Who is my social worker, and what does she do?

6 05 2012

One of the major tenets of social work is starting where the client is. I might recognize that a mother needs counseling for domestic violence. If she’s not ready, though, insisting isn’t going to do much good.  I need to start with what she feels she needs most, like getting the kids into day care, to build a relationship and work up to what the real problem is.

As a result, it can be kind of hard to explain exactly what my job is. I do a lot of things. I do what my families need, with a few notable exceptions.

It’s always interesting to hear other people’s interpretations.

Now, remember-I went to college for four years. I worked for two years in a related field. I put myself into debt to get a Master’s in social work, while interning three days a week and working to support myself. It may seem snobby, but I fancy myself a professional.

ACS workers, who refer a majority of our clients, very often have no clue what it is we do. (Take a moment to wonder how that’s possible.)

At one home visit to meet a new family for the first time, I asked if the mom and the worker had discussed the referral. “Sure,” mom said. “You’re going to be my advocate.”

I hope so. But 1) that’s not really a profession and 2) that’s far from everything.

There are also the times that I ask the referrer what they were hoping to come out of preventive services. “Monitoring” is almost always brought up.

Yes, there’s value in having someone poke their head in once a week to make sure the kids are eating, going to school, and not getting smacked around too much. Routinely assessing for safety is, of course, something that I do with families I work with. But I don’t do a job that could be easily fulfilled by Gladys, the nosy neighbor on Bewitched.

It wouldn’t be so bad if the ACS workers would accept it when I explain what I actually do.

PotentialClient: “So what is counseling with you like?”
ACS: “I’m sorry, SJ wouldn’t be actually doing the counseling.”
SJ: “No, I would.”
ACS: “Well, she’d be referring you for counseling.”
SJ: “No I wouldn’t.”
ACS: “You can do counseling?
SJ: “I’m a licensed social worker. Why are you referring them to me?”
PotentialClient: “Do you two need counseling?”

This even comes up when I’ve been involved for a while. The following exchange took place at a six month planning conference, shortly before I ripped lots of hair out of my head.

ACS: “Mom still isn’t acting like a parent.”
Mom: “I’m working on it with SJ.”
ACS. “Maybe family counseling would help.”
SJ: “Well, we are doing that.”
ACS: “Where?”
SJ: “Um, here? At the office?”
ACS: “Can you refer them somewhere for family counseling?”
SJ: “I can refer you for a foot in your ass.”*

Then there are the interpretations of people I’ve been working with for an extended period of time. You know, the people with whom I’ve developed a relationship and understanding?

Mom: “SJ, I need you to take my daughter back to school shopping to make sure she buys appropriate clothes.”
SJ: “I’m not going to do that. Why aren’t you able to take her?”
Mom: “You know we’ll just fight. Why wouldn’t you take her, you’re her worker!”

Somehow, despite all of the family sessions and advocating for special ed services, the term “worker” was closely linked to “servant” in this mother’s mind.

Mom: “His teacher wants to refer us for family counseling.”
SJ: “Did you tell her you’re already doing that?”
Mom: “…we are?”
SJ: “You know how we meet every week and do all that work together?”
Mom: “Oh! I thought she meant like, with a couch.”

That fucking couch. It’s an image that’s got quite a hold on people.

Mom: “I’m busy tomorrow, so I need you to take him to register for school.”

We need to talk about how we ask for things.

8 y/o: “But SJ is our very good friend!”

Said upon finding out services were being terminated, causing my heart to fall out of my butt.

8 y/o: “This is SJ. She is my therapist. We do play-doh.”

Hmm…go on.

Classmate: “Why does SJ come see you at school?”
6 y/o: “Because my family has problems and she helps us.”
Classmate: “Ooooh, we have one of those!”

Excellent! Are you available for public speaking?

2 y/o: “Hi Auntie SJ!”

All right, we’ll let that one go.

I have a weird job and a complex relationship with my families. It’s something that takes a bit of time to explain, and even then, it’s something that really needs to be experienced. Trying to limit the job to just “advocate,” or “counselor,” or “lady who keeps coming to my house” is never really going to do it justice.

Though “personal shopper” is always going to be wrong.

*This was only thought, not said.





Why Mental Health is Bad for My…Mental Health

12 04 2012

When ACS refers a case to us, there are certain things they want done. (Most often, these are things we don’t do. But that’s for another blog…) A lot of times, it’s counseling for domestic violence, sexual abuse, or substance use. These don’t apply to everyone. But one thing is constant. Everyone in the family–parents, kids, household pets–should have a psychiatric evaluation.

I’m rarely against an evaluation. It can’t hurt, right? Well, I guess anything can hurt, but the professional would have to be a real idiot. Surely there aren’t any of those. I think our kids are overdiagnosed and too often prescribed serious psychiatric meds but evaluations…why not?

There are a few problems, of course. Some parents don’t agree with them, some kids think it means I think they’re crazy. The number one obstacle, though?

Where the fuck are they supposed to get this done?

With the health care debate raging in this backwards ass country, I keep hearing about these “free clinics” that one supposedly trips over on any stroll through the ghetto low-income side of town. They’re doing free well-child visits and tossing out birth control like Gobstoppers at Willy Wonka’s factory.

Unfortunately, they don’t exist. Most of those “free clinics” actually charge Medicaid. You can get urgent care, not ongoing treatment.

This is also true for mental health clinics. In my first months on this job, I thought they were a myth, like Sasquatch, or the G train. But they’re out there. They’re just hard to find. It’s especially hard to find one that takes your insurance. Sure, everyone has Medicaid, but most people also have supplemental insurance. This place takes straight Medicaid, not Health First. This place only takes blah blahdiddy blah…

Most unfortunately, we don’t have mental health staff here at anonymous agency. We’re social workers and case workers, but no doctors. I can do family counseling, play therapy, which is all good stuff, but I can’t prescribe Ritalin. No matter how much I may try. This means that we have to refer out.

Until recently, we had a connection with a nearby mental health clinic. They came by when they felt like it to collect our referrals, and our clients were able to get appointments within a couple of months. To be honest, I thought they did supbpar work. But we had to take what we could get.

That relationship was terminated for some reason that hasn’t been explained to any of us because we’re not important. Now, we’re back to the old referral process.

Agency names have been changed for my amusement.

I call Shining Time Mental Health Station to refer a nine year old girl and a thirteen year old boy. Their mother is also to be evaluated, but I don’t mention that at first, as I don’t want to seem greedy. No one answers, so I leave a message. I do this fourteen days in a row, while also leaving messages at Miss Kitty Fantastico Memorial Mental Health Center and St. Mungo’s Center for Nonmagical Mental Maladies. No one will answer me, and I start to take it personally. I leave decoy messages, telling the intake worker that she’s won a sweepstakes and needs to call me immediately, or saying that I’m holding her puppy hostage. Nothing. That woman does not care about her imaginary millions, or her puppy.

At some point, I give up on St. Mungo’s, because they don’t take this family’s supplemental insurance. Miss Kitty Fantastico is no longer seeing children. That leaves me with one in their area. Oh god.

Finally a coworker sees me sobbing into the phone, and mentions that she has a contact at Shining Time, who might help. I get my hopes up (always a mistake) and call. Of course, this person is a domestic violence specialist only. Could you encourage their dad to stop by and rough up the mom? OK, in that case I can’t help you. Let me transfer you to our intake worker.

NOOOOOO!!!

Next, I try the child study center at St. Anastasia Beaverhausen Hospital. I call their general intake number, and am given the option to press one for the diabetes program, two for women’s health, three for dental, all the way to nine for foot problems, but no child study center.I start cursing into the phone, hoping that this will cause them to connect me with a real person (it works with FedEx) but all this gets me is some looks from my coworkers.  I hit zero for all other calls, and am told that my call is very important to them, but there are six other callers ahead of me. After an hour, I begin to doubt the importance of my call. Someone answers. I ask for the child study center. She transfers me to the foot center. I ask for the child study center. Foot lady transfers me back to the lady who transferred me to her. I finally get the child study center after three more rounds, only to be told that they aren’t accepting new clients for five months. Can’t I put my kids’ names down now, that way in five months they can have an appointment? No, it doesn’t work that way, because we say so. Oh.

While I’m chasing my tail, there are children who need help and aren’t getting it. Counseling, play and art therapy, are crucially important to their well being, and I do that. But when there are things like PTSD, ADHD, bipolar disorder, or a family history of schizophrenia going on, they need to see a doctor.

People in need can always walk into the ER. We always hear this from people who don’t want to pay for our frivolous health care, and it’s true. They can walk in, sit down, and wait for hours. Wait, and wait, and wait. Often they choose to leave. Generally, if they aren’t actively suicidal, they don’t get to stay. I once got frustrated enough that I asked a mobile crisis worker if I should wait to call back when my (pregnant, schizophrenic, drug abusing, cutting, but not presently suicidal) client was setting herself on fire.

In retrospect, that was too far. This is not how we get what we want.

If a client is admitted, they’re often transferred to a different hospital, particularly if they’re a child. Depending on insurance, this can take forever. Not literally, but just about. There’s a sort of time suspending limbo you enter when you walk into an ER.

One of my teen girls who had attempted suicide more than once wound up being sent to a notoriously unpleasant (to say the least ) psych hospital in Brooklyn. They had an available bed and would accept her despite not having insurance. Her mother was afraid to send her there, and didn’t want her to be two and a half hours away, but she did it because she had no other choice.

I don’t think I need to point out the irony that the mental health system in the Bronx has driven me a bit insane. I’m glad I get to absorb this frustration for the parents I work with, honestly, because I can’t imagine that they could do this on their own while also worrying about everything else going on in their lives. But it’s infuriating to see how difficult it is to get someone help. Are they a danger to themselves or others? Yes, but not enough of a danger. Come back when something tragic happens, so we can all blame the parents for not having done enough.

We are tragically failing our people in need when the only way to get (temporary, kinda-ok) treatment is to be brought in slitting your wrists.

I wish I could end this by offering a solution. All I can say is that we need more, and we need better. Prevention is almost always the answer, says the preventive worker. Maybe if some of those earlier evaluations and mental health treatment could happen, we’d be taking fewer trips to the ER.

But what do I know.





Getting to know all about you (Whether I like it or not)

3 03 2011

Joyous news! I’ve got a new family on my caseload.

Engagement is always a tricky process. Getting to know people, letting them know you’re there to help and they can trust you, all while getting the information you need and setting appropriate boundaries…there’s a lot going on.

It’s especially tough as a preventive worker. A lot of our families come to us because of a CPS investigation. When CPS comes into your life, they tend to be fairly blunt. I need to see your kids. “OK kids, roll up your sleeves and pant legs so I can check for bruises. Let me talk to you without your mom. Does your mom hit you? How does she hit you? How often? OK mom, open the fridge. No I don’t want a snack, I’m checking for food!”

It needs to be done. But it’s a rough process for people already in a crisis situation.

CPS then sends me in as “the new worker.” So why would those families expect me to be any different?

My latest family has a grand total of ten kids.

Did anyone else’s uterus just try to escape?

Single mom, ten kids. The youngest is severely disabled, with cerebral palsy. There are six kids under 18. Nine of the kids live in the home. Dad pops in and out when he damn well pleases can.

This was an unusual situation, because CPS was still involved. The family’s case was transferred over to me, after the mom was called in for educational neglect. Translation: YOU get this damn teenager to go to school! Before CPS could even close the case, another investigation was called in. This time for the 14 year old boy inappropriately touching his 16 year old sister.

When this happened, I had the case for two weeks. I had been to the house once, for a brief visit, before the family signed on. The 14 year old had come in for an individual session.

Then I got a call from a CPS worker, telling me that my presence was requested at a conference.

JK. What she said was, “We’re having a conference Thursday morning at our office. You have to come to it.”

Technically speaking, I don’t. Of course I will, but I don’t have to. Even if it was required, is it so hard to ask? Honestly, people.

Let me explain something–I’m old enough. I have my Master’s degree and a couple of years of experience. However, I appear to be about 15. I get carded on the rare occasion that I head over to the tavern for a night cap. I was recently asked if my mother was giving permission for me to donate blood. (You don’t need that after age 17.)

This often means that people think they can talk to me a certain way.

We went ahead with the meeting. I explained that my knowledge of the case was limited, because I had barely even met the family.

Then the condescension kicked in.

“So you didn’t do a home assessment?” asked a supervisor who clearly realized she was old enough to be my mother. “I’m confused, I thought you had been to the home. Well, I suppose that’s something we’ll have to work on.”

It was as though she was assigning me homework.

This continued for the next hour. By the time I made it back to my office, I was fuming. Fortunately I have an understanding supervisor, who allows me to vent and rant sarcastically every day so often.

This woman didn’t speak to me as though we were colleagues, from different agencies working towards the same goal. She spoke to me as if I were a stupid child. As if she was trying to shift some sort of blame to me.

Oh wait, that’s it.

When different service providers are involved, it so often gets forgotten that we’re working towards the same goal. We’re all trying to help this family to function independently, to keep the kids safe, to help them to achieve their goals. Instead, it’s “You want me to do the referral? But your agency is connected with theirs, it will go through faster if you do it!” “I am not writing the thirty day service plan, I only got the case ten days ago. Ha!”

A lot of this comes from being overwhelmed. Everyone has too many families and not enough time. If you can put work off onto someone else, especially if that someone else is someone you don’t see too often, you’ll do it. A lot of this also comes from fear. Especially when there are a lot of safety and risk factors for a family, but the kids are still in the home, no one wants to have the ultimate responsibility. We all remember the stories of children who have died from abuse or neglect. The parents are often almost an afterthought. Where was the school, where were the social workers, where was CPS? Who fell down on the job?

No one wants to be that one worker who shoulders the blame in the media, in the case of a tragedy. But the ironic thing is that such tragedies would probably happen a lot less if we worked together a little more. If we did things that didn’t strictly fall under our umbrella of responsibility every so often, and talked to each other before resorting to blame.

But what do I know. I’m just a kid.





Did you forget to take your meds?

17 02 2011

The kids I work with are nuts. I think we all know that is said with affection. At times I get concerned, but for the most part, they’re a hoot and a half. If you can’t be crazy at age eight, when can you?

Not everyone shares my view of childhood.

I got a referral for a six year old the other day. Presenting problem? “Child plays around and is very silly.”

It’s high time for this lad to settle down. That mortgage is not going to pay off itself.

I’m sure there’s something there. It’s distressing his mother. But what was recommended for this child? The all-powerful psych eval.

I have one eight year old waiting on a psych eval. Family court is insisting. What behavior is she getting up to? She stopped doing homework and her grades dropped. Then her mother beat her with a belt. (Hence the ACS case.) The kid had just been diagnosed with diabetes over the summer. Her life changed. To make up for it, she got tons of attention from her family and friends. By the time school started, the attention had faded, but the diabetes was still there. She acted out.

But we need a psych eval. Even though the kid’s mother doesn’t really want it. Even though the kid is doing much better.

I’m not against medication. My cousin was prescribed Ritalin for ADHD, right when everyone was saying that it was incredibly overprescribed, and that those kids were just being kids.

I saw what Ritalin did for this kid. He didn’t turn into a zombie. It allowed him to be himself. He was still energetic and hard to keep up with, but he was able to channel this into his love and talent for sports. He was no longer angry at everyone and frustrated with himself. It made a huge, positive impact on his life, and our family.

That being said–not all of my kids need medication. And yet I’m being told that they do. ADHD isn’t even enough anymore.

I was working with a seven year old recently, who had what everyone thought was a pretty clear case of ADHD. He was bright, but doing poorly in school because he couldn’t concentrate or sit still. He was delightful in counseling, but required constant one on one attention. He got up to do the running man at random moments. (I admit, I never wanted that one to end.)

His mother was against a psych eval. She felt that he would be drugged and his personality changed. In this case, I felt the evaluation was really necessary. As did my supervisor, and the kid’s teachers and doctor. The mother and I talked about it at length. We went over her concerns, and her right ask questions. She finally felt comfortable with it.

Also, she couldn’t take another homework session interrupted by this boy’s need to express himself through 80s dance moves.

They were on three waiting lists for months. Mental health services in the Bronx are frighteningly hard to come by. Finally, though, the kid was in.

After three meetings, this seven year old had been diagnosed as bipolar and sent home with a free sample of Abilify.

Who doesn’t love samples?!  The little packets, so fun.

Being a responsible, loving mother with an internet connection, this woman did a little Googling. Reading the fine print for any medication will terrify you, no matter what. WebMD convinced me that taking more than one Tylenol causes internal bleeding, asphyxiation, talking in tongues, and the ability to fly.

Abilify, though, is serious business. For bipolar disorder, it’s only approved in ages ten and up.

Not to mention that the psychiatrist met this child three times. A grand total of 135 minutes. Her first thought was a label like bipolar, and a powerful antipsychotic? The mother’s very legitimate concerns were brushed aside. Just try the medication, keep an eye on him, he’ll be fine.

Ultimately, mom couldn’t go through with it. She returned the samples, and discontinued mental health services.

And I supported what she did.

Again, I’m not anti-medication. But I think we can all agree that not everyone is bipolar. A third of the kids I work with have had a doctor or counselor speculate that they might be bipolar. About the same number are on psychiatric medications.

I would think that this is a nationwide issue, but I recently spoke with a nurse in a lovely, wealthy suburban community. She was shocked to hear that a sixteen year old she knew was diagnosed with bipolar disorder. “They try not to put a label like that out there until age 18, because the kids are changing so much.”

What?!

She couldn’t believe what I was telling her about my experiences. Apparently, likelihood of serious mental illness decreases as tax bracket increases. Curious.

People should be open to medication. They should not be ashamed to admit to having a mental illness. But why the disparity? Why is the future of a child of affluent parents in an impressive zip code so important that he can’t be saddled with a serious diagnosis, while my kids and their parents, many of whom are rather young and rather not-white, are told to just be good and take their meds?

Stories like this seven year old’s are exactly what people are afraid of when the idea of a psych eval is raised. It drives people away from mental heath treatment that their children may really need.

It’s hard as a social worker to question the opinion of a doctor. Who the hell do we think we are?

We are the ultimate advocates for our clients. And for our kids’ right to be nutty kids.





Social Workers Run More Numbers Than the Mob

7 02 2011

I talk about my clients all the time. I’m sure you’re dying to know how someone gets so lucky as to work with me. Well I’ll tell you!

The vast majority of our referrals come from ACS (New York’s Administration for Children’s Services, which includes CPS) or from PINS (Person In Need of Supervision) diversion.

Go acronyms!

An ACS referral means that there has been a credible allegation of abuse or neglect, but that the children will not be removed. In order to prevent foster care, which is the last resort, families are referred to us for counseling.

PINS is a warrant parents apply for if their child is “out of control.” Skipping school, engaging in dangerous behavior, all the tomfoolery the kids these days get up to. The warrant makes it so that the child can be sent to a residential treatment facility, or something similar.

Because that’s expensive, and the city is a little short on cash (I think they’re going to start charging sidewalk rental fees for walkers) before the courts will grant these warrants, they send the families in for preventive services. So social workers such as myself can fix everything.

Our services are voluntary. However, the ACS workers tell families, “You need to sign on for preventive services.” I then tell them that services are voluntary. The ACS worker looks at me with hatred in his or her eyes, because if the case is not moved to preventive, it stays with that ACS worker. The families are often threatened with returning to court, and ultimately, they sign.

PINS diversion cases are also voluntary. Parents are willing to sign on, often under the assumption that counseling will fail, and then they’ll be granted the magical warrant. These families have been through a lot, and feel that they’ve tried everything. They’re not eager to meet for weekly counseling to explore alternative disciplinary methods, and discuss their own childhoods.

A lot of people who initially seem eager to sign on for services disappear after a couple of weeks. We’re required to see each family at least twice a month, at least once in the home. The goal, of course, is to see them weekly.

This doesn’t sound too hard. But oh, it can be.

I had one family who was at home for a visit by myself and their ACS worker, then came to the office for two visits before singing on. After that, they promptly disappeared. This was over the summer, and it turned out that the mom had sent the two kids to California to visit family for six weeks.

I’ve gone to Staten Island for visits. I could swing San Diego. But my proposal was rejected.

There are people that you need to chase on this job. It’s one if the most frustrating things we deal with. I understand it. These are people who have had negative experience with service providers, and “people just trying to help” in the past. They associate us with ACS, and think I’m there to check up on them. What could be more frightening than the idea that someone is judging you, making a case that you don’t deserve your kids?

But come on. I’m fun! I really am here to help! And for the last time, I cannot take your kids! Even if I really like them. When I haul myself out in a blizzard to try for a home visit , only to find that no one is there when they said they would be…I have to struggle to stay empathetic.

Numbers are incredibly important at my job. I recall one conversation I overheard between my director and my supervisor.

“She’s only seen this family once this month.”
“I know. But she went to the house four times.”
“Yeah, she needs to see them again.”
“I know, she’s trying.”
“OK. She needs to see them again.”

Apparently he’s a believer in The Secret. Just keep saying it, it’ll happen.

A valid excuse doesn’t matter. What matters is results. Stereotypical tough football coaches in movies about high school in Texas are more accepting of, “Well, I did the best I could!” than social work bosses.

My director once decided that a monthly competition would get everything in gear. The person with the most contacts wins a prize!

We can’t afford juice boxes for kids’ group, but we’re going to give out incentives to the workers. Fortunately, it never happened.

I had something to do with this. My supervisor had warned me that I was in the lead during supervision (oh yes, I’m very good.) We wound up talking about how uncomfortable this made me.

I understand that numbers are important. We need to document that we are seeing these families. We need to make sure that everyone in the home is safe. We need to meet our funding requirements.

But there are times that it feels like that is what being a good social worker is. I have run into a family in the bodega and counted it as a contact. (Casework, and Sunchips? Yes please!) Did I get any work done? What did we accomplish? The idea that my work is often judged at my agency based on how many times I see these families, rather than the quality of the sessions, is rather disheartening.

This is what frightens me when I think of being in a supervisory role at some point. How do you achieve a balance between the requirements for funding, and what’s best for clients? When these things are at odds, how do you decide what is most important?

No matter what, at least I know what the answer is not–a monthly contest in which grown professionals compete for a (proverbial?) cookie.