“Am I A Good Social Worker?”

Posted on September 9, 2013 by

As social workers, we serve many masters—our clients; our supervisor; our program; our organization; our funders.  With so many to please and with interests that sometimes compete, it can be hard to know which voice to listen to when seeking feedback that will help answer the question “Am I a good social worker?”

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This is an important question.  We all like to be seen as competent, efficient, compassionate, present, warm, hard working—the list goes on.  And while some might think it’s a simple case of “My supervisor does my performance evaluation, and my evaluation forms the basis of whether or not I get a raise or promotion or get fired.”—it’s not that simple or clear cut.

Most of us who work in not-for-profits or for government agencies know all too well how stressed the systems we work in can be.  When there’s not enough to go around, something’s got to give.  At one organization I worked for performance evaluations were done consistently and very thoughtfully because the programs were adequately staffed.  As such, performance evaluations were a useful tool in helping us get a sense of the quality and consistency of our performance.  In my experience, this has been the exception rather than the rule.

In the single adult shelter silo at another organization I worked for, performance evaluations were rarely done on time—if at all.  While not condoned, it was understood that because we were in a “high volume, high intensity” setting that was chronically understaffed, resources (time and “person”-hours) needed to be allocated toward meeting contractual obligations.  Regular performance evaluations, and supervision, most of the time, went out the window—we were scrambling.  In situations like this it’s much more difficult to get a sense of our effectiveness as social workers because we’re either consumed with putting out fires or we’re stepping outside our job descriptions to “get it done”—whatever that “it” was at the moment.

Fact of the matter is the answer to the question “Am I a good social worker?” is often a matter of perception.  To illustrate this point, here are some of the dynamics at play when trying to answer that question.

1)   You meet program goals consistently, but your clients don’t seem to respond particularly well to you.  Are you a good social worker?

2)   Your clients love you, but your supervisor expresses a concern that certain service indicators are falling short of the mark.  Are you a good social worker?

3)   What if your program is under resourced, which is fairly common?  You’re paid to work eight hours, but out of five case managers you’ve been down one for the last three months.  The numbers are tanking.  Does that mean you’re not a good social worker?

4)   The funder(s) cut your program budget by 15% without being willing to modify your program goals because you exceeded them last year (remember, no good deed goes unpunished).  If you and your social worker team members don’t pull off a miracle and meet their goals again, does that mean you’re not good at what you do?

What I’m trying to get at here is this—what, exactly, does it mean to be a “good” social worker?  And good to whom, and under what circumstances?

In my list of the many “masters” we serve, did you notice anyone missing?

The measure of your worth as a social worker is not in how much your clients love you.  It’s not in whether or not you get all your service plans done on time.  It’s not in whether or not your supervisor can check all the boxes.

At the end of the day, the answer to the question
“Am I a good social worker?” can only be answered by you.

If it is true that we are our own worse critics, then it is up to us as social workers to maintain not only our professional and ethical standards, but our own standards for how we conduct our work no matter the setting, no matter the population.  Standards higher than that which is expected of us.

Toward that end I now contend that “Am I a good social worker?” is not even the right question.  The right question is the one we ask ourselves while staring into the mirror before getting a well-deserved nights’ sleep.

“Have I done all that I could do today to help my clients
move toward the achievement of their goals?”

If you can look at yourself in the mirror and say “Yes,” then you could fairly claim “I am a good social worker!”  In terms of what happens in the workplace, the rest will take care of itself because your best effort will always be enough (within a larger context we have little control over) and your work will be respected and appreciated.

If you look in that same mirror and the answer is “No, I wasn’t on my ‘A’ game today” the good news is that every tomorrow is another opportunity to get it right.

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Of Safety and Dreams

Posted on September 2, 2013 by

As our children, grandchildren, nieces or nephews return excitedly (or reluctantly) to school, two contrasting themes come to mind: their safety, and the ways in which they embody our collective hopes and dreams.

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As social workers, we are mandated reporters.  The Summary Guide for Mandated Reporters in New York State, published by the New York State Office of Children and Family Services, states that “Mandated reporters are required to report suspected child abuse or maltreatment when they are presented with a reasonable cause to suspect child abuse or maltreatment…”.

From there it gets somewhat murky and jargony and this is not what I want to spend a post on.  Besides, as social workers, you know the deal.  What I want to convey is simply this:

As human beings, we are all mandated reporters of child abuse and neglect

As this Labor Day weekend draws to a close, our children will soon begin streaming back to school.  The insecurity we experience as parents and caregivers can be daunting, as they slip beyond our watchful eye for the better part of a day.  Let’s be more active observers within our community of caretakers, this “village” we hear so much about.  If you see or hear something unusual, something that just doesn’t fit, take notes and seek appropriate counsel—immediately.  The children we love, including the ones we don’t know, need us—all of us.  It doesn’t take a degree and a certificate to notice, or at least suspect, when something’s not right with a child.  And while we are vigilant in our love, let’s also remain mindful of what matters to our children.  The simple yet incredibly potent messages they share, dreams they implore us “big people” to turn into reality.

From two villages hundreds of miles apart—one in Coney Island, Brooklyn, the other in Charleston, South Carolina—come the hopes and dreams of the innocents in whom we will be entrusting our future.  Through our actions each day let’s love our children—all our children—and work to make real the wishes they so beautifully share.

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As a parent, I thank you.  I am glad to know we are in this, together.

Questions for Further Consideration

1)   Do you know any child who you suspect may be covertly or overtly abused (emotionally, physically, sexually)?  If yes, why do you think this?
2)   Do you know the local hotline number to report suspected child abuse?
3)   If you could do one thing right now to become a more active and involved member of your community, what would it be?

Helpful Information

Childhelp’s National Child Abuse Hotline / 1-800-4-A-CHILD (1-800-422-4453)
Comprehensive information on knowing the signs & symptoms of child abuse at:
http://www.childhelp.org/pages/hotline-home

New York State Office of Children & Family Services
Summary Guide for MANDATED REPORTERS in New York State (Pub. 1159)
http://ocfs.ny.gov/main/publications/pub1159text.asp

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Cultural Humility, Part II – Promoting Cultural Humility In the Workplace

Posted on August 26, 2013 by

“Cultural competence means we’ve been educated about other cultures, humility is how we should be practicing that competence in the field.”  So writes social worker Sarah Elizabeth, who blogs at RootedInBeing and got this conversation going.

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I agree, Sarah.

As I pondered the implications of this statement it occurred to me that cultural humility, as a further expression of cultural competence, is symbolic of the schism between any theory and its actual practice.  Some things sound great on paper, but “where the rubber meets the road,” “in the trenches” and elsewhere in the Land Of Overused Metaphors—it’s different (see “Cultural Humility, Part I – What Is ‘Cultural Humility’?”).

Understanding the reality of this dynamic and how it plays out in so many realms, we serve ourselves and our clients very well to remember (yet again) not to practice from a textbook.  When it comes to understanding the unique experience of any given individual, cultural competence is theory, cultural humility is practice.

Quoting my post of August 19—“To practice cultural humility is to maintain a willingness to suspend what you know, or what you think you know, about a person based on generalizations about their culture.  Rather, what you learn about your clients’ culture stems from being open to what they themselves have determined is their personal expression of their heritage and culture, what I call their personal culture.”

With this understanding how, then, do we as supervisors and program managers promote cultural humility in the workplace?

By no means is this methodology exhaustive (nor is it intended to be), but is offered as several of many possibilities.

A.    Normalize not knowing

As supervisors and managers we have to help our staff become more comfortable with the idea of not knowing.  How many meetings have you led where you asked “Any questions?” and not a soul raised their hand?  Then, you were followed back to your desk by one or more staffers with questions.  Don’t get me wrong, I’m glad those questions got asked, but this scenario typifies the level of discomfort individuals have admitting that there are things they don’t know (I wrote about this in my 8/10/13 post “Structuring Supervision”).  Everyone wants to appear competent, and this is no less true with cultural competence.

What puts the humility in cultural humility is the reality that when it comes to understanding our clients and the various cultural influences that helped shape them, there is much more that is unknown than known.  Not knowing doesn’t mean you aren’t intelligent, it means you’ve not encountered it before, either abstractly or experientially.  If you as a social work practitioner are uncomfortable with the idea of not knowing something, if you equate not knowing with stupidity, it will be a challenge embracing the concept and practice of cultural humility.  Supervisors and managers, we need to instill in our staff the understanding that it is not only okay to not know—it is a necessary condition for growth, central to the practice of cultural humility and good social work practice.

B.    Create a culture-based client self-assessment tool

An intake instrument using closed- and open-ended questions can allow clients to define their personal culture; to share with us (to the extent they are comfortable) those aspects of nationality, ethnicity, religion, gender preference, and any other aspects of their experience that comprise how they self-identify.

Most of the intake instruments I’ve come across are of the check-box types that go no further in exploring culture than asking you to indicate your ethnicity.  This is beyond inadequate—it does next to nothing in terms of telling you about the unique cultural experience of any given client.  I’ll be the first to admit, I can’t think of a one of us who wants to complete more paperwork when entering a doctor’s office or any other system.  But at the very least we need to convey the respect of letting our clients know that the total of all the factors shaping their cultural self-identification is not going to be reduced to a single check box.  We need to offer them a mechanism by which they can be seen and heard—an instrument such as this affords that opportunity.  While our clients have the right to refuse to complete it, we as practitioners can nonetheless remain vigilant and true in our practice of cultural humility.

C.    In-service: A cultural self-identification workshop

One of the best possible ways to help staff grasp the importance and power of cultural humility is to make it personal.  As a supervisor or program manager you can lead an in-service style conversation where staff members self-report how they differ from the cultural stereotypes others may believe about them.  In so doing they can come to better understand the concept of a personal culture, providing them with a theoretical framework for seeing the ways in which their clients may be both a product of, and separate from, their respective cultures.  And the good news is that as a leader, you get to go first!

Here are some questions to guide the discussion.

  1. Starting with ethnicity and religion, which cultural “check boxes” would you check on a questionnaire?
  2. What are some of the cultural qualities and or stereotypes ascribed to someone of your ethnic and religious background?
  3. In what ways do you differ from those stereotypes?

There are certainly other kinds of culture-based questions you may or may not want to pose, depending on the size and comfort level of your staff, time considerations, et cetera.  But even if you limited the conversation to these three questions, the point will be made.  As staffers share their responses, the inherent limitation of practicing from a purely culturally competent standpoint will be revealed, and a deeper understanding of cultural humility promoted.

The practice of cultural humility suggests, on some level, that we ought to forget our training in cultural competence and see our clients’ personal culture as unique (which it is) and based on nothing other than who they are right now.  Yet this would be a mistake.  The best use of our training in cultural competence is to help us formulate the most useful questions to ask our clients about who they are and what experiences shape their current dilemma—not to label them, put them in a box, see them as a “Hispanic male” rather than as “Mr. Rodriguez,” or make any other assumptions about these vastly complex individuals.  We are our best selves as professionals if we are serving from an assumption that we don’t know what our clients know—a blatant truth which can sometimes get lost as we seek to draw from a generalized pool of knowledge in our effort to understand.  Our expertise, then, is tapping into their expertise on themselves, their experiences, and their abilities.  Together, one step at a time, we are then in the best possible position to help each culturally unique individual move inexorably toward the achievement of their dreams.

Special thanks to Sarah Elizabeth at RootedInBeing for using ‘Suggest A Topic’ to begin this conversation on cultural humility.  You may visit Sarah at:

http://rootedinbeing.wordpress.com/

A Request

If anyone knows of the existence of something akin to a culture-based client self-assessment tool, kindly let me know.  I’d love to see one.  Sometimes, detailed intake and assessment instruments form a component of customizable social services database software, and a template can be printed out.  If it is against the policy of your organization to reproduce in any form or share such information, please keep yourself in compliance with that policy.  Thanks.

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Cultural Humility, Part I — What Is ‘Cultural Humility’?

Posted on August 19, 2013 by

A follower of my blog went to the ‘Suggest A Topic’ section of my website and posed this question: “As a program manager, and/or supervisor – how does one promote and enforce cultural humility and an inclusive workplace?”

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This is a great question, and I appreciate the opportunity to address it.  It’s also a very BIG question—articles, chapters, and books have been written about both cultural humility and inclusivity in the workplace.  Given time constraints, I’ve taken the liberty of rewriting the question and dividing it into two more easily digestible posts, the second of which will appear next week.

Although I’d intuited what cultural humility might mean, in all honesty I hadn’t heard the term until this question was put to me.  This despite the fact that I went to a really good grad school.  Was I absent that day?  Was there an elective I didn’t elect?  Where was this crucial concept hiding, in the course curriculum?  While perplexed and slightly troubled that cultural humility hadn’t found its way into my social work lexicon, I assume I’m not alone.  So before delving into ways a supervisor or manager might promote cultural humility in the workplace, I’ll first explore what it is.

What is “cultural humility” (and what does it have to do with “cultural competence”)?

To practice cultural humility is to maintain a willingness to suspend what you know, or what you think you know, about a person based on generalizations about their culture.  Rather, what you learn about your clients’ culture stems from being open to what they themselves have determined is their personal expression of their heritage and culture, what I call their personal culture.

In a compelling YouTube video by Director Vivian Chavez, Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility.  Here’s the URL:

They describe cultural humility as having ‘three dimensions.’

1)  Lifelong learning & critical self-reflection — to practice cultural humility is to understand that culture is, first and foremost, an expression of self and that the process of learning about each individuals’ culture is a lifelong endeavor, because no two individuals are the same; each individual is a complicated, multi-dimensional human being who can rightfully proclaim “My identity is rooted in my history… and I get to say who I am.”

2)  Recognizing and challenging power imbalances for respectful partnerships — while working to establish and maintain respect is essential in all healthy and productive relationships, the root of effective social work practice is in acknowledging and challenging the power imbalances inherent in our practitioner/client dynamics.

3)  Institutional accountability — organizations need to model these principles as well (from micro, to mezzo and macro practice)

This model incorporates and expands upon what some adherents view as the limitations of “cultural competence.”  Here is an excerpted passage from the video that illustrates a consequence derived from a reliance on cultural competence without cultural humility.

“An African American nurse is caring for a middle-aged Latino woman several hours after she’d had surgery.  A Latino physician, on a consult service, approached the bedside and, noting the moaning patient, commented to the nurse that the patient seemed to be in a great deal of post-operative pain.  The nurse summarily dismissed his perception, informing him that she took a course in nursing school in cross-cultural medicine, and knew that Hispanic patients over-express the pain that they are feeling.  The Latino physician had a difficult time influencing the perspective of this nurse, who focused on her self-proclaimed cultural expertise.”

The video goes on to point out that the Latino doctor might have been a resource for the nurse, but because of the nurse’s self-perception of cultural competence she did not grasp the opportunity to learn that was right in front of her.  She was not seeing her patient as a unique individual, but as a “Hispanic patient.”  Confident in her cultural competency training the nurse believed she knew all that she needed to know in order to make a critical call about the patient’s well being in that moment.  Sadly, this is not an uncommon belief.

Tervalon and Murray-Garcia cite an assumption among some who view their practice as culturally competent that they’ve “got it down”—that among providers, they are the expert and they know better than the consumer what the consumers’ experience is and needs are.  Nothing could be more arrogant or further from the truth.  Our clients are the experts on their lives, not their service providers.  This personal belief, which in practice I have held inviolable, is the single thing that had me realize that although I’d not heard the phrase cultural humility I was, in fact, practicing it.  Imperfectly, to be sure, but like I said—it’s a lifelong endeavor, the central tenet of which is a respect for the unique cultural experience of the individual and a commitment to learning that knows no end.

Cultural competence is a helpful starting point in the development of a caring, compassionate, and effective practice, but in light of a deepening understanding of cultural humility its limitations are revealed.  In the example of the Latina patient, what the nurse claims was “true” for Hispanics was not true for her.  If she’d had the opportunity to develop an understanding of the philosophy and practice of cultural humility it is likely she would have recognized what the Latino doctor suggested to her as an opportunity to learn.  As a result, she might not have been so quick to dismiss her patient’s pain.

NEXT WEEK:  Cultural Humility, Part II – Promoting Cultural Humility In the Workplace

Questions for Further Consideration

1)   What is the relationship between the practice of cultural humility and expressions of cultural pride?
2)   What experiences and qualities comprise your “personal culture?”

Additional Information On Cultural Humility

Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education, Journal of Health Care for the Poor and Underserved (May 1998)

http://muse.jhu.edu/journals/hpu/summary/v009/9.2.tervalon.html

Foundations For Community Health Workers, Berthold, Miller, Avila-Esparza (2009)

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Structuring Supervision

Posted on August 10, 2013 by

An unfortunate reality of the “high volume, high intensity” settings that many social workers work in is that supervision is either sacrificed, or done exclusively on the fly.  And while supervision on the fly—as supervisor and supervisee pass each other in the hall, run into each other at the coffee machine, or otherwise track each other down somewhere in the building—is necessary, it cannot, and should not ever, replace having a weekly sit down.  Get something to drink, close the door, and let the appropriate parties know that you are not to be interrupted unless it is an emergency.

Supervisors and their direct reports should compile their own prioritized list of topics to discuss.  Prioritization is important, because very often neither of you will make it all the way through your lists before one of you gets pulled out—you need to be clear about which are the “must have” conversations.

Supervisors

When meeting with your direct reports I’d highly recommend going to a neutral setting where you’ll have privacy (if such a place is available), or coming out from behind your desk and making it more conversational.  The feeling should be collegial rather than hierarchical.  “We are here to talk and solve some problems together.”  This sets a tone that is more relaxing and is certainly very much appreciated by your supervisee.  After all—we’re very aware of who we are in our respective roles.  It’s not conducive to an open and productive conversation if I’m sitting behind my desk like Michael Corleone in “Godfather II.”  This meeting is a (hopefully) uninterrupted time to exhale, focus, and dig in.

Let your direct reports speak first.  It will convey that this is their time and that what they have to say is important to you.  And, it gives you an opportunity to see what’s most on their minds, or not, and how they prioritize various issues.  This can give you a real window in to which areas they are uncomfortable or shaky with (higher up on their list, as their trust in you builds), and which issues they may feel more confident about (lower priority, they won’t feel the need to discuss it right away, if at all).

For Program Managers who have two or more layers of staff they are responsible for, I would highly recommend an occasional, informal meeting with your indirect reports.  This provides an additional opportunity to stay connected with them, let’s them know you are interested in their work and well being, and also gives them a chance to address any concerns they may have about their own supervisor or other programmatic issues they may not feel comfortable discussing in staff meetings.

Case Managers

It is in your best interest to confirm that your regularly scheduled supervision is going to take place as planned.  If your supervisor has not said otherwise, it is safe to assume it will still happen, but—I, personally, never left it at that.  On the morning of your meeting, put “Supervision” in the subject line of an email and confirm that you will, in fact, be meeting.

There are a couple of ways to do this.

1)    “Hi, are we still on for 10:00 a.m.?”

I got emails like this a number of times.  Fairly common.  But since in most cases I hadn’t canceled or rescheduled supervision, this question left me wondering whether my supervisee was, in effect, looking to postpone.  If at times you need or want to postpone, it is best done in person or on the phone.  But, if circumstances dictate that email is the best or only timely option, be direct.  “Hi, I’m wondering if there are any other times we might meet today.  Mr. Jones left me a voicemail stating he’s stopping by at ten to pick up some donated goods and asked if I could help him choose some things.  I’d really like to do that, if possible.  Please let me know what works best for you.”  By stating this from the get-go you are anticipating your supervisor by answering why, instead of just saying that you want to reschedule.  It’s efficient, and respectful.

2)    “Hi, I’m looking forward to meeting this morning for supervision.  See you at ten.”

This can be a helpful email.  It lets your supervisor know that you haven’t forgotten, which is reassuring—especially if you ever have forgotten about supervision before.  If your supervisor is someone who cancels, outright forgets every once in a while, or gets swept downstream by various things, it serves as a reminder and lets them know that you value this time with them.  If they were planning on canceling because of something else they’d rather do, your proactive email makes it harder for them to do that.  Keep ‘em honest!

What should go on your list for supervision?  Here’s how I learned.

As an MSW intern at Coalition for the Homeless in New York City I was very eager to impress.  Naturally.  My first ever supervisor was Richard Lombino, Esq., LCSW, CCDP-D.  I was so eager to show him how smart and thorough and intuitive I was (or so I thought!) that I would go to Rich with everything.  I was popping in on him all the time.  Finally Rich, embodying his gentlest and most patient self, said, “You can see me anytime with issues that are emergencies or are timely in some way.  Everything else put on a list and bring to supervision.”  That’s it.

As professionals we tend, in most cases, to talk with our colleagues and people up the chain in terms of “facts, not feelings.”  While supervision isn’t therapy, it’s a good opportunity to go beyond the strategic (task supervision) and speak to the emotional component (clinical supervision) as it pertains to the work you do.  You need to know that you have, in your supervisor, someone you can talk to about the range of feelings that invariably will come up in the course of your work week—especially if you’re experiencing countertransferential feelings that may interfere with effective service delivery.  For example, if your client is reminding you of an angry parent and you’re frozen in your seat with fear, you need to talk about it with your supervisor.  And supervisors, you need to be willing to explore this with your staffer and provide the supports necessary to keep them calm, focused, and on the right track.

Lastly, Case Managers—don’t be afraid to say that you don’t understand something, don’t know how to do something, or wouldn’t know what to do in a given situation.  Keeping quiet because you’re afraid of how you’ll be perceived does no one any good, and what you don’t know will eventually show up in your work anyway.  But if you feel too vulnerable to ask in a staff meeting, follow-up immediately in supervision, be it scheduled or on the fly.  Either way, get yourself out in front of the learning curve; make proactive learning a career-long habit.  I have more confidence in and respect for a staffer who asks for the help they need, than for someone who plays it cool and drops the ball later (hopefully not to the detriment of their client).  When you ask, it shows you’re interested, engaged, and want to get it right.  That’s the kind of Case Manager it’s a pleasure to have as a colleague!

NEXT WEEK:  Two choices I’m considering.  One is a response to ‘Suggest A Topic’ (click on the menu heading to see the brief conversation about this), the other an Editorial piece I’ve been developing.  Both will post in the near future.

Questions for Further Consideration

1)   What has worked well for you in supervision?  What has not worked so well?
2)   Share your stories of supervision heaven or hell.  I’d love to hear from you.
3)   What questions do you have about supervision?

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Once Upon A Client: Boundaries

Posted on August 3, 2013 by

Welcome to the first in my new periodic series here at The Social Work Practitioner called Once Upon A Client.  Once Upon A Client will explore aspects of social work practice through experiences I’ve had with particular clients.  These experiences will speak directly to abilities and skill sets that are essential for us as social workers to develop.  Names, of course, are always changed and circumstances sufficiently muddied so as to maintain confidentiality.

Once upon a client, there was Raymond.

Raymond arrived 45 minutes late for a scheduled one-hour intake.  He was toting a large green canvas bag, stained and torn, the size of an overstuffed backpack.  “Ray-Ray” hoisted it onto my desk with a thud as he undid the clasp and proceeded to turn it upside down.  The papers were log jammed at first, but with a couple of surprisingly vigorous shakes for so slight a man, they began to plop and slide out.  As he lifted the bag higher and higher and shook, the tumbling out continued.  Papers after papers, stapled, clipped, and rubber-banded, sliding off two sides of my desk onto the floor and consuming my keyboard like a tsunami.  I lifted my coffee out of danger in the nick of time, too stunned to say anything but “Well, don’t you have a lot of papers there!” eyes wide and eyebrows raised.  When done he ceremoniously dropped the emptied bag, which dragged a bunch of papers with it onto the floor and said, “I need some help here.”

“Looks like you do” was all I could eek out, befuddled and grinning like an idiot.  Truth is, I was overwhelmed.  My heart was thumping, I became instantly light-headed, and I didn’t know what else to say.

I had stood up to shake his hand when he entered my cubicle, but slowly sat back down.  Then, before another thought had a chance to slip into my brain sideways, Raymond flashed some more of  his history—literally.  Lifting his shirt fully to his armpits, he revealed a twelve-inch scar from just above his navel to a few inches below his collarbone.  I was horrified, and lost.

At this point, what would you have done?

1)   Let him know that before the two of you could talk he needed to pick up all his papers (of course you’d help)
2)   Excused yourself to get your supervisor
3)   Cried / laughed / run out screaming
4)   Told him that because he was late and would need time to pick up his papers (again, you’d help) that you would have to reschedule
5)   Nothing (i.e., continued with the meeting)

I did number five.  Newbie mistake.

I was a first year MSW intern at Coalition for the Homeless in New York City, learning intensive case management in the Client Advocacy Program (CAP).  The CAP’s goals were two-fold:  to help disabled street homeless and shelter residents obtain Social Security disability benefits, and to leverage those benefits into a move off the streets or out of shelter and into supportive housing.  It was very early on and I was meeting clients for the first time, assessing them to see if the program was appropriate for the kind of help they needed.  Ray-Ray had been referred from the Coalition’s Crisis Intervention program as someone who might be psychiatrically disabled to the extent that he might qualify for federal benefits.

Well, at that point I didn’t know if Raymond was psychiatrically disabled or not, but for the whole time I sat there I felt functionally disabled.  He was forceful, a little scary, extremely bright, and he’d just dumped his world of problems all over my desk.  I was so flooded with “What the…?” that I did not ask him to sit down.  I did not offer him a drink of water.  I did not talk about my program.  I’m not even sure I introduced myself.  I sat back checking my breathing, gripping the arm rests of my chair and let him talk and pace and talk and pace.  I didn’t know what to do, and didn’t ask for help.  To make it worse, my next client was on time and I kept her waiting for over a half hour.  Not okay.

Let’s have a look at a clip from the “20/20 hindsight” reel.  Here’s what I wish I’d done.

1)   Meet him where he’s at.  Raymond came in energetically and very focused on his agenda.  I needed to meet him with the same presence and strength.  When he started to dump his bag, I needed to make some effort to stop him.  Calmly, clearly, but matching his energy I needed to say “Mr. Raymond, hold on for a moment please?  Before you empty your bag we’re a little short on time, so let’s cover a few bases first.”

2)   Engage in appropriate social niceties.  Introduced myself.  Offered a chair, a drink of water.  All those things I was too stunned to remember.

3)   Manage the time.  I should have acknowledged that there is only 15 minutes remaining before the next appointment, and that I understand things happen that can sometimes make us late.  I’d let him know that I will always do my best to respect his time by working hard to finish the session before his on time, so that he should not have to wait to see me.  That being the case, I did not want to keep the next client waiting.  Since I am very interested in hearing what he has to say and given the amount of material we need to cover, the first thing we should do is schedule the next appointment.  “Then I’d like to hear what brings you to our program today and briefly share some information about the Client Advocacy Program in the time we have remaining.”

4)   Check in.  “How are you doing, Mr. Raymond?”  Try to keep his response focused in the present.  Oh, it’ll be a challenge—after all, he just dumped a big chunk of his life on the desk.  The client, depending on who they are and what challenges they are living with, can take the “How are you?” question and run with it and start to get into history you don’t have time to unpack.  If that were the case I’d need to step in respectfully, but firmly, and let him know that I want to be sure he has certain important information to think about in anticipation of our next meeting, when we’d have time to go into fuller detail about what’s going on in his life.

5)   Set the agenda for the next meeting.  I needed to try and provide the information I’d just referred to, including any handouts or other materials he may find helpful.  Give him my card with the day, date, and appointment time on it.  Make sure he understands what’s written there (in case there is a vision or literacy problem).  If there’s any time left, talk a little.  All this could have been done while helping him clean up his papers—after asking him first.  Some folks don’t want you touching their stuff.

6)   Close the meeting.  Don’t assume the meeting will end neatly.  “Thank you.”  “Thanks.”  “Nice meeting you.”  “Bye.”  Uh-uh.  If it does, great, but many times it won’t, particularly if you’re working in mental health with someone who is floridly symptomatic.  If the client is still talking, you can always say as you walk out of your cube area or office “Please, come walk with me while we’re chatting.”  If you have a client who’s hell-bent on continuing the conversation and you are not stopping them from talking, odds are they will walk with you.  Continue your focused attention and active listening as you head toward the elevator or building exit, being mindful of confidentiality issues and reminding them, if necessary, that their business is their business and that there are other folks around.

Like I said, 20/20 hindsight.

On this last point, I have often walked a client to the elevator, pushed the button, and continued chatting until it came.  If they stopped engaging I would at times simply thank them, turn around, and go back to my cube.  Otherwise I would wait until they boarded with a “See you next Tuesday morning at 10” or some such.  The important thing is to remain respectful and engaged so they don’t feel like you’re rushing them out, but rather reinforcing that their time with you will be similarly respected.

Setting and maintaining boundaries is a huge topic and could be the subject of its own blog.  This brief exploration highlights the importance of setting the proper tone from the beginning so the client feels informed, respected, you feel grounded, and work can proceed as it should.

NEXT WEEK:  Supervision – A Meeting of the Minds

Question for Further Consideration

1)   What alternative strategies might you have employed to handle Ray-Ray’s assertiveness?

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Why Social Work?

Posted on July 27, 2013 by

“Social workers are a depressed bunch.”

So said a colleague of mine, a social worker himself.  We were on break during a training and a few feet away, sipping coffee and popping Dunkin’ Munchkins, was a group of our fellow social workers.

“Funny thing is,” he continued “you talk to half of these people and they’re in so much pain themselves.  Why would you want to sit all day with other people who are in pain, if you’re in pain?”  It seemed like a fair enough question, but something about it bothered me and I reflexively said “Well, everyone’s got pain.”  Dissatisfied with my defensiveness, I leaned in to ask him why he became a social worker.  At that moment the speaker called us to attention, and I never got my chance.

Hours later on the subway home, his comment and question haunted me, raising a host of other questions.  Was he right, even partly?  Was I somehow hiding from my own emotional pain by keeping company with people who were in many ways much worse off than I?  Why had I chosen social work?  Was it for the “right” reasons?  What were the right reasons?  Could I actually help people if I wasn’t “fixed?”  My head started to spin.

I decided to put the question to myself.

ME:  Why did you become a Social Worker?
MYSELF:  To help people.
ME:  Very noble.  But why a Social Worker?  You could have become a doctor.  A lawyer.  A repairman.  They help people, too.  A call center representative.  “Your call is very important to us.  Please hold.”
MYSELF:  Cute.
ME:  No, really.  Why did you become a social worker?  These clients, consumers, whatever you want to call them, you sit with them every day and they’re in pain.  Pain pours out of these people.  They’re hurting.  Lonely.  Ill.  Desperate.  Addicted.  You chose this.  Why?
MYSELF:  (blank stare)
ME:  Well?

Yes, I did.  I chose this.  But other than “To help people”, I didn’t really have a clue.  For all the times I’d had an especially challenging day and asked myself aloud “Why am I doing this?” I never tried to honestly answer that question.  Clearly, something else was driving my choice, something beyond “To help people”, but I couldn’t say what it was.  I didn’t know.

What I did know straight away is that like so many of my fellow social workers, there is something in me that recognizes pain, not only on the most obvious levels—anybody can do that—but also on the more subtle levels.  It’s noticing a wince in the eye of an elderly person with Paget’s disease when they try to stand.  It’s our curiosity about the misplaced smile after someone tells you they relapsed for a minute but they’ll get off the junk—“promise.”  It’s understanding that when a mother barks at a child who asks for a Dora book bag that she’s not really angry, but just scared to death that she’ll soon have to choose between school supplies and food.

“Okay.  So?” I said.  “Recognizing it is one thing.  That doesn’t mean you have to sit with it every day.”  But that’s just it.  We’re not social workers to hold hands with pain.  We’re social workers to help alleviate pain.  We recognize it because, like every other human we’ve had, and have, our fair share.  Death, illness, loss, financial difficulties, struggles—we know all about it, but it doesn’t stop there.  It is the recognition of our own pain and our ability to see it in others that not only moves our hearts—it compels us to action.  That’s what sets us apart, because the thing that our hearts know that our heads haven’t caught up with is that we’re stronger than our pain.  Strong enough to sit with it and have enough adult left in us to help our clients face theirs.

But how does this work, exactly?  Maybe the guy was right, maybe half, even more, of all of us have experienced an inordinate amount of emotional pain in our lives.  A divorce.  A death, or illness.  Chronic pain from an accident.  Anxiety manifesting in a tendency toward perfectionism.  Now someone sits down in front of us, and we smile and hold the space, sitting with our pain, and trying to help them alleviate theirs.

How do we help people in pain, when we are hurting?

I’m not going to lecture you on self-care.  You’ve heard it all before and already know what you need to do.  But I will say this.  When your own pain is right there with you, jumping up and down in your body while you’re sitting with your client, you’ve got options:

1)   Notice your body and adjust.  Come back to the present by wiggling your toes, pressing your feet up against your desk, the wall, something, to create sensation that will help ground you by bringing you present.  If your hands are clenched or your shoulders raised, release them.

2)   Breathe.  Even if you think you are already breathing, take a long, slow, deep breath.  As your lungs fill push your stomach out, expanding your diaphragm and letting even more air in.  Exhale slowly.

3)   Slow down.  Nothing that is done well is done in a rush.  If you need more time, for whatever it is, take it.  “This is important and I want to make sure I get it right.”

4)   Err to the side of caution.  Generally speaking, when you don’t know what to do, don’t do anything.  Especially if supervisory or expert advice is not immediately available.  Mistakes are more common when our own pain is activated, and it is usually better to make a passive mistake (do nothing), than an active mistake (give bad advice or wrong information).

The conversation with myself went a little better the second time around.

ME:  Why did you become a Social Worker?
MYSELF:  To help people.
ME:  More specifically.
MYSELF:  To help people who are anxious.  And sad.
ME:  More specifically.  To help them what?
MYSELF:  To help people who are anxious and sad… not be anxious and sad!
ME:  Now you’re being funny.
MYSELF:  To help people who are anxious and sad, to be right here, right now.  Here, in the present, not in the past thinking about why they’re sad, not in the future worrying about what might happen.  Fighting for themselves, fighting for the life they want to live, right here, right now.
ME:  What’s in it for you?
MYSELF:  What’s in it for me?
ME:  You’re not in it for the money or the glamour.  There’s got to be another reason.
MYSELF:  I became a Social Worker because I want the world to be a better place, by virtue of my own direct efforts to alleviate suffering, than it would have been if I had never been born.
ME:  I think you’ve got something there.
MYSELF:  And I became a Social Worker because by helping others heal, I heal myself.
ME:  (Smile)

When you have an especially challenging day and ask yourself “Why am I doing this?”  What’s your answer?

Questions for Further Consideration

1)   What do you do when you’re sitting with a client and your head is swirling with your own problems?  What would you add to numbers 1) through 4) above?

2)   Is there a profession other than social work that would also satisfy your need to alleviate suffering?

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“I’d Like You To Meet Our New Program Manager”

Posted on July 20, 2013 by

“Hello” was not the first thing I said to the assembled staff when I walked into my first meeting as a Program Manager at a large not-for-profit.

When you’re new and people are friendly (or curious, or wary) it can take 20 minutes to make it down the hall.  You can either view that as annoying, or you can appreciate the reality that when there’s a new PM in town, people can get a little nervous and want to chat and get a sense of you.  They want to know who you are and what might be coming, who will be reassigned, whose desk will be moved, what’s going to happen to caseloads, and yes, who’s going to get fired.  Given the number of concerns both real and imagined, staff had extra time to get themselves worked up by the time I breezed in 20 minutes late.

“Nice first impression,” I thought, as I entered with a smile.  “Fine example.”

But, it was forgivable under the circumstances and I knew I’d be setting the example going forward.  I walked into the multi-use room with everything I needed to have a friendly, informative, conversational, comfortable meet and greet—a legal pad and pen in one hand, in the other a bag holding one of those donut-shaped cushioned-seat things that looks like a padded toilet seat, the aptly named “Softeze Comfort Ring.”  I made no secret of pulling it out of the bag in plain sight, my cheeks warm and tinged with red.

“I would have brought one for everyone, but…” and I kind of shrugged as I slipped it underneath me and sat down.

Needless to say I got some looks, but it broke the tension and that was part of my motivation.  At least half the group cracked up, a few were wide-eyed and slack-jawed and there was one woman with that “Okay now that’s just weird” look on her face.  And that’s fine.  I had an issue, and I was rolling with it.  I can be kind of audacious that way, but not gratuitously—it was for a specific, strategic purpose.  Virtually everyone in that room was some degree of anxious, so to have that trapped energy suddenly and unexpectedly released was, well… therapeutic.  Beyond that, this “use of self” sent two messages that I believe are important for any Program Manager to convey to staff.

Message One:  I’m going to keep it real.  I hope you will, too.

Message Two:  I’m going to laugh at myself.  I hope you will, too.

Having said that, when it comes to program management or any other opportunity for leadership, it’s important to strike a proper balance between style and substance.  Your style isn’t my style, my style isn’t your style, and it probably shouldn’t be.  Most new Program Managers wouldn’t walk into their first staff meeting clutching a “Softeze Comfort Ring” and use said ring to break the ice with people they’ve never met.  But on that day, in that moment, that was the “keepin’ it real” style I used to connect to the substance I wanted to convey.

With regards to the substance piece, there is less wiggle room than there is with questions of style.  While personal style can vary greatly, as PM’s we should be in the same ballpark and presenting some approximation of the same qualities—the same substance.  This is particularly true in the earliest days of connecting with our staff, when we’re getting to know one another as we prepare to pursue a common vision.  The qualities I am speaking of should put the individuals with whom we are working at ease in anxious moments, thereby setting the stage for the effective and compassionate service delivery to come.  Those qualities include but are not limited to: Respect.  Humility.  Sincerity.  Clarity. Humor.  Knowledge.  Presence.  Vision.  Heart.  Consistency.  Openness.  Resolve.  Generosity of spirit.

In possession of some number of these qualities, to the extent possible, here is Message Three—the message I both try to convey and would most like to hear from a program Manager who hopes to be a true Leader.

You are the experts in what goes on here.  You’ve been here, seen it, heard it, and when it comes to finding new and better ways of doing things, you may well have tried it.  I have great respect for your individual talents and collective knowledge.  For me to be as helpful as possible, as soon as possible, I need to know what you know.  Toward that end, I need your help.

And while I can definitely start helping you right away, in the early going there will be a lot of information about the program and clients flowing from all of you, to me.  I’m going to be asking a lot of questions because I have a lot to learn, so I’ll ask you to be patient with me.  I’m not testing you.  I’m not trying to play “gotcha” if you don’t know all the answers to all the questions.  No one does.  I will be trying to learn as much as I can as fast as I can so that if there are ways we can improve upon things, and there almost always are, I’ll be able to work together with you from a place of knowledge.  With an understanding of what’s been tried before, what’s worked and why, what hasn’t worked and why, and where we need to go as a program.  I am not here to turn your world upside down.

I am here to help you succeed.  This is my most important role.  To make it possible for you to rise to the level of your ability, and maybe even go beyond what you think is possible.  If I can do that you will be happy in your work, our clients will be well served, we will be contributing to the fulfillment of our organizations mission, and our program will be a model for others.  So rest easy—there’s much to do, but we’ll do it together, and in good time.

While perhaps not quite so clearly, I have said some form of this to anxious staff before.  I expect I will say it again.

In your own way, and in your own style—I hope you will, too.

NEXT WEEK:  (I don’t know yet—lots of good choices!)

Questions for Further Consideration

1)   What are the limits to humor as a “use of self” in the workplace?

2)   What are some of the ways you’ve tried to connect to staff in the earliest days of your leadership?

3)   What do you see as some of the differences between being a Manager and being a Leader?

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A response to “Helping Social Workers Help People,” by NASW CEO Dr. McClain

Posted on July 15, 2013 by

Hi everyone!

Next weeks blog will be on schedule (Sunday night), as promised, but I couldn’t resist sharing the following letter with you all.

Dr. Angelo McClain, PhD, LICSW, Chief Executive Officer of the National Association of Social Workers (NASW) wrote an article for the July 2013 NASW News titled “Helping Social Workers Help People.”  I recommend it.

One particular passage jumped out at me.  “We know there’s a pressing need to raise social work salaries to levels that allow retention of experienced social workers and incentives for students to enter the field.”

I have replied to Dr. McClain, and share it now with you.

Dear Dr. McClain,

I appreciate the opportunity to reply to a point made in your article “Helping Social Workers Help People,” in the July 2013 NASW News.

Firstly, I want you to know that I very much appreciate your “…plan to help social workers help people.”  I, too, share your commitment by way of a new blog I am writing, which I would like to share with you and my fellow social workers.  It is called “The Social Work Practitioner: A Nuts & Bolts Blog On Social Work Practice, Supervision, and Project Management” (www.thesocialworkpractitioner.com).  This blog is my way of contributing to the collective knowledge of our profession, thus supporting your vision of helping social workers help people.  I would be honored if you would be willing to look at my first post, “Trust,” a topic that I chose because of its centrality to caring, compassionate, and effective social work practice.

I am a New York State licensed MSW who graduated from Fordham University’s Graduate School of Social Services in August 2007.  There is a line I wrote in a draft of a commencement address I was not selected to deliver which, though exaggerating a point, speaks to an issue you raise.  The line is “My fellow Social Workers, we just borrowed about $40,000 for our graduate degrees.  We’d all better get right to work, because with a starting salary of about $40,000, it will take us about 40,000 years to pay it back!”  Funny, I think, in the “dark humor” way of expressing ourselves that we sometime have.  But it speaks to your point that “…there’s a pressing need to raise social work salaries to levels that allow retention of experienced social workers and incentives for students to enter the field.”  With regards to the latter there seems to me to be a significant dilemma to address.

As you know, organizations compete to win contracts from various government entities in response to RFP’s.  To win these contracts, they of course try to offer the lowest bid possible.  As private funding sources began drying up in the economic crisis begun in 2008, the competition for government contracts became even more fierce than it had been, historically.  One of the results of this competition has been that organizations are increasingly willing to overlook Social Workers as job candidates in favor of individuals with some human services experience and a Bachelors or Associates Degree (in almost anything), or “equivalent experience.”  Why are they doing this?  A trusted friend and colleague of mine who is responsible for recruiting and hiring new Case Managers in her program told me that it saved her $3,000 per worker, per year, to hire someone other than a Social Worker.  Three thousand dollars!  She was allotted $35,000 to hire Case Managers and wanted to hire BSW’s or MSW candidates, but in so many words was told it would be “really great” if she could find “other” new hires for, say, $32,000.  This was extremely distressing to my friend and she tried to hire the BSW and MSW candidates anyway.  She wanted Social Workers for her clients.  The social workers wouldn’t go for it—and who could blame them?  That’s the reality.  That’s how tight the money is.  And I have it from other sources that this is a generalizable dynamic in cash-strapped not-for-profits.

So will raising social work salaries result in hiring more Social Workers?  Right now, I’m hard pressed to see how.  But if at any point you decide to assemble a team to figure this out, count me in.  I have ideas, and like so many of our colleagues I’m a social worker in search of more money!

Thank you for the work you do on behalf of Social Workers everywhere, and I wish you every success.

Craig Moncho, LMSW

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Trust

Posted on July 13, 2013 by

Capital “T” Trust.

You know it when you feel it, but it’s hard to define.  Let’s try, though, because as Social Workers, the ability of our clients to trust us will have a direct effect on the progress and outcome of our work together.  If we can understand what trust means to us, we’ll do a better job of creating more trusting relationships in support of our clients as they advance toward their goals.

Toward that end, here’s a challenge I hope you’ll take.  When you hit the end of this paragraph, don’t read another word until you can answer this deceptively simple question.  As best you can.  Write it out if that helps.

What does it mean to trust and be trusted?

Well?  What’d you come up with?

Was it as easy to define as you thought it would be?  Was it harder?  I’ll tell you what I came up with in a minute, and we can compare notes.

There is little reason, based on everything our clients have lived right up to the moment we begin our work together, for them to think we’re any different than anyone else who’s ever lied to or betrayed them.  Sure, we may be granted a small amount of de facto trust at the onset.  After all, in most cases our clients have either come to us seeking help, or we’ve done outreach and offered help (the exception being those who are mandated for treatment).  But this de facto trust doesn’t mean they trust you.  Or me.  Or anyone, for that matter.  And rest assured, that trust will be short-lived if we present in such a way as to elicit unwarranted defensiveness (no pressure).

“I’ll start letting my guard down when people stop giving me reasons to keep it up.”
– Anonymous

In the context of competent and compassionate social work practice, what does it mean for a client to trust you?  To finally let their guard down, even a little?  Let’s compare what we each came up with.

To be trusted means that the client sitting opposite you can, over time, consistently predict the manner in which you respond to the various issues and challenges that are the subject of your advocacy.  Notice I said “the manner”—I’m talking about behavior.  I didn’t say they will be able to guess what you are going to say, but they will know that what you say will be the truth.

Merriam-Webster’s online dictionary puts it this way.  Trust is “assured reliance on the character, ability, strength, or truth of someone or something.”  Assured reliance meaning that the behavior that first elicits a feeling of trust in our client is one they feel can be relied upon (assuredly), i.e., one that they believe will happen again.  Returning to the definition I expressed a moment ago, it is a behavior that is predictable.

More concretely, if you say that a housing interview has been arranged for Tuesday at 9am, it is because a housing interview has been arranged for Tuesday at 9am.  If you say no, a recommended psychotherapist cannot see them until an opening comes available, it is because you have confirmed that is the case.  If you say you do not know how long they will need to remain in treatment, it’s because you do not know.  This last one is the hardest.  Clients who are anxious, afraid, traumatized, what have you, often loathe hearing “I don’t know.”  They want something concrete, something they can count on.  They’ve been living “I don’t know” for way too long.  But if “I don’t know” is the appropriate response, then that’s the one our clients need to hear—like you and me, they just want someone who’s going to give it to them straight.  And it’s an excellent idea to share with clients what it is that needs to happen so that you do know.  Let them know what they can do to change the “I don’t know” to something more concrete, let them know what you can do, and let them know what you need to do together.  This level of ownership of your respective roles and abilities instills hope and gives shape and direction to the journey you take together toward the achievement of their goals.

Put another way, it’s expert customer service of a particular kind.  When your clients come to experience you as someone who is competent, sincere, responsive, proactive, a truth-teller, you have sown the seeds of trust.

The subject of ‘Capital “T” Trust’ is one of enormous importance to effective, competent, and caring social work practice.  I reflect on it often, and work hard to assure I am being clear and truthful, especially when at the end of a particularly long day or week I would rather say, “Don’t worry.  Everything will be all right” and just go home.  In fact, I did say that, early on in the foundation year of my grad school internship, to a distraught, heart-broken older gentleman who I was hoping would agree to come off the street and enter the shelter system.  I said it because I made the mistake, which I’ve made before and since, of thinking this closing exchange we’d had was about me.  I needed to wrap it up.  I needed to feel good, as if something useful would come from our efforts by the sheer force of my will.  I had unconsciously decided to instill hope at the possible expense of the truth, even if that meant risking my professional credibility.  Of course, I didn’t realize all these dynamics were contained in that moment—but they were.

Well, I got some school that day, when my client looked up at me and said “Don’t tell me it’s gonna be all right, cause you don’t know if it’s gonna be all right.  Just tell me we’ll work on it.  Can you tell me that?”

Yes, I can.

And on that day, with that client, in that moment, capital “T” Trust was born.

NEXT WEEK:  “I’d Like You To Meet Our New Program Manager”

Questions for Further Consideration

1)   How do we use our knowledge, our instincts, our respect, our humanity, and our professionalism, to help the person in front of us even consider the possibility that they can trust us?
2)   Do you trust yourself?  What does it mean to trust yourself?
3)   To what extent can someone trust you, if you do not trust yourself?

Favorite Quotes Relating to Trust

People ask me why it’s so hard to trust people,
and I ask them why is it so hard to keep a promise.
– Anonymous

You see THAT girl, yeah her.
She seems so invincible right.
But just touch her & she’ll flinch.
She has secrets & she trusts no one.
She’s the perfect example of betrayal.
Cause everyone she trusted, broke her.
– Xanga

I’ll start letting my guard down when people stop giving me reasons to keep it up.
– Anonymous

To be trusted is a greater compliment than to be loved.
– George MacDonald

Trust takes years to build, seconds to break, and forever to repair.
– Anonymous

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