Historically, social workers are change leaders. They have been at the forefront of critical moments in U.S. history, advocating for civil rights, minimum wage and safe workplaces, women’s reproductive rights, immigrants, and LBGTQ communities. Because of this experience and exposure, social workers are uniquely qualified to understand the social complexities that influence health and how those factors impact peoples’ everyday lives. Most recently, we are seeing an integration of social work and behavioral health within medical care settings, with policy and funding to back it up. How do we build on this interdisciplinary momentum to create systemic change in healthcare that supports the whole person? The answer is social work leadership.

CISWH Executive Director Eleanor Zambrano paints a picture of social work leadership and explains how CISWH supports social workers who are looking to become leaders in the field.

What is a social work leader?

Social work leaders are the community engagement experts–the community organizers, activists, and advocates. They are systems thinkers. Social work leaders understand that change has an ecological impact. That’s why it’s always so important to think about a whole person, because if their socio-economic situation or status is inequitable, there are direct correlations to how it impacts their health.

What role do social workers play in community health settings? What does that landscape look like currently and how is it evolving?

Social workers really value the importance of direct practice, clinical practice, or interactions with communities. I think that informs a lot of social work leadership and there is an opportunity here to utilize practice experience to drive health policy. That’s why interdisciplinary work is so important. We need to have a cross-sector of professionals at the table when we’re making or changing policy.

Social workers’ direct experience, expertise, and practice within community health settings; their understanding of community engagement; are all invaluable when it comes to community change. They have the ability to amplify the voice of a community and to understand what is needed in terms of how healthcare systems plan for care.

Additionally, we learn a lot about policy in our work. Even when a policy is really well thought out, we need to think about how we engage communities in those changes. Without that preliminary relationship-building, it makes it really difficult to create real change. Social workers have a unique ability to capture opportunities and make connections, build upon existing relationships, and create partnerships in their communities.

What does civic engagement in social work look like in practice?

We recently hosted an event where two social workers spoke about their work in civic health and it was a great illustration of what it looks like. For example, Justin Hodge is a professor at the University of Michigan. He has been serving in public office, and is also teaching in academia and training social workers. A big part of his work is focused on how do we engage social workers in the political context and help them understand how it impacts the work they’re doing.

A lot of times there is a disconnect about whether or not it is ethical for social workers to be political. There’s also the concern that we’re not going to have much impact. But the truth is, policy changes and leadership decisions impact us all the time, because it directly affects the way in which we can engage in the delivery of care–whether it’s through parity in reimbursement for care or whether it’s in how we access communities to provide innovative types of care.

How is CISWH supporting social workers to become leaders in their communities?

One of the areas that we’re focused on is the representation of social work in healthcare. We are developing research and data that supports the need for social work in healthcare settings. The impact is pretty significant when you talk to healthcare providers, because these are issues that really impact the future of care. For example, if you have patients who need care but are struggling to get to their appointment, social workers are the ones who help them access or navigate systems so they can follow through with doctor recommendations.

Another way is through our CISWH fellowship program for graduate students. Most of the CISWH fellows work closely with social work leaders including our Core directors. These provide opportunities for them to see themselves in leadership roles. And they can explore potential future career opportunities as they see what goes into developing social work strategies. We’re focused on building communities within the Center and inviting leaders and students to participate, provide feedback, and inform the work that we do.

How do we center social justice in this work?

Social workers often need to maintain a balance around racial equity and health equity in various settings. When you work for government or state programming, there are a lot of restrictions in terms of disclosure and how you interact with these types of political systems. But there are also many non-partisan ways in which you can advocate for people to ensure everyone has what they need to thrive.

Social workers are focused on this – making sure everyone has what they need in order to be their healthiest–and that is a social justice issue. We know that our society is unhealthy in many ways. . So we ask, do our clients have access to what they need? Do they have opportunities to thrive? These are the questions that we really need to focus on.

Learn more about CISWH’s work. 

This graphic was originally presented at the Association for Maternal and Children Health (AMCHP) 2021 national conference and created by Karina Branson at ConverSketch.

The Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity (CMC CoIIN) team at the Center for Innovation in Social Work & Health, alongside partner organization Family Voices National, has released a new infographic that shares CMC CoIIN’s learnings on how to build robust and meaningful family partnerships that lead to improved quality and innovation in clinical systems of care. The tips in this infographic can help elevate and integrate family leaders as equal partners in this important work.

The Problem

Bringing families on board is not done consistently and can be challenging. How does one get started with family outreach? How do clinics and healthcare organizations make sure that community voices are heard?

It Starts With Values

CMC CoIIN works with teams to embed family engagement by making sure that teams and organizations have three core values baked into their action plan:

• Accountability: Outline an action plan to ensure that your team is truly working towards implementing family engagement and partnerships.
• Equity: Everyone involved must be on the same playing field. Doctors, family members, and other members of the care team all play a valuable role in improving care for children with medical complexities.
• Transparency: CoIIN organizes family leader affinity groups where family leaders can bring their true, and sometimes challenging experiences and work through them together before bringing them back to the larger team. Affinity groups provide a safe and supportive space that honors the community’s lived experiences and builds trust with the wider team.

Systemic Barriers

Values provide a good starting point for family partnership work, but it’s important to be aware of the inherent systemic barriers that prevent teams from putting them into practice. These barriers include:

• Family leaders deserve to be paid for their invaluable work, however funding is often not allocated for this role nor is it built into medical family advisory board policies.
• Families are often not seen as equal members of the care team.
• Larger systems changes are required to break down silos and truly engage with families and build strong relationships.

CoIIN’s Proof of Performance

CoIIN has a proven plan to combat these systemic barriers:

• Family engagement is required. Every single team must have family leaders engaged in their leadership team.
• Flexibility is key when it comes to working with families and interdisciplinary teams. CoIIN takes an adaptive approach when it comes to supporting teams by incorporating their specific needs.
• CMC CoIIN supports teams with technical assistance and coaching. They provide ongoing instruction on how to work together as a multi-disciplinary team where family partners play an active role.

Tools for Individual and System Change

Family Focus Groups Facilitator Guide
View the tool

Each state team is required to host focus groups with family members of kids who are enrolled in the clinical program. The focus groups asked families about their child’s quality of life, as well as overall family wellbeing. CoIIN developed a family-driven process in which family leaders come up with the focus group questions, approach, and structure. Rather than simply looking at hospitalization rates or other quantitative data, these focus groups give teams a fuller picture of children and family needs.

Family Engagement in Systems Assessment Tool (FESAT)
View the tool

The FESAT tool helps teams understand family engagement’s role within a medical system. Teams will assess family engagement within four categories and score themselves before coming together to discuss progress and reach consensus on how the work can move forward. These four categories are:

• Transparency: Do families feel like they know what’s going on behind the scenes in regards to their child’s care? Are family needs represented in decision-making and policies?
• Commitment: Does the clinic really have commitment to family engagement and family partnership? Are families involved in tangible ways that can be measured?
• Representation: Are diverse families represented in systems level decisions? Does your family leader and general interdisciplinary team match the patient population that you’re working with in terms of different identities i.e. race, disability status, etc.?
• Impact: Does the work that you’re doing in terms of family engagement and partnership actually make a difference? Are the patients who are coming into the clinic feeling the effects of these efforts?

View Infographic

CMC CoIIN is an HRSA-funded project that aims to improve the quality of life for children with medically complex conditions and their families, and increase the cost-effectiveness of their care. The project is housed at the Center for Innovation in Social Work & Health (CISWH) at Boston University School of Social Work.

For more information on the CMC CoIIN’s work around family engagement and family partnership, please visit their website.

Photo by Barbara Zandoval on Unsplash

Dr. Luz M López, director of CISWH’s Global Health Core and clinical professor at BUSSW, will join a Border Studies Program at the Texas border from March 4 – March 14, 2022. The program is focused on identifying practices to best support migrants at the Rio Grande Valley Texas border—an area that includes Brownsville and McAllen, Texas, and Matamoros and Reynosa, Mexico. Prof. López will join Dr. Carrie Preston, director of the Boston University Kilachand Honors Program and co-founder of the Initiative in Forced Displacement; and Dr. Muhammad Zamad, professor of Biomedical Engineering. A group of 9 BU students, including dual degree MSW/MPH graduate student, Sharette Bello-Suazo, fill out the BU team headed to Texas next month.

The BU team will collaborate with Refugee Services of Texas, The Rio Valley Relief Project, La Posada Providencia, and the University of Texas Rio Grande Valley School of Social Work, organizations currently working with displaced families in the area.

“[Our Texas partners] wanted a social work perspective and clinical mental health support. They learned about the work I had been doing previously with trauma and immigrants and refugees, and I was very happy to collaborate,” said Prof. López.

Displaced people come to the United States border escaping violence, fear, and trauma, only to be faced with more of the same upon arriving in Mexico and the U.S.

“Some are in tents on the border. Some are in detention centers in very difficult conditions, and some are hosted by families or organizations in the area. The goal of this trip is to interview those who are displaced and learn more about the conditions so we can determine how we can contribute and fill in gaps,” Prof. López added.

The COVID-19 pandemic, as well as evolving political and policy challenges are additional hurdles for migrants, and will also be topics of the BU team’s research. Once the initial study is completed, the team hopes to arrange support groups for the families that are waiting for their immigration status, giving them space to talk about their emotional needs. The group aims to provide support to overburdened staff as well, in addition to providing translation and documentation services.

“This is the first iteration of the IFD Border Studies Program, and we are eager to provide additional support for ongoing initiatives to build on what we learn,” said Dr. Carrie Preston. 

Prof. López hopes the border program will serve as a learning opportunity for students. “My intention is to also see if we can further collaborate with our partners in Texas and give our students practical and skill-building experience providing services to those families.”

Rather than a one-and-done research initiative, Prof. López sees the Border Studies Program collaboration as a way to provide sustainable, community-centered support to migrant communities.

Photo by John Ra, Courtesy of Partners in Health

The Center for Innovation in Social Work and Health (CISWH) at Boston University School of Social Work mourns the loss of advisory board member and dear colleague Dr. Paul Farmer, who passed away early this week in Rwanda at the age of 62. Dr. Farmer helped guide the Center’s work on global health equity initiatives and strategic partnerships in Africa.

A medical anthropologist and physician, Dr. Farmer dedicated his life to improving health care for the world’s poorest communities. He co-founded international non-profit Partners in Health (PIH) in 1987 to provide quality health care and advocate for those living in poverty. Dr. Farmer led teams in 13 countries over the past 26 years, developing sustainable, community-based strategies for global health care.

The Center’s board chair, Carla Meyer shared, “Paul was a dear friend and inspiration. His loss is irreplaceable. At this time of global pandemic, his insight that – until all receive equitable health care, none will be safe – is more pertinent than ever before. We must find a way to carry on his important work.”

“Paul was a humanitarian, an innovator with a relentless commitment to addressing human rights to improve the lives of the most impoverished populations around the world,” said Dr. Jorge Delva, dean of the BU School of Social Work and Paul Farmer Professor and director of CISWH. “He was a person with a great sense of humor and kindness.”

Dr. Luz Lopez, CISWH Global Health Core director reflected on her work with Dr. Farmer, “Dr. Farmer was actively involved as a board member of CISWH. He was a physician committed to humanitarian work who pioneered new community-based treatment strategies and improved access to quality health care globally. He was a champion for global health and social justice.”

“Dr. Farmer demonstrated the importance of strengthening partnerships abroad to support and bring resources to communities experiencing poverty and health disparities. CISWH continues to honor his work by fostering strategic partnerships in southern Africa and Latin America” said Ellie Zambrano, executive director at CISWH.

The global health equity community faced an incredible loss this week. Dr. Farmer’s impact is immeasurable. However, colleagues, mentees, and partners in the fight for global health equity have made it clear they are determined to carry on his legacy and shared mission.

Access to quality health care is a social determinant of health. In this letter-to-the-editor, CISWH Leadership Core Director and BUSSW Prof. Geoffrey Wilkinson warns against Mass General Brigham’s continued expansion into affluent suburbs, which could have a negative impact on health equity and underserved communities.

Excerpt from “Pounding Footsteps You Hear Belong to Mass General Brigham” by Prof. Wilkinson, originally published on The Boston Globe: 

“I’m reminded of pharmaceutical company ads designed to drive consumer demand for products with questionable value as compared with effective, less expensive drugs. In MGB’s case, we should have a voice-over warning about all of the potentially dangerous side effects that may occur if the DPH accedes to the health care giant’s demands: ‘These projects may raise your health insurance rates, gut the state’s cost-containment goals, and imperil existing health providers. Don’t take this product if you have concerns about racial health disparities, property tax exemptions for rich corporations, or equitable distribution of health resources.'”

Read the full letter.

Learn More About Prof. Wilkinson’s Research