Behavioral Health – Terry Reilly Health Services

What Does a Social Worker Do Exactly?

March 8, 2017

At age 12, I decided to be a social worker and I’ve never looked back. Social Work is a profession steeped in tradition. It offers a wide range of practice options. I’ve been an advocate, program developer, supervisor, psychotherapist, and community organizer. I’ve worked for nonprofit agencies, for-profit agencies, church-based social service agencies, medical settings and private practice. When I look at this list of social work roles and settings, I begin to understand why colleagues, friends, and yes, even family, ask, “What does a social worker do exactly?”

To understand this question, you have to understand the roots of social work. “Social workers promote social justice and social change with and on behalf of clients” (National Association of Social Workers Code of Ethics-Preamble). Social work in the United States started with a very simple and ancient principle: help the impoverished. Before the Revolutionary War, Americans were providing child welfare assistance, mental health services and assistance for the poor. In the early 19^th century, urbanization led to a significant increase in need. The upper-class was the provider of aide, or charity, through religious and secular organizations. Society began to ask questions about causation: why was someone poor? What causes homelessness?

Modern social work dates back to the establishment of Settlement Houses, considered the first social service agencies that integrated direct services, research and advocacy. The most famous Settlement House was Hull House in Chicago, established by Jane Addams and Ellen Gates Starr in 1889. The first social work class was at Columbia University in 1898. This marked the formalizing of social work as a profession.

From its inception, the profession of social work has been involved in bettering individuals, families, communities, and institutions. “The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (NASW Code of Ethics- Preamble). The profession’s six core values are service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. These values are present in everything a social worker decides to do. Child labor laws, unemployment insurance, child abuse and neglect prevention, and the de-stigmatization of mental illness and substance abuse are a few of the privileges we enjoy because of social work.

Social workers have been an integral part of the Terry Reilly staff for decades. Our Behavioral Health Consultants have fine-tuned observation and assessment skills to ferret out information to help a patient with problem-solving and accessing solutions. Our counselors build trust with clients in order to help them heal from years of trauma and unhappiness. Social workers not only bring skills and knowledge to the patient’s care team, but also a unique perspective. We not only see and hear the client in front of us, but must also consider influences such as the neighborhood where a client grew up, culture, and social policies that affect their lives and who they have become.

March is National Social Work Month. Remembering the foundation of social work reminds me why I love my profession and encourages me to find solutions for the challenges I see daily at Terry Reilly.

Libby Engebrecht, LCSW, is a Social Worker for Terry Reilly Health Services

The System is Failing this Person

May 24, 2016

Fundamental to the Fulfilling Lives program is a focus on system change. That is to say, changing the culture and the practices within the physical health, mental health, housing and criminal justice service delivery system to provide a more holistic and well-connected service user experience. The Big Lottery, the national organization that funded the 12 Fulfilling Lives programs across the country, mandated that every Fulfilling Lives program should include in their vision and business plan, a focus on better coordination of services between all sectors. The individual vision of the Fulfilling Lives program in Newcastle-Gateshead is:

We want to radically change the health, social care and criminal justice culture in Newcastle and Gateshead so that people with complex needs can make it from crisis to stability, getting a home, a job and sustained wellbeing. Concentrating on outcomes for people rather than organizations, services will be better joined-up, less risk averse and see people’s assets rather than their problems.

I spent time my first week here with several of the System Brokers who work with Fulfilling Lives. The Navigators, who are front line staff, report back to System Brokers. Navigators notice the system barriers as they work to help people connect to resources in the community. System Brokers are the next step in addressing those barriers, in part by keeping people updated and informed about the program’s goals and projects and by strengthening relationships with community partners. At a meeting with a local service provider with which there had been some tension around perceived referral rejection, I observed how the System Broker took a wide-angle look at the problem in a way that was very non blaming of the partner agency or any individual staff member. The system focus was epitomized in statements like, “We just need to trust one another – everyone is doing their best job,” and “The system is failing this person.”

System Brokers also develop relationships, provide information to and influence people who are in a position to change some of the rules governing things like housing. For example, there is a rule in the UK called Local Connection which means if you can’t prove your connection to an area, you aren’t eligible for what we in the US would call subsidized housing in that area; this rule disproportionately affects the homeless and people in recovery who may need to change areas to have a successful recovery. One of Fulfilling Lives system brokers has worked with local authority members who govern housing programs to consider a type of exception to the Local Connection rule for people with multiple, complex needs, similar to an exception that is granted for survivors of domestic violence.

Service users or Experts with lived experience are also extremely important to this idea of system change, for the obvious reason that they have firsthand knowledge of what is getting in the way of better service delivery. Fulfilling Lives has even trained Service User/Peers in the basics of how to conduct research. The Peer Researchers, with ongoing support from the Research and Evaluation team are then able to conduct the research that will help create a body of evidence to support the system changes identified by Navigators, Brokers and the Peers themselves.

Of course system change happens in the US as well; Coordinated Entry is a type of system change mandated by Housing and Urban Development (HUD) which requires that all Continuum of Care (CoC) funded housing programs work together to prioritize the most vulnerable people for housing. Currently, a subgroup of the CoC in Boise is working on a plan for Coordinated Entry locally. Another large scale system change operation is Idaho’s State Healthcare Innovation Plan or SHIP, a statewide effort to transform the healthcare system in Idaho.

There are several aspects to the focus on system change in Fulfilling Lives that stand out for me: it seems very much a part of everyone’s job description, the approach is very bottom-up, and there is staff development and organizational structures in place to facilitate it. As one community partner put it, “Fulfilling Lives is part of the system and charged with commenting on the system at the same time.” In some ways this could be seen to make things easier as there is a general awareness and buy-in within the local and larger healthcare system that facilitating change is part of Fulfilling Live’s role; on the other hand it can still be quite difficult because the U.K. Universal healthcare system has many layers to it and, as within any large system some people and organizations are more amenable to change than others.

For an outsider, coming from a different country with a different governmental structure and different ideas about healthcare systems, system change and advocacy, this system change focus within a service provider organization has me reflecting on systems and change within my own local context. It is like having another lens with which to view the familiar, giving me a new perspective … one that is still being mulled over and shaped the more I learn.

Resources:

Inspiring Change in the Northeast & Cumbria

That’s what people with lived experience are good at – the engagement piece.

May 19, 2016

I spent some time this afternoon, my first day of learning in Newcastle, talking to someone who works as a Navigator with the Fulfilling Lives program. He explained that when someone is referred to a Navigator, they meet up in the community and help them access and connect with community services that might be beneficial. He told me about his efforts to connect with someone for over 3 months and he was finally able to meet with him face to face. When he did meet with him for the first time, it was really helpful in establishing trust by relying on his first-hand knowledge of some of the difficult life experiences that people like him were going through.

There are times when something is said that isn’t exactly new information – you may have heard it before or even given it some thought in the past – but for some reason in that moment it resonates with you differently and/or new possibilities seem to open up upon hearing it. That’s what happened when the Navigator with Fulfilling Lives said, “That’s what people with lived experience are good at – the engagement piece.” In that moment, my thoughts went first to the Peer Specialist who works at the Terry Reilly Boise clinic and how his position as a peer, and not as a professional, enables him to engage with people on a different level. I’ve known Matt was good at connecting with people because I’ve seen him do it again and again, with his co-workers and with peers; the challenge has been creating opportunities within the clinic for his engagement skills to shine. I also thought about the wider Boise community’s goals behind implementing Coordinated Entry and Housing First to connect with, house and provide support to the most vulnerable. In many instances these individuals aren’t currently accessing available services for a variety of reasons; people who in some cases have burned bridges, or have “multiple, complex needs” which is a common phrase used here in the U.K to describe them. I also thought about the PATH program in Boise which currently has Peers working in a similar way to the Navigators with Fulfilling Lives. One difference in the tow programs is the Navigators in the U.K are embedded in and part of different partner agencies while still working as part of the Fulfilling Lives program; which means they have the support to access services and identify barriers within the larger system in a unique way. I also thought about the Peer Wellness Center which is peer directed and has had great success in engaging peers at all stages of recovery.

In summary, all of this had me thinking about possible collaborations between agencies who already employ peers for this very important engagement piece at which peers are uniquely skilled, in particular when it comes to people with multiple, complex needs. As this is only day one, I’m looking forward to learning more about all aspects of Fulfilling Lives program in the days to come.

Transatlantic Practice Exchange – Learning About Homeless Services in the U.K

May 10, 2016

In May I’ll be spending two weeks learning about homeless services in the United Kingdom!

This is an opportunity funded by The National Alliance to End Homelessness (www.endhomelessness.org) in the United States and Homeless Link (www.homeless.org.uk/) in the UK to increase understanding and collaboration around best practices in working with people experiencing homelessness. Through a competitive application process, five candidates were chosen to go to the UK and five from the UK will come to the US, spending 2 weeks at different placements around the country. My placement is in Newcastle which is Northern England, close to the Scottish border, with a program called Fulfilling Lives. From what I have read and in talking to several people there, they are doing great work in care coordination and with Peer Specialists. I will be there from May 16-27th and I’m very excited about this incredible learning opportunity.

As part of the Practice Exchange experience, in order to spread the word about the work, and to provide a structured place for participants to reflect on their experience, they asked each of us to set up a blog; this is the result!

Even though my practice exchange doesn’t officially start until May 16, I wanted to send out some background information prior – thus the links here to the agency, Fulfilling Lives (www.fulfillinglives-ng.org.uk/), as well as links to articles about homeless programs and services in the UK and reflections from the providers that participated in the practice exchange in 2014. Also, I’ve included below the proposal I wrote up as part of the application process, that explains my area of interest.

I have two main intersecting areas of interest that I would like to explore during the Transatlantic Practice Exchange Program: the essential elements of a successful Care Coordination model, and the holistic involvement of Peers, or people with lived experience in this model. I am also interested in ways to measure participant’s experience of care.

The United States (USA) and The United Kingdom (UK) are both grappling with the question of how to better address the needs of their respective nation’s most vulnerable individuals. Based on what I have recently learned about the work of Making Every Adult Matter (MEAM) and Fulfilling Lives this vulnerable group in each country is composed of people struggling with similar problems: substance misuse, mental health disorders, chronic physical health problems and housing instability. (In the USA, the offender label is not commonly used to describe people in this group although a high percentage of vulnerable people in the USA interface with the criminal justice system.) In both countries, one of the primary reasons for focusing on the most vulnerable has to do with reducing costs associated with the high utilization of community services like hospital, jail, and emergency care.

One of the biggest problems currently for vulnerable people in my community is navigating a health care system that is not well integrated and highly inflexible. The service providers with whom people have regular contact don’t have formalized ways of sharing information and “case management” is only reimbursable under certain conditions so there is a lack of resources to help people navigate the fragmented system. Recently, due to an increase in community awareness around the topic of homelessness, steps have been taken toward more local government and inter-agency collaboration around the question of how to increase housing opportunities for this vulnerable group; at the same time, I have become more aware of how supportive services are tied to specific agencies or funding but seldom cross over to sustain an individual as they navigate multiple touch points within the system. This is in contrast to the aforementioned programs I have been learning about in the UK.

One of the first things that stood out for me when I read about the MEAM project was the high level of collaboration between multiple professionals and agencies. Subsequently, in a brief conversation with Neil and Sophie with Fulfilling Lives, I learned about Service Navigators and System Brokers who work together with the participant, focusing on engagement and connection to existing services, while also identifying and working to eliminate barriers to care. I was struck by something Neil said about the System Navigators working out of a variety of settings where vulnerable people might interface with the care system. In my experience, this is a novel approach and one that requires a great deal of community investment and relationship building. By experiencing the model used by Fulfilling Lives, I hope to learn how to encourage and support inter-agency collaboration and help create culture change within my own workplace. To that point, I am interested in a better understanding of the roles of the Service Navigators and System Brokers, and I hope to learn about how they have successfully influenced system change.

I am also interested in how to create more space for participant involvement and decision making in their care and more generally, opportunities for Peer involvement in service delivery.

My understanding is that in the UK there are fewer barriers to including Peers at all levels of service delivery. A participant lead “professional meeting” as practiced in MEAM is not common practice here; nor is Peer involvement in staff selection or program evaluation as occurs in Fulfilling Lives. I am curious if Peer involvement in evaluation helps to more full capture participant voice. Locally, as a first step, I am interested in developing a Peer Advisory Committee composed of people who were formerly homeless to make recommendations and be involved in the planning process that is occurring around a new Housing First program. I believe Peers have important things to say about what was helpful for them that will contribute to a better model and the opportunity to give back is something Peers in counseling frequently talk about as a value. In addition, I see the development of a Peer Advisory Committee as a way to more fully integrate a system of Peer Support into our service delivery model.

Resources:
Transatlantic Practice Exchange 2014 (PDF)
Making Every Contact Count; a Joint Approach to Ending Homelessness (PDF)
Fulfilling Lives; Understanding Multiple and Complex Needs in Newcastle & Gateshead (PDF)
Transatlantic Practice Exchange Information (PDF)
MEAM.org.uk