces and nephews really pushed for her to go into an assisted living home. Sally didn't want to leave the home that she owns and worked hard all her life for. So she went back to her home and has been under the care of our home health nurses for the last few weeks. Her nurse referred me to her after she started talking about how she doesn't have any food or money.

Sally is an interesting woman. She likes to have people take care of her, and she is very limited in what she can do, yet at the same time she insists that she does not need help. It's kind of a puzzlement to me. Sally was also very affluent in her earlier life, and she is used to having all kinds of luxuries that she does not have access to anymore. She is frustrated with herself for not being as independent as she used to be. Her family is frustrated with her for not listening to them and moving to an assisted living facility. Her nurses, occupational therapist, and I are all a little frustrated with the whole situation because she has a right to stay in her home if she chooses, but we can see how enhanced her quality of life would be if she chose instead to move to a place where she could get the care she needs. The nurses and therapists are ready to dscharge her, and once they are gone, I can't continue to see her. But I can't in good conscious leave her alone in her home with no assistnce or care. I don't think she'll realize how much help she really needs and make an effort to get it until we discharge her, but I don't feel good about discharging her until she has that help. But she won't ask for it until we're no longer making visits.

This life is the time to prepare

2010-03-17T19:26:00.000-07:00

I can see where working with terminally ill patients can be difficult. The first patient that I ever visited as a hospice social worker passed away last week. She was a lovely patient to visit, and she has a wonderful, supportive family. Four days prior to her passing, I visited her and she was sitting up in her chair applying makeup and chatting amicably with us. Three days later, the nurse informed me that she was on her way out. That evening, she was gone.

Having never really dealt with the death of a loved one in my life, I have a hard time understanding the emotions that go through an individual’s mind as they watch their loved ones decline in health. Grief is a complicated thing. A lot goes into the process. I recently got put in charge of the grief and bereavement process, and so I am learning a lot about how people grieve. I work real closely with a chaplain and I absolutely love the fact that I can bring spirituality into this. People are so close to God at this unique time in their lives, and so I love the fact that we can freely discuss spiritual principles in a public setting.

I am looking for more information on the bereavement process. I am trying to study and learn about how different people grieve and how they heal. I am getting the hang of the healing process myself, but I need to learn more about the grieving process. Interesting. Hmm. I think I need to study more.

One thing I’ve learned in the month of living and working here is that there are many things that we can do to prepare ourselves so that the end of our lives are as non-stressful as possible. People on their deathbed shouldn’t have to worry about Medicaid applications. They shouldn’t have to worry about paying for a Notary or appointing a power of attorney. They should all be able to focus their energy on their family, preparing for the next life, and dying peacefully, pain-free, and worry-free. It really is important to figure those things out now, so that we have the time and energy later in life to focus on what really matters at that time.

“Death comes upon mankind… therefore this life became a probationary state; a time to prepare to meet God; a time to prepare for that endless state which has been spoken of by us, which is after the resurrection of the dead.” -The prophet Alma

A little about me

2010-03-15T19:28:00.000-07:00

Hello, my name is Laura. I am 26 years old and in the beginning stages of my social work career. There are a few things in life that I am passionate about. Social Work is one of them. Death and dying is quickly becoming another one. I graduated with a Bachelor's Degree in Social Work from the University of Utah in May, 2009. I worked a few odd jobs for several months. By what cannot possibly be anything less than divine intervention, a hospital in southern Virginia decided to take a chance on me and hired me (someone who has no medical social work experience to speak of) to become the social worker for their hospice. While on this Adventure with a capital A, I am hoping to complete my Master's Degree in Social Work as well. I am an active member of the Church of Jesus Christ of Latter-day Saints (Mormons) and my religious beliefs ooze into all other aspects of my life. You'll see it on these pages.

The benefit to being completely inexperienced in this field is that I learn new things every day at work. I continue to feel inadequate, stretched, and blessed beyond belief as I do this job, and I've been in need of a location to record the many wonderful things I continue to learn each day. So here it is.