Alameda County Health Center
Medical Social Workers

Health care in America is in crisis. Even if you are lucky enough to have health care coverage, either through your job or out of your own pocket, you pay the most for less of any country in the West. Over 44 million American citizens lack any health coverage whatsoever. Of these, nearly half aged 18 to 64 work full time. Over 100,000 people lose coverage every month. With private hospitals decreasing their allocation of charity care, families have been turning in greater numbers to public health care facilities like Alameda County Health Center for medical care and treatment. Many are MediCal patients. Though chronically under-funded and overworked, health care workers serve the most needy at Highland, Fairmont, and John George hospitals, the facilities that make up Alameda County’s Health Center.
In the Department of Social Work Services at Highland Hospital, 30 Local 535 social workers, on call 24 hours a day, seven days a week, provide a comprehensive array of psycho/social services to patients and their family members.

LENORA BEERS

Lenora Beers is one of four medical social workers at Highland Hospital. “Many patients who come to this county hospital have a lot of pre-existing social needs,” notes Beers.
“They may have very limited financial resources or a life-threatening illness. We have to make an assessment of what services would best meet their needs.

“Being hospitalized is a traumatic situation. You’re sick or injured and you need someone who can help you sort out what to do at this point. The social worker is there to say, ‘Okay, Mr. Johnson, the doctor asked me to see you. Can we talk a moment about how I can help you?’ Sometimes it could be a support group, financial assistance or, if you’re eligible for disability programs, state disability or long-term disability. When we reach out to a patient we try to take into account the whole patient, the family dynamics, and what services are available in the community to help the patient once they’re post-hospitalization.”

Beers works with many cancer patients. “Understandably, they have strong reactions to their diagnosis, ranging from shock and disbelief to grief, loss, and adjustment to the chronic illness and treatment. They may experience depression and anger, and ask existential questions like, ‘Why is this happening to me? What did I do to cause this?’”
Beers sees a diverse mix of cases. “Many patients are uninsured or working in jobs where they don’t have health insurance. Many are chronically homeless, suffering from trauma, or are elderly. Many elderly have not made any preparations for long-term care. They’re brought to the hospital where they have no family and no one to help them. I’m seeing a patient who was a practicing therapist. But she’s in her 80s, has not made plans for the future, and has been declining over the past few years. She got into our system as someone who was potentially a danger to herself because of her forgetfulness. Up until recently she was very stable, but she hasn’t made any plans for the future. I make the initial assessment of her resources. Does she have family? Can she make informed decisions for herself? If she can’t, I will try and offer her support and refer her to county adult conservatorship. We are there to support and advocate for the patient, and bring balance to their lives. We want to make sure that patients are followed through with a continuum of care.”

Though her resources are limited and her workload high, Beers enjoys the challenge of working with chronically ill patients. “Many who come in here are in difficult economic straits. They need someone to talk to and some direction. You’re really a professional advocate for that patient. We are very busy. I might see 50 patients a week, and we have to keep documenting and charting. It’s almost more than we can manage.

“When you engage a patient as a social worker in a therapeutic relationship, you start just being there with the patient, wherever they are, and whatever is important to them at that time. You can’t solve all of the patient’s problems, but we boil it down to a few simple things that can help them.”

At one hour per assessment, and 50 patients a week, medical social workers are always behind schedule. “We’re always working overtime,” says Beers. “Assessments involve consultations with the doctor, reviewing the chart, and talking to the family. We prioritize according to age and severity. We see anyone over 70, patients in danger to themselves or others, and anyone brought in by the police first. We must also consider risk factors such as abuse, neglect, and domestic violence.”

Beers has an ethnically diverse caseload and must be sensitive to differences. “You shouldn’t assume anything, you wait for patients to guide you. For example, some people don’t use the word death or dying, even though they’re in a hospital setting where people die all the time. It’s unspeakable in their culture and makes the patient more depressed. So you can’t tell them they have a terminal illness, even though patients have the right to know what their diagnosis is.”
Beers has worked at Highland for 15 years. Part of her job is teaching social work students. “It’s interesting to see how much students want to have an answer for everything. I remember one of my students asking me after we received some referrals from the doctors, ‘Well, what are you going to say to the next patient?’ I thought that was an interesting question, and probably the type of question you get from someone inexperienced, because I never know what I’m going to say to a patient. I don’t pre-program what I’m going to say. I’m going to go to the floor, I’m going to review the chart, I’m going to talk to the nurse, and then I’m going to see the patient.

“At first, I might have very little to say to them. I’ve learned that patients teach you how to be a good clinician. They have taught me patience. There are certain things that transcend class, race, sex, that are so universal you don’t have to say anything to know what the person is feeling. I believe there is a universal language of illness. Patients communicate the things you can do to help. It could be a short-term illness, or it could be very serious, it could be renal failure, it could be a heart attack, it could be an illness related to aging. But we will all become ill at some time. And if you’re ill, you want someone to be sensitive to you, and to listen.”

ZORAINA JAMES

Highland Hospital’s Sexual Assault Center is open 24 hours a day. Last year, the Sexual Assault Response Team saw 583 patients, the majority of them women, more than they have ever seen.
“When patients come in here they are in crisis,” says Zoraina James, medical social worker. “Victims of sexual assault exhibit a range of symptoms, from stoicism to outrage. Many are fearful and crying uncontrollably. Some are unconscious. They feel caught up in the moment, afraid they’ll never get over this crisis, and that they’ll always be afraid. Our job is to help them through this very difficult time and to assure them that they will survive.”

Sexual assault is a problem that afflicts all economic and ethnic groups and is getting worse. “When I came here 10 years ago, we saw between 27 to 32 assaults a month. It went up to 40. Now I see up to 58 cases a month. The problem has gotten worse. Thankfully more people are reporting it than living with it in silence and shame. They also have greater access to available services. That’s where we come in.”

Medical social workers provide crisis intervention, advocacy, information, referral, and accompaniment. “We escort assault victims wherever they have to go, such as court. To be on the stand, answering very personal questions, can feel anonymous and threatening. Victims need a friendly face and someone who will go through this crisis with them.”

Advocacy is another critical part of the center’s services. Medical social workers intervene on a victim’s behalf as they interact with agencies, assist in the follow-up lab results, schedule HIV testing appointments, and expedite any medical follow-up services. “Part of what we do is case management to make sure victims are in a safe environment,” adds James. “If the perpetrator is intimidating, we help them get them away from the area and identify needed resources. Our goal is to help these sexual assault victims survive the enormous mental and emotional trauma they have suffered. Sometimes they just need their hand held, some eye contact, a smiling face to overcome the shame and guilt they feel, or a big hug.”

AN NGUYEN

One of the hardest parts of medical social worker An Nguyen’s job is counseling women whose babies die at birth. “When a baby dies it’s very traumatic. The families are very stressed and anxious. People aren’t equipped for this because delivery is supposed to be a happy occasion. People don’t plan for a death. When it does happen, whether a still birth or neonatal death, it’s unexpected and sudden. I do what I can to help people get through it. I approach the family with a lot of care. Many mothers feel it’s their fault, as if they could have prevented it in some way. We reassure them, do a lot of hand holding, and leave space for tears and sadness.”

In the Highland Hospital pediatrics department, Nguyen also provides crisis intervention and grief counseling to high-risk patients, like pregnant women from Santa Rita Prison. They deliver their babies at Highland because the jail does not have the capacity for mothers and babies to live together. A large part of Nguyen’s job is finding a placement for the newborn.

“If a mom has been incarcerated from the beginning of her pregnancy or before she’s due, the worker at Santa Rita is able to begin the placement process. But often it doesn’t happen. So, it falls on me to do it here and we have to scramble to get it done in time for the birth. Sometimes I’ll have 10 different family members calling me, and everyone wants the baby, which is great, and it’s good to have families, but we have to refer everyone back to the mom and children’s protective services.”

“If a mom comes in in a dire situation, if she’s homeless, a substance abuser, does not have any motivation, and does not want my help or intervention, there’s not a whole lot I can do. I can keep coming back to try to give her information, but she has a right to self-determination and the right not to take my referral. She may not be ready at the time. What usually happens is CPS is called. The baby is placed in foster care and might get adopted later on.

“Though I do have hard days, I like my job and the moms and babies. Most of our births are routine, and we see a lot of happy families. Sometimes families or mothers will call me later on and tell me what happened to the little baby. And so, there are some happy occasions.
“My goal is to ensure the baby is as healthy as possible and has a safe discharge and placement, whether it’s with other family members, or with a couple who wants to care for the baby. I know that sometimes I have to resign myself to the fact that there won’t be happy discharges, and it’s really tough if I have more than one fetal death a week. I’ve had as many as five, and that was the hardest week ever for me. Because these situations can be so stressful you really depend on your co-workers for support. We have a great staff here. We laugh a lot and pick each other up when the going gets tough. It’s not an easy job, but I think it’s much needed. For me, that’s very rewarding.”