This webinar on November 21, 1:30-3:00 pm ET, will describe outcomes and lessons learned to implementing and achieving the HIV Care Continuum from CISWH’s Dissemination and Evaluation Center project. Participants will learn about the background of each intervention, its implementation, and the initiative’s goal of creating replicable Care and Treatment Interventions. Presenters will share findings from the four interventions:
Peer Linkage and Re-Engagement of Women of Color Living with HIV
Enhanced Patient Navigation for Women of Color Living with HIV
Transitional Care Coordination: From Jail Intake to Community HIV Primary Care
Integration of Buprenorphine for Opioid Use Disorder into HIV Primary Care
The webinar is presented by the HRSA HAB SPNS supported DEII Dissemination and Evaluation Center (Boston University/Abt Associates) in collaboration with the Implementation Technical Assistance Center (AIDS United).
Starting on a path to substance use recovery might not begin with checking into detox, or even speaking with a medical professional. It could be as simple as coming in off the street for a cup of coffee — or so says the philosophy of Boston Public Health Commission’s Recovery Services Bureau.
In 2017, the Bureau introduced its engagement center, which offers quality-of-life interventions for individuals managing substance use — basic creature comforts for people who often don’t have stable housing situations. As a drop-in location, the center allows people to stop in and take a break from the streets, even just for a warm beverage, to watch TV, or to unleash their creative side with art supplies.
The Bureau’s priority is to find ways to reach people who aren’t likely to engage with traditional healthcare systems, providing low-threshold, open-door support wherever their clients are. Together, the Bureau keeps tabs on the welfare of the community they serve and, when people are ready, links them to many options for healthcare, mental health care, and substance use treatment.
The approach works. Each week, about 90 people enter into treatment.
“By creating a low-barrier environment to services, we are able to meet people managing substance use right where they are,” says Devin Larkin, director of the Bureau.
An empathetic view of treatment barriers
Larkin (SSW ’07, SPH ’09), who has a master’s in social work and public health from Boston University, credits her educational training as being key to her innovative approach to serving people with substance use disorders — from understanding the impact of social determinants of health, to respecting an individual patient’s autonomy.
By creating an environment that is, first and foremost, kind, the Bureau provides an open gateway of support to a vulnerable population.
Under-resourced clients can face challenges in piecing together the different aspects of their healthcare. They may have a doctor’s appointment in one community and a visit to a detox center in another. For a person without reliable transportation, having to arrive to an appointment on time can be a hurdle. For someone involved in the criminal justice system, engaging with security desk staff at a clinic can be a deterrent to engaging in care, says Larkin.
“You could have the best opioid treatment team in the world, but if nobody wants to walk past the security desk to find that clinic, it’s just a passive recruitment strategy,” she says.
Devin Larkin, director of the Bureau of Recovery Services at the Boston Public Health Commission, advocates for low-barrier environments for SUD treatment services. (Nilagia McCoy)
The Bureau has a significant footprint in Boston. It currently manages three residential treatment centers, a street outreach team, an access to care program, a needle exchange program, resources for homeless individuals, and more. At about 150 employees strong, the Bureau also cultivates a wide network of external partners to spin its significant support web: health centers and treatment centers, community groups, homeless outreach teams, first responders, and more. The Bureau’s staff can step in to help break down barriers by navigating clients’ care alongside them. If a client needs a replacement ID, or has an open court case, for example, Bureau staff can help with the process or even accompany the person so they don’t have to navigate these channels alone.
“All those things where other systems typically say, ‘Go take care of that, then come back’—that’s where you lose people, especially people who are complex psychiatrically and medically,” says Larkin.
Once someone walks through the door at the engagement center, they can then be introduced to services and resources they need, such as housing and healthcare, without judgement. And when they’re ready, they can begin treatment for substance use disorder. Honoring client self-determination is key to creating partnerships with individuals engaging in the recovery process, says Larkin, regardless of whether it’s their first pass, or one of many, into recovery.
Integrating harm reduction into healthcare
The Bureau’s emphasis on low-barrier services has had its share of critics, some concerned about overwhelming the system with needy people. Larkin invites skeptics to come learn more about their person-centered approach, which has been well-received in the substance use community. She believes that if social, behavioral, and medical care systems come together in a harm-reduction mindset, they’d all share equally in the commitment to support vulnerable patients.
“We’d like to see needle exchanges in health centers,” says Larkin. “We’d like to see more low-threshold services for behavioral health; if someone comes to their appointment an hour late, they can still be seen.”
As a social work practitioner, Larkin also wants human service providers to recognize that every interaction a client has affects their future likeliness to seek care. If programs and interventions are designed to help people feel welcome and worthwhile, they are more likely to produce positive future outcomes.
“People need to feel like the programs are built for them,” she says. “That’s how you engage people in care.”
This article is part of a series from the Boston University Center for Innovation in Social Work & Health (CISWH) for Boston Medical Center’s HealthCity that highlights social workers working in healthcare and public health to address the nonmedical factors that impact health, known as social determinants of health. Know of a healthcare team that’s doing innovative work involving social workers? Contact us — we want to hear your story.
A symposium hosted by the Center for Innovation in Social Work & Health and Boston University School of Public Health focused on elevating the field of public health social work and the importance of policy in addressing social determinants of health.
On October 22, 2019, members of the social work and public health communities came together to discuss how both disciplines can collectively address issues affecting the health of domestic and global populations. After a warm welcome from Dr. Jorge Delva, dean of the Boston University School of Social Work (BUSSW) and director of the Center for Innovation in Social Work & Health, and Dr. Sandro Galea, dean of Boston University School of Public Health (BUSPH), the podium turned over to keynote speaker Dr. Charles E. Lewis Jr., director of the Congressional Research Institute for Social Work and Policy (CRISP).
Dr. Lewis recalled his own journey to find social work first as a consumer, then as a student; eventually, discovering his passion for social work advocacy in politics. Reflecting on his social work practice in Washington, DC, he noted, “I call myself a ‘political social worker,’ meaning, I’m up on the Hill, promoting active engagement of social work in political spaces.” His passion is to move policy discussions to political channels, where people can turn ideas into action. As founder of CRISP, he urged the audience to engage congresspeople on important social issues, and said he hopes to bring social workers into congressional field offices for work placements to give the next generation of social workers exposure to grassroots political action. He closed his remarks with a call to action, for social workers to honor the work of the late Elijah Cummings and to do their part to support democracy by voting in elections.
Next up was the afternoon’s panel discussion moderator, Harold Cox, associate dean for public health practice and associate professor of community health sciences at BUSPH. He turned the conversation toward exploring ways to initiate and sustain upstream change in the public health social work space. Two questions were posed to the panel of guest speakers: 1) What does public health social work bring to the table in these discussions? And 2) What can public health social work do to improve its reach and outcomes?
Jennifer Valenzuela discusses Health Leads’ work on social determinants of health.
Betty Ruth (SSW ’84, SPH ’85), clinical professor and director of the MSW/MPH program at BUSSW, spoke from a higher education perspective. “Social work is a health profession,” she said. “Half of social workers work in a health setting.” Yet, she observed, most ultimately work downstream in clinical capacities, where impact on public health is often limited. She urged educators to think more broadly about social work to better encompass public health, ideally by integrating public health more fully into social work curricula.
Linda Sprague Martinez, associate professor at BUSSW, offered her thoughts from a community health perspective. In her experience, she sees that broader social systems have an impact on people’s overall health. “We need to learn from communities, instead of just educating them,” she said, observing the two-way linkage between people and environments in social work practice. She also suggested more crossover between public health and social work curricula and educators as a way of promoting cross-discipline partnerships and competency.
Speaking from a healthcare perspective, Jennifer Valenzuela (SSW ’00, SPH ’01), principal of equity and people at Health Leads, gave examples of how public health and social work can come together to address social determinants of health, which are “fundamental drivers” of many health conditions. She shared how Health Leads has integrated social workers into their organization to address not only the needs of individual patients, but also in their plans to address policy and broader systems.
“Public health social workers have earned their place at the policy table.”
Heidi Allen, associate professor at Columbia University School of Social Work, next took the stage and highlighted policy’s widespread impact: “Policy affects everything, and everyone…policy is the avenue to creating change.” She urged social workers to develop a strong professional identity, ready to address questions of race, power, and privilege in conversations about meaningful change. “Public health social workers have earned their place at the policy table,” she said.
The final panelist was Fernando Ona (CAS ’92, SSW ’15), clinical associate professor of public health and community medicine at Tufts University and a clinician at the Boston Center for Refugee Health and Human Rights at Boston Medical Center. His work abroad with refugees and victims of humanitarian crises has given him a view of social work practice in dangerous and delicate conditions. “Systems must not always be outcomes-focused. Process matters, and social workers are right there with patients.” He challenged social workers to “radically listen to the populations we’re engaged with” in their practice.
Linda Sprague Martinez speaks during the panel discussion.
Following the presentations, Dr. Cox invited all panelists and Dr. Lewis to join him for a group discussion. A common theme was that social workers need to change the nature of policy discussions by ensuring they are present at the table: public health social work, as a practice, needs to do a better job of identifying itself as a profession, and mentoring and developing the next generation of leaders.
With some self-effacing humor, the group noted that, for a discipline that generally has an aversion to power, social workers need to embrace their professional power to ensure that social work is represented in key places where policy is made. “We may not be your typical leaders,” observed one panelist, “So we should be asking: how are we innovating around leadership and leadership education?”
The audience offered a few suggestions for social work practitioners. “Think about how to articulate the complex and comprehensive nature of our work when we engage with agencies and businesspeople.” Another suggested, “we work under so many different labels, with less emphasis on the term ‘social worker.’ Would it help make us more visible to standardize under a single term?”
Watch the panelists’ presentations in full, and hear more of their ideas for public health social work policy, scholarship, and practice in the video of the event.
Article by Mariah LeStage, photos by Craig Bailey, Perspective Photo.
The social determinants of health (SDOH) are the social circumstances in which people live, work, and play. A recent shift from acute care treatment to chronic disease management has brought a renewed recognition of the ways in which a person’s socio-environmental context affects their health and well-being. Some estimates credit these factors with twice the impact on health outcomes as quality healthcare has.
Not by chance, the social conditions within which people live, work, and play are gravely inequitable. Racialized social policies, for example, have given rise to a socially stratified society with separate and unequal conditions and opportunity. Within these circumstances, people have different access to education, safe housing, income, healthcare, fresh food, and other needs that influence their health outcomes. Social determinants like these are significant from a health equity lens because they help us understand the ways in which educational, racial, socioeconomic, and other social inequities contribute to health inequities.
Outcomes do not occur in a vacuum. As a profession, social work has long recognized the relationship between individuals and broader social systems — which we both shape and are shaped by. Now and since its inception, social workers play a critical role in advancing public health and eradicating these health inequities for future generations.
Social work’s value in addressing SDOH
The profession has roots in structural change efforts and the social determinants of health. Although the community health center movement — which radically changed the way we conceptualize healthcare in the U.S. — is often associated with Jack Geiger, MD, his advisor and co-conspirator in advancing the movement was Dr. John Hatch, who at the time was a social worker. Hatch’s work with Geiger lead to a healthcare delivery model aligned with the social work values of community development and asset-based intervention, including workforce development, food access, and healthy housing.
Achieving health equity requires fundamental change across multiple systems and at multiple levels.
Among today’s healthcare professionals, social workers are specifically trained to navigate the multiple dimensions that influence health — policy, community, healthcare settings, and family. In their day to day work, many social workers function as boundary spanners, facilitating communication among healthcare providers and the community partners that can offer critical social supports for a patient’s disease management.
Notably, social workers employ a person-in-environment approach to meet with people in nontraditional settings, creating access for the most marginalized segments of our population and for those who otherwise might not be able to reach care. As the boots on the ground, social workers have valuable insight and familiarity that can make all the difference in delivering effective care that addresses individuals’ unique needs. As Nobel-prize winning social worker Jane Addams once said, “social work’s special genius is its closeness to the people it serves.”
Achieving equity requires collaboration and systems change
At the end of the day, achieving health equity requires fundamental change across multiple systems and at multiple levels. As such efforts to advance health equity expand, medical communities must elevate the expertise and assets of social workers. Similarly, social workers focused on catalyzing change will benefit from equitable partnerships with health and public health practitioners.
Healthcare is a dynamic and evolving system, and we invite you to embark on this adventure with us. The Center for Innovation in Social Work & Health (CISWH) series will highlight success stories and provide an inside look at how integrated teams work and provide ideas that can be replicated to continue to address the social determinants of health to improve services for patients.
This article is part of a series from the Boston University Center for Innovation in Social Work & Health (CISWH) for Boston Medical Center’s HealthCity that highlights social workers working in healthcare and public health to address the nonmedical factors that impact health, known as social determinants of health. Know of a healthcare team that’s doing innovative work involving social workers? Contact us — we want to hear your story.
Faculty and staff from the Center for Innovation in Social Work & Health (CISWH) presented their research at the 2019 American Public Health Association Annual Meeting and Expo, in Philadelphia, PA, from November 3 to November 6.
Additionally, Ada Avila, Boston University School of Social Work alum and CISWH research fellow, received the 2019 Social Work APHA Student Award. Congratulations Ada!
Friday, November 15, 2019
8:45 AM – 12:15 PM
Westchester Institute for Human Development
20 Plaza West, Cedarwood Hall, Valhalla, NY
Children whose parents have intellectual disabilities are more likely to be placed in foster care, which is associated with long-term negative outcomes related to mental health, substance use, and education. What interventions can help parents with intellectual disabilities safely parent their children, keep families together, and encourage healthy child development?
This half-day symposium will highlight findings from a study of the Westchester County-based Project IMPACT, an intensive in-home training program for parents with intellectual disabilities who are at risk of child removal due to allegations of child maltreatment.
The event will also feature a panel of practitioners from the fields of social work, child welfare, psychology, and legal services, who will discuss the current child welfare landscape, implications for related fields (e.g. education and law), and effective and replicable interventions.
Schedule
8:45 – 9:14 AM Registration and light breakfast
9:15 AM – 12:15 PM Presentation of Project IMPACT findings, panel, and conversation
Speakers
Dr. Astraea Augsberger, MSW, Ph.D, Assistant Professor at Boston University School of Social Work
Dr. Wendy Zeitlin, MSW, Ph.D, Assistant Professor, Social Work and Child Advocacy, Montclair State University
Sarah Lorr, Assistant Professor of Clinical Law and Deputy Director of the Disability and Civil Rights Clinic at Brooklyn Law School
Dr. Trupti Rao, Psy.D., Psychologist, Program Manager, Project IMPACT, Westchester Institute for Human Development
Ari Chiarella, Social Work Supervisor and Co-Director of the Queens practice at the Center for Family Representation
The Honorable Carol S. Klein, Orange County Family Court, 9th Judicial District
Danielle Weisberg, LCSW, Director of Child Welfare Services, Director of Children’s Advocacy Center (moderator)
When cancer disrupts a patient’s life, social workers and patient navigators provide crucial support for social needs to ensure access to care.
When a patient receives a cancer diagnosis, following the doctor’s recommended treatment plan is critical to ensuring the best possible outcome for their situation. But for people who face mental health issues such as depression or who lack access to basic needs such as reliable transportation and food, adhering to treatment is easier said than done.
“A diagnosis impacts the whole ecological system of a patient,” says Erica Criscuolo, a clinical social worker for the Cancer Center at Boston Medical Center (BMC). Lindsey Streahle, an American Cancer Society patient navigator who works closely with Criscuolo, says factors beyond the quality of care can have a major impact on outcomes.
“Patients often bring up transportation when talking with a provider about an initial treatment plan—’How am I supposed to get to care when my family is working? What if I feel too sick to take the bus?'” says Streahle.
Integrating social workers and patient navigators into the care team can make a significant difference in helping people overcome such barriers and obtain the treatment they need. Rigorous studies have shown that addressing social needs, particularly through patient navigator programs, can effectively help patients access care and reduce treatment disparities.
Oncologists Criscuolo works with at the center increasingly understand the connection between cancer care outcomes and social supports, says Criscuolo, and they will refer patients to her if they detect signs of emotional distress or underlying mental health conditions. With social work and patient navigation in the mix, clinicians are seeing marked improvements in patients’ ability to follow through with their care plans — a pattern that suggests a need for greater support services in cancer care.
Social supports in cancer care reduce no-shows
Criscuolo provides a range of services, including one-on-one counseling sessions throughout the duration of treatment, on-call mental health interventions, and support groups. Streahle and the other five navigators on the team connect patients to resources such as free and low-cost transportation, lodging for intensive treatment, meal delivery, and financial assistance to help replace missed work income. If a patient doesn’t show up for an appointment, a navigator will help them reschedule and address barriers to prevent them from falling out of care.
Erica Criscuolo (left), clinical social worker, and Lindsey Streahle, American Cancer Society patient navigator. (Nilagia McCoy).
Meanwhile, communication is happening at all levels to ensure coordination. For example, if a patient mentions to Criscuolo they need a ride to their chemotherapy appointment, she will inform a navigator who can coordinate the appropriate services. And all members of a patient’s care team—doctors, nurses, the patient navigator, the social worker, and if needed, palliative care workers—meet together with the patient to discuss treatment and prognosis. Regular communication ensures alignment on how to support the patient’s individual needs as they navigate their cancer care.
This integrated approach pays off. In an informal analysis of missed oncology appointments within a 6-month period among several doctors, the Cancer Center found that patients without a navigator had a no-show rate of 10%. By comparison, patients who were assigned a navigator had a no-show rate of only 4.5%.
The importance of team communication and support
The key to making these programs work for patients is regular communication among the cancer care team — not only about patient support needs, but also about their own needs as they confront serious illness in their patients.
Criscuolo works with approximately 50 patients at any given time, while each navigator works with about 70 to 100 patients — and some prognoses will remain bleak, despite the best care.
“It’s heavy work,” says Streahle. “You have to have each other’s backs.”
During twice-monthly resiliency huddles, members of the care team come together to discuss difficult experiences. Allowing space to process with the team, says Criscuolo, is an important part of ensuring longevity in work that can be extremely emotional at times.
Addressing social needs on a systemic level
Even as BMC’s Cancer Center makes progress in addressing barriers for individual patients, Criscuolo stresses the need for systemic and societal change.
“We care for some of the most vulnerable, oppressed populations,” she says. “We are here to be your cancer support team, but we can’t individually solve bigger issues such as homelessness.”
Criscuolo encourages health systems to ensure that social workers and patient navigators — the people working on the ground — have a seat at the table when creating hospital policies, discussing social determinants of health, or designing pilot programs.
“It’s important to break down silos that often exist in the medical field. We can talk about integrating supports, but still not know what resources are there or what databases exist, or have a unified way of communicating with the community,” Criscuolo says. “We try to mitigate that in this clinic, but it’s a larger systemic issue that goes beyond oncology.”
By Nilagia McCoy. This article is part of a series from the Boston University Center for Innovation in Social Work & Health for BMC’s HealthCity that highlights social workers working in healthcare and public health to address the nonmedical factors that impact health, known as social determinants of health. Know of a healthcare team that’s doing innovative work involving social workers? Contact us — we want to hear your story.
The report makes recommendations on how to: 1) expand social needs care services; 2) better coordinate roles for social needs care providers in interprofessional care teams across clinical and community health settings; and 3) optimize the effectiveness of social services to improve health and health care. Recommendations address areas such as integration of services, training and oversight, workforce recruitment and retention, quality improvement, research and dissemination, and governmental and institutional policy for health care delivery and financing.
A congressional briefing, “Integrating Social Determinants of Health Into Future Health-Care Policy,” will be held on Thursday, September 26. The briefing will focus on concrete federal policy solutions for integrating social determinants into health care policy and will feature several social workers and federal health care policy experts. The briefing is sponsored by CISWH, the Council on Social Work Education, the Society for Social Work and Research, the Center for Health and Social Care Integration, Congresswoman Karen Bass (D-CA), MSW, and the Congressional Social Work Caucus.
Tuesday, November 12, 2019
12:00 PM – 1:00 PM
Boston University School of Public Health, Crosstown Building
801 Massachusetts Avenue
Third Floor, Room 305
Dr. Julie Cwikel is a chaired full professor in the Spitzer Department of Social Work at Ben Gurion University of the Negev, in Israel. In this presentation, she will review basic principles and a brief history of social epidemiology based on her best-selling textbook: Social Epidemiology: Strategies for Public Health Activism. To illustrate the versatility of social epidemiology as a research method, she will present findings from six different research projects on the topic of addressing perinatal mental health challenges among new mothers from diverse populations. An open discussion will follow. Lunch will be provided.
Services for Deaf and Hard-of-Hearing People Provided
Cohosted with the Boston University School of Public Health.
Social work and public health are both centrally concerned with the social determinants of health. This half-day symposium will explore how, together, social work and public health can improve population health, from individual-level to systemic change. We aim to generate ideas for future collaboration in scholarship, policy, and practice.
2.5 free social work CEUs available.
#PublicHealthSocialWork
Agenda
3:00 p.m. – 3:15 p.m.
OPENING REMARKS
Jorge Delva, Dean, Boston University School of Social Work and Director and Paul Farmer Professor, Center for Innovation in Social Work & Health
Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health
3:15 p.m. – 3:45 p.m.
KEYNOTE
Charles E. Lewis, Jr., President, Congressional Research Institute for Social Work and Policy
3:45 p.m. – 5:30 p.m.
PANEL
Community Health Linda Sprague Martinez, Associate Professor, Boston University School of Social Work
Health Care Jennifer Valenzuela, Principal of Equity and People, Health Leads (SSW ’00, SPH ’01)
Global Health Fernando Ona, Clinical Associate Professor of Public Health and Community Medicine, Tufts University and Clinician, Boston Center for Refugee Health and Human Rights, Boston Medical Center (CAS ’92, SSW ’15)
Policy Heidi Allen, Associate Professor, Columbia University School of Social Work
Educating Social Workers for Public Health Betty Ruth, Clinical Professor and Director, MSW/MPH Program, Boston University School of Social Work (SSW ’84, SPH ’85)
Moderator:Harold Cox, Associate Dean for Public Health Practice and Associate Professor of Community Health Sciences, Boston University School of Public Health
