Once Upon A Client: The End of Homelessness

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There is no symbol more reflective of the end of homelessness than a set of keys.

As Manager of the Client Advocacy Project (CAP) at Coalition for the Homeless in New York City, I had the privilege of leading a team that helped put keys in the hands of over 100 homeless men and women.  These single adults, either street homeless or languishing in the city’s municipal shelter system, lived with a range of physical, mental, and emotional disabilities.  With a housing stock that to this day is grossly inadequate, this was no small accomplishment, and I am extremely proud of the team of dedicated individuals who made this possible.

The primary goals of the CAP were to secure federal disability benefits for those who, with appropriate advocacy, were eligible, and to leverage those benefits into a move to supportive, supported, transitional, or independent housing.  The timelines involved were quite long—3 to 5 months for an initial application for benefits and two to four years to appeal the denial of benefits—sometimes longer.  This being the case, in providing intensive case management for our clients we got to know them very well.

One such client, who I’ll call Mr. Franklin, came to the CAP through the Coalition’s Crisis Intervention Program.  Five days a week, homeless single adults, couples, and families would line up to receive services, referrals, or advice at the Coalition’s office at 129 Fulton Street in lower Manhattan.  Mr. Franklin, a lean muscular man of about 50, had been on the street for a few years and was living with schizoaffective disorder.  He was tired of being on the street, but refused to enter the shelter system.  “I’m safer on the street,” he told me.  For some, I knew that was true.  He also was suspicious of “the system” and unwilling to “jump through all the hoops” that were held up as a condition of shelter.  Despite our willingness to advocate for him and the fact that a number of newly sheltered and formerly street homeless individuals were willing to vouch for our program, Mr. Franklin chose to do it his way and remain on the street—of course, we stuck with him every step of the way.

Through our advocacy and with the assistance of our partners at The Legal Aid Society, Mr. Franklin was awarded disability benefits 18 months after coming to the CAP for assistance.  Three months later, together we were able to secure a studio apartment for him in the Bronx with on-site social services—what a victory!

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Mr. Franklin, who rarely smiled and for whom eye contact could be quite difficult, absolutely beamed the day he walked into my office holding a set of keys.  I sat back in my chair and smiled. “Well!  What’ cha got there?” “Could you make me six copies of these?” Mr. Franklin requested.  “Out the front door, make a left, across the street in the middle of the block.”  “No no no…” Mr. Franklin replied. “I mean, on the copy machine.”

I was terribly curious where he was going with this.  “Sure thing, Mr. Franklin.”

I placed Mr. Franklin’s keys in the center of the glass on the copy machine, fanning them into a semi-circle—three keys in all.  Then I took the long cord they were attached to, which he wore around his neck, and circled the keys.  Mr. Franklin took the six copies and sat down to write.

A few minutes later, he handed me a copy with a note of thanks.  “You saved my life.  I love my apartment.  Thank you.  Franklin B.”  It brought tears to my eyes.  Mr. Franklin took the other five copies he had personally inscribed and gave them to the five staffers who had helped him in various ways.  We were all so excited and touched, we were like little kids!

I asked Mr. Franklin if he minded if I put the picture up on the wall in my office.  I explained to him that if other clients saw it, it might inspire them to hang in there a little longer until they got their own keys.  Mr. Franklin didn’t hesitate.  “Go for it.”  With Mr. Franklin looking on, I taped the picture of his keys right in the middle of the wall.  We stood there for what seemed like the longest time, just staring, and smiling.  I turned to Mr. Franklin and shook his hand.

“Congratulations, Mr. Franklin! You are formerly homeless!”

He smiled back then, for the first time, gave me a hug.  It was one of the most beautiful moments of my life.

From that day forward, every single client who came into my office looked at those keys up on the wall.  Some of them just stopped and stared, taking it in.  How profound, how potent a symbol to the end of homelessness.  Several of the clients would tear up.  A week later I was sitting with Ms. Carol, who had just gotten a room in a supportive housing residence in Queens.  She leaned in, like she had a secret.

“Mr. Craig.  Can I have a copy of my keys, too?”  I smiled.  “And uh… have you got room up on that wall for me?”  “Ms. Carol, we always have room for you.”

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I made the copy, which she signed, and let her choose her spot on the wall.  She chose a spot directly below and a little to the right of Mr. Franklin’s.  Ms. Carol couldn’t have been more proud!

This started a tradition in the Client Advocacy Project at Coalition for the Homeless.  I can scarcely think of one other person who, when they got their keys, didn’t ask to sign a copy and choose a spot on what I dubbed the “Wall of Fame.”  It was really a Wall of Freedom, though.  Freedom from this affliction, this scourge, known as homelessness.  From time to time, when someone was really hurting and needed a little inspiration, I’d write their name on a post-it and stick it to a spot on the Wall of Fame.  “This is your spot,” I’d say.  “This is where your keys will go.  I’m not putting anyone else’s keys up there but yours.”

It worked—every time.

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Readers Respond to “Social Workers Deserve Higher Pay Now”

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Emotions ran high in response to my September 16, 2013 article “Social Workers Deserve Higher Pay Now.”  While there were several interesting suggestions on how to address the issue of low salaries, three things are abundantly clear.  Social workers are frustrated on the issue of compensation, they are angry at the NASW, and they are hungering for leadership and advocacy.

At the time of publication 36 readers commented on the article, a significant number given the newness of my blog.  Here is my completely and thoroughly unscientific categorization of those comments.

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  • 39% of the responses featured some form of expressed frustration (complaint) as the dominant response; of those
    • 6% asked that someone do something (i.e., “Help!”)
    • 11% offered to help, offered information, or at least one suggestion
    • 22% straight up complained
  • 8% took a stand in support of higher salaries for social workers (without making a complaint, as such; e.g., “It is high time social workers received compensation that appropriately reflects their contributions to society.”)
  • 16% commented without taking a stand in support of higher salaries (e.g., “Social workers knew what they were getting into when they signed on for this profession.”)
  • 3% offered direct assistance to anyone who advocates (e.g., “I can’t do this alone, so if you want to make something happen count me in.”)
  • 34% contributed meaningfully to the discourse in one of the two following ways:
    • 28% provided research or the names of sources where research can be accessed, and or at least one suggestion about how to approach the issue of advocating for higher salaries
    • 6% expanded the dialogue by reblogging my article, providing links, or sharing via other means

Here are excerpts of some of the comments.

“About time social workers & pay equity came into the 21st century.  I have endured low low wages for 36 years.”

“…this issue comes up again and again … we are the lowest paid among those complaining (psychologists, psychiatrists, etc.).  No one will step up as an organization because of fear of “colluding.”  I get that this is a real legal issue (or is it?), but it is laughable.  Really?  “They” won’t allow us to talk to each other about these ridiculously low salaries?  “They” are afraid of us?  And our $43,000 salaries?  Really?”

“We should not accept that Social Worker=poorly paid.”

“I was lucky enough to become a union member when I became a CPS social worker, which directly affected my pay in a positive way.  I would call for social workers to unionize through the help of NASW.”

“Most social work(ers) that do fieldwork are working over 40hrs and are not being properly compensated and there are not enough incentives for anyone to stay in this field.”

“With Medicare cutting reimbursements to the medical field, and most likely private insurers will do the same, I don’t see how social workers will get paid higher.”

“I have been involved in discussions regarding salary with social workers on LinkedIn, however invariably the conversation turns to “we didn’t get into social work for the money”, as if there is something noble about undervaluing your worth.  I didn’t go into social work to be living in poverty, either.”

“Would also be nice if social workers received credit towards their student loans as teachers do.”

“I work two SW jobs and I am always working.  This is terrible.  A 66 credit Masters to be treated and paid like a HS graduate.  The not for profit programs pay even less.  Where can we get some help??”

“The only thing we are doing is complaining and venting our frustrations.  This energy can be directed in becoming active in our cause of insufficient salaries.  Has anyone taken action?”

“For 50 years or more, social agencies have been using all available resources for the clients and hoping that the employees will “hang in there” due to their commitment.  In my opinion, when we start by taking care of employees, the needs of the clients will be met in an even more superior way.  There are many examples in the for-profit world of the wisdom of taking care of employees first.  It results in better customer service and far better financial performance for the organization as a whole.”

“I firmly believe that NASW needs to step up to the plate.  They are the largest professional social work association in the US.  They have the resources (including a team of lobbyists).  Unfortunately they have not shown interest in doing so.”

Wow.

One of my readers was able to get a response from someone at the New Jersey chapter of NASW on the issue of advocating for higher salaries.  I share this with the understanding that I have not been able to independently corroborate this as of the time of publication.  I will continue to attempt to corroborate it and will update everyone via the News & Notes section of my blog.

“We are often asked why NASW does not negotiate for higher reimbursement rates for Social Workers.  The answer is because it is illegal.  Unfortunately, federal anti-trust laws do not allow a membership organization to negotiate payment rates.  This must be done by the “employees” themselves.  That means YOU.  NASW-NJ is talking with NASW National about how to develop a strategy for organizing private practitioners to work collectively toward this goal.  Nothing would make us happier than to have Social Workers paid what they are worth!  But this is not something NASW can do on its own.  Toward this end, NASW-NJ is organizing a Managed Care Roundtable to maintain ongoing dialogue with representatives of the NJ insurance companies.  We also intend to use the NJ Social Work Summit, a group of representatives from all NJ Social Work organizations, including NASW-NJ, to engage all NJ Social Workers on these issues.”

It is curious to note New Jersey’s effort to organize “private practitioners (italics mine) to work collectively toward this goal” of higher reimbursement rates.  While commendable, this unfortunately does not help social workers who are not private practitioners, thereby reinforcing their “otherness” and driving the wedge between clinical social work practice and “everything else” even deeper.

If the information provided by the NJ-NASW representative is accurate, if it is actually illegal for the NASW to negotiate or otherwise advocate for higher salaries for social workers—where does this leave us?

Among us are individuals with the personal or organizational resources to devote themselves full-time to the intensity of effort required to earn our profession the recognition it so richly deserves, and the compensation that all social work practitioners daily earn.  It pains me as I write this that I am not one of those individuals.  I cannot lead this charge because, like so many of you, my life concerns are very local.  Paying rent.  Putting healthy food on the table.  Funding worthwhile after-school activities for children and saving for college.  Exercising (remember that “self-care” thing?).  And, in my own way, giving to my profession by trying to crank out a thousand or so readable words per week.  After all that I do, and all that you do, what’s left?

By saying this I am in no way conceding defeat.  Nor do I mean to suggest that it is all on one person or organization to make this happen.  I believe what we all wish for ourselves and our profession is attainable—I simply don’t know, any more than you do, how exactly it will come about.  Or when.  But if we individually have no greater role at the moment than joining the chorus of those calling for change, then so be it—we cannot, and should not, fault ourselves for that.  Nor should we fault others.  The important thing is that we do not stop sounding the alarm and calling for change.

In the meantime, the chorus will grow louder and the debate will unfold.  You and I will go to work and we’ll continue being present as we fight for our own calm, looking into the eyes of someone who hurts while we, in our own ways, also hurt.  We’ll keep holding that space and in so doing offer not only our wisdom and pragmatism, but a silence our clients can step into—the possibility, the suggestion, that there is a better way.  And there is.

This is beautiful work that we do.  The moment-to-moment chaos characterizing much of our workday is a battle for health, happiness, and love, the proverbial “good fight”—it is sacred work.  And regardless of how we are compensated or our willingness or ability to do anything about that right now, let us never forget it, and never lose focus.

I personally thank each and every one of you for the courageous, whole-hearted work that you do.  The world is a better place for your efforts.

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Social Workers Deserve Higher Pay Now

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A September 2009 CNN·Money article listed 15 stressful jobs that pay badly.  Number 1?  Social worker – median pay: $43,200.

The article states:

“Social workers step in when everyone else steps aside to help people and families in vulnerable situations.  They provide patients with education and counseling, advise caregivers and make referrals for other services.  And with social workers in short supply and programs underfunded, few must juggle the work of many, while reaping little reward.”

An incomplete characterization, to be sure, but basically correct.

Why is this so?  Why is “the system” set up to pay social workers less than we are worth?  Because the value we derive… (Did I hear someone shout, “Because we let them!”)?  The value we derive from helping others is not salary-based.  We choose to go places most people don’t want to go, to stare into the twisted face of pain and feel the thrill of helping those muscles relax—even just a little.  The monetary value of that benefit is the price of our hearts, and that price is $WhatEverItTakes.00.  We exercise our heart muscle in a big way in this profession, and we get the job done or burn out in the effort, which is all too often the case.

Given a degree of burnout that is now legend among our colleagues why, too, are we willing to risk burnout for so little money?  To enable a broken system of compensation to remain broken?  Are we too busy helping our clients and trying to have a life of our own to hold our leaders accountable?  While that may be part of the answer—it’s not all of it.

There is a game of chicken going on between not-for-profits and funders, primarily government entities, and the not-for-profits blink—every time.

About a year ago I attended a meeting of supportive housing providers (not-for-profits) hosted by the New York State Office of Mental Health (OMH) at Creedmoor Psychiatric Center in Queens Village, NY.  While we were waiting for the OMH reps to come in, word went around this enormous conference table that RFP’s (Requests for Proposal) were about to be issued for the creation of new CR-SRO’s (Community Residence-Single Room Occupancy residences, a category of supportive housing).  As word spread of these impending RFP’s, the individuals seated around the table, middle- and upper-level managers from an assortment of contracted service providers, looked at one another stealthily, furtively.  First left, then right, a series of head movements that pulsed like a slow wave moving around the table.  I’m watching this, and forgive me for being crude, but it was like someone passed gas and they were seeing if anyone else smelled it.  But instead of “It wasn’t me,” the facial expressions read more like “I don’t want it,” “You can have it,” and finally, “No thanks.”  But sure as heck those same people knew that their organizations would compete fiercely for those contracts, with their puny budgets.

But if the budgets are so puny that the managers responsible for running those programs are looking at each other as if to say “Good luck with that”, why do the not-for-profits blink every time?

Jobs.

Because in the view of many of these organizations we work for, some programs are better than no programs—even poorly run programs, some of which operate at a deficit.  Because it’s better for residents recovering from mental illness to be in a woefully funded community residence than in a shelter, on the street or, heaven forbid, in a jail or prison.  I get it, but—it’s not a good enough reason to underfund a program and underpay professional staff who have families and bills and student loans.  The men and women who live in these residences, many of whom have lived horribly difficult lives filled with fear and tragedy and loneliness, deserve better, and so do we.

But what is our role, as social workers, in perpetuating this ill-fitting status quo of too high stress for too little money?  Are we actually complicitous in maintaining, through our inaction, the very state of affairs we so object to—are we enablers?

An anonymous contributor on wiki.answers.com, in response to the question “Why are social workers willing to work for low pay?” posted:

“I am just entering the field as an LLMSW and I am very concerned about why we have accepted this (low pay) for so long. We are supposed to be able to advocate for others and we also know that we need to take care of our needs in order to be good social workers. We also know that this is one of the reasons for high burnout. Why have our leaders not stepped up? I am asking that we challenge NASW to do more. If the NASW (2010), “works to enhance the professional growth and development of its members, to create and maintain professional standards, and to advance sound social policies,” then why are they not advocating for our needs so that we may continue working in our chosen field without as much fear and shame of our salaries!”

My colleague—I hear you.

A call-to-action for NASW CEO Dr. Angelo McClain

Dear Dr. McClain,

I hear you are a good man and exceptional social worker, this from a reader of mine who claims to know you for many years.  I don’t doubt it.  And I’ll admit right up front, I don’t know the history of the NASW’s efforts to advocate for better salaries for social workers, nor do I know of any personal efforts you yourself may have undertaken.  Perhaps there are and have been many such efforts and I’m the last social worker on the block to know.  It would seem, though, that despite any such efforts, we as a profession remain in a quandary over the issue of inappropriately low salaries.

In your article “Helping Social Workers Help People” (July 2013 NASW News) you wrote “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.”

In response, I shared the following with you.

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.”

I emailed this to you at naswnews@naswdc.org and naswceo@naswdc.org on July 17, 2013.  The full article was published in my blog The Social Work Practitioner on July 15, 2013.  The NASW’s auto-reply email notes, “Individual letters cannot be responded to.”  Well, what can be responded to?  I am knocking on your door asking not for help, but to help.  I am publicly asking you how a nation full of social workers can make higher salaries a reality.  Certainly we can go outside the auspices of the NASW, but we are stronger together, don’t you think?

Dr. McClain, we need you to help us see how this is going to work.  Or at the very least what your thinking is, at this point.  If you lead a sensible campaign with a clear and reasonable chance of success I, and others, will rally behind you.  We already have an abundance of the “pressing need” part you referred to—we need a path to a solution.  We need your leadership and we need it to be a very high priority of your administration.

Are you up for it, Dr. McClain?  Are you with us?  We need to hear from you.

Respectfully and with best wishes,

Craig Moncho, Social Worker

Okay, I’ll get the ball rolling here, though I’m sure that I’m less qualified than Dr. McClain to figure this out.  But what the hey, I’m going for it.  Here are two initial thoughts to get this conversation going.

A question for our social work research colleagues

What studies can you cite (or what studies need to be done) showing the benefit to consumers and funding entities of hiring masters level social workers?  Send me links, email me (contact information is available on my blog ‘Contacts’ link) and we’ll move this conversation toward meaningful action.

Political action

We need to compel government entities to require master’s level social workers to fill particular staffing niches in the RFP’s that not-for-profits are competing for.  How do we do this?  Social work researchers, kicking the ball back to you.  We need bona fide research that conclusively proves that client outcomes are significantly improved when masters level social workers are leading the way.  If bang for the buck is the “currency” economists and politicians deal in, let’s show them the research, and push—hard.

Just because no one could pay social workers enough to properly reflect the heart we bring to our work doesn’t mean we, as a profession, should be Number One on the list of the 15 most stressful jobs that pay badly.

There is a silent calculus at play among those who are in the position to fund programs for the needy and disadvantaged.  That calculus takes into account an understanding that those of us who choose to become social workers have uncommonly big hearts.  They know we can’t or won’t walk away from our clients.  They know the price of our hearts: Insultingly low salary + $WhatEverItTakes.00 to get the job done.  And we’ve been doing it, we still do it, and it’s still not okay.

So—what are we going to do about it?

That’s not a rhetorical question.  I really want to know.  I hope you’ll talk to me, and that Dr. McClain talks to us—soon.  If he takes our plea to heart, a plea made innumerable times and most recently elucidated in this article, I hope he will begin addressing the “…pressing need to raise social work salaries…” soon.  I hope we will hear from him via the medium of his choosing by December 31st.

Together, maybe we can make this dream of a higher salary that someone will actually pay, a reality.


References

http://money.cnn.com/galleries/2009/pf/0910/gallery.stressful_jobs/

http://wiki.answers.com/Q/Why_are_social_workers_willing_to_work_for_low_pay

https://thesocialworkpractitioner.com/2013/07/15/a-response-to-helping-social-workers-help-people-by-nasw-ceo-dr-mcclain/


Questions for Further Consideration

1)   How can we effectively advocate for higher salaries for social workers?

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“Am I A Good Social Worker?”

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

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

“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’?

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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