PaRT 1:

Identify an organization or group in NYC that is using community organizing to advocate for an issue that you are concerned about. Go to the organization's website and identify how the community organizers are working with the people that want a change.

Part 2:

Community members' relationships with resources in their community determine whether or not they are assets or "nonassets." One resident might "grade" an asset as an "A" because the person experiences a strong connection there. Another community member might give that same resource an "F" because of racism or sexual harassment that occurred there. When community members need to leave their geographic communities for resources, that might indicate whether there are needed assets that are missing.

Instructions: Review the Participatory Asset Mapping: A Community Research Lab Toolkit

https://communityscience.com/wp-content/uploads/2021/04/AssetMappingToolkit.pdf (pp. 10-11, 33, 37-39). Then, consider the geographic community in which you live and identify the assets, nonassets, and missing assets.

Part 3:

What strengths and challenges do you foresee in participatory asset mapping, given your focal community and the issue you identified?

Part 4:

Instructions: Review the Morris Justice Project websiteLinks to an external site.. https://morrisjustice.org/#/id/i8622615

After exploring the way the group came together, how it is using research for action, and how they are sharing their work, answer the following questions:

1. How did the project begin organizing?
2. How did the project design their research?
3. How did the program gather data?
4. How did the program analyze data?
5. How did the program organize and present data?
6. How did the program report back to various stakeholders?
7. How did the research inform community action?

Part 5:

Interview 1

So, hi, Robin, good to see you. Hi, Rachel, how are you doing today? Thank you for joining me for this conversation and interview. I'm really happy you could do this with me.

I'm excited to be here. Thank you. Great. For students, I just want you to know that Robin and I are colleagues in New York City.

And I asked Robin to talk with us because she is a social worker in private practice. And one of her specialties--

she's got a lot of training, interesting training--

but one of her specialties is in working with couples. So I thought it would be interesting in our family unit to talk about specifically some clinical work with couples. And I wanted to start out with Robin by just asking her what she sees as some of the differences between working with couples versus working with maybe larger family systems or traditional family therapy. So maybe we can start there.

Sure, and as you and I have talked about, Rachel, the couples work is a form of family therapy. But with couples work, what I find is it's a little bit easier to track because you've got one conflict cycle in the room with you. So with a traditional family therapy, you're tracking more than one conflict cycle. For instance, the conflict cycle between the parents, the conflict cycle between one child and one parent, between that same child and the other parent.

And then you bring in other children or other family members, and you're tracking all of those cycles. So with couples therapy, it almost seems a little simpler to me where you've got the conflict cycle right there in the room with you. Got it. So you might be talking with a couple about their family and their children, right?

But in the room with you is the two people. Absolutely. Yeah, and that one conflict cycle. No matter what the content is, it's that cycle right there in the room in front of you.

With those two people. And tell us a little bit about what drew you to social work in general, and then in working with couples in particular. Sure, so I came to social work because I noticed that there was just a lack of equality, disparity, and wealth, too much poverty. I felt like a lot of people didn't have a voice or weren't represented in government.

So I got a political science degree and I started working with women's organizations that promoted equality for women and also promoted female candidates running for office. And it was great, but it was a little bit slow for me. I wanted to see change happen more quickly, I think I got a little impatient. And so I started looking in the classified ads, and I saw that all the jobs that I was really interested in doing an MSW degree was required.

So I went back to school and I got my MSW degree. And then in terms of my work with couples, while I was working as a therapist and I had couples calling me--

pardon me--

to be prospective clients, and I kept turning them away because I didn't have the experience, I didn't want to work with couples. But they kept calling and they kept calling. And so I talked to my consultant or my supervisor and I said, all these couples are calling me, I'm referring them to other therapists. And she said, why don't you work with them.

And I said, well, I don't know how. She said get some training, and so I got some training. And how long have you been working with couples? I would say I've been working with couples for about 11 or 12 years, maybe even 13 now.

Great. And can you just tell us--

we don't have a lot of time, but tell us a little bit about what it's like to have a private practice and a little bit more about some of the trainings that you've gotten after your MSW that you found particularly useful to you in your work? Sure. So I started my private practice in 2005 and I started a small private practice on the side of the work I was doing, which was I was working at a cancer treatment center as their director of mind, body, medicine, and I started my private practice on the side. And my additional training initially was all mind, body, medicine.

So it was tai chi, qigong, reiki, mindfulness, meditation, guided imagery, things and in that realm. And then as I continued and started working with couples, I started to get couples training. So I started with PACT therapy, which is the psychobiological approach to couple therapy. It's attachment and neuroscience based.

And then I started working with emotionally focused therapy, which is also attachment based. So I got a lot of training, and I'm now certified in emotionally focused therapy, as well as PACT therapy. Interesting. And can you tell us a little bit about what kinds of issues couples come to you for.

What are some examples of reasons people would seek out couples therapy? Well, whatever they come in for, the content, whether they're having issues parenting children together, or they're having issues getting along with family members, in-laws, money comes in, religion, all of that, whatever that content is, it's always really about what's underneath the content. And those are the attachment needs and fears. So if you go through the content, underneath it, there's can I trust you, can I rely on you, will you be there for me.

Do you like me, things like that. So people come in with very different, like you said, overt issues. But then there's a lot of stuff underneath that really has to do with safety and feeling at home. And it sounds like a lot of old family issues that have been passed down and that people find that they start struggling in their intimate relationships with.

Is that? That's exactly right. It's always, always that secure base, that attachment, those needs, those fears is underneath all of that content and noise. So with that, what skills do you think have been most useful to you in working and helping clients navigate some of these challenging areas?

Empathy. Empathy. I always say, empathy, empathy, empathy is number 1. It's really hard when you're going through problems, issues in relationship.

And if you can just really show them that you're attuned, you're actively listening, you don't fill in the space, you let them speak, and then you just let them know that they're heard, I think that's really powerful. Along with that comes that nonjudgmental stance. So a lot of times they come into therapy and they feel judged. They feel judged by their partner or their families or at work or by society.

And so you can offer them complete acceptance and non-judgment. I would say those two. I'm trying to think of what else. I would say understanding the importance of relationships, that relationships, healthy functioning relationships are the basis for well-being, health, and well-being.

So understanding the importance of relationships is crucial. I would say in the therapy room you can give clients a corrective experience of secure attachment by being attuned, by being present. My second practicum instructor when I was doing my practicum in hospice said, do whatever you need to do to center yourself before you go into the room with the client. So that self-care, whatever it takes to ground yourself so that you can really show up and be present and focused on the client.

That's great. Are there specific things that you can think of that help? Let's say that two people, a couple, are really polarized around an issue, or really struggling. Are there certain things that come to mind, maybe there aren't, but that where you can help to unfreeze that a little bit?

Are there certain things that you have seen that work in terms of getting people to start to be more fluid with one another and get deeper than maybe the superficial issue that they came to you with? Yeah, it's really helping them. One of the things I love about couples work is you can see changes in the room in front of you. So you can give couples a different experience of being together right in front of you.

So whereas they may have felt very judged or, like I said before, not liked by their partner or misunderstood, in the room you can help them really understand the point-of-view of the other, right? And maybe they don't agree with the point-of-view but they can truly understand the point-of-view of the other. And you get there by really helping them see the more vulnerable parts of each other. So behind all of the blaming or nagging or the withdrawal, those are the fears or the needs that aren't being met.

So you can help them see those fears and those needs, the fears of the other. And you can really help them attune to those in the room where they haven't been able to because they've been stuck in that position of feeling blamed or shutting down and withdrawing to avoid conflict. So it makes sense to me then that creating this very safe, nurturing space is like where you started is just critical for anything to happen. And then you use some--

Crucial. Crucial. And then you start to help them to get beyond what they initially came in with to be safe enough to be open to their own vulnerabilities and the vulnerabilities of their partner, and have often a corrective experience there because they're actually connecting in a way that they had difficulty doing outside of your office, right? Absolutely.

I mean, it's really about slowing everything down. They come in and their arousal level is so high and they're so activated. And if you can just slow everything down and say, do you see this, do you see that this person is really afraid that you're not going to be there for them, that they turn to you and you'll turn away. Can you see that part, right?

And it really slows it down. And then they see this other side of that partner that they viewed as a threat. Is there any typical length of time the treatment usually lasts? Or is that just so individualized?

It's really individual. The same with individual clients--

will it take a few months to get anywhere, will it take a few years to get anywhere. It's very individual, I would say. Yeah, that makes sense. And what would you say, Robin, do you find most rewarding about your work in general, but specifically around your work with couples?

I love my work with couples. You can see change, like I said, I think I've referred to it before, right in the room in front of you. So someone is having a very different experience of the world, right, of their relationship, thus the world, right in front of you. So you see change happen.

I think I was talking about how I'm impatient for change when I started my social work career. And I love that you can see the process move very quickly with couples. And is your experience of what's most challenging in doing couples work? Most challenging at times can be to ignore the noise and the content piece to see the attachment needs and fears, because sometimes it's hard when the content is compelling.

And you find yourself saying, well, why don't they just try this. But that's not what it's about, right? It's really about what are the fears underneath that. Why is this person feeling so vulnerable?

So reminding yourself that don't get distracted by that and to stay present with what's really deeper than that. Yes, constantly reminding myself of that. Don't go to the content, look underneath. And in general, I mean, just because I'm sure some of the students in this class will have a goal of maybe having a private practice, any words you can say about the rewards and challenges briefly about private practice?

Well, one of the most satisfying things about private practice is that you are constantly working on your own personal growth, right? Because I would advocate for always having supervision or consultation. I use those interchangeably. Having your own therapy, going to trainings, you're constantly growing as you learn more information at trainings.

For instance, if I go to a couples therapy training, I apply that to my own relationship. So constantly learning, constantly growing. There is an emphasis on self-care, as there should be, because that's part of grounding yourself to get into the room with the client or clients. So you are able to do that for yourself and take good care of yourself because ultimately you are a model for your clients.

So if you're taking care of yourself and taking breaks and taking vacation and thriving, it will help them to do the same. Great. And any specific challenges that stand out in terms of private practice that you'd want to mention? Sure, I mean, I think I learned because I had a private practice that I started in 2005.

And then I moved across the country and started another private practice. It's really important how you set up your practice. So you want to be able to have good boundaries so that you have balance, right? That's my mind, body expertise that I still bring with me.

It's like always have balance. Don't set up your days so that you don't have breaks. Don't take too many clients in one day or in one week. Make sure to take time off because you can have burnout if you aren't taking care of yourself.

So learn your own signs of burnout and depletion so that you can address that right away. Excellent. And, I mean, my last question is, do you have any general recommendations to people starting in the field. So you just mentioned something that's crucial, I'm wondering if you have anything else you would say about recommendations in terms of working with couples and having a private practice for somebody who's just beginning social work?

Well, so private practice can be isolating because you spend a lot of time alone, right? So you want to be proactive in setting up networks, right? So you want to have peers. You and I are peers, right?

It's really wonderful to be able to bounce ideas off of you and to have you in our AMDR supervision group together. That's wonderful to have peers like that. I know that I can call you if I need to run a case by you or if I'm struggling a little bit. Absolutely.

Right, so find clinical homes, meaning organizations or groups with your peers. Always have supervision or consultation. Have your own therapy. Find out whatever it is that you're passionate about and make sure you make time for that, right, because that comes through.

If you're taking care of yourself in that way, that will help to model the way of being in the world for your clients. Excellent. I think that's all really, really, really important. Wonderful.

Yeah, absolutely. And just helps you grow so much, supports you, helps you grow, helps you figure out what your next step is going to be, all of that. And finding friends and colleagues who really you have so much in common with, there's so many benefits to that. I agree wholeheartedly.

Anything else you want to add before we wrap up? I don't think so. I think that those were the points I wanted to get to. Excellent.

Well, I really appreciate seeing you and talking with you and having you as a colleague. And I will see you soon, and I appreciate you being a part of this very much. I am so very honored. Thank you so much for having me.

OK, see you soon.

Interview 2

Jenna, thank you so much for being a part of this interview. I just want to briefly introduce you. Jenna, at Fordham, Jenna was in our Bachelors in Social Work program last year. So she was an undergraduate in her senior year and did her internship at a hospital called St.

Barnabas Hospital and worked in the pediatric mother-baby program as well as in the emergency room. And she did really interesting work. I oversaw her internship at the university, and she did very interesting work working with mothers and new families in the South Bronx with a low-income, very diverse population. So I'm very excited, Jenna, that we can have this interview together.

So thank you for being here. Thank you for having me. So I have a few questions I'd like to use as a framework for our discussion. And the first is, can you just talk to the students--

these are new social work students--

about what drew to you to social work and what interested you or what you found interesting about working with families? Right. So when I first started college, I was not--

I did not come in expecting to major in social work. That wasn't really a career path that was even on my radar when I started college. And as an elective, one of my elective classes, I took Intro to Social Work, and I found that social work was actually what I had been kind of looking for. And I just didn't know what really existed.

And so when I took that Intro to Social Work class, it really--

I was like, wow, this is what I have been looking for, and here it is. And Fordham has a great social worker program. So I jumped right on that opportunity. And that's when I decided to declare my major as social work and pursue that program.

I'm interested in working with families, specifically, because I find them so interesting. There's so many components and dynamics in the family that it really takes a lot of skill, and knowledge, and patience to work with families. And that was something that I was drawn to. Excellent.

So when we set up your interview--

your internship, you had a real interest in working with, getting exposure to working with families. Is that right? Yes. Yeah, good.

And tell us, I mentioned where you worked, but tell us a little bit more about where you worked and what some of your responsibilities were. And again, this was your first internship in graduate school, so tell us a little bit about where you worked and what your responsibilities were. So I worked at, like you said, St. Barnabas Hospital, which is located in the Bronx, actually right near Fordham's campus at Rose Hill.

So luckily for me, I had a short commute to work. And when I worked there, I spent half my time working in the pediatrics unit as part of the mother-baby team. So I would work with new moms, their newborns, both in the nursery and in NICU, as well as working on the pediatric unit with our children. And then the other half of the time, I would work in the emergency department, where I saw a range of people, all ages, all backgrounds, all socioeconomic levels--

really anyone who just came into the emergency department and needed social work help. OK. And what kinds of--

can you say a little bit more about what kinds of concerns clients needed help for in the hospital? Mm-hmm. So in the mother-baby unit specifically, we worked a lot with new parents who had never had the experience of being a parent before. So we would set them up with services in the community that they would need.

If the mother had any type of health issue, we would help her get resources out in the community, set up referrals for her, things like that. As far as the children go, we had a lot of children who had asthma, diabetes, other health issues like that. And we would do the same thing for them, just with a pediatric perspective, and set them up with services in the community, such as Bronx Air was one of the example of something we would set up. So with that specific service, the Bronx Air would go to their house and identify certain triggers for the child asthma and things like that, educate their family.

The overall goal was to decrease the number of readmissions we had for our patients. So when they came to the hospital, we would do everything we could to prevent them from having to come back in the future. And because of the nature of the setting you were in, most of your work was quite short-term, is that accurate? Yes.

I would say for the emergency department specifically, I saw a patient once or twice before they left the hospital. It was very quick. And there was really, unless they had a long-term need to be in the hospital and be admitted, the time that they spent in the emergency room was very short. For our mother-baby unit, new moms were there from a range of two to four days.

So I would see them a couple of times. But usually with our moms, there was really only a need for me to go see them once or twice to set up those services in the community. And then on the inpatient pediatric unit, I would say the longest time I ever had a patient was maybe a week. And so relatively speaking, that was short for a hospital stay.

So, yeah. A lot of my patients was a very quick turnaround. I would see new patients every single day. And so how would you just--

I was just thinking--

how did that then--

how did that then impact the way that you did assessments? So I had to be very brief in my assessments, but also thorough so that I would know that I was getting all the information that I needed. So I went into every assessment knowing what questions I had to ask every patient, regardless of their situation. So just things that you would find on any biopsychosocial assessment--

who lives in the house with you, where you live, level of education, things like that. And then depending on what the person's specific situation was, then I would ask more specific questions regarding their mental or physical health. And when you think about the skills that you used in that position--

again, this was your first year internship--

what, reflecting back on that, what skills do you think were most useful to you in working in that context, working with families, working with some families that really didn't want to be working with you, right? Because you were dealing--

a lot of times the families that you were dealing with were families that perhaps the mother had used drugs when the baby was prebirth. And then you had to deal with issues once the child was born or issues where the child was born with a positive toxicology for drugs in their system, right? So you were dealing with some pretty challenging, in my view, pretty challenging situations. So I'm curious, reflecting back, what skills you think were most useful to you, social work skills.

Right. I think, specifically--

not to say that I didn't have great supervision there. I really did. And I'm very grateful for the opportunity. But I was--

I had to jump right into it. There wasn't much time for me to sit back and kind of get comfortable with the situation. I had to really just learn on the run as I was going. So I would say that, not really being a social work skill, just a skill in general, was definitely something that I had to--

it was like, go in there, or you had to pick it up on the go really. But working, like you said, working with patients you didn't necessarily want to be working with me, I had to remind myself that this was my job, and that I was there for a reason, and that the patients who were there that I was seeing were there--

needed to be seen by me. And so I was doing what I was supposed to do to help them. And that was the end goal for both of us. They wanted to get out of the hospital, and I wanted to get them out of the hospital but in the safest kind of discharge possible.

So knowing what your role was and what your purpose was and keeping those in mind were really important to you. Right. And then in terms of--

go ahead. Did you want to say something? Well I was just going to say, and I know a lot of times, like you said, specifically with the mothers in the drug intoxication cases, a lot of times I had to remind the parents that this was my job, and this is what I was there to do. And they might not be happy with that, and they might not be thankful at the moment that I was doing that, but at the end of the day, that was my job.

And they were in the hospital under hospital care, and so we had to work with that the best we could. And in working with those folks, again, it was your first internship and it was over the course of one year, but when you think about working with those families, do any specific skills come to mind in terms of what made that process easier, or made clients trust you a little bit more, or work with you a little bit more effectively, or where you felt like you built a little bit of a relationship with them so that you were able to, in some instances, help them see that this is really going to be beneficial for them, that this isn't sort of punitive, but this is an opportunity for perhaps the parent to get help, for the child to get help, for the family to get help?

Right. No, I would say that throughout the course of this internship, I really was able to see how my classroom experience was applicable to my practice. And so I found myself a lot of the times, especially working with this specific population in this specific area, I relied a lot on strengths perspective and things like that. Because what I always say is when people come into the hospital in the emergency room, they're at that emergency, right?

This is their last resort. They're coming into the emergency room because no other outlet of assistance or help has really worked for them to this point. So they come into the hospital for care. So it was important a lot of times to remind the patient of their personal strengths, strengths they have, assets they have in the community, their family, supports, and other things like that.

So I'd say for the majority of my clients, regardless of their medical, mental, family situation, I always relied on the strengths perspective. Because at the end of the day, they needed to know that when they left the hospital, everything would work out. And we would do what we could to make it work for them once they left St. Barnabas.

Good. You know, it keeps flashing in my mind that one of the things that you did that often terrifies new social workers is that you made a number of calls to child welfare, right? You were mandated to do that in this circumstance. So could you just, if you don't mind, spend a couple minutes telling us about making those calls and, again, maybe some of those skills or some aspects of your social work training that were useful to you in making those calls or just what that experience was like for you over time?

Right. So I will not lie. When I first started working there, I was very nervous about having to make those phone calls. And it was something that I spoke to my supervisor about a lot.

And I remember the first time she said to me, well, you can make the phone call on your own now. I was like, oh no. You want me to do this by myself? But I did it, and I had to do it a lot throughout my time there.

But I would say one of the most important things that she taught me was that my role as a social worker in the hospital was not to be, quote unquote, "the investigator." So it was not up to me to determine whether or not this was a case of abuse, or neglect, or anything like that. It was just my job to provide the facts to ACS. Because when someone's in the hospital, I don't know what their home life looks like.

I only know what they're presenting with at the hospital. So it was just my job to call ACS, make the report based on what I saw, and then from then, it would be out of my hands. And that's what I would say to the patient also. The majority of the ACS cases that I did have to call in were due to positive toxicology screens at the time of delivery.

So a mom would test positive to a number of substances when she gave birth to her child. And in the state of New York, you have to call in any case when that happens as a mandated reporter. So at the end of the day, like I said before, I just resorted to knowing that it was my job. That was what I was required by law to do as a mandated reporter and a social worker in my hospital was to call in those cases, and just to be confident that if I had a gut feeling that something was wrong, just to call it in and report it.

Best-case scenario, it gets investigated by ACS and they find that nothing is wrong and that everything is OK. But--

or otherwise, if they find something that needs to be further investigated, then I was the one who was able to help that child out. So it got a little easier over time, would you say? Definitely. Yeah.

I also want to, and I don't want to put you on the spot, but I wanted to ask, you know, one of the things we're teaching in this class is systems theory and how families are a system. And it's different than working with an individual. And I'm just wondering if, off the top of your head, in terms of the families that you worked with, if you have any example that comes to mind about this idea of family systems and how the birth of a new child impacted multiple members of the family, or how that got--

you know, were there positive things in terms of supports, or whether there were challenges because of the circumstances? And I know, too, like, you were working, when you think about micro, mezzo, macro, you were working in a hospital in a part of New York City, where there is a lot of poverty, where there's a lot of families who are perhaps not in the country legally, where there's other concerns, where, you know--

so I was just curious if you could speak to anything related to the idea of family systems and how you saw that being meaningful, or if you could give an example. Right. I would say I saw the family systems most evident amongst families from different cultural backgrounds. That was kind of how I saw specifically how family systems changed between specific patients.

I would have families who--

so, like, I had a family who had a large extended family, especially, I would say, we had a lot of families from Puerto Rico or the Dominican Republic who had a large extended family in the Bronx. And so when they delivered, when the mother would deliver the baby, the aunts would come in, uncles would come in, grandparents would come in. The hospital room would be full. And when I would talk to the mom and do my assessment as to your family supports at home, and who is going to provide for the child, and if they had resources at home for the child, and things like that, everyone in the room would jump at the opportunity to say how they were going to help support and raise this child.

So that was really nice to see. Then it was very easy to see how the birth of one child impacted the lives of all these different people that were in the hospital at that time. And then I would say in other cases, you would enter a room and there would be just the mom. And so in that situation, you could tell she didn't have as much family support.

And so that was when we would rely largely on community resources. Because it is very difficult to raise a child by yourself. And so we would, in those cases, let the mom know, you're not alone. You may not have the family resources, but here's all the resources in the community that can help you and kind of, not replace that family support, but be an extra resource for you when you leave the hospital and have to raise your child.

Excellent. Thank you for addressing that, because it really fits with the course. And what would you say were some of the most rewarding about working in that role and particularly working with families? What was most rewarding?

I would say, this is--

I have a story, a story that I think made my whole time there really worthwhile. So we had this newborn baby whose mother came in, and as soon as she came in to deliver him informed us that she was going to put him up for adoption. She had made up her mind, came in with the paperwork all filled out, everything like that. And so whenever that does happen, we talk to them, just to make sure that that is really what they--

they're sure that that's what they want. And this mother was sure that that was what she wanted. So she, the mother, was discharged, and we still had the baby in our care, because we would keep the baby in the hospital until either the adoption agency, the foster parents, anything like that comes to pick the baby up. So we had this baby in our nursery, and the adoption agency actually didn't come to get the baby.

It's adopted mother came to get the baby, which doesn't usually happen. But in this case, they found a parent right away for the baby. So the mom came in, and as soon as she saw him, she just fell to her knees and was crying and was thanking all the nursing staff for helping her finally get her son. And that was all she wanted.

And I think by the end of that experience, everyone on the floor was in tears, because it was just such a beautiful thing to witness. And so I would say things like that, seeing families reunited, or seeing families, new families, being created, and things like that. That just was very heartwarming. And knowing that despite all the not-so-fun things we had to do, when I call ACS and make reports and things like that, there was a balance between that.

So there were also really nice and great things that happened while I was there. That's really lovely, because it was like helping that one family start a family that really, like, was so excited about that, and this other woman, her circumstances, having a safe place, a safe home and family for her to send her child to, and that family being a constellation that makes sense for her at that time. So that's a beautiful story to me about like families, and where they're at, and how they can look, and how they can be very different, and, you know, the fluidity of families as well, I guess.

Great. I'm wondering what you found most challenging in your role there at the hospital. Perhaps you could speak to both what was challenging kind of working in a large system like that, if you have anything you want to share, as well as challenges with working with families or any aspect of that. OK.

Specifically at St. Barnabas Hospital, this might not apply to all hospitals, but I know specifically at our hospital, the most difficult thing I had to face was working within the services and resources that we had as a hospital. Our hospital, specifically, did not have pediatric psychiatric, a unit for that. So we only had an adult psychiatric unit.

So if we received from EMS a patient who was under the age of 21 that needed inpatient psychiatric services, we could not admit them to our hospital. So in that case, what would happen is they would require social work services, and our job would be to find them a bed in another hospital that did have those services in the city. And it sounds like that might be simple, but it was actually very difficult because the number of pediatric psychiatric inpatient units in New York City does not meet the need. So a lot of the times, like specifically, another in the area would be Bronx Lebanon, and they did have a pediatric psychiatric inpatient unit, but they would take patients from their own emergency room.

So in cases like this, having to find a bed for this patient who is in critical need of care was very difficult. And we face a lot of obstacles and boundaries in those cases. And it happened very often, unfortunately. And it would take sometimes days to find those services for that child.

And so I'd say that was the most difficult, just because we did not have services to help that child. So we had to find them somewhere else, and they were limited. So it was very frustrating, when we did everything we could, and sometimes it just wasn't--

based on physical availability, there is just not really many options for these kids. So that was, I would say, the hardest thing for me personally. And in terms of working with families, I would say just conflicting personalities. A lot of times there would be a lot of strong personalities in a family, and they didn't always agree on the best plan of discharge or form of care.

And in those times, you really had to put the needs--

remind the parents and other family members that the need of the patient came first, and we were going to do whatever was best for the patient regardless of--

I mean, you try and take the opinions of the family members into consideration, but sometimes we had to put the patient first and do what was best for the patient, regardless of all the many opinions that the rest of the family had. Mm-hmm. That makes sense. I think it's interesting, too, the frustration you're talking about with not being able to get services for people, or the time that it took to get the right kinds of services for kids, or sometimes not being able to do that.

And it's making me think, too, about the many roles that social workers play, right? So you were in a very direct practice, like micro-level work, but how vital it is as social workers, as people working with these systems, to have people who are at the advocacy level, the people who are writing grant proposals to get funding, people who are doing research that are documenting we have these kids with severe psychiatric needs that don't have a place to go, people on the policy level, like how all of us really need to work together. And each of us--

sometimes you'll have multiple roles, but all of those pieces are so important because you're identifying a need that occurs not just in a big city like New York but in rural areas, where you just don't have that kind of care anywhere around, or people really have limited access to services. So it just reminds me that there's lots of work for social workers to do. And that's a good example of, like, there's other places where you're doing this good, direct practice work, but if people are doing something about obtaining the necessary resources for folks, that's going to work together so well with what you're trying to accomplish.

Most definitely, and especially in a hospital, I think it's very easy to see the direct influence that policies, whether it's hospital policies or government policies, have on practice because their funding directly affects what we do on a daily basis, whether it's the resources we have, the supplies we have, the staffing that we have, things like that. So I was really able to see that in the hospital setting. Excellent. Excellent.

And then finally, I just wanted to ask you, Jenna, if you had any recommendations for somebody who's just starting out in social work, just considering social work, or this is one of their very first classes, recommendations you'd have for a new social worker who might be interested in working with families. Right. I would say the biggest thing would be to be confident in your skills and your knowledge. You know what you're doing, whether or not you think you do.

Whether or not you think you do, trust your gut and your education. You guys are getting a great education at Fordham, and it's really going to prepare you for working in the field. So I think to trust that and know that you are an advocate for the patient, despite what their other family members may think or the opinions that other family members might have. You are there as an advocate for the patient specifically, so to trust your instinct, and trust your knowledge, and trust the skills that you build not only in school but at your practice as well.

To really stand up for your patient, because a lot of times the family dynamic has a large role on the patient and what they may be willing to say to you, or to say to their health care provider if you're working in the hospital. So just to remember that--

that families are hard and complicated. And I'm sure you know from your own families, there's all those different relationships, and power dynamics, and things that go into that. So really remembering that you're there for your patient, you're there to support and help your patient as best you can. Excellent.

Excellent. So those are basically the questions I wanted us to review. Is there anything else you think we've missed or that you'd want to add on or summarize? I would just say don't be afraid to ask questions.

Right now, at the beginning of my internship, that was something I was a little timid about. And then I--

I was lucky enough to be blessed with an amazing supervisor who really took the time to make sure that I was understanding and fully grasping everything that I was doing. But I know not everyone does have that great of an experience in their field work. So I would say really advocate for yourself. You can't really advocate for your patient unless you also advocate for yourself.

So ask questions. There is no such thing as a dumb question. Especially in your first internship, you're not supposed to be a professional social worker already. The point of your internship is so that you can get there eventually, but you want to be learning as you're going.

So don't be afraid to ask questions. Ask for help if you need it. It's better to ask for help than kind of just wing it and make an assumption. So I'd say that was something I was constantly having to remind myself.

It's OK not to know what to do. Ask someone. That's why you have supervision. Excellent.

Excellent. Well, I really appreciate your willingness to do this with me. I appreciate your insights, and I know the students will appreciate it as well. So thank you again, and good to see you.

You, too. OK. See you later. Bye-bye.

Interview 3

Hi, Debbie. Hi. How are you? Good. We're going to get started. Thank you so much for agreeing to be interviewed for this class.

I think the students will learn a lot about social work with families speaking with you, and maybe if we have time, we'll talk a little bit about how--

because your work with families really overlaps with group work in many ways as well, but we'll focus initially on your work with families. So maybe you could just introduce yourself and say where you work and what your title is at ABC? Sure. So my name is Debbie Santana.

And I am program director at the Association to Benefit Children. Though I wear many hats, my main role is to be the director of one of their children mental health clinics. Excellent. And you've worked at ABC for a very long time, right?

Yes. Probably about 13 years. Great. Great. In different capacities. Different capacities. Yes. And so can you talk to us a little--

talk to me a little bit about just what wrote drew you to social work and then what drew you to working in mental health and particularly working with families with mental health issues. I've always been a natural helper. I was that child in school that always wanted to help her peers and always get in trouble for doing so. So pretty early on, I knew that I wanted to be in the helping profession.

When I began this career, I really wanted to work with adolescents. And so I did a lot of group work and psycho educational groups with teenagers and I loved it, and so after graduating, I decided to work in child welfare. All of my child welfare cases were teenagers who were really displaying lots of behavioral issues, and the parents would say, here you go, fix them. And so I quickly learned that doing individual work with them was fabulous and I can teach them every skill under the sun, but there was that piece missing to really helping them to be able to sustain change, and that was involving the family.

And so a lot of that revelation grew my desire to work with families and with individuals within the family context, and then it naturally progressed into mental health. Excellent. And can you talk a little bit about what your work with families looks like in the realm of--

in the work that you do in the mental health clinic? Sure. So children typically come referred to us by families or other resources because a child is displaying behavior that is concerning and really as we assess indicates to us that there is some sort of distress. And because of the emotional immaturity of a child sometimes or their developmental stage, they're really not able to say, hey, caretakers, I need help.

So the work really becomes bringing the child in and the family, doing a full assessment, and getting a real clear picture of what the child's symptoms are and how long they've been experiencing them and really, A, working to help decrease the child's symptoms. So that can be through individual psychotherapy. We do a lot of play therapy, and we use a variety of different modalities to help a child learn coping skills, identify triggers. And then the other piece is really helping the families to gain the skills necessary and to also learn what the underlying issues are for the child so that they can then help them deal with those stressors as they come up.

So do you typically do some work, it sounds like, with the individual child, but then you bring the family in as well to share with the family what the child is learning or have the child share with the family what they're learning and look at how the family, given the context and the parents and the personalities, how they can start to incorporate some of the skills that the child is learning. So that can be, like you use the word before, sustained. So is that a piece of what you're doing? Absolutely.

That's the big bulk of what we're doing. And initially, it really is helping the child to even identify what it is that they're feeling. Because in most circumstances, they don't know--

they're just reacting to certain things. And so really the first question if therapy is helping them to understand their triggers, to identify their feelings, to be able to talk about it in a way that they feel safe and comfortable, and then to learn the coping skills to manage those situations when they do come up. And then a piece of that is also--

a big piece of that is working with family and collateral sessions as well in certain circumstances makes you--

charts and parent management and stuff, and give them the skills and tools that help you deal with the stressful situations. So it's very case specific, I would say. No two therapy cases are alike, so we really take the time to really assess what the needs are and then to implement an intervention that is specific to the child's needs and to the family's needs. I see.

And so a lot in this class, we've been talking a lot about how families are systems, and that sometimes the problem can--

sometimes the problem is primarily in one person, but often, it's a problem in terms of communication and the way that the system is functioning. Do you find that in your practice and that sometimes a child will come in and be identified as the problem, but then as you assess, you start to see that the problems may be more with communication and the problem or the child reacting to something else that's going on in the family and that you need to really brought in the work that you're doing from focusing on the child and helping the child to helping the family system. Can you speak a little to that.

Absolutely. That's a really big part of what we do. When we assess, to me, in social work, I know you just use the term peel the onion, the layers off the onion. It's like that.

As we talk to these kids, as we get a better sense of what's going on, we really start to uncover that these kids are dealing with a lot more than just being aggressive in school. I mean, there's lots of family stress going on, there's sometimes very complex trauma that has happened, or the family is just dealing with a variety of different systems in their lives and are experiencing so much pressure that often at times, kids just get caught in the shuffle and parents are not necessarily paying attention to the signs of stress that a child is dealing with. So we need to a lot of that, really be taking a look at the family system as a whole and exploring what other systems they're involved with and what's going on with those things and then how that involvement or those other issues that are impacting their functioning as a family or a child's functioning individually.

I would think that a lot of the families that you work with, it's challenging for them to ask for help, and then it's challenging--

it's one thing if you need help for your child, it's another thing if you need help for yourself or your family. So I'm wondering if you can speak at all to some of the skills that you use or that you think are important in terms of even like helping families to feel OK about coming in. I know you work with families from very diverse cultures who might very different perspectives on what it means to come for psychotherapy, so I'm just wondering, you and your staff or some of the approaches that you take to normalize or make it OK for people to actually even engage in the treatment and then open up to being a part of acknowledging that what's going on--

they're a part of what's going on and part of then finding solutions, if that makes sense. Absolutely. Well, you said one of the skills--

normalizing--

is definitely something that we do, letting parents know that it's OK and all families go through some period of stress. I think engagement is really huge, really as part of that really actively listening to what the parents or the family is perceiving as a problem. Sometimes we'll get referrals and the referral form will say all these things and when you sit down with the parents, the parent will say, that's not really what's going on--

this is what's going on. So really actively listening to what their needs are. I think also reflecting back to them that you've heard what they're saying, exploring--

explore, explore, explore. Exploring behaviors, exploring thoughts, exploring feelings. Really getting a sense of the problems from their perspective really gives us a deeper understanding. And that's a skill that you will always use.

And I always tell my staff engagement is also a skill that you will use in every session. It's not just in the beginning when they're coming in--

it's every session that you're meeting them, you're engaging them, and you're really getting them to want to come back to the next session. Because oftentimes, we'll see that where we try very hard in the beginning--

this is something that we want to do and you should do and then the engagement kind of dwindles and then the parent drops off treatment. Feedback, I would say is really huge in what we do. Families like to know how things are going. They'd like to know and need to know how children are progressing in treatment.

It will absolutely not work if you're just seeing a child and trying to address their symptoms and not communicating with the parents skills that you're teaching them or giving them feedback on how the child is doing or progressing or how they can be a part of the process. I think boundaries is also a skill that we really use. We need to be clear about our goal. We need to be clear about our expectations of treatment for ourselves and for the family, and they need to be clear with us on their boundaries what works for them from time frame when they can meet with us, to their own cultural norms, or how they manage things in their families.

We have to bring those things to light. We use a lot of feeling identification with the children, but also I use it with my staff as well, helping them to discuss their own feelings about their work with a particular client or with a particular family. Let's see, what else? Summarizing, I would say.

At the end of every session, we really like to summarize what we've talked about, what we agreed to do, what the parent agreed to do, what the child agreed to do. I think it really helps to set accountability for all parties. And those are some of the skills that I can think. And it's making me think like--

There's so many. So many. And just to veer off a moment, I know that you run parenting groups at your organization, like Parenting Journey, right, which helps I'm just thinking that--

which really helps parents be in a group and look at how they were raised and some of the things they might want to continue to embrace and some of the things they might want to discard from the way that they were raised, and that helps them to think about their current parenting. And I want to imagine that--

if I'm defining that decently, that that would be a good adjunct for some of the families that seek therapy for their child in terms of the parents looking at their own upbringings and how that's been impacting their parenting. And then that might lead to more flexibility in terms of thinking about options in terms of how they're working with their child. Do some of the families that you work with, are they involved with both programs and find that useful? Sometimes.

Depending on the family and their circumstances, sometimes doing both is a little bit overwhelming. But I can say when they do it hand in hand with therapy, it's great because they're really opening themselves up to gain a little bit more insight regarding their own upbringing. And I think it also gives them the opportunity to engage in some self care because that group in particular is very process-oriented, but it's really focused on being very nurturing to yourselves and listening to other people's stories and giving feedback and developing a sense of community with others who may or may not have experienced the same type of situation as you, but understands.

So I think that it's great when it can happen. At the same time, sometimes it doesn't. Maybe one of the things I'll do is I'll give the students a link just to look at all the different programming that goes on at ABC because it's really a very dynamic and rich organization. I'm wondering in the little time that we have left if you could speak about what you like most about working with families.

Family work is great. Getting to know families, developing a nice therapeutic alliance with them is fantastic point to get to when you're working with the family because you become part of their system but in a very clear and defined way, where everyone's roles are established and parents feel comfortable sharing and you become more like a team than you do--

you're the therapist and I'm the mom. And so when you have that, I think that it's great to see. And the other piece of it is there's nothing better than sitting in a room and seeing a child feel validated by their parent or families communicating, not screaming at one another or feeling supported or acknowledged. Those are some of the best moments when we can have those things happen.

Nice. And what would you say some of the major challenges are as a social worker working with families? Quite a few. I would say that, as I had mentioned earlier, some of our families have a lot of family stress, and some of them are dealing with multiple systems at the same time, which can be, again, extremely demanding of their time.

So sometimes that can impact adherence to treatment appointments because if they have to pick between going to their public benefits appointment versus attending therapy, guess what gets bumped off. So sometimes that can be challenging, and we try to be as flexible as we can be. We're not ever going to penalize someone for needing to cancel an appointment. But that is definitely a challenge because sometimes we can't make--

or you're making progress, and then when a few sessions are missed, sometimes it's like going back to square one because kids are very much about routine and structure and that's kind of broken. It poses a little bit of a challenge in the treatment process. I also think some challenges, and we kind of touched on this, really relates to engagement. So if a family comes in and they're requesting services, obviously, their level of engagement is going to be much greater than someone who is being told you have to be here.

And so we never want to be in a situation where a parent or family feels like I'm coming in because I have to, not because I want to. And sometimes working through that initial resistance can be challenging, but again, a big part of the work and you can break through that, oftentimes, those are the families that then love it can come very frequently. So as therapists, we have to be aware, and sometimes--

and this is something that I'll work on sometimes with my team. Sometimes we'll get resistant to the client's resistance, and so that--

we have to put that in check and work through that so that we can really provide the services that are needed. And then I think those are two main challenges that I really see a lot and I'm seeing across the board regardless if I worked in mental health or some other program. I love what you're saying too about the importance of checking how--

because we use ourselves in our work, how important it is for us to check ourselves and see where am I and how might I be impacting positively or negatively, but just how is the way I am with his family, how might this be impacting what's happening in the room, rather than only focusing--

because it's a relationship. So what's happening in this relationship, that may be affecting what's happening with the clients I'm working with. So that self-awareness, that self reflection. And it sounds like in your organization, making space for opportunities for that kind of reflection and encouraging that and making a safe space, if I'm correct, for that to happen is important to you as a director.

Is that accurate? Absolutely. Yeah. Let's talk about it. Yeah. Let's talk about it. Let's talk about it.

That's great. So are there any other suggestions or thoughts that come to mind in terms of speaking to a group of social workers that are just entering the field in terms--

specifically around working with families? Any suggestions or thoughts that you'd want to share? So family work is a very special type of work. I really would encourage anyone who really is passionate about working with families to learn about their own family.

Really take a moment and draw a genogram. We love the genograms here. We're all about them, the families love them, the kids love them, and it really is a great exploratory tool. Excellent.

And I would say explore your own family, your own family system. Take a look at generational patterns of things, family relationships, family interactions, and really think about your role within a family, how your family has impacted your beliefs, how you manage challenging situations. It's so important, and I think it really helps you to connect with the theoretical concepts just through your own experience because we have to be aware of how family and how important the role of family is and how much it impacts who we are as a person. And if we're trying to help children or adolescents or adults learn about their families, I think it's important for us to know about ourselves and our own families.

I would also say be comfortable in the role of facilitation because family work, and depending on how big a family is, could be a lot like group works, like you mentioned. And so you're going to be using a lot of those social work skills to help foster conversations and to help families communicate about difficult topics. And so you have to be OK with being a facilitator of that. So actively listening, reflecting, and saying, well, I think this person said that, what do you think.

I would say that. And then if you're seeking internships or even employment and you're really thinking of the organization and if there's going to be opportunities or that type of work and if there's going to be support to do that type of work, because it is very challenging. It's not an easy thing, but it can be very rewarding as well if you have all the right components in place. So that would be mine.

I think that's excellent advice. Excellent advice. Well, Debbie, thank you so, so much for speaking with me today and sharing your experience with all these students and--

Thank you for having me. I really, really appreciate everything you've shared, so thank you. And I'll see you soon, I'm sure. OK.

Part 2:

After listening to these interviews, reflect on the following:

1. What do you think you would find most rewarding about working with families?
2. What do you think you would find most challenging?
3. What are some of the themes you noted in these interviews?

Part 3:

Read the case study and jot down a few thoughts related to the questions. We will discuss this in the live class session.

Case Study The Spirit Catches You and You Fall Down Lia Lee was born in the San Joaquin valley in California to Hmong refugees Foua and Nao Kao. At the age of 3 months, she first showed signs of having what the Hmong know as quag dab peg (the spirit catches you and you fall down), the condition known in the West as epilepsy. Lia's parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment were vastly different. The Hmong saw illness and healing as spiritual matters linked to virtually everything in the universe. Lia's parents ascribed her illness to the wandering of her soul. The medical community marks a division between body and soul. Lia's doctor ascribed her seizures to the misfiring of her cerebral neurons. The doctors prescribed an array of treatments. Communication by the doctors how to do so was poor. Also, Lia's parents believed strongly in other types of healing practices such as animal sacrifice. The Hmong believe their children are the most treasured possession a person can have, and therefore Lia Lee's parents were very attentive and nurtured Lia in a typical Hmong fashion, and were naturally distressed to think that anything might compromise her health and happiness. They therefore hoped for her that the quab dab peg would be healed. However, they also considered the illness an honor because they felt Lia was an "anointed one." In their culture, she was a very special person because she had these spirits in her and she might grow up to be a shaman, and sometimes their thinking was that this was not so much a medical problem as a blessing. Lia's parents could not read or write in their own langu