A Big Picture, Bottom-up Approach to Student Well-being

Sexual assault affects one in five female college students, with LGBTQ+ students facing a greater likelihood of assault. In recent years, colleges nationwide have responded with new Title IX policies and resources to support survivors medically, psychologically, and legally. Yet prevention remains an area for improvement. 

“It’s not that common to have violence prevention resources on campus,” said Ashley Slay, (SSW’16), prevention program administrator at Boston University’s Sexual Assault Response & Prevention Center (SARP). Only 61% of colleges report having a prevention program. Slay, who is a macro social worker, looks at the problem through the lens of systemic change. “How can you use an individual person’s experience—that you are seeing multiple times over in other people—to create a solution?”

SARP, a part of BU’s Student Health Services, provides undergraduate and graduate students with trauma-informed counseling, a 24-hour crisis hotline, and assistance in navigating medical care, law enforcement, and academic resources. These services for survivors are provided by four crisis counselors—three social workers and one psychologist.

The prevention programming that Slay oversees includes student-led outreach, educational sessions, and skits based on survivor accounts, which are held throughout the academic year, including events such as freshman orientation, Domestic Violence Awareness Month (October), and Sexual Assault Awareness Month (April). “Young people can come in with a lot of stereotypes and preconceived notions of how sexual violence happens. Unpacking and challenging that is very important,” she said.

Social work is not about telling people what’s right, it’s about talking to them and finding out what they believe is right, what is going to be the best solution to their problem.

Slay, who was previously a youth outreach coordinator at the Boston Area Rape Crisis Center, educates and empowers student ambassadors to talk with their peers about topics like consent and bystander intervention. “They are the faces communicating the messages to students,” she said. She hosts weekly meetings for ambassadors that cover topics like racism and poverty, and how they intersect with sexual violence so they have “a well-rounded way of addressing the issue. If students ask them, ‘what about this?’ they can [answer questions].”

At the same time, Slay also learns a lot from the student ambassadors. The SARP office was established in response to student activism, and students plan the events, deliver the curriculum, and often teach her about new aspects of intersectionality. “Social work is not about telling people what’s right, it’s about talking to them and finding out what they believe is right, what is going to be the best solution to their problem, and saying ok, these are the tools I can contribute—there’s a lot of collaboration.”

Slay noted that her macro social work background—which has roots in community organizing principles—adds a valuable, complementary perspective when addressing public health problems. “Public health and social work share social justice values, but there can be some differences in their approach. There’s a perception that public health folks come up with plans and focus on process, while social workers think about how a plan is going to play out in the communities being impacted. Social workers start from the center and build out, whereas public health people start outside and build in.”

This article is part of a Center for Innovation in Social Work & Health (CISWH) series that highlights success stories about social workers working in healthcare and public health to address the non-medical 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.

Article and photo by Nilagia McCoy, Center for Innovation in Social Work & Health.

What does it mean to be a public health social worker? CISWH’s Boston University Advancing Leadership in Public Health Social Work (BU-ALPS) project explores the career paths and impact of MSW/MPH alumni.

Jenn Valenzuela, MSW, MPH, Chief People Officer, Health Leads, Boston, MA

Jenn Valenzuela graduated from the Boston University MSW/MPH Program in 2000/2001. She was a Clinical Practice major at the School of Social Work and Health Policy/Management major at the School of Public Health. Jenn is currently Chief People Officer at a national health organization, Health Leads, where she has worked for seven years. She describes her job as “100% Public Health Social Work (PHSW). I have both feet firmly planted in both social work and public health. At Health Leads, we deliver direct services to approximately 10,000 patients in health care settings every year. With my clinical hat on, I lead all the program implementation and integration in health systems and clinics across the country. My team is responsible for coaching and training staff, establishing and promoting best practices, and codifying Health Lead’s program model using data analytics and clinical expertise.” Jenn notes that her experience as a clinical social worker in health settings has informed her thinking about always keeping patients first and that her public health expertise allows her to speak with health care executives about population health strategies.

Jenn’s achievements are numerous: While at Children’s Hospital, she led a five-year U.S. Department of Health and Human Services Office of Population Affairs randomized control trial to study the effects of individual life skills and parenting interventions among urban teen parents. She also spearheaded a partnership with fifteen community service organizations to create, develop and implement an Annual Summit for Teen Empowerment and Parenting Success, which is now in its 7th year. At Health Leads, she has created a Patients Advisory Council to increase the voices of those who receive services, co-led the development of a client database, and has recently been promoted to the Executive Team where she heads up the organization’s equity work.

Jenn notes that her experience as a clinical social worker in health settings has informed her thinking about always keeping patients first and that her public health expertise allows her to speak with health care executives about population health strategies.

She is also passionate about the need for social work to strengthen its role in health. She notes that when she started in public health almost twenty years ago, almost no one knew what an MPH was. At that point, “Social work was very well understood and the profession never needed to define itself—although it really was only known as a clinical profession. Now, public health has surpassed social work in its brand and professional identity. Public health is well-respected in the health care field and always brought to the table. And there are more public health folks in the administrative roles than social workers. And when social work is invited to the table, we don’t come with data that can tell our stories and make the case for ourselves.” Jenn observes that much of the conversation in health care is about social determinants, population health, unmet social needs and empathic inquiry. She is concerned that social work, which has been doing this work forever, has not told its story well enough. “We must do better!”

Jenn makes a compelling case for PHSW. She sees public health social workers as capable of bringing and keeping social justice at the forefront of the work. “Public health social worker is the best combination. We’re people that can see the bigger picture and look at how to prevent the problem, while at the same time recognizing that the problem still exists and we can intervene…when I tell people I’m a public health social worker, I have to explain it. But once I do, they get it.”

Jenn’s advice to students: Rather than waiting until after graduation, engage in leadership development while in school and learn “concrete things like facilitation of meetings, team leadership, staff development and financial management.”

This profile is excerpted from the Advancing Leadership in Public Health Social Work Education Toolkit. This free resource, designed to help advance the field of public health social work, was produced by CISWH’s BU-ALPS project and funded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

This article was originally published by the Lucile Packard Foundation for Children’s Health. 

By Meg Comeau, MHA, Senior Project Director at the Center for Innovation in Social Work & Health, Boston University School of Social Work, and parent of a young adult with a chronic condition.

I’m currently working on a project that is focused in large part on improving the quality of life for children with medical complexity (CMC) and the well-being of their families. It’s exciting work, and I’m privileged to be part of it. In addition to working in the field, I’m also the parent of a young adult who was born with a complex genetic syndrome.

Perhaps because of this dual identity, I have found myself a little uncomfortable with certain terms and concepts that are commonplace and generally accepted within the world of CMC. I’m not sure that families and professionals always understand what these terms can mean from different vantage points.

Two terms in particular could benefit from reexamination.

When researchers seek to measure concepts that influence children’s quality of life and the wellbeing of their family, they often consider measuring “family burden.” The concept of family burden generally includes measures of financial hardship, emotional stress, and the health-related impacts of physical caregiving.

But these burdens are not caused by my child or any of my family members. They are not the direct result of my complex caregiving responsibilities. They are the result of deficits in the systems that surround us; the systems that are supposedly designed to support us.

I’m concerned that these deficits are not recognized as the causes of family burden. My personal experience is that often the child with complex needs is seen as the burden, not the systems that fail to provide adequate insurance coverage, meaningful mental health services, and easy access to high quality community-based supports.

We should place responsibility for burden on the system deficits that cause the burdens, not on the child and family.

Stigmatizing the child is obviously upsetting (as a parent, a public health professional, and a human being) but it’s also dangerous. When people with special health care needs and disabilities are perceived as “less than” or “burdensome” (either on their families or on society) they become vulnerable in ways that can be frightening, such as an increased risk of bullying, abuse, or neglect.

A second, related term that I find problematic is “complexity.” What do we really mean when we talk about complexity? In my work, I use a definition of medical complexity that is widely acknowledged as a standard in the field. One of its many attractions to me is that it includes “need” for a high level of health care services in addition to receipt of them. Simple utilization data will only tell you what was paid for, not necessarily what was needed by a family.

It certainly can’t easily tell us anything about the impact – the burden imposed – of unmet needs or services.

The current definition of medical complexity is typically focused on multiple affected body systems, the need for or use of high levels of health care services, and often the presence of life-sustaining medical technology. This definition has great utility in many contexts. But is it enough? Could we broaden our definition of what constitutes complexity when thinking about sources of family burden and systems-based deficits?

For example, social determinants are appropriately beginning to be included as part of the definition of medical complexity. A relatively straightforward and manageable health care need in a child can become astonishingly complex if that child is homeless, or in foster care. Similarly, families of children who experience significant behavioral or mental health issues encounter systems that are not designed to meet their needs: coverage is scanty, providers are in short supply and there is little integration to help coordinate and improve the quality of their care (not to mention its cost-effectiveness).

It’s no wonder that families who experience any combination of these factors often are crushed beneath the burden of system-based deficits.

These types of issues should be factored in when deciding what constitutes complexity and thus eligibility for services.

The lack of high-quality, reliable, affordable services is felt most acutely by children and families, but others—pediatricians, schools and payers—also experience related burdens that hinder their ability to operate at peak performance. This in turn inhibits their ability to serve children and families effectively. It begins to feel like a never-ending cycle in which we’re all stuck together.

I encourage those who have the power to influence CMC research, and to improve the systems that serve these children and their families, to examine their thinking about the terms family burden and complexity. We should place responsibility for burden on the system deficits that cause the burdens, not on the child and family, and we should acknowledge the many non-medical factors that contribute to complexity. Having better definitions will allow us to work together to repair the system flaws. Anyone and everyone who loves, is in service to, or has responsibility around the health and well-being of CMC has a role to play.

The views expressed here are my own, and not representative of the CMC CoIIN project or the Maternal and Child Health Bureau.

About the Foundation: The Lucile Packard Foundation for Children’s Health is a public charity, founded in 1997. Its mission is to elevate the priority of children’s health, and to increase the quality and accessibility of children’s health care through leadership and direct investment. Through its Program for Children with Special Health Care Needs, the Foundation supports development of a high-quality health care system that results in better health outcomes for children and enhanced quality of life for families. The Foundation encourages dissemination of its publications. A complete list of publications is available at http://www.lpfch.org/publications CONTACT: The Lucile Packard Foundation for Children’s Health, 400 Hamilton Avenue, Suite 340, Palo Alto, CA 94301 [email protected] (650) 497-8365

A social worker and patient navigator discuss how they provide services, reduce stigma, and break down barriers to care.

Being a new parent is a tough job for anyone—but it’s even more difficult when substance use recovery is part of the mix. For parents who are also struggling with a lack of resources such as housing, transportation, or childcare, the situation can be overwhelming. Enter Boston Medical Center’s (BMC’s) SOFAR (Supporting Our Families through Addiction and Recovery) program, which provides care and assistance to families to encourage healthy outcomes for both parents and children.

SOFAR, which turns two in July 2019, sits within BMC’s pediatric primary care clinic and expands upon the prenatal care offered by BMC’s Project RESPECT. SOFAR’s team of seven—comprised of physicians, nurse practitioners, a social worker, and a patient navigator—currently serves 125 families that are affected by substance use. The integration of a social worker and patient navigator is an essential part of the program, helping patients make progress on their parenting and recovery goals, and preventing parent-child separation.

Jill Baker, SOFAR’s clinical social worker, provides behavioral health support and crisis management services. “A lot of my work is helping parents with whatever they need help with, because if the parent’s not doing well, the child’s not going to do well, and they will end up separated,” she said.

“Especially when the kids are younger, it’s a lot of parental mental health, making sure that they’re connected to therapists, recovery support—and if they’re not going to connect, I’m the one doing the relapse prevention, recovery work, providing emotional support, and all the stuff that comes along with being a new parent,” said Baker. “I’ll give referrals to specialized daycares, programs that work specifically with parents in recovery, and work with DCF (Department of Children & Families).”

Kristin Reed, SOFAR’s patient navigator, focuses on eliminating barriers that can stand in the way of families accessing the care they need. She is often a parent’s first point of contact, and is a resource for a variety of issues, from baby formula to public benefits: she schedules appointments to help families consolidate their trips to BMC, coordinates access to WIC, Early Intervention, and MassHealth’s PT-1 transportation service, and connects patients to housing services through Metro Housing Boston. She also reminds patients of their appointments and follows up if they miss appointments to ensure they stay connected to care.

“We have moms come to us and say ‘this is the first time I haven’t felt judged.'”

“Having a direct line makes everything better for the families—knowing us personally, and us knowing the families so well,” said Baker. “From a patient perspective, the relationships they’ve been able to develop with all of us, including their primary care doctors, is great. Knowing that a mom trusts me to have a conversation when she’s not doing well—and not feeling scared—is amazing.”

Stigma is often a barrier to care, said Baker, which shows up in families either using emergency department services, or not coming in for medical appointments out of fear of DCF removing their children. Positive relationships are key to the recovery process. “We have moms come to us and say ‘this is the first time I haven’t felt judged,’” said Reed.

While SOFAR is still reviewing their preliminary data on patient outcomes, Reed said that many families have stayed intact. “We’ve gotten over one of the big humps – the 6-9-month age is when relapse is most likely to happen,” she said.

Open and frequent communication between team members is key to SOFAR’s success. The team meets weekly to make sure patients don’t slip through the cracks, said Reed. And although in many medical settings, doctors have ultimate authority, SOFAR’s operations are more egalitarian. “It doesn’t feel like a top-heavy approach in this clinic – they really value our opinions and constructive criticism and feedback,” said Baker. “Our providers are very appreciative. They know how much easier their job is because we’re here,” added Reed.

The program does face its challenges, however, often due to systemic problems outside of BMC. “So many expectations are put on [parents in recovery],” said Baker. “If they’re in a residential program, they need to be doing chores. They need to go back to work after six weeks of maternity leave. Getting kids into daycare is so difficult for these parents—they need to be working to get a daycare voucher, but they can’t work if they don’t have daycare. It’s an impossible system.”

Additionally, Medicaid and Medicare do not currently pay for all of the services social workers and patient navigators provide. “We’re not able to bill for our services, but we are being extremely helpful,” said Reed. “We are saving money in the long run. If a mom is feeling sad and stressed out, spending time to help her overcome challenges – that’s going to have a better outcome for her kids. Building these relationships takes time. But it’s hard to show that on paper, because it’s not an immediate box we can check that says ‘this has been completed.’ It can take a year for something to come to fruition.”

Workforce capacity is also an issue. “Ideally we need more of us,” said Reed. “There’s so much more that we could do.”

This article is part of a Center for Innovation in Social Work & Health (CISWH) series that highlights success stories about social workers working in healthcare and public health to address the non-medical 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.

Article and photo by Nilagia McCoy, Center for Innovation in Social Work & Health.