A Day in the Life of a Social Worker Embedded in Primary Care
Note: this blog was originally posted in March, 2018 at the Bread for the City Blog to honor social work month.
Before I get to my desk, the day begins with Eddie, a long-time medical patient, who asks for help activating his cell phone. Eddie has been living without housing or income for nearly 20 years. Eddie relies on Bread for the City as a safe place– free of the ethnic, racial, and class discrimination that has made him distrustful of most businesses and government agencies. I smile at Eddie and encourage him to follow up with Taniek, who manages the medical resource room–a drop in center for the various social services and health information patients need to care for themselves. Primary care social work means constant team collaboration.
Back at my desk, I scan the full schedules of the five primary care providers seeing patients today–about 60 patients a day. I look for patients who have met me or other social workers in the past to address stress and anxiety, depression, complex trauma or other common symptoms that I can help with.
I chat briefly with Dr. JoanE about a young mother coming in mid morning who might need some support coping with motherhood and help navigating the resources available to her. I coach one of the medical residences about my role and the diabetes management goal set by 55 year old Derrick, who they are about to meet. I also scan the schedule for medical patients who are working with others in the social services team –including those receiving support for their disability application, or coaching on subsidized housing resources. I G-chat my colleagues to ensure we don’t miss an opportunity to coordinate care while these patients are in the clinic.
I have a sense of my schedule. Though my day could change at any moment with patients who drop in for care or new referrals from primary care doctors, there are 6 patients on my schedule. Three are follow up visits for treating the complex symptoms of depression, anxiety and trauma. And the other half include a mixture: a patient working to get healthy by losing 25 lbs before her 65th birthday; a patient living with schizophrenia who is coping with the death of his mother, and a patient living with mental illness and addiction who is trying to decide whether or not to go back into treatment. With everyone I see, time will always feel too short, and my focus must always be on building upon their natural strengths, and encouraging specific self-care practices they can bring to their day to day lives.
I take a moment to collect myself. I know that the upcoming time with Roxanna, a single Latina mother of two, who is seeking treatment for insomnia and anxiety–will require my emotional calm and strength. Roxanna is living with complex Posttraumatic Stress Syndrome, which includes insomnia, raging headaches, nightmares, and panic attacks. She survived cruel physical and verbal abuse from the father of her children, and also a history of abuse and neglect in childhood. Roxanna has had a flood of panic and nightmares since she learned that her father in El Salvador passed away. Roxanna has always been the rock in her family, but this new flood of symptoms threatens her identify.
For the next 45 minutes it is my job to create safety for Roxanna to experience emotions that her life has not allowed her to feel. At the same time, I must pull out Roxanna’s many strengths and resilient coping strategies, and instill hope so that she can go back into her world with a greater sense of power and possibility. As I sit with Roxanna, I am reminded what an honor it is to share this intimacy with another person and to see how truly powerful humans are in the face of pain. Roxanna leaves the clinic today with a new mantra: “I am safe now,” and a plan to establish a nightly self-care routine while the kids do their homework.
I debrief with Dr. Randi on Sally, a 61 year old grandmother of eight, who I just coached through a deep breathing exercise and who wants to manage her high blood pressure without prescription medication. “Great!” We all three agree to check back in a month. I respond to a chat from the front desk about Henry, a 63 year old African American man, who wants to see a social worker about housing for an upcoming surgery. I receive a request from Jaime to see a new 26 year old medical patient who is sad and feeling lost after losing a job last week.
I take a deep breath. Phew, thank goodness I am not alone and Bread for the City values the work social workers play in optimizing health. We are the engine, the vibranium, and the glue.
I am munching on my lunch as I finish a few clinical notes. I’m reminded that I want to talk with Brionne, a nurse practitioner, about how my visit with Roxanna went and if she can refill a medication that is working for her. I turn to Brionne, and we talk for 2 minutes. We share in that moment a brief exhale of the intensity of our collaboration with Roxanna and our shared admiration for her strength. “Yes, we’ll refill her scripts, and two weeks is the perfect time for her to come back and check in.”
I scan the afternoon schedule before I prepare to take a 15 min walk and breather.
I’m laughing with Sandra as we walk out of our session. “I am envisioning you in that white dress on your 65th birthday.” Sandra missed her weight loss goal this week, but set some smart new goals for herself that better match her lifestyle–like scheduling a weekly walking date with her daughter rather than going to the gym, and preparing half of her weekly meals on Sunday when she cooks. I grab her a referral to the nutritionist at Giant, which she can arrange at her convenience in the coming month.
Jasmine, another Behavioral Health specialist in the clinic pulls me aside to talk through a possible referral for a 53 year old man living with depression. We decide to do some additional assessment within the primary care behavioral health model before we lay out his options.
I am in the middle of a session with Cynthia, a 56 year old grandmother who is living with depression. She is fighting for greater meaning and more joy in her life after deciding to separate from her long-time partner. I am exhausted. I’m feeling the heaviness of Cynthia’s daily struggle in my bones. I wonder what she’s feeling in her’s? “Cynthia, I feel so much heaviness as you speak about this, are you feeling that in your body, and where?”
Cynthia has been living with chronic back pain for decades, and we connect these physical complaints with her emotional struggle. One of the many benefits of working in a primary care clinic is that we weave together mental health and physical health—since they are inseparable. Emotions surface. And then Cynthia and I explore where she feels lighter in her body and when she feels that lightness. We design together a self-care plan that maximizes the time that she spends with her prayer community and that she spends with her pet birds. We both exhale.
I wrap up a visit with Jerry, a 46 year old man with a history of alcohol addiction and complex trauma. He’s still not ready to start treatment. The fear of failing again, and the fear of facing so many complex emotions is too great. Jerry is going to get his social security card this week–though–just to prepare in case he needs an ID for treatment in the future. I head back to my desk to finish up notes, check phone and emails, and plan my day tomorrow.
As I leave, I take a moment to reflect on everything I got to experience with clients today and how that is sitting in my own body. I start thinking about all the things left to do, but then I stop myself. It’s important to take time to celebrate the victories.
*Names and biographical details have been changed to protect Bread for the City client confidentiality. The scenarios throughout this blog provide a representation of the day-to-day challenges faced by Bread for the City medical patients and the social workers like Ali who support them.