Helping individual patients with health crises, learning about the constantly changing field of healthcare and being with patients' families in times of emotional stress are a few reasons why University Health System medical social worker supervisors Chris Popish and Lisa Repaske are drawn to their work. Popish, Repaske, and medical social worker Fayola Kojo recently spoke to The Cavalier Daily about social work — or aiding clients who have social or psychological concerns — and its current role in patient recovery. Medical social workers perform a wide variety of tasks, including connecting patients with social resources, communicating with the patient’s family members and offering counseling.
Medical social workers are integral parts of the hospital and oversee much of the non-medical aspects of a patient’s recovery. Their duties include assessing the social and psychological states of the patient, leading counseling and group therapy sessions, working with loved ones on a plan of treatment after discharge from the hospital and referring patients to community resources.
At the University hospital, each social worker is assigned to a specific unit — such as surgery and trauma, pediatrics or psychiatry. With each new admission into the unit, they look through the patient’s medical history for indicators that a social worker needs to be involved in their case. A few of those indicators include mental health history, a poor prognosis, a history of substance abuse, homelessness and history of child or domestic abuse.
“Social workers get involved from the beginning,” Repaske said. “Even if we're not called in to see every patient, we are assessing by a high risk indicator need .… Could everyone benefit from a social worker? Absolutely.”
A social worker will meet with a patient and conduct social and psychological assessments if the patient has an indicator on file or if the social worker simply feels the need to.
“I'll meet with the patient,” Kojo said. “I’ll let them know what my role is, why I'm seeing them, pretty much just like as a brief check in. It builds rapport with them, and then eventually, I let them know that it's part of an assessment that we just want to make sure that their needs are being met. Ideally by the end of the assessment, we've identified what they need assistance on, and then, we work with them during their admission in order to reach those goals.”
Kojo is a “float” social worker, which means that she is able to work in a wide range of units. On any given day she could be overseeing anywhere from five to 15 patients. Although the medical procedures differ from unit to unit, Kojo said the psychological and social concerns remain similar among patients. Many times, medical social workers also assist with the patient’s financial matters in relation to treatment and the terms of the patient’s health insurance.
“No matter what unit you are in you can still see patients with the same needs,” Kojo said. “Just because you're in the [intensive care unit] doesn’t mean that you won't have … financial issues or a history of homelessness, substance abuse, depression.”
In the intensive care unit — where Kojo has recently spent much of her time – medical social workers have the added responsibility of helping families cope emotionally with the conditions of their loved ones, especially when the patient is coding or unable to communicate. They also lead patients and family through end-of-life conversations and sometimes collaborate with the chaplain.
Throughout their stay, patients can ask medical social workers questions related to their social standing or mental health and participate in counseling sessions.
“Social workers are known as community resource experts, but that changes and evolves all the time,” Repaske said. “Knowing your resources and staying in tune with that is something that social work does very well.”
One current change the social work department examines is the recently-expanded Medicaid program in Virginia. Those who are eligible could enroll in the beginning of November with coverage starting in January. Although social workers do not complete Medicaid applications, they are responsible for educating the patient and family on health coverage options — including cases where the patient does not have health insurance — and supporting the patient and family through that process.
“Just because you pass a bill, and you have it out there doesn't mean people really understand how that's gonna benefit them. It's a big social work role,” Repaske said. “So as leaders, we have to go and do that throughout the hospital and … make sure it's really touching the patient, the family.”
Another social work supervisor at the University, Chris Popish, spoke about social workers’ role during the violent events of Aug. 11 and 12 last year, when white supremacists rallied in Charlottesville.
“Staff are there with the families and having to break bad news, and then trying, we were trying to link the families with the patients,” Popish said. “It was really hard because it was chaotic, and it was the first time we ever had to do something like that here .… Everyone pulled together.”
Because their work is highly emotional, social workers are strong advocates for self-care. The department will often have debriefings and huddles to discuss current cases, help each other problem-solve and simply talk about their day. In addition, the department is able to bring in outside support and therapy for the social workers and often refer individuals to a therapist who specializes in counseling people who work in healthcare. Some social workers have certain self-care rituals outside of work, such as meditation or exercise.
Both Popish and Repaske worked in non-academic institutions before their tenure at the University. While Popish said she found the University has a more collaborative environment than her previous experience, Repaske said there is more bureaucracy when working in academia and taking away administrative layers would stimulate out-of-the-box thinking.
At the University Health System, in addition to overseeing patients, medical social workers teach residents and medical students how to react to patients and families in high-stress situations. The medical social work department offers internships for graduate students to gain experience in the field as well. However, those students do not usually come from the University.
“We have to go to Richmond or other programs to get students to come here because U.Va. doesn't have a school of social work,” Repaske said. “I have never worked in a large academic setting that didn't have that .… That to me is a missing element here.”
This article previously contained typos which mistakenly referred to Chris Popish as male. She is female, and this article has been updated to correct the error.