Course Articles

Editor's note: This text-based course is a transcript of The Effect of Childhood Family Trauma on Adult Relationships Podcast, presented by podcast host Benjamin T. Bencomo, DSW LISW, LCSW, and podcast guest Kaytlyn Gillis, MSW, LCSW-BACS.

Learning Outcomes

After this course, participants will be able to: 

• Describe childhood family trauma.
• Identify ways childhood family trauma can manifest in adult relationships.
• Identify the six stages of healing from childhood family trauma.

Podcast Discussion 

Ben: Hello and good morning, Kaytee. I am very excited about our podcast today. We have with us, Kaytee Gillis. Kaytee Gillis is a psychotherapist, author, and consultant with a passion for working with survivors of traumatic relationships. She's a licensed clinical social worker and a board-approved clinical supervisor. Kaytee has extensive experience working with survivors of family trauma and dysfunction. Due to both her personal and professional experiences, Kaytee has focused her work on helping survivors grow in the aftermath of trauma. She has published two books on intimate partner abuse, and her third most recent book is being released this weekend, the first weekend of July, 2023. Through her published writing, as well as her presentations and trainings, Kaytee hopes to help others develop awareness and healing. Kaytee, I'm very excited for our conversation today. Thank you so much for joining us. I know it's a busy time for you, an exciting time for you. Thanks for being here.

Kaytee: Thank you so much for having me. I'm really excited to talk about this. I know it's weird to say exciting to talk about trauma, but it is really a passion of mine to talk about this topic.

Ben: Absolutely, and a passion for many of our listeners, I'm sure. So I'm sure that everything that you have to share with us today will be very well received by our listeners. Kaytee, I am always really interested in hearing about how people find social work or, better yet, how social work finds us. I find that very interesting. So if you wouldn't mind, would you share a little bit about your own path to social work? How did social work find you?

Kaytee: I love that you say it like that. I love that you say it finds us because that's actually how I was gonna answer that was, you know, I remember as a child always being like, "Oh, I wanna be a veterinarian," and I even could say that word as a child. And I remember my mom being like, "Oh, that's interesting. She can say that word at a very young age." So I really wanted to be a veterinarian. I really wanted to help animals. And then, for a while, I thought I was gonna be a lawyer for maybe a second or two. And then, all of a sudden, by the end of high school, I was like, "Oh, I'm going to go to school and study psychology." 

And now I know, as most social workers and therapists, is that many of us, not all, but many of us, go into this field trying to kind of figure out our own history and like, "Oh, if I can study psychology, that'll make things make sense, or if I can solve other people's trauma, that'll help me kind of help my own." So I really think it just kind of fell on me like that. So it definitely, like you said, came to me.

Ben: My daughter is currently in the "I want to be a vet" stage, so she and I watch all of the vet shows as often as we can. But yes, it is interesting how social work at different points in our life just kind of starts to make sense for us as well. I know that I and many others are glad that social work found you and that you have been able to share a lot of your experiences already through your writing and presentations. So again, we are happy to have you here.

Kaytee: Thank you.

Ben: How did you first become interested in working in the specialized area of family trauma specifically?

Kaytee: So this is definitely another thing where, you know, it is weird because I feel like so many of us have kind of two minds. It is like we know we have dysfunctional history. You know, if we have dysfunctional history, we know it, but maybe we just kind of compartmentalize it, we put it on the back burner, so to speak. And we think, "Okay, well, it's not going to affect me. You know, I just am aware of it." And then I noticed that the universe has its way of sending you clients who you can relate to, like, have the issue that maybe you have or something. I really think the universe does that to us. So many of my clients, if not most or all, had some kind of family trauma, and even if they were coming in for other things, like relationship issues, I work a lot with domestic violence, it is a lot of people coming in for help with that of course, depression, anxiety, life stressors, things like that, but then we would find that there was some underlying dysfunction or some underlying trauma that was more than just the, like, and I'm using, like, my air quotes, like normal dysfunction or things like that, things that really stuck with them.

And so they were coming in for anxiety, yeah, they were coming in for insomnia or an unhealthy relationship or even an abusive relationship. But then we start talking about, oh, well, they haven't had any healthy relationships in their whole life, and we would really start to kind of unpack that. And I started being like, "Wow, okay this is really a pattern. It's a pattern among all my clients," like patterns I can see in them because of my professional experience with them, but also because I'm like, "Yeah, I remember that. I remember having those thoughts and those feelings and those kinds of awakening moments and things like that." So it really kind of all started to kind of come down from there.

Ben: Kaytee, can you define for us what is childhood family trauma specifically? To use some of your words, can you share information on the difference between, and I'm gonna use air quotes as well, between a normal level of dysfunction and what might make a family experience traumatic, especially in childhood?

Kaytee: Absolutely, okay, so I always kind of say that trauma, right now, is a buzzword. I feel like it is every third thing that you click on, especially if you are on, like, the TikToks and the Instagrams of the world. Everything is trauma, and that's good, but it is also kind of, you know, many argue that we are kind of watering it down and things like that. So I do want to say that I recognize that it is really broad right now, but I also wanna recognize that family trauma itself is broad. There is a normal level of dysfunction because I feel like no person, no human being, is going to go through this lifetime with a perfect childhood.

And people who do, I mean, good for them, but maybe, I don't know, I think that in itself would be a form of trauma because then you're sheltered, anyway, podcast for another day. But I really think that people who have gone through trauma, like family trauma, understand that this is something that affects them more than just the, "Okay, like Mom had her quirks, or Dad did his thing," or whatever. It's more than stuff like that. So, what I like to do is kind of give an example. A normal level of dysfunction is a family who can usually acknowledge that they're imperfect. Many times you'll hear them even joke about it.

I'm not saying it's exact, like it's an exact determinant to figure out what's normal dysfunction and what's not. But usually, families who are healthy in their imperfections, they're able to say, "Yeah, we're imperfect. Like this is something that we recognize," and you can bring it up. You can acknowledge it, and there's not a power struggle behind it. You know, you could probably say to your caregiver, "Hey, this is something you kind of do," and, "Oh, I do kind of do that." You know, and there's more of that give and take as opposed to the punishment that comes from growing up in a very dysfunctional environment that is weaponized. So I know I say all that, and that's very, very broad, but family trauma is, like, anything that a person feels happened in their family of origin and in their childhood that is affecting them today.

So it could be anything from growing up in a place where there was a national disaster, growing up in a war zone, having to flee your country and come to another country, or having parents who have a mental illness. I always like to specify it's untreated mental illness. I'm not trying to stigmatize mental illness. There are people every day, all day, managing mental health and parenting. And that's not at all automatically a trauma. I'm talking about untreated. You know, I have many clients whose parents were dealing with some serious mental health symptoms, and they were untreated, and that can be traumatizing for a child. And the same thing with substance use, untreated, I mean. So things like that that happen in the childhood environment that people feel impacts them today in their adult life.

Ben: That makes sense, and I'm glad you explained that because it is a bit of a double-sided coin when we see these conversations happening more readily in different circles. And so I appreciate that you explained that, that while we are excited that people are having these conversations and acknowledging traumatic experiences, we wanna make sure that it's not diluted and that we really understand what that traumatic experience might look like.

Kaytee: I always tell clients, you know, I work a lot with teens and adolescents, and they'll come to me and be like, "Oh, I found out on TikTok that," and whenever they start the sentence with, "I found out on social media that," I'm like, "Oh, yeah." So they're like, "Oh, this means that I have this disorder. This means that I have trauma." And they're not always wrong, but they're not always right. And so definitely, just be careful of where you get stuff. And I'm glad we're having these conversations, but on the other hand, I feel like there's always going to be, like you said, a give and take.

Ben: Yes, exactly. Kaytee, you started talking and defining some of these, but I wonder if we can go a little bit more into some of these major areas of problematic dysfunction that you talk about in family systems. Maybe if you can give us an example of what they might look like. You know, you spoke of untreated mental illness and substance use, but I know that there are many others. Would you mind going into those and giving us some examples?

Kaytee: Absolutely, so the ones I talk about in my book, and I'll just kind of give a rundown, and then I'll go back and give examples. So I talk about abuse and neglect, and I know that they are often linked, but they are not always the same. Many times, they are different. Abuse, as we know, is something that happens to a person, and neglect is the absence of things happening. Substance use or mental illness within the family that is untreated; divorce or death in the family; changes in the family structure that are not dealt with appropriately; parental abandonment; and then psychological or narcissistic family structure or family system. So the first one, abuse and neglect, are frequently linked together. And I do link them together in my book, just for the sake of explaining them.

But abuse, of course, as we know, is something that happens to the person. Emotional abuse, physical abuse, sexual abuse, and things like that. Neglect is, I find in my experience, and maybe other clinicians have had different experiences, I find that neglect often is something that was not done maliciously. It is kind of something that happens as a result of other things going on within the family. And I do want to say that many of the things I said, the reason why I listed them off first before explaining, is because so many of them can be intertwined. For example, let's say you have a parent who has an untreated mental illness or untreated substance abuse disorder, and they are really struggling with that. That can, of course, impact the whole rest of the family. And maybe the kid was, or the kids were neglected because the parent was struggling so bad with that mental illness that the kid was not getting the things that they needed for school and getting the care that they needed and the medical care and things like that.

So, so many of these things can really kind of happen together. It's not like they're mutually exclusive. So abuse and neglect, abuse happening to a child, of course, that's absolutely going to result in a traumatic history. Neglect, I find in my practice that neglect is something that so many people feel shame discussing because it's like abuse, for example, and not to minimize it in any way, shape, or form, but abuse you can come in, and you can say, "This happened to me. I was abused, this happened. I was hit, I was sexually abused," whatever. And you have almost, again, air quotes, evidence that it happened. And then that almost gives you the permission, again, air quotes, to grieve and be upset about it.

With neglect, there are so many other factors, especially when I work with clients from generations older than mine. So generations or cultures, where they were, like, "I wasn't neglected. I had to take care of my brothers and sisters. That was my role. That wasn't neglect." So there are so many different factors that come into that. It is definitely not something that is as easily examined. So I did talk about substance use and mental illness in the family, but again, untreated things like that.

I have had clients who wake up in the middle of the night, and Mom or Dad is acting paranoid or screaming with severe mental illness that is untreated. That is very traumatizing for a child because they do not know what is going on. Or absences where maybe a parent is hospitalized, or I have had a lot of clients whose parents have to be taken by EMTs or the police or stuff like that because of mental illness. It is that, right there, that is so traumatizing.

Divorce or death within a family. And again, I always wanna specify these are changes that are not dealt with appropriately. Having a divorce, like I always want to tell people, sometimes that is the best thing you can do. I'm not in any way trying to say do not divorce. It is not the divorce, and it is not the death. That is nobody's fault. Death happens, and, of course, it's scary to a child, and it's sad to a child, but it does not have to result in lasting trauma because ideally, in a loving, my air quotes again, perfect situation, the parents and the caregivers will help the child and say, "Yes, like this is what happened, the person," and dealt with it. However, it is that that family relates to death and how they want to kind of convey that message. What I find is traumatic is when it's something that's just brushed under the rug, like all of a sudden Mom never comes home, or all of a sudden Dad just, like, moves out one day and has another family. And then the kids are like, "Wait, what?" That needs to be explained. I have a lot of people come to me and say, "I'm really scared of getting divorced because I do not want to traumatize my child." And that is definitely a decision that I can never make for the client. But I always kind of want to stress that, on the other hand, we could be traumatizing kids by not doing the healthy thing and splitting a relationship that needs to be. So divorce that is not dealt with in a healthy way or any kind of change in a family structure; I usually use divorce and death, but anything that changes a family structure that is not dealt with.

Parental abandonment and this is not something like adoption. This is something like a parent just all of a sudden washing their hands of a child. And you see that a lot with kids who are involved in the criminal justice system. In my work with teens and a kid gets arrested, living in New Orleans, we have a lot of teen crime right now, and I know it is everywhere, but New Orleans really is dealing with a lot of it. So I have a lot of kids who are caught stealing a car, and their parents are, like, "I'm done with you." And you can not do that to a 15-year-old, and so it really fuels that cycle.

And then psychological or narcissistic family system, so when you have that psychological abuse. And I always like to differentiate psychological abuse from abuse; even though I know it is abuse and many times people use it the same as emotional abuse, I consider it as something that is just so unique and so different, and the experience is something that is so, like, it's hard to explain to people who have not really been through it. And so it is like a whole family system that works to kind of create the homeostasis of this dysfunctional system.

So those are the ones that I list in my book. I want to say these are not an exhaustive list. I mean, there are many other ways that people can say, "Okay, I had a different experience in my family that wasn't listed." These are some of the major ones that I see in my practice.

Ben: Absolutely. Thank you for that. Thank you for sharing those. I can see how so many of these can be very intertwined and interrelated, and you can have almost that layering, that compound trauma that happens within a family system that is experiencing, like you say, untreated substance use, untreated mental illness, and maybe there are absences of the parent because of the manifestations of some of that untreated mental illness or untreated substance use. And then there is also possibly acts of commission of abuse, acts of commission of neglect, and some of those things.

Kaytee: I like how you say that. "Layering." Because it is true, it is not like, okay, this one thing happened. So many of these things can affect each other.

Ben: Absolutely. Now, in your experience, what are some of the major ways that childhood family trauma can affect the survivors of those experiences into adulthood? In one of your articles published in Psychology Today it's entitled "10 Ways Childhood Trauma Can Manifest in Adult Relationships." So I am wondering if you wouldn't mind going into those ten specific ways that, in your experience, in your professional experience, those ten ways that those who experience that trauma that can find that this affects them in adulthood, can affect their relationships in adulthood, would you mind expanding on those a little bit for our listeners?

Kaytee: In my article, I have ten major ways that I have seen in my practice of having a childhood family dysfunction affecting us in relationships. And again, not an exhaustive list, but these are probably the major ten.

Number one is fear of abandonment. And that can look different in each of us. For some people, they are so scared of abandonment that they avoid relationships because if you never get into a relationship, then you are not going to be abandoned. And that even goes as far as some people struggling with friendships too. I mean, it does not always affect us in romantic relationships. A lot of times, it is with coworkers or things like that, you know, there is always like that guard up of this person is eventually going to hurt me, so I have to really kind of prepare accordingly. People who are in relationships and they find any kind of hint that the person is going to leave, they freak out. It really comes across as an anxious attachment. So anytime someone is like, "Okay, well, we just got in an argument, and I'm worried they're gonna leave," or they go out with friends or they do this, and it really is affecting every day, every aspect of their life. It's not just, "Okay, I have a fear of abandonment, and I acknowledge it." It's that, "I worry about my partner going to a guy's weekend because I'm scared they're gonna leave me," or stuff like that, that kind of thing where it affects their relationship, it affects the ability of the relationship to be a healthy trusting dynamic.

Number two, easily annoyed with others. I get a lot of interesting questions about this one, like, "What do you mean easily annoyed with others?" I have found that people who have had maybe narcissistic family structures allow psychological abuse in their family. They are very hyper-aware of things that other people might do that are going to set them off. And I am not excusing it in any way, but I find that it is like they are kind of in this constant state of hyper-arousal. So maybe their partner did not take out the dishes, and they're like, "Are you kidding me? Like, you didn't take out the dishes." Take out the dishes, I hope you aren't taking out the dishes. Put away the dishes or take out the trash. They took out the dishes!" So if the partner didn't take out the trash or something like that, "This is a sign that you don't love me. I knew it. You weren't listening to me." Things that are above, like, the normal, okay, if you're getting easily annoyed by other people and you're able to acknowledge it and you're able to say, "Okay, I'm feeling really irritable today." Like, I think we all have that time where we're like, "I'm feeling kind of irritable today, or maybe this weekend, maybe it's a change in our life," but what I'm looking for usually is a pattern. Like, are you constantly annoyed with the other person, like the way they sit, the way they dress, the way they sit down? This is usually a sign that you've been mistreated for so long in your childhood and you were unable to say anything. Because of the power differential, you were unable to say anything. So then, now that you have the freedom and this space, you're able to explain, and you're always in, like, that hyper-aware, hyper-aroused state.

Number three is kind of similar. Number three is needing a lot of time to yourself. And when I say it is similar, I mean that there are people who need a lot of time themselves, and there are people who get easily annoyed with others, and it has nothing to do with trauma. So especially for people who are neurodivergent, for example. That can just be who they are. So it does not necessarily mean that you have a history of trauma because you need a lot of time to yourself. But what I mean is a lot of times, these things, kind of like the things we were talking about earlier, they coexist at the same time. So people who have had a lot of overstimulation with being around other people or people who have a history of mistreatment in their childhood and were not allowed to take care of their own needs. So spending a lot of time by themself is a safe space because it is they were not allowed to do that. They were not allowed to take care of their own needs. They were not allowed to just be alone and things like that. So they take a lot of time to just be in that safe space.

Ben: Right, almost like an overcompensation for a lack of control in previous experiences and overcompensating by really wanting to over-control that experience.

Kaytee: Yeah, I like how you say that. It is funny because sometimes I'm like, it makes sense perfectly in my head. I feel like I find that when I'm writing, it makes perfect sense, and then I'm trying to explain it. I'm like, "How come it isn't coming across like how I wrote it in my article?" But yeah, you said it perfectly. That's exactly what I find. And I remember working with clients, and I would find that so many of them were like, "Oh, I just needed to take time to myself, like, after we had an argument or something." And I was like, "Huh, I'm seeing patterns here."

Number four is settling for unequal financial or household responsibilities. What I mean by this one is that the person is settling for mistreatment. I do not mean, "This is my responsibility, this is your responsibility, and then that's fine." And I'm not here to tell you what's yours and what's theirs. But settling for having someone who is, I have a lot of clients who someone was really mooching off them. Someone was really using them for their finances. They were using them for their home, and they always had some excuse of why they couldn't work or always had some kind of excuse of why they couldn't contribute. Or maybe they were working, but their money was going towards something else, and the person would just put up with it and put up with it and put up with it. And I would say, "What's going on here? What are you getting from this?" And it goes back to, again, sometimes, that fear of abandonment. Sometimes it's, "Well, they're gonna leave," or sometimes it's, "Well, this is the best I'm going to do in this relationship." And these are not, like, conscious statements. Like, people do not usually sit and say, "Oh, I'm never gonna get anyone better." It's usually something that's way back here in your head. You're not conscious of it, but somewhere the little voice, your inner child, is saying, "Okay, you're not going to get much better," or, "This is what you deserve," or things like that. That's common. Another common thing is people who observe that in their childhood, maybe they observed Dad never worked, and then Mom had to work three jobs, take care of the house, take care of the kids, that kind of thing. So they really learn that dynamic, and they learn that that is what happens and that you have to put up with it. So that is definitely something that is, definitely something that we would work through.

Staying in relationships much longer than their expiration date really follows that, so that is number five. And, like I said, a lot of these really kind of go together. So that one is something, again, goes back to that fear of abandonment, that fear of, "I'm never going to do anything, but I'm never going to get anyone better, I'm never going to get another relationship, like, this is the person who loves me. I might as well stay with them. This is the best I'm going to do." I mean, these are really this inner voice that many people are saying, and there's a lot of shame in that. There is a lot of shame in saying, "I feel like I can't do anything, do any better," but it's true. And it ends up with people staying maybe years past when the relationship was supposed to end. And a lot of times, in my work with domestic violence survivors, we will look back years before, and they will be like, "Well, that was red flag number one, and then this was red flag number," and I've been there, I've done that. "Okay, well, that was red flag number 70. Why did I ignore all these red flags? Probably because I grew up that I was supposed to ignore red flags or I was supposed to intellectualize them or excuse them or even deny them." Like, "Oh, that's not really happening. They're just having a bad day." So that is definitely something that we work with, that I work on with clients when they are dealing with that.

Another thing that ends up presenting a lot in the therapeutic session with couples is number seven, which is avoiding conflict. Wait, I'm sorry, that was number six. I jumped from number six, constant arguing and relationships or avoiding conflict at all costs. So that is something that I see a lot with couples where one person, I see that there is, like, one of two dynamics that will happen to the extreme. I mean, I feel like everyone kind of has their way of arguing. Everyone has their way of how they present themselves in an argument, and that is fine.

But I am talking about the extremes where, like, "I'm going to avoid any and all conflict because I'm scared of what's gonna happen," or, "I am going to like constantly argue to the 10th degree about everything like everything is a huge argument." And I always tell people, like, I worry about clients who are couples who will come in and say, "Oh, we never argue." And I'm like, "What do you mean never?" Like, you've been together ten years, and you've never had an argument? Like, I would kind of explore because I feel like arguing, even the word argue, the word fight, those things are such, like, negative words, but a lot of healthy things can come from having a healthy conflict as long as it's done in the right way.

Ben: Absolutely.

Kaytee: A lot of times, people who have had traumatic histories with family members where maybe communication felt like a war zone. If we say anything, it is going to get worse, so we really learn to just be quiet, or we learn that there is no way to just say, "Hey, I was kind of upset about this thing that you did. Maybe we can kind of talk about it." Instead, it is I look at it for those extremes. 

And then number seven kind of follows up with that is not knowing how to repair after fights. And this is something that is very common that I see with people who grew up in arguments, grew up in environments where there were no healthy arguments. And this is why when I work with families, people say to me, "I don't wanna argue in front of the kids." And I'm like, I understand that. I do not think anyone, like, loves arguing. I do not think anyone wants to argue in front of other people, but I feel like kids, like all human beings, need to see how healthy conflict is managed. Like, yeah, I mean, it's basically from social learning theory. We learn how to express our needs and express our displeasure through watching others.

Ben: That is a life skill, that learning how to resolve those conflicts in a healthy manner.

Kaytee: Absolutely. So, kids who do not see that, they do not know how to have an argument. So maybe a lot of teens I work with, it's like, "Oh, she looked at me wrong, and next thing I know, we're fighting, and whoa, how do we get to this point?" Because that is what they are seeing. That is how conflict is managed. You know, they would never sit down and just have a conversation. So people who do not know how to repair after having an argument. Maybe they'll have an argument, and then they separate, and they do not talk for three days, or they just never address it again. It's almost like it's brushed under the rug, and it never is talked about again.

There are many ways that you can have an argument and then handle it in an unhealthy way. And then there are many ways you can have an argument and handle it in a healthy way. So the people who don't know how to repair, the people who don't know how to come back and say, "Okay, maybe that wasn't my best moment. And how can we prevent this from happening again? You know, what would you like me to do? Would you like me to make sure I take out the trash every day or something like that?"

Or take out the dishes. Take out the dishes, want new dishes. So number eight is serial monogamy. And that one is the people who are, like, so scared to be out of a relationship, and it kind of relates back to the fear of abandonment, but it's like a step above that. It's like I can't be alone. So you'll see the people who are, like, in, like, a long-term monogamous relationship, as soon as that ends, boom, the next one, and then boom, the next one. And for some people, that just happens, and it works out. Maybe someone is in a long-term relationship, and then they get another long-term relationship, and that's fine. But what I mean is that people who cannot be alone. They have to then look for the next person. Then they have to kind of have someone lined up before ending a relationship because the fear of being alone and the feeling of being alone is so much worse than being with someone who isn't right for them.

Ben: Right, so they feel that need to immediately look for that security that they find externally in a relationship.

Kaytee: Yeah, absolutely, it's like security. Like, they feel like, "Okay, I need to have that person, 'cause having someone is better than not having anyone," because there's that inner voice that many children who grew up with neglect or grew up with abuse or grew up with really unhealthy levels of dysfunction, grew up with a lot of trauma, there's that inner voice in the back of their head that's like, "See, you're not lovable, you're not worthy, you're not able to be loved, you're not going to be able to be in a healthy relationship. You're going to be alone. You're gonna end up alone." And again, it is not conscious. It's really, like, in the back of the head.

Unless you have enough insight, then it is conscious. But usually, it's something that people aren't necessarily aware of, but they just know that they feel uncomfortable alone or they know they feel anxious. And so being with someone, it, like, helps to kind of prove to them, "See, I'm not unlovable 'cause I have a relationship." It doesn't matter if the relationship is unhealthy, it doesn't matter if the relationship is past its expiration date, but they have a person, so it's proving that they're lovable.

Ben: Yeah, that makes sense.

Kaytee: Yeah, so number nine kind of plays off of that is worrying about commitment. So I notice that clients kind of do the, or survivors do one of two things. That's either serial monogamy or they're afraid of commitment. And again, it kind of goes back to that fear of abandonment, but not always. But the people who are like, "I'm kind of avoidant of relationships," or, "Okay, I'm kind of interested in this person, but I don't want to commit," or anytime the relationship starts to get serious, they get kind of anxious and things like that because, again, people who were close to them hurt them. So either going to have other people who are close to them, then they're setting themselves up again to be hurt.

Ben: Right.

Kaytee: And the last one is trying to change your partner. And I find that many survivors of family trauma try to change their partner. And I remember, I mean, many of us have done this. I did this for years. You know, being like, "Oh, if you would only just do this, or if you'd only not do that, or if you only didn't use substances, or if you only could just get a job," or whatever it is that you feel like the person needs to do, trying to change them. And that definitely goes back to trying to change that caregiver who you couldn't change, and you couldn't provoke any kind of change in your caregiver. You couldn't give them any kind of constructive feedback or any kind of you couldn't even really tell them what they were doing and how it affected you. So it's like your brain is almost like, "This is your chance to change this person." Yeah, so those are the 10.

Ben: Yeah, thank you. Thank you for sharing those. They make perfect sense. And I can tell that this is something that you have a lot of experience with. In one of my previous lives, I worked with teens who were aging out of foster care and starting to navigate those adult relationships and adult responsibilities, and because of the traumatic experiences that they had experienced, I think that I was able to picture each one of these as you were explaining them. And that was sort of a constant cyclical pattern of not having that sense of control in childhood and because of the trauma that they experienced and having to move in and out of state foster care systems, trying to gain that control or searching for it in any way that they could by putting up those walls and pushing people away, "I'll hurt you before you hurt me," or the opposite of, "I really need this in my life." I wasn't really sure what you meant at first by serial monogamy, but when you explained it, that process of having to always have that person to feel that sense of security was manifested in a lot of the kids that I worked with as well. So those polar extremes.

Kaytee: Yeah, I talk about a lot of people who've gone through foster care in my book because I feel like when we talk about family trauma, we always end up assuming it's the parents. And many times it is, but I mentioned that in my book. I'm like, for each one of us, it's gonna be whatever was your home environment, whether you were raised by two uncles, by your grandparents, whether you had a foster family, whatever. And so I talk a lot about the people who've gone through the foster systems. That's really interesting that you've gone through that. Yeah, I bet you could see them in the examples.

Ben: Yeah, absolutely. Thank you again. I feel like this is a good transition time maybe to start talking about, we've talked about what some of these traumatic experiences might be, what they might look like, and then how they might manifest at different stages of a person's life. Now, this weekend, for those listening or watching us on the Continued YouTube page, this weekend, the first weekend of July, 2023, your book goes live, I guess, is the right word, right?

Kaytee: Yes, it is live on Amazon.

Ben: Okay, all right, and that book, I think, is a good transition of looking at what we do now, right? And so that book entitled "The 6 Stages of Healing from Family Trauma." Now, based on what you were talking about in regard to those specific areas of dysfunction, how might we start that process? What would be the first step in healing from family trauma?

Kaytee: So the first step, and I'm gonna start by just kind of doing a quick run-through of the six, just to say the names, just because it kind of helps people kind of visualize that there are six steps. So there's pre-awareness, uncovering, digging in, healing, understanding, and nurturing. And I say that so people kind of get that visual of almost like the mountain like you start to climb the mountain, and you're in pre-awareness. Well, pre-awareness is really, like, before you even start hiking. It's like you're not really sure yet. You know that there's a lot of anxiety, you have a lot of anxiety, you have some unhealthy patterns. Maybe you keep getting into a relationship, or you keep repeating the same stuff.

People will come in and say to me, "I keep dating the same people, I keep falling for people who are mean to me, what's going on?" And so there's a lot of patterns there, but we haven't really started to uncover that there's a link between our history. Maybe we just think, "Oh, I'm just attracted to mean people." So pre-awareness is really, like, before you even start kind of doing the work of climbing the mountain. It's like you're kind of not really there yet. People are kind of still in, like, the denial phase. And there's a lot of safety in denial. It's really unsettling, sometimes unsafe, especially for younger people or people who don't have a lot of support.

It can be unsafe to examine our family trauma history, which is why I try not to go there too much with kids or people who are still, like, living, people who are still kind of, like, in that family system, especially if you're still living at home because you can't afford to move out. It can be difficult to start the uncovering process when you're still living at home. But pre-awareness is really, like, you're not really sure why it is that you're having these feelings, but you're recognizing that there's something kind of weird going on or some kind of patterns. So then there's uncovering. Uncovering is the second stage. So uncovering is when you start to realize, "Okay, yep, I'm seeing some patterns here, and I'm recognizing them, and I'm recognizing that there was some stuff that happened in my past that might be connected to that." 

And so uncovering is when you start kind of ascending the mountain, and then you're like, okay, I, kind of getting the tools ready so people will, you know, we start to talk about all the ways to manage self-care and to manage the symptoms that come up. Because as you start looking at your history, a lot of negative feelings can come up, and a lot of negative feelings will come up. And unless you know how to handle that, unless you have your support system and things like that, you know, we work a lot on tools, like making sure that you're taking care of your body every day, whatever that looks like for you. If it looks like taking a walk, it looks like making sure you're drinking more water, you know, what kind of foods do you like to eat? Things like that that make you feel good. So that way, when you're starting to uncover, you have the tools needed to really kind of take care of yourself.

Ben: Yeah, so this third stage that you talked about is digging in. What might this look like in an adult who's experienced childhood family trauma?

Kaytee: So digging in is really when you start to look at, and I picture, go ahead and dig, like uncover the stuff. Start to look at patterns that went on in your childhood. Start to look at things in your childhood that maybe you had ignored, denied, excused. There are so many defense mechanisms that come in when we're going through our childhood to help us get through it. We intellectualize things. Oh, well, they're just having a bad day. We excuse things, we deny things. Maybe we, like, don't remember, like we block things out. And so digging in is really when we start to kinda look at those patterns and be like, "Okay, I blocked a lot of this stuff out, or I denied a lot of that, or I excused a lot of that, and that was really dysfunctional, and that was really traumatic." 

And really kind of looking at, "Okay, these are the things that happened." How did it impact what you look like today or like what your patterns look like today? What can we do to uncover? For some clients, it looks like just coming in and talking. Some clients will come in and, okay, well, we just talk about patterns that happened. A lot of times, I find that people will start to notice patterns around holidays. For some reason, i have a lot of clients that will come in around holidays, and they'll be like, I think it's because of all the time that people have to spend with their family around the holidays. So they'll come in and say, "Oh, for the last, like, 10 Thanksgivings, I've had to host Thanksgiving at my house, and it always has to be me, and my mom always did this growing up." 

It all starts to be uncovered because then, for the other ten months out of the year, it's easier to kind of just go on with your days because you're not dealing with your caregivers, your parents, like, every day. You know, it's not like when you're a child, and you're seeing them every day. Yeah, so like a lot of times, ten months will go by, and then people are all excited for Thanksgiving, and then they're coming into my office like the week after Thanksgiving, and they're like, "Ah, like, I remember she used to do this like she'd wake me up at quarter four in the morning to make me bake all these pies, and then we'd," stuff like that would come out.

And so digging in is really like allowing yourself to sit there and be like, "Yes, that happened." Many clients will tell me, for some reason, people have a lot of deep thoughts either when they're in the shower or driving, and, of course, exercising too, like if people are out walking and running and stuff like that. But clients will come in and be like, "Oh, I was driving, and I remembered this thing that happened." And then, we start talking about the pattern of why it is that they act a certain way because they were conditioned to act that way.

Ben: Right, that makes sense. Yeah, thank you for explaining that. When I first heard digging in, I immediately went to, oh, digging in their heels and being stubborn and not wanting to do that.

Kaytee: No!

Ben: Maybe it is because I'm raising a teenager right now.

Kaytee: Probably. But that is good insight because that helps to explain what I'm trying to say. It helps to know how that would come across, like that word. So that is why I give the visual of a mountain to depict digging into it. Actually leaning into it.

Ben: That makes sense, for sure. Thank you for that. So then we move to these final three stages. The next stage after digging in you have is healing. Can you go a bit into that stage of the process?

Kaytee: So doing the work of healing is when we're growing, we're learning. A lot of these stages are going to be some like each person hits the stage sometimes before even realizing that they're at the stage. And so healing for a lot of people is like, how are you growing? How are you moving forward? And a lot of times, we don't know that until we can look back and be like, "Wow, this year I've really grown." You know, I don't think people know, "Okay, today, June 26th, I'm hitting this healing stage." It's usually something that you can kind of notice in hindsight. But that is when we start to notice, or we start to work on, okay, what patterns were happening?

In what ways are you seeing your history manifest now? How can you do the work to change that? And so a lot of times that's done sometimes through therapy, sometimes just talking about it. If people have, like, a severe enough trauma history, so of course, sometimes I recommend other modalities to work through the trauma and stuff like that before you can do the work of healing. I always like to tell clients it's never anything where I'm like, you, like, have to hit stage three by a certain time, and we start healing. Like, I want you healing by a certain time. Like, no, no, no. It's something that usually people start to realize, "Okay, I'm recognizing, I'm seeing the behaviors in myself.

I noticed I was about to snap at my partner about such and such, but then I remembered, okay, and I took a breath, and I was able to change that pattern on my own." And so that is when they're noticing that they're growing or big things are like not reenacting the dysfunctional patterns with the caregivers. So a lot of times, people will get, maybe they have that dysfunctional issue with their mom or their dad. They get into that dynamic, and they're able to stop that. Maybe they're able to stop the argument, or they're able to disengage. And again, around the holidays, for some reason, that puts everyone into, people are really having to test their patience and stuff like that.

And so, excuse me; people will come back in January and be like, "Okay, I noticed a change. I was able to walk out of the room during Thanksgiving and go and set the table, or I was able to take the kids outside for a game of football or something like that," that they noticed, "Okay, whereas in the past, I would've sat and gone with my dad. Like, nope, and we're gonna argue about this, and we're gonna bring up all those unhealthy dynamics. But nope, now I was able to notice that I didn't see myself getting as activated," whether that looks like less arguing, whether it looks like removing yourself, whatever it looks like for you. So that's like the growing stage.

Ben: What an empowering moment, I imagine. That must be that feeling of recognition and of the fact that they were able to do that in that point.

Kaytee:  It is.

Ben: The final two stages that you talk about are understanding and nurturing. What does understanding and nurturing mean? How might that look like for these people healing from this trauma?

Kaytee: So understanding is understanding how our past influences us. So this is what I usually refer to as, like, the aha moment. "Oh, this is why I do that." Or, "Oh, that's what I was doing that whole time." Or things like that, understanding why we do the things we do, how our past influenced us. And it's not about blame. I definitely wanna stress that it's not about blame. It's not like, "Oh, I'm like this because it's my parents' fault," or, "I'm like this because of my environment." I mean, is there a factor? Absolutely. We are a product of our history. However, it is also taking the responsibility of like, "Yes, this happened to me, and it was traumatic.

However, now as an adult, I have the tools and I have the resources available to me to work through it and to figure out what I'm gonna do. And I no longer have the right or the excuse to continue these dysfunctional patterns." And as a teenager, you go to school, and you're fighting with your peers, like literally fist fighting with your peers, and things like that. I'm not saying that that's okay, but you're an adolescent, and you're learning what it is that you've gone through. Now in our 30s and 40s, if we go to work and we're fighting with our peers and stuff like that, like no, we need to really do the work of healing, of recognizing, "Okay, I'm really triggered by this type of situation.

For some reason, I was really irritated by whatever happened in that meeting. I need to kind of do the work through that. The same pattern is happening with my partner again and again. What can I do to change that? Or what can I do to, like, what role am I playing in the dysfunctional pattern that I am continuing to perpetuate." And so that right there is something that, the reason why that is a later stage, of course, is because in the beginning that can be very, it feel very victim-blaming, and it can feel impossible. I mean if you talk to someone who's just starting to uncover or just starting to be comfortable enough acknowledging and recognizing how dysfunctional or even traumatic their family was, it's not likely for them to be like, "Okay, well, what part am I playing in the way that I'm perpetuating this dysfunction with my current partner?" 

It's too much of a jump, and you can have people actually go the other way. So you need to take the time and go through the work of uncovering and go through the work of digging in and things like that. And number six nurturing. And the reason why I say nurturing is because it's more of like a maintenance stage. It's kind of like having a car like you have to do regular maintenance for your car. It's not like you get to healing, and then you're healed, and you're fine, and it never affects you again. Like, you get to the stage of healing, and then it turns to maintenance. We never fully recover. We never fully get to the point where it's, like, never gonna affect us or never gonna be a part of who we are.

Ben: Right, yeah, that process isn't necessarily finite in that we're looking to, "Oh, okay, I'm done. I'm done doing the work."

Kaytee: Yes, and that's it, and I'm healed. Yeah, and I'm going to put the cap on it. That is why I consider it kinda like a mountain. It is not like you get to the top of Everest, and you get the selfie, and you post on Instagram, "Okay, I've healed from my family trauma." Absolutely not. Now, will you get to the point where it's manageable? Absolutely.

Will you get to the point where you can go on and do podcasts and talk about it and help other people? Yes, but it is always something where there's maintenance. There's going to be things, or maybe you are driving along and a song pops up, and that song reminds you of your childhood or maybe there's a death in the family, and everyone is brought together for those events that have to take place and things like that. So there will be times in your life when things will pop up where it's almost like healing really ebbs and flows. It's not like a fine line.

Ben: That actually leads me to my next question. You talked a little bit about how there's not really a set time limit for a person to work through each one of these stages. Everyone kind of works through them at their own pace and based upon their own needs. But in your experience, is it common for people to progress through these stages, maybe in a different order, or for people to revert to a previous stage when they have that trigger, if you will, that kind of puts them back in that space of feeling the trauma in a very real way again? Is it common for people to work through those stages in different ways and revert to previous stages?

Kaytee: Yes, absolutely. I feel like most people are going to start with pre-awareness, whether or not that pre-awareness happened in your childhood. Some kids are very insightful and are able to know that there's something wrong, and they maybe are even in the uncovering, even as an adolescent. Most adolescents, just by nature of needing to survive their environment, are not aware of the level of trauma that's going on in their environment, just because that's how they survive. So I say all that to say most people start there, but it can go any, people can go back to other stages. You know, for example, death in the family is a common one, that people would be like, "Oh, I thought I was healed, and then my dad died, and then I had to go back, felt like I was going back to the digging in, felt like I was going back to uncovering. It's like it all came rushing back."

That is very normal. It is very much like Elisabeth Kubler-Ross with the stages of grief, she talked about how you can go back and forth from other stages, and it's very similar to that kind of pattern that she found with people recovering from, or people managing grief that you can go back and forth. And you can repeat stages. You can skip stages, you can go back and be like, "I thought I was in the understanding, but I guess I'm in uncovering. Maybe I'm kind of wavering back and forth." It's definitely something, kinda like what I said earlier, it's something that usually clients, like, or people know in hindsight that they've gone through the stages.

I mean, rarely, you know, people know, like, the second it happens. It's usually something where they can look back and be like, "Okay, yeah, I've gone six months without any headaches or insomnia or arguments with my mom or things like that." And then each person progresses for a different amount of time. There's no set amount of time. For some people, if they have a lot of support, maybe they do a lot of reading, they do listen to a lot of podcasts, they have a really good support group, a really, like, maybe strong spirituality, strong faith, I feel like they progress faster because they're able to use those resources.

Ben: We know that people have different support systems and different levels of resiliency and just different personalities, and it manifests differently in people. Is it realistic for everyone to expect that their history won't affect them in adulthood? We already talked about the fact that it's not really like you get to that point to where you're done doing the work, but rather you continue to nurture that process throughout the rest of your life. But in your experience, is it realistic for people to expect that the history won't affect them in any way?

Kaytee: I feel like it's unrealistic. I feel like our history affects who we are today and affects really everything from our sense of self, our self-esteem, to how we relate to other people. Now, we can do the work to kind of change that, but it definitely is not realistic to expect that it wouldn't affect us. I know a lot of people think that it doesn't, and I respect that. I think that's the stage of change that they're in, but no, I don't think it's realistic, unfortunately.

Ben: Our listeners are, by and large, social workers. So what are some interventions that might be utilized for social workers who are working with clients who are trying to understand more about their own traumatic experiences and their trauma history and how that's manifesting in adulthood? Are there any interventions specifically that you would recommend for those social workers working with that client?

Kaytee: There are a lot of different theories and interventions like EMDR. I personally really like IFS, but I also feel like it depends on the year or whatever is the popular therapeutic technique of choice. And I respect that. I have many clients who have benefited greatly from EMDR, and that was the only thing that worked. I have many clients that benefited greatly from IFS, and that was the only thing that worked. I really feel like the number one thing that's going to affect change in your client is your relationship with them. I mean more than the modality or anything like that. If you have a client and you feel like EMDR is, for example, the only thing that is going to work for them, absolutely, that is between you and the client, your clinical discretion of what you feel like you need to do for the client, if you need to refer out, whatever you need to do.

But the number one thing is really letting the client direct what they're comfortable talking about and your relationship with them and believing them. So many times, and I've had this experience too on the other side when I was in college where the therapist's saying you really need to get over that, that's in the past, and things like that. And that can do more damage to a client than any modality that you use that you shouldn't have used or something like that. Like, a lot of times, clinicians will say to me, "Well, I'm using CBT, but should I try this?" I worry more about, are you believing the client. Are you providing a safe space for them to talk about their history without judgment and without feeling like you're denying or minimizing? That is like the number one, above all else.

Ben: That makes sense. So for those looking to heal from their own history, many of us in this profession also have our own histories, right? And so, what would you recommend for people who are living in those stages currently and seeing the manifestations of that trauma? Is therapy necessary for everyone? Is it recommended for most? What would you say to help support people who are healing currently from their own histories of traumatic experiences?

Kaytee: So the thing I like to tell people is to do something that helps them develop their own self-awareness. So some people like journaling. For some people, that's the last thing they wanna do is journal. Gardening, going out and taking time to meditate, doing yoga, walking, whatever works for you. If I say, do yoga, and the thought makes you go, "Oh, that's the last thing I wanna do," don't do that. You know, whatever it is that works for you, you can take time to really self-reflect. The big things are self-reflecting. The big things are developing self-awareness, doing a lot of educating, listening to podcasts, reading books, things like that, talking to other people about their history, and reading.

I think that therapy is something I recommend if you feel like the symptoms are impacting your life. If you're feeling like it's impacting your sleep impacting your relationships, then then it's necessary. If you have a lot of support, or if you have what you feel like is the support you need, and you don't feel like you need anyone to help you manage any negative symptoms that are coming up, you're just kind of exploring and becoming aware, I don't think therapy is necessary.

Ben:  Thank you for that and for this discussion, Kaytee. Now, for anyone listening who might want to learn more about this topic, how might they get a hold of you, or where can they get a copy of your books?

Kaytee:  I would like just to direct everyone to my website. It's kind of confusing. My mom spelled my name kind of weird. It's www, and it's my full name, Kaytlyn Gillis, LCSW. So it's K-A-Y-T-L-Y-N G-I-L-L-I-S-L-C-S-W, for licensed clinical social worker, dot com. And my books are available all on Amazon, so you can put my name into Amazon, and my books will come up, or you can go to my website, and there should be links there.

Ben: All right. Well, perfect. Well, Kaytee, thank you so much for your time and for this conversation.

Kaytee: Thank you.

Ben: I know that I found it very helpful and enlightening, and I'm sure that our listeners will as well. Keep doing the incredible work that you're doing, and thanks again for joining us.

Kaytee: Thank you so much for having me.

References 

Cai, J., Li, J., Liu, D., Gao, S., Zhao, Y., Zhang, J., & Liu, Q. (2023). Long‐term effects of childhood trauma subtypes on adult brain function. Brain & Behavior, 13(5), 1–9. https://doi.org/10.1002/brb3.2981

Gillis, K. (2023). Breaking the Cycle: The 6 Stages of Healing from Family Trauma. Lisa Nicole Publishing.

Hong, A., Zhou, S., Yang, C., Liu, X., Su, S., & Wang, Z. (2023). Impact of childhood trauma on the abnormal functional connectivity of brain regions in the fear network model of panic disorder. Journal of Affective Disorders, 329, 500–510. https://doi.org/10.1016/j.jad.2023.02.128

Laghaei, M., Mehrabizadeh Honarmand, M., Jobson, L., Abdollahpour Ranjbar, H., & Habibi Asgarabad, M. (2023). Pathways from childhood trauma to suicidal ideation: mediating through difficulties in emotion regulation and depressive symptoms. BMC Psychiatry, 23(1), 1–13. https://doi.org/10.1186/s12888-023-04699-8

Li, C., Fu, P., Wang, M., Xia, Y., Hu, C., Liu, M., Zhang, H., Sheng, X., & Yang, Y. (2023). The role of self-esteem and emotion regulation in the associations between childhood trauma and mental health in adulthood: a moderated mediation model. BMC Psychiatry, 23(1), 1–11. https://doi.org/10.1186/s12888-023-04719-7

Editor's note: This text-based course is a transcript of the School Social Work Efforts to Support Students in Public Schools Post-Pandemic Podcast, presented by podcast host Benjamin T. Bencomo, DSW LISW, LCSW, and podcast guest Capella Hauer, MSW, NCSSW.

Learning Outcomes 

After this course, participants will be able to: 

• Describe the role of a school social worker.
• Explain the impact of the COVID-19 Pandemic on students.
• Identify effective strategies for supporting students post-pandemic.

Podcast Discussion 

Dr. Ben Bencomo: I am very excited about our podcast today. This is a topic that I know many of our listeners have probably been encountering in their work in different school systems, both public and private post-pandemic, and supporting students K-12. And I'm very excited to welcome our guest today, Capella Hauer. Capella Hauer graduated from New Mexico Highlands University in 2015 with her master's degree in clinical social work. Since then, she has worked as a school social worker, primarily in the elementary setting. She has provided trainings on both self-care, as well as trauma-informed work in schools. Capella recently achieved national certification through the School Social Work Association of America, the first to achieve this certification in her state. She is currently a practicing school social worker in Tucson, Arizona, working part-time in schools and part-time for the School Social Work Association of America as their membership coordinator. And I must say, I am doubly excited for today's podcast because it is always fun catching up with former students and seeing all the amazing things they are doing. And Capella, you really are doing some amazing things. And it's really fun for me because I get to flip the script and learn from you today. So thank you so much for joining us today.

Capella Hauer: Yes, thank you so much for having me. I want you to know and let our listeners know that I'm going to try to show up today just as my authentic self. School social work is really near and dear to my heart. This is the niche I've found myself in and have not left yet, so I'm sure I'll share some personal opinions today. And I want everyone to know I'm not an expert. I don't believe anyone can be an expert in anything. So my hope with this, and having this conversation with you, Dr. Bencomo, is to hope that our listeners become more interested in school social work, or at least what's kind of going on in our schools right now, and then really do some more research and advocacy afterward.

Dr. Ben Bencomo: Absolutely, yes. Thank you for that. Well, your experience and your practice wisdom is definitely something that we appreciate you sharing with us today. Now, if we can start from the beginning if we will. I'm always interested to know a little bit about guests' path to social work. I do remember some of this story from you in class when you were completing your master's, but would you mind sharing with our listeners a little bit about your path to social work and your social work education background? So how did social work find you, Capella?

Capella Hauer: Yes, of course. I think I've always been one of those helpers. I think a lot of social workers can identify with that. But even when I was younger, or I especially remember a little bit more vividly in high school, I tended to be that student that other kids would come and talk to if they had an issue at home or at school. And it just always felt very natural for me to kind of help problem solve, lend an ear, or just be someone that they could vent to.

And then, as my high school career was coming to an end, I didn't want to, at first, attend a university because I wasn't quite sure what I wanted to do. So I just ended up doing a lot of volunteer jobs. I was working at our animal shelter. I was volunteering at our local domestic violence shelter. And it just sort of became a little bit obvious to me that all the jobs and things I really liked to do were kind of in the direction of social work, or at least all these volunteer jobs. I was like, "Well, I can't just keep volunteering forever. I should probably start a career, and I need to be able to pay rent."

So I had kind of debated back and forth on whether I should do social work or psychology. And I just found, for me, for my personality, it felt like it fit more with social work because I could experience all sorts of work settings, working in prisons and hospitals, schools, all sorts of different niches. So I ended up choosing social work, obviously. And then, I got my undergraduate and master's degree from New Mexico Highlands. And ever since then, I've been working in public schools as a school social worker.

Dr. Ben Bencomo: That is great. Thank you, Capella. Well, we are definitely glad that you found your way to social work. I know that you've already been engaged in doing a lot of really good work, so we're happy that you found your way to our profession. Now, after graduation, how did you first become interested in school social work specifically?

Capella Hauer: Yes, so one of the things that, I guess, I should have said too, more specifically, that got me into social work was I really wanted to work in the field of adoption. For whatever reason, I think I really idealized and romanticized the whole work of adoption. I now realize it's much more complex and not as beautiful as I think I may have had it in my mind, that whole process and that work.

But really, actually, it was New Mexico Highlands that kind of led me to school social work. I know you know, Dr. Bencomo, but some of our listeners might not know that Highlands is in a really rural area, and that just translates to limited opportunities for internships. So I've always enjoyed working with children. I've always really connected with them.

And a really close friend of mine from high school ended up being a school counselor. And so, I always really admired that career that she was creating for herself. And that kind of had a connection with me. And so I had a wonderful opportunity actually to do internships at the elementary, middle school level, as well as an alternative high school for my practicum. And once I started that, it all kind of clicked, and I knew that that was a space that I really wanted to stay in. I also think back to when I was a six-year-old who was playing school with my cousins growing up. There's definitely that little girl in me who's so psyched that I grew up to be working in schools. So it's always just kind of been thrilling to me. I really love collaborating with the teachers and different professionals on campus. I really enjoy getting to really know families and kids and advocating for them, and then working with students one-on-one and in groups. It was just a blast. And obviously, I haven't left.

Dr. Ben Bencomo: Well, thank you for that. That's amazing. I'm glad that that internship sparked this interest for you and that you were able to find your niche within the social work profession because I know since that time, you've been able to do some pretty incredible things in the area of school social work. Now, many times, I think that social workers aren't sure about what is required to become a school social worker in particular. Is there a specific educational path? Are there licensure requirements? So if you could, could you clarify for our listeners whether a MSW is required for a school social work position? Or does the BSW suffice? And also, are there any specific licensure requirements that are needed for school social work practice?

Capella Hauer: Yes, so this is where the practice of school social work gets a bit tricky as far as requirements. So this is something that our profession is really trying to work towards. But right now, unfortunately, school social work doesn't have parody across the states. So each state, and even down to each district within states, can have their own requirements. A vast majority of school social work jobs do require at least a minimum of a master's degree. There are some that do work on a bachelor's level, but I've found that that's more in rural areas. And their work is primarily a broker or community liaison, and they might even have a specific focus or even a different title. So rather than school social worker, it might be a title like behavior interventionist or attendance clerk, or homeless liaison.

I think Alabama, and Louisiana, are some states that might have positions like that. And so, for another example, I'll talk a little bit about Missouri. So in Missouri, there isn't a master's degree required by the state. However, most of the school social workers in Missouri have a master's degree, and most positions require an LCSW, and that's becoming more and more common. There are some districts and agencies who contract to provide mental health in schools, and they might hire bachelor's level, but not often.

And, of course, school districts, when they're hiring, they prefer to see social workers who've had either school-based practicums or some type of experience with direct practice with youth. So yes, I would say overall, the vast majority of the positions require an MSW. And then, the second part of your question, it gets a little more complicated as far as certification. So again, it's different everywhere. Some states have their own certification requirements. So in California, in order to step foot in the school as a school social worker, you have to have the state certification. Here in Arizona, we have a certification through the Department of Education, but it's not required. It's up to each district if they want to list that as a requirement.

And I will say, too, part of the work we're doing as a profession to try to create more consistency across the board, SSWAA, the School Social Work Association of America, began offering a national certification. That's the one that you mentioned that I had recently gotten. And that's an advanced certification that shows that the practitioner has mastered the competencies within our national model. And we really hope that that's going to help create strong practitioners, more representation, as well as that parody in our practice.

Dr. Ben Bencomo: That's really interesting. And I think that brings up another question for me. I know that in the early days of what we considered school social work, a lot of times, many school social workers worked primarily in the area of special education, maybe working to help ensure IEPs were provided for students and that those IEPs were being followed to make sure that students had whatever resources they needed available. Would you say that this is still the case with many school social workers? Or are school social workers branching out into different areas of professional practice within the school setting?

Capella Hauer: So, the history of school social work is interesting, and I want to dive into this. So the very first traditional brick-and-mortar school social workers actually began what was called visiting teachers, and I want to describe that a little bit, but I kind of want to go a little bit further back because I think it's really important to first bring attention and recognition of the role social workers have played in schools, that maybe don't immediately come to mind when we think of our schools, and that's the Indian boarding schools.

I'm learning this, so I actually want to take a little pause here and just share that I want to discuss some really difficult historical trauma of our Native peoples over the next few moments. So our listeners, if you need to pause or skip ahead, I encourage you to do that. I know this isn't always a topic that we expect to maybe hear when we've logged onto this podcast, but I think it's an important piece, and I just want to touch on it a little bit.

So in 1819, I believe, the Civilization Fund Act began, and that was the beginning of the Indian boarding schools and the systemic effort of the U.S. government to forcibly remove children from their homes, with the goal of assimilating them. I think some of our listeners have probably heard the quote, "Kill the Indian, save the child." These boarding schools only goal was to eradicate our First Nations' culture and identity through this guise or belief that First Nations did not or do not already have any cultural beliefs or family values. And this was cultural genocide.

These boarding schools were more often than not run by religious organizations, and children were forcibly brought to them from their homes, often states away. There are records of children being taken from southern New Mexico all the way up to Idaho, and children as young as three were taken from their families. And if families didn't comply and turn over their kids, they were criminalized. So some Native men were sentenced to up to 20 years in Alcatraz for refusing to allow the churches to seize their children.

 I bring this up, and it's important because social workers were some of those government employees who enforced the removal of Native children during that time. And the children were emotionally, physically, and sexually abused and neglected. They self-harmed. They ran away or even completed suicide. And there are thousands of these children who never returned home and are to this day unaccounted for. Their burial sites are unmarked, and the number of child deaths is unknown. And this wasn't just during this time, that social workers had a role in this. Our role in this cultural genocide continued even after the boarding schools became less common.

So in 1958, the Bureau of Indian Affairs started the Indian Adoption Project. And this project enlisted social workers to visit reservations and then convince Native parents to sign away their parental rights. So we, as social workers, have a really long, painful history with our First Nations peoples. And again, I share this because it's really critical that, as social workers, we recognize the historical harm that our profession has caused.

You better believe that those parents, those ancestors, and these children remember on a cellular level the harm that we've done. And so, I want to share that because we, as social workers, need to walk into our door at work and know what weight that title carries and what harm that title has carried in the past.

Dr. Ben Bencomo:  I want to thank you, Capella, for sharing that because we, within the social work profession, sometimes have this tendency to romanticize the profession and romanticize the history of the profession. And in order to authentically practice in some of these spaces, I think it's important that we understand contributions that the profession has made in the past as well to some of these atrocities and to the historical trauma that a lot of marginalized populations, Native American, indigenous communities, and others that we have contributed to. So I want to thank you for sharing that, absolutely.

Capella Hauer: Yes, of course. And then, back to your initial question. So more officially, as for the brick-and-mortar schools that we think of, down the road from where we are now or whatever, social workers really started being hired and paid through the schools themselves around the 1930s. And again, that's when they were referred to as visiting teachers. So the visiting teachers' primary role was to be the liaison between home and school. They would help encourage attendance, address any needs of the families, and things like that.

And then, at that time, it was kind of, well, interesting for me because I adore SSWAA, but at that time, there was the National Association of School Social Workers, and then 40 years later, around the '70s, they dissolved to become what's now NASW and SSWAA. So during that time, we saw a shift and an introduction of new models in school social work practice, from primarily a casework model to then start including group work and systems interventions.

Also, at that time, the Education for All Handicapped Children Act became law, and that's when working with students with special needs became a bigger, more significant role for school social workers. And then, of course, school social work positions really start growing during that time. And you saw more school social workers deal with IEPs and things like that.

Dr. Ben Bencomo: So, in what ways has the field of social work changed, do you think, in terms of areas where social workers are supporting students in those school settings currently or recently?

Capella Hauer: I think now, again, it can be so different from state to state, school to school, district to district. It really is different every day. For me, a lot of the work that I do is a lot of group work. I have a fairly high caseload and only work part-time, so a good amount of the work that I'm able to do with students is in groups. We can do some one-on-one with students. We do home visits for attendance or basic needs, anything like that, crisis intervention. A lot of school social workers do class lessons, go into classrooms every week every day, and do class-wide lessons,  student meetings, and consulting with other professionals both in and outside the school. And then connecting with those community resources. Schools are such a massive hub in our community, so it's so critical to have those community resources around you as well.

Dr. Ben Bencomo: Absolutely. I think that the skill set that we bring, that social workers bring to that school setting, is being tapped into in a wider way, I guess you could say. Now, many of our listeners may already have a good understanding of this, but can you walk those listeners who've never had any experience with school social work, can you walk them through the typical day for a school social worker? I know that you mentioned that currently, you're doing a lot of groups. Is that something that you see with a lot of your colleagues who are also school social workers? Or do their days look different?

Capella Hauer: I think for quite a few, the majority of school social work colleagues that I have, groups are a big part of it. And that's a great opportunity to really focus on the needs of the students. And it can be a bit of a game of Tetris, sort of, putting those groups together and making sure they're all having the same needs, and those same needs are going to be met in the group. So that's a very common one, especially with high caseloads.

Quite a few school social workers that I know also do class lessons on social-emotional learning, and that can be sort of a year-long experience where you're going into a classroom for half an hour or an hour every week. And that is the school's SEL curriculum, and you're sort of teaching that curriculum. Or it could be class lessons because this 12th-grade class is having an issue with X, Y, and Z. And so, you come in to lend that extra support. School social workers really are massive leaders on their campus. So there's a lot of systemic teams that you might be a part of. And just, again, that consultation with other professionals on campus is a big part of it too.

Dr. Ben Bencomo: Absolutely. It's refreshing to hear that social workers have a bit more say so in terms of having a place at that table and in those discussions. I know that recently my son came home and said, "I thought you taught social workers. I didn't know you taught teachers," because one of our graduates mentioned that he had me an as a professor, and he was teaching social-emotional learning. And that was just a regular class, just like PE and music, and some of the other specials that they have in school were a couple of times a week they go to social-emotional learning. And it was very refreshing to see that skillset was being utilized in that way to help support kids, even in my son's elementary school.

Capella Hauer: I love that.

Dr. Ben Bencomo: Capella, in your experience, what are some of the challenges that you see in your role as a school social worker?

Capella Hauer: Again, I want to emphasize that this is just my personal feelings about what's a challenge. For some other people, it might be completely different. When I reflect on this, a lot of the things that are challenging to me are systemic problems. The day-to-day stresses that come with the job that's all things I signed up for. That's why I became a social worker. And that's manageable because I've learned how to manage that stress. But the systemic stuff, that's what gets to me. So one of the things I personally really struggle with is the more recent increase in attacks on our youth and just their right to equitable education.

So last month, we're just a little bit into April as we're recording this, but as of last month, there were over 400 anti-LGBTQ bills, just three months into the 2023 year. And that breaks my heart. But then, there's also this glimmer of hope because we're actually seeing a bit of a shift in acceptance. So, for example, the Human Rights Campaign they have some data that shows that we're seeing a massive shift in our youth and how accepting and affirming they are of each other's identity expression. And youth today are much more accepting in general of their peers than in previous years.

So when we were growing up, there was a lot of this talk about being worried about going to school because the kids were going to be picking up on us. But now that's sort of switched. And it gives me a lot of hope and fills my heart. But at the same time, these children are growing up in a world where there are elected officials who are taking aim at them, at who they are at their core.

And school social workers have a lot of responsibility for this, to ensure that our students feel welcome and accepted no matter who they are. Because the bottom line is that all students learn best when they feel safe, and they all deserve to feel safe and cared for.

We just to touched on this a little bit, but I'm going to flip it a tiny bit. We see, in conjunction with this anti-LGBTQ+ rhetoric, there's also a fight against anti-racist teaching as well as social-emotional learning or SEL in schools. And we hear things like, "Parents should be the ones teaching their kids values, not schools." And I'm going to be my authentic self right now, but it kind of makes me laugh a little bit for two reasons. But the first is our Founding Fathers created public schools to provide moral instruction, build character, and really set the tone and virtues of our nation. That was the goal of public schools. And I also laugh because if you are an auntie, a parent, any adult with kids in your life, if you spend six hours with a kindergartner or any kid, it's really hard to go six hours and not have to have some sort of conversation on sharing or kindness or any of those values that they're saying SEL is so dangerous for.

But I want to talk about it a bit because I know some listeners might not completely know what the term SEL is. And I want to, if it's all right, read a little bit from CASEL's website. And CASEL is the Collaborative for Academic, Social, and Emotional Learning. So they're like the pioneers or the leaders in the field when it comes to social-emotional learning. So I'm going to just lean on them because I think they could say it better than me.

So they say, "SEL is an integral part of education and human development. It is the process through which all young people and adults acquire and apply the knowledge, skills, and attitudes to develop healthy identities, manage emotions and achieve personal and collective goals, feel and show empathy for others, establish and maintain supportive relationships and make responsible and caring decisions. SEL advances educational equality and excellence through authentic school, family, and community partnerships to establish learning environments and experiences that feature trusting and collaborative relationships and meaningful curriculum."

So this sounds really familiar to what we as social workers do. At our very core, this sounds like a social work job description, and it's very reflective of our ethical standards. We teach and advocate for positive relationships. We advocate for safe and healthy communities. And then, going back to that equity, there are so many, many studies and evidence-based research that show that schools who prioritize SEL have higher outcomes on test scores, they have a more positive school climate, and overall, much higher well-being of their students and staff.

And this is what makes it really difficult for me and other school social workers. We know that this is evidence-based, and we know it works, but it's in a very real way tied to our ethical standards, along with the rights of LGBTQ+ students. So when there's this push from state legislators, and we start seeing new laws that are forcing school personnel to no longer teach SEL or even to out a student to their guardians, this goes against the core of our ethics. So it's a very tough field to navigate right now, and especially in those states where a lot of this destructive legislation has been happening.

We've also seen, and this has been going on for about a decade or so, but we've also seen a shift and this push to privatize education in America. And I'll use my state, Arizona, as an example because they are an example of privatizing education and how it can go wrong. So since around 2014 in Arizona, our government officials have been opposing and shutting down legislation and budgets that would supplement public education. So for those who don't know, Arizona ranks 49th in the country for teacher salary, last in the nation for per-pupil spending, and does not fully fund kindergarten.

So instead of putting money towards those critical pieces, our elected officials have been approving private school vouchers year after year, which in its most basic sense steals money that's meant for public schools. So I'm going to try to explain it, but this is again where I hope people afterward will kind of do a little bit of research and dig in.

So schools and districts receive a certain amount of funding from the state and from the federal government, and that funding is determined by the local census on how many students would be attending that school or district. So with the voucher system or what some people call school choice, a guardian can choose to remove their student from a public school, which is totally their right, and put them in a private school or homeschool, and the funding that would've been allocated at that public school for that child follows the child and is instead given to that private school. So that sounds kind of fine, but then it gets a little tricky.

So if a student leaves their public school, the funding for that student goes to the private school or straight to the family if they're homeschooling, and the public school can't get that funding back. So simplest breakdown, let's say I have a school of 100 kids, and 25 of them go to a private school, so I just lost funding for 25 students. Say I get more kids to enroll back in my school, so now I have 100 students again, but I don't get the money to cover those 25 students. So I'm now operating at 75% funding even though I have 100% of the students that the budget was initially created for.

So let me take a pause real quick. The other kind of issue with this is that these vouchers aren't regulated. So if you've ever worked in a school, there's like this red tape nightmare of something as simple as having to get approval for purchasing school supplies or attend a webinar. But private schools and home schools just aren't regulated in the same way. They don't have to justify every line item, which results in really no accountability for how that money is spent. Or, at the very least, it's a very inequitable system of how our money is spent on children.

And additionally, private schools don't have to adhere to the same equity laws as public schools. And public schools have been seeing a lot of parents choose to send their students with disabilities to a private school to try to get more support, more one-on-one. And they just return, saying that the school either didn't accept them or they were kicked out. And it's creating this even larger chasm between socioeconomic groups and, really, people of color. And again, it's complicated, and I hope people kind of do some more research on it because it is really fascinating and interesting how all this works. But it is a very methodical way to drain public school funds and privatize education systems.

Dr. Ben Bencomo: It's very interesting and telling, I think, to me that when I ask about challenges you experience in your role, it's not those day-to-day micro-challenges, but it's more looking at these systemic changes and systemic inequities and how really there is that trickle-down effect that you're seeing in front of you with the students that you're working with. We and I'm using the collective we for society, but sometimes we lose sight of the fact that our children, our K-12 children, are also multidimensional human beings. And so, when we focus primarily only on, "Well, these are the test scores, and this is the education," to the exclusion of do they feel safe, do they feel a sense of belonging, can they see themselves excelling in this way, can we create emotional safety.

And then, is there equity, and is there funding? Is there support needed to really create a meaningful supportive experience where these children can grow? I think it's so important, everything that you say.

I have a colleague, and I probably have mentioned this in previous podcasts as well, but I have a colleague who uses the mantra, "Micro is macro, and macro is micro." And I think you, in a very eloquent way, are explaining how this is the reality for school social workers, trying to do more with less in many instances, and also seeing the effects of what these macro-level policy decisions are having on the students that you're seeing in school every day. 

Thank you for sharing that, Capella. There's a reason that you continue to be passionate about the area of school social work as well. So would you mind sharing with our listeners a bit about what you see as some of the benefits that you find, some of the positive areas that you've found being a school social worker?

 Capella Hauer: Oh, there's a lot. But like you just said, working in micro and macro and those meso levels, I really enjoy that, because I feel like I can flex so much of my brain in different ways. So there's the one-on-one work with students, but then I also was on a school team that our whole purpose was to create a positive culture at our school in a systemic way, so then working on those meso levels. And then also on the macro levels, you have to be aware of what's going on in your local legislation and really advocating for that and calling up your legislators and looking at what's happening at the district level. So I like having that kind of complexity.

It's not just one-on-one with a client, and that's all I do. I also really enjoy working with a diverse team of professionals. It's really helped me grow as a professional to work with a phenomenal school psychologist and an amazing speech pathologist. There's a teacher that I worked with for many years who was a self-contained classroom teacher. And just the amount of things that you learn from these different disciplines is just amazing. And having principals who you can learn these phenomenal leadership skills from, I really like that too, just working with a diverse group of professionals.

I think something that also drew me to school social work is that you can work with students, and you kind of have access to these clients, so to say, for a longer time. So there are some of my students who I've known literally my whole career who are now in middle school, going into high school, and I have this beautiful honor of also working with their siblings and having these really strong relationships with their parents, with their families. And that's something that's really hard in other settings, and I think that just fits my personality. For other people, they may not like that, but I think that's such a beautiful piece of my work.

There's kind of like this community enmeshment that you might not find in private practice, where you're really connected with the food bank, and you know the people there, that come by name, and you know this whole family's history, and now their aunt is coming. There's just so much more involvement. I really love that.

And really, it's the kids. I'll try not to get emotional, but I just love being inspired by them. They lead the way. They clear the path. I don't think it's the adults that do that. I think children do. Their voices show a glimpse of what our future is going to be like. And bearing witness to their growth and their family's growth, it's an amazing honor. It really is. And kids say hilarious things, so you always know you're going to get a really good laugh each day.

Dr. Ben Bencomo: That they do. That's amazing, Capella, and inspiring, I think, to think about the real impact you've had working with so many children and families and commune entire communities and having that lasting impact as they continue to grow and develop. So yes, thank you very much for sharing that and for the work that you're doing.

Now, I do want to shift focus just a little bit to talk about current realities. Now, as our listeners well know, the COVID-19 global pandemic has really rapidly changed the field of social work in so many ways and in so many different areas. And in a little while, I'd like to talk about how that reality has changed for the kids that you work with. But first, how has the pandemic affected the setting of school social work and school social work jobs? What have you seen in that area?

Capella Hauer: So I think it's going to be interesting, especially looking forward to the next few years. During the pandemic and then in the years after, there was this flush of funding. We had a massive increase in funding for public education through a lot of different federal programs and state programs. I wish I had the data on it. The School Social Work Association of America's currently working on a massive census so that we hopefully get some of this data. But I believe, just through connecting with and talking with school social workers from across the nation, that there was quite an increase in positions in school social work positions across the states because of that additional funding. And there was a huge emphasis on social-emotional learning and building stability and safety returning back to school.

And so, a lot of districts, a lot of states put an emphasis on hiring school social workers. I'm curious to see what that will look like in the next few years. I think, in some places, that funding is starting to go away, so it'll be interesting to see what remains. And in that respect, I think school social workers need to advocate really hard for their positions right now, especially if they're funded by some of this. And, of course, that puts a lot of pressure.

But another thing that I think really affected school social workers, and I'm sure a lot of our listeners just noticed this in general, was there were increased crises and mental health concerns across the board. And then, in conjunction, there were fewer mental health supports because we had a lot of practitioners leaving the field, whether they were social workers, counselors, or whoever. The mental health system was just overwhelmed. And so, of course, that's going to affect schools too because a lot of our families couldn't get those mental health supports. So then we become the mental health supports on top of a lot of other things that we're doing too, rather than having kind of that community wraparound type service.

I think another thing that directly affected the school social workers is there's also this really high number of burnout among staff, especially teachers, for some of the reasons I've already discussed, the systemic reasons. And again, school social workers are really leaders on their campuses, at their schools. And so, we're not just working with the children. We're also providing a lot of support to teachers and consulting with them and trying to help make sure that their classrooms are a safe and welcoming environment for them as well. And that's always been in place, but after the pandemic, returning to school, I think that was definitely magnified, just because there's such a high burnout.

Dr. Ben Bencomo: Right. Definitely. So looking also at how the pandemic has affected kids in particular. Now, we know that the pandemic has affected school-aged children in so many different ways, but really, probably nowhere more so than in the school setting. And I've seen this even with my own kiddos. I have two in elementary, one who's going to be in middle school next year, and then one high schooler. But what did you see in terms of educational needs most affected during the pandemic? And how have kids that you work with been impacted as we've moved from the acute pandemic era into the later stages of the pandemic or post-pandemic?

Capella Hauer: It's only 2023. We don't have a lot of data on this yet. I think it's going to come in the years. It just takes time. But I'll share just from my experience and what I've heard from colleagues and other mental health professionals as well, and maybe make some inferences based on some data that we have from other traumatic events.

So we had this global event, this trauma, COVID-19, but I think at the core of so much of this event is just massive loss. Loss of jobs, homes, schools, loss of consistency, loss of safety, and security. And then, of course, our loss of loved ones. And this is what I feel like we've seen most in our students, is grief and loss. A large part of what we do as school social workers work with both trauma and grief support and treatment of those two things can be different.

So anyone who's experienced any sort of grief can understand how major of an impact it has on your world. And we, as adults, can relate to the struggle of being in a pandemic. But imagine if you were five years old again or when you were in fourth grade. So when I was in fourth grade, that was when the World Trade Centers were hit. And everyone in my generation, everyone alive and cognizant of that event at that time, can still remember exactly where they were during that attack. So they did research in the New York City public schools after that event, and they found that 87%, so almost nine out of 10 students in grades four through 12, reported at least having one type of reaction six months after the event.

So we're doing some inferring here. So this traumatizing, horrible event that took place over one morning had drastic effects on the children then. So we can insinuate and imagine how our students now have been even more so affected by nearly three years of COVID. And, of course, academics were affected. How could they have not been? The majority of students struggled to learn effectively at home. Some were really successful at it, but I think we're social creatures. And as educators, we needed to return to campus with reasonable expectations. So meaning we wouldn't be able to teach them everything they missed, and trying to do that would overwhelm and distress the students and their teachers. So we really needed to return to campus and start at the basics again. We needed to establish trust and safety for everybody, kids and adults. 

And then, from there, we reestablished expectations and just how to be in school again. This was such a struggle when the first year was constantly changing. So we were in person, now we're virtual, now we're in person again, and then virtual. And once we were finally back fully, really in person, the regulations for quarantining and the practice of reducing the spread changed so often. And I'm sure you saw that too since you were in the university.

So another piece of data that we can sort of use to apply this to and infer some information, but research on transient students or students who are in foster care have been studied and researched as far as their academics. And so studies show that for every move a child makes from one school to the next, so just one move, one school to the next, they lose six months of learning. So depending on where you live in the U.S., most schools are in session for nine and a quarter months out of the year. So each time you move schools, you're missing roughly two-thirds of your learning. That data in and of itself can tell us a lot.

And we also know that there was a massive disparity in students' educations during COVID, and there were a lot of reasons for this. Each one is unique, but some students had their adults stay home with them and monitor their learning. Others were maybe caring for their younger siblings or had to work. Other families were just trying to find housing or basic needs. And then, some families might have just been completely remote, and they all worked together. So those kiddos who didn't have an adult over their shoulder, helping to ensure that they logged into their classes, or the kids who can't focus on school because they're suddenly homeless. So just moving a school can cause six months of missed learning. So what about those three years from doing school at home, with no school, in person, back to home, and that constantly changing environment?

Dr. Ben Bencomo: Right. I think that is incredibly insightful to look at, "This is what we know, and this is what has been proven," because we are still so early in this post-pandemic phase that the research is going on currently. But I think that can help us understand some of this prolonged trauma and some of these disruptions to the educational experience that our kids experience so that we can then look to ways to support them currently. And so, I do want to ask you, how can school social workers best support children and adolescents currently, given the current reality? And also, how can school social workers best support teachers, administrators, counselors, and other colleagues that are in the school setting currently?

Capella Hauer: I think at the very basic, we need to go back to social work 101 and look at Maslow's hierarchy. And that needs to be something that's always placed in mind. And just having in the back of our heads, too, that our students are still experiencing grief, loss, and trauma. So really just taking into account their basic needs first, really taking into account the whole child, the whole family, and the whole community, really. And I think for both teachers and students, anyone on your campus, I think a big thing that we need to get back to and really put the highlight on is connection and relationships. We are social creatures. We learn, grow, and develop through being with others.

There are all these studies on incarcerated people who have been in solitary confinement and the damage it does to their brain system. So the amount of time that we were alone, there was so much loss and connection and so much isolation. And I'm sure the data and the research in a few years is going to show us that it had a massive effect on our brains. And so, we learn through relationships. Even as a baby, we learn from that initial connection with our mother or whoever was there when we were firstborn. And if you have been blessed to have beautiful friendships or marriage or whatever, you know how much those people in your life have such a massive impact on your motivation, on your mental health, and on your physical health.

We missed out on that for three years, for two years. And so, I think really focusing on those connections and those relationships and getting back to that is going to really help build that safe space, that support where students and adults feel more regulated, more calm, more up in their brain, in their forward part of their brain, to be able to learn and to really participate. But those relationships have to come first.

Dr. Ben Bencomo: Absolutely. It's so essential to everything that we are and everything that we do. And I think that bringing it back to those basics, bringing it back to Maslow and looking at our basic needs being met, and that social connection to others is that basic need being met as well is really important. Capella, now I know that you currently serve as the membership coordinator for the National School Social Work Association. Could you tell our listeners just a bit about this position and this organization on the whole? What is the National School Social Work Association and what is your role there?

Capella Hauer: Yeah, absolutely. So SSWAA is really the only professional organization for school social workers. It's similar to what NASW is for all social workers, but really it's just for the niche of school social work. We host webinars. We do an annual conference. We actually just wrapped up our annual conference a couple of weeks ago. We provide tools, practice resources, liability insurance, networking opportunities, and then we also have state chapters too, so we provide support for states. And, of course, we also advocate for all school social workers on that national level. It's a really wonderful organization. I absolutely love my work there. I love being able to practice on a macro level, and kind of have that mission, that sole mission of really just driving this particular niche of social work forward and growing the profession. I definitely encourage our listeners to check it out because they have a lot, a lot of resources and information on their website.

Dr. Ben Bencomo: Absolutely. You mentioned there were state chapters as well. Are those active in every state?

Capella Hauer: Almost every state. I think the last time I looked, we had 38 or 40 states that were affiliated with us. So there are some state chapters too.

Dr. Ben Bencomo: I think that often we don't realize the importance of having this connection to colleagues and these organized advocacy efforts on that wider stage. But it's important for us to understand, I think, the importance of joining some of these professional organizations. Capella, how can some of our listeners learn more about school social work if they're interested?

Capella Hauer: Again, checking out SSWAA's website is a really good place to start. So it's just sswaa.org. Again, they have a ton of resources and articles, and they also have a blog, which I think provides really good insight into the field. And then, of course, there are also social media groups. So there are a lot of school social work groups on Facebook that you can join, and there's a really rich dialogue on those as well. And that can kind of give you a good idea or feeling of what this particular role is like.

Dr. Ben Bencomo: That's great. You just finished talking a couple of minutes ago about the importance of connection and finding that support for students and also for teachers and administrators, and other staff in school settings. I think that this could be a great avenue for school social workers to find that connection and mutual support as well as other people who understand what it's like and who can share resources and can be there to provide support. I think is really important.

We are almost out of time here, Capella, but I did want to thank you for being here. Thank you for sharing your practice experience and all of your knowledge. I want to thank you for sharing with our listeners the history, the good, the bad, and the ugly of the history of social work and of school social work in particular, and also a bit of understanding that can help us move forward. Where do we go from here in this post-pandemic era, and how can school social workers help to lead the way really with supporting the next generation that's coming up. So Capella, thank you so much for your time and for sharing so much of your authentic self with us and with our listeners today. We definitely appreciate it. Continue to do the work that you do, and just rock on, Capella. Thank you so much.

Capella Hauer: Absolutely. Thank you so much for having me. I really appreciate it. It's a great way to spend an hour.

References 
 

Daftary, A.-M. H., Sugrue, E. P., Gustman, B. D., & Lechuga-Peña, S. (2021). Pivoting during a Pandemic: SchoolSocial Work during COVID-19. Children & Schools, 43(2), 71–78. https://doi.org/10.1093/cs/cdab005

Lara, L., Saracostti, M., & de-Toro, X. (2022). Adaptation and psychometric properties of the school engagement and contextual factors questionnaires for Covid-19 and post Covid-19 context. PLoS ONE, 17(9), 1–14. https://doi.org/10.1371/journal.pone.0272871

Marraccini, M. E., Griffard, M. K. R., Whitcomb, C. E., Wood, C., Griffin, D. C., Pittleman, C., & Sartain, L. (2023). School‐based mental health supports COVID‐19: School professional perspectives. Psychology in the Schools, 1. https://doi.org/10.1002/pits.22869

Matsopoulos, A., & Theron, L. (2023). Resilience to COVID-19 challenges: Lessons for school psychologists serving school-attending youth with experiences of marginalization. School Psychology International, 44(2), 123–134. https://doi.org/10.1177/01430343231151591

Owens, C. L., Johnson, A. H., & Thornton, A. (2022). Addressing Equity in Schools: Youth Participatory Action Research and Transformative Social and Emotional Learning during COVID-19. Children & Schools, 44(1), 48–54. https://doi.org/10.1093/cs/cdab029

Sugrue, E., Ball, A., Harrell, D. R., & Daftary, A. H. (2023). Family engagement during the COVID‐19 pandemic: Opportunities and challenges for school social work. Child & Family Social Work, 1. https://doi.org/10.1111/cfs.13011

Yadav, R., & Yadav, A. (2023). The 6 A’s model of social worker associations and COVID-19: A preliminary insight. Qualitative Social Work, 22(2), 357–380. https://doi.org/10.1177/14733250211068066

Editor's note: This text-based course is an edited transcript of the Continued Learning Podcast episode entitled, Recognizing and Treating Traumatic Grief, presented by Lisa Zoll, MSW LCSW, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes

After this course, participants will be able to:

• Explain what traumatic grief is, why it occurs, and the long-term effects of traumatic grief.
• Determine high risk elements for traumatic grief.
• Identify evidence-based interventions for treating traumatic grief.

I am Dr. Ben Bencomo, and I am very excited to be talking with our guest today, Lisa Zoll. Lisa will share a bit about the work she does in her social work practice. Her area of expertise is traumatic grief. I can't think of a more timely topic. Trauma is all around us, and as social workers, we are called to respond to trauma and to support people as they are experiencing it.  We see people in the days, weeks, months, and years afterward to help support them as they recover from some of the traumatic experiences that they have lived through.

Lisa Zoll is a licensed clinical social worker. She graduated with her master in social work degree from Temple University. Lisa's professional social work practice experience includes 12 years as a clinical psychiatric specialist at the Penn State University Medical Center in Hershey, Pennsylvania. During that time, she worked primarily in the adult partial hospitalization program and the psychiatric outpatient clinic. In 2008, Lisa began teaching loss and grief as an adjunct instructor in the master of social work program at Temple University in Harrisburg. In 2014, she was appointed as a full-time faculty instructor where she taught courses across the curriculum. Lisa founded Grief Relief, LLC, in 2019 and specializes in helping clients challenged by loss, grief, and trauma. She's published several articles and has spoken on these topics at the local, state, and national levels. She specifically addresses loss and grief and how they impact individuals, families, communities, and organizations.

Recently, Lisa is certified and completed the training in Eye Movement Desensitization and Reprocessing (EMDR) in January 2022. She has added this to her tools for supporting people who have experienced grief and trauma. Lisa, thank you so much for joining us today. I'm very happy to meet you and to be able to learn from you today.

Lisa Zoll: Thank you, Ben, and I am excited to be here as well. 

Dr. Ben Bencomo: To start, let me ask you what brought you to social work, and what are some of the educational and professional experiences that have influenced your work today?

Lisa Zoll: Social work was actually my second journey into higher education. I initially graduated with a bachelor's in business management as I thought I would be a nursing home administrator. I worked as an activity director at one point and went back and got my master's in therapeutic recreation. I had a desire to do more, so I went back and got my master's in social work in 2003. I worked at e Penn State Hershey Medical Center for 22 years, and then higher education came knocking at my door.

I began teaching in the program I graduated from. On graduation day, I remember mentioning to someone that I wanted to come back and teach the loss and grief class someday. The class I had taken wasn't great. I thought there could be more. There was more to know about loss and grief than what we were able to cover in class. I started just teaching a one-credit course over the summer and that eventually turned into a three-credit course. I started teaching another class, and then another, and they asked me to become a full-time instructor. I never imagined myself being a full-time instructor at the college level. I did take the position and a year or two later they closed the Harrisburg program where I was teaching.

That left me wondering what I would do next. I thought I wanted to stay in higher education as I had experience with students and I had clinical experience. I started looking at jobs in college counseling centers but they were looking for people with college counseling experience. I applied for a job as a bereavement counselor and they told me they thought I would get bored with the position. I heard a lot of "no" and I finally got tired of people telling me "no".

I had an interest in grief from both a professional and personal perspective. I knew it was a niche that I thought I could fill. Ben, I think a lot of people really focus on children and grief, as they should. There absolutely needs to be a lot of focus on children and grief. I don't work with children, and I am not a child therapist by any stretch of the imagination. Where I live we have the Highmark Caring Place, for children who have experienced significant loss (such as siblings, parents). I wanted to start a similar place for adults.

I wasn't familiar with anything that was being done to specifically target adults and grief. I know there are a lot of generalist social workers and therapists who probably do good work with grief, but I wanted to focus my practice on grief. I had to open my own door, and that's how it started.  

Dr. Ben Bencomo: Interesting. You mentioned that it was both a mix of professional and personal experience that led you to be interested in this specialization area. Can you tell me more about that?  I know that many of my students may pick a population or specialization area like behavioral health or addiction, but it's not often I hear of someone who wants to specialize in grief or trauma. What specifically did you find appealing about that specialization area?

Lisa Zoll: On a personal level, I was sheltered growing up when it came to loss. My parents, sister and I didn't go to any funerals until my grandmother died when I was an adult. We didn't go to any funerals. We didn't talk about death and we didn't have any grief rituals. I think my parents did not know what to say or do, and I think they were trying to protect my sister and me from pain. And I understand that.

Then I had some other losses of people that were closer to my age, and I went to their funerals.  I realized how hard it is to lose people you love.  You may talk about it when it first happens, and there is some collective grief in the beginning. I was a volunteer firefighter and EMT and I'd been to a couple of funerals for the firefighters that had died. The funerals were very ritualistic, but we didn't talk about it and we still don't. As an outpatient therapist, I was working with a couple of people that were experiencing losses, and I wasn't as familiar with how people get through grief as an adult. I was drawn to that part of social work and therapy.

Also, I had a close friend that died. A week or two after the funeral I was having a hard time functioning. I got to work one day and I thought, "I can't move, I can't do anything." There was a chaplain program at my workplace, and I explained how I was feeling to one of the chaplains. She said, "You have unresolved grief." I said, "Oh, it has a name." Naming it was so helpful. And then I said, "Well, what do I do?" I worked with her for a few sessions. I ended up writing a letter to the person that had died, and it was helpful. I wanted to be able to help other people in that way. I wanted to help others understand what's going on with grief and loss, and to offer things they can do to help process it.

Dr. Ben Bencomo: Naming the feeling and being able to process the feeling I think is very important. Traumatic grief encompasses a couple of areas that I think social workers have focused on for some time, but the term traumatic grief may be new to some social workers. I want to define traumatic grief but first, let's start by defining trauma. How would you define trauma, Lisa?

Lisa Zoll: Many of us have worked with people who have experienced trauma. I think there's variability in people's responses to stressors and traumatic events. The impact of a potentially traumatic event is determined by the objective nature of the event and the person's subjective response to it. If a person experiences something as traumatic, then it is traumatic. Tara Brach writes, "Trauma is when we have encountered an out-of-control, frightening experience that has disconnected us from the perceived world order, our perceived world order, a sense of resourcefulness and coping." We're left in that state of shock, and often numbness and disbelief.

Dr. Ben Bencomo: I remember one of my professors, Dr. Gorman, who described it similarly to you. Dr. Gorman described that trauma happens when the person's coping is exceeded by that event. We are client-centered and it is up to the client to determine when they experience trauma. We don't get to define what is a traumatic event. Rather, how that person reacts to that event is what's most important.

How would you define grief?

Lisa Zoll: I was fortunate to work with a woman named Lynn Shiner. Twenty-seven years ago both of her children were murdered by her ex-husband who then took his life on Christmas day. She wrote a book called "Stabbed in the Heart" that I came across and I was so inspired by her. I invited her to speak to our classes, and she was always willing to do that. We formed a wonderful friendship while working together. We defined loss as something that people experience - it can be death or non-death related - when they have an emotional connection to something that is no longer there.

That's a very basic definition. Therese Rando writes about experiencing the psychological, behavioral, social, physical, and I will add spiritual, reactions to our perceptions of loss.

William Worden wrote a textbook on grief and he says, "Each person's grief is like all other people's grief; each person's grief is like some other people's grief, and each person's grief is like no other person's grief."

We have some universal characteristics of grief that we know that people experience. These might be things such as sadness, yearning for the person that's been lost, crying, and socially withdrawing. There are some common reactions to grief.  All cultures have some reaction to grief, and we even think that animals respond to losses and death. But then as we drill down into that, every person's experience can be very individual.

Dr. Ben Bencomo: This is interesting - the idea that we can empathize with loss and grief because we've all felt it to some level, but we can't fully understand what that person is going through.

How would you define traumatic grief?

Lisa Zoll:  Traumatic grief, in short, is the death of a loved one or a person that we are very close to, with a distressing preoccupation of that person, a yearning to be with them. I've heard so many people say that, while they're not suicidal, they would love to be with the person who is gone. They say, I just want to be with them again. There is a clinically significant impact on them and their ability to function sometimes. I've done some research on this and there's clinical debate about whether trauma and grief are individual events or entities that should be treated as such, or if there is an intersection or connection between trauma and grief, and thus they're mutually exclusive.

In my experience, I was thinking of grief in one silo and trauma in one silo, and they meet in the barn. I can't separate the two because of what I see in my office. So many of the people that I see in my office are impacted and challenged by a significant loss. A significant loss may be the death of a child as well as sudden deaths, accidental deaths, and accidental overdoses, to name a few examples. These people are struggling to make any kind of sense of their new reality. They want to know what this means, and how they can move forward without this person that they weren't supposed to have to bury. Certainly, there can be grief without trauma and there can be trauma without grief, but I think traumatic grief occurs when the loss is sudden, tragic, and/or unexpected.

Dr. Ben Bencomo: Ah, I see. For social workers that are working to support adults in this area, what are some signs that they can look for in someone that might be experiencing this interconnection of trauma and grief?

Lisa Zoll: There is some variability but also some commonality in the experience of traumatic grief. There is an intense fear and a feeling of helplessness. People feel unempowered rather than empowered, and it tends to really engulf the individual's immediate ability to cope; it overwhelms their system of coping. They feel that they have never experienced anything like this and have no frame of reference for this. And in the aftermath, those who are affected are left to identify ways to reorder their lives. 

Typically, we may feel we have some semblance of order in our lives - we have a routine, we have a job, we have a home, we have family, etc. Then, one of these events happens, and it seems that everything comes crashing in. It creates a massive amount of disorder. That disorder is a result of the event that happened, and then we are left to reorder our lives. There is an order-disorder-reorder concept. 

Earlier I mentioned the distressing preoccupation about the death itself. This can be a preoccupation with the manner of death, such as how the death occurred and if it were preventable. Maybe there is a perpetrator also that needs to be held accountable. There may be a sense of disbelief that it actually happened and how it happened. It is hard for the individual to wrap their head around the death because of the often tragic circumstances that surround it.

Dr. Ben Bencomo: Yes absolutely. Does this look different for different populations such as children, adolescents, adults, and older adults? And how do we account for the differences in how someone might exhibit those outward signs of that traumatic event?

Lisa Zoll: I am not an expert in children and grief, but my understanding is that children tend to have more somatic symptoms or regression. As adults, we don't always have words for what we're experiencing. Teenagers and adolescents may act out more. Children and older adults are the two populations that are often disenfranchised from the grieving process. This is because we may think children are too young to understand what's going on, and we may think older adults have been through it and experienced it before.

Dr. Ben Bencomo: So then people assume they should already know how to cope, right?

Lisa Zoll: Exactly. People may think "They've got this" or that they could have expected it since they are older.  That is a disenfranchised response to loss in general.

We know that when an older adult loses a spouse that they've been with for 50-plus years, that is a huge disorder; how do they reorder? 

Dr. Ben Bencomo: Yes, that makes complete sense. I think that a lot of times we make those assumptions, and those assumptions can be even more harmful than starting from the idea that a loss is a loss, regardless.  And maybe the significance of that relationship building over time even compounds the feelings of trauma and grief that that person is experiencing.

Are there any differences that you've observed in your professional practice among people of diverse backgrounds in terms of how they present, or how that traumatic grief might look different in different communities?

Lisa Zoll: The main thing I could tell you about is the difference between how some men and some women come into my office. I have worked with men who have lost wives or significant people in their life. There were two of them that I specifically remember who came in with a list of questions that they wanted to be answered, and topics they wanted to discuss. They told me what they wanted to talk about. Women can be more emotional. I know I'm being very stereotypical, but there is definitely a difference between the way men and women process grief.

I've heard the analogy that men have brains that are more like waffles, where sometimes they tend to compartmentalize things better than women, whose brains are more analogous to spaghetti, where their emotions are kind of everywhere. And again, that is stereotypical, but there is something to it, at least in some cases. Certainly, there are men that process emotions and women that can compartmentalize.

Dr. Ben Bencomo: I have heard you speak about the three D's in regard to a person's response to a traumatic event. What do you mean by the three D's?

Lisa Zoll: The three D's are disorientation, distress, and devastation.

The event can cause disorientation, we could use the word disorder as well. It may leave the individual in shock, feeling confused, lost, or in some sort of altered mental state where they are not able to think clearly or process things in their usual manner. Distress is a psychological reaction associated with emotional suffering. It can include a wide range of emotions, such as sadness and despair, uncertainty, anxiety, and fears that can be difficult to cope with and are often out of the ordinary demands of life. With a traumatic event, we have to join this world of the living, but also, we're in this world where we are struggling to maintain some sort of order. Devastation is simply defined as severe and overwhelming shock or grief.

Dr. Ben Bencomo: How might these responses change or evolve in the weeks, months, or even years following a traumatic event?

Lisa Zoll: I will go to my scholarly advice from the DSM and look at the intensity, frequency, and duration of the responses. I taught the DSM class for many years, and when we look at clinically significant distress we ask, what are the intensity, frequency, and duration of the symptoms? In the initial weeks, we think about a high level of intensity of those feelings such as sadness, despair, and anxiety. In terms of frequency and duration, it is happening all the time as we are living it.

As we move out in months and years, I use the analogy of a stereo or your car radio. At first, the volume is turned way up and almost every thought is about the loss. Over time, the volume gets turned down, sometimes more slowly than others, and sometimes more quickly than others. For the people I see, the volume is still there. Some people self-identify that they need help because they experience a tragic event and even a year out they are having a complicated reaction to the loss. For some people, others in their life tell them, "I think you need to talk with someone".

Dr. Ben Bencomo: So there isn't a timetable if you will, and these aren't mutually exclusive. You don't move from disorientation to distress to devastation in the same way. Have you seen people who cycle through the three D's over time? Or are they all compounding at one time?

Lisa Zoll: That's a great question. I think it's a lot of compounding all at one time, and it varies. I think that they are experienced in a variety of ways, at a variety of times. Therese Rando talks about STUGs, sudden temporary upsurges of grief. This can happen when there is a reminder such as a holiday or an anniversary and the volume gets turned up again and then goes back down. I often use a snow globe analogy. You shake a snow globe, then all the snow eventually settles on the bottom, then something happens and it all gets shaken up again.  

Dr. Ben Bencomo: What a great metaphor to think about. We all have these triggers, whether it's a certain song, a smell, an event like an anniversary, or a certain time of year, and it shakes everything up again. I'm a visual person so that metaphor really works for me.

Lisa Zoll: I have a little collection of snow globes in my office, and I show them to people when I explain that. 

That's one thing I wish I would've known about early on. As a clinician, you look back and feel sorry for the people you've treated first because you didn't know as much as you know now, and I'm still learning. Early on, I didn't know about these sudden temporary upsurges of grief, and I wish I could have told people that this is a very common reaction. Now I can tell them if they have an anniversary or something coming up.

I just went through EMDR training, and I think about people I had seen in the past that could have used it.  There is so much to learn about loss and grief. It is an ongoing process for us as clinicians, I think.

Dr. Ben Bencomo: Absolutely. We evolve, our skillset evolves and we continue to grow and learn throughout our careers. I've often told my students the day that you know everything as a social worker is probably the day that you should retire because we always continue to learn. And now I will be using your snow globe metaphor when I talk about STUGs.

When a social worker is responding to someone in crisis, what are ways that they can begin to support that person or those people that are experiencing that traumatic event? What should they be looking to do first?

Lisa Zoll: I'm thinking of the crisis in two ways. Crisis is the initial response to an event where we go in and do crisis intervention. The other way we can look at it is that they're in crisis because they're coming to our office.

We are always looking at the safety and security of people. My office is very non-clinical if you can imagine. I have snow globes everywhere. We have an emotional support dog in our office, a little cockapoo who is laying on the couch as we speak. The thing that makes for the best therapeutic relationship is building rapport. How we present ourselves to people is part of that, and we all have our own brand of doing that.

That includes having a space that's welcoming and comfortable. We also bring ourselves to the table. We hold space for somebody to vent. We hold space for them to talk about their experiences and things that they can't talk to other people about or that they believe other people are tired of hearing about.

I have a woman that I work with who's an Episcopal priest. We had a very long discussion one day about holding space for people and their grief and the person that is no longer with us. I think that is sort of a sacred space for people.  

We invite people to bring in pictures of their loved ones and we display them on a wall in our office. I've had people that like to come in and see that. We do a lot of different things which are really about validating their experience. One thing I've learned is important, especially in the first session, is to ask the name of the person they lost and to ask them to tell me about the person. I ask them to tell me whatever they want me to know about the person. I say,  "I'm a blank slate about Bob. Tell me everything you want me to know about Bob."

Then, I get to experience Bob through their eyes and what they're seeing. It is very important; Lynn taught me this about asking and saying their names. I don't even know if it is a clinical skill as much as a very human connection to people.

Dr. Ben Bencomo: I like that. I think telling the story of the person and adding in the ritual of having that person's image on the wall can be very helpful for creating and holding that space you described.

After we have established rapport and created that space you describe, where do we go from there? I'm thinking in terms of the intensity of emotion and the idea of "functioning" and what that actually means. We do want to help people be successful in their environment and think about how they were being successful prior to the trauma (you see I'm avoiding the word functioning). How can they return to that pre-crisis level in terms of flourishing in their environment? How do we start to move from that initial stage to the second stage of supporting a client?

Lisa Zoll: One of the things that we're looking to do is to help to reduce the acute stress of the event that happened. Lynn and I came up with this: the event, the work, the forever.

The work is what we do to try to make meaning out of the loss. The first thing that we often do is have a funeral. That may be the first ritual that we have to try to make sense of the loss and bring meaning.

Then there are other things that people do. Some people get tattoos, and some people have races or start foundations. There are also a lot of little things that we do to try to figure out how to integrate that whole narrative of trauma and grief. As social workers, we're trying to restore and enhance their coping skills or adaptive capacities. From a social work perspective, that may mean using that strength-based perspective that we talk about so often. You may ask, "How have you dealt with something like this before?" and they may reply "I've never dealt with something like this before, and I don't want to deal with this now."

Part of what we do is talk and try to figure out if there is any meaning to be made out of it. I don't know that we can ever make sense out of a traumatic event, but are there things that we want to do that we might not have done because of this loss?

Connecting people with support systems is very important. There are many studies that show that the stronger and better the support system, the better the outcome. Some of the people that I work with say that neighbors are still looking out for them or that their families are still supporting them months and years after the event.

Then we talk about timeframes, the forever. Lynn says that we loved them forever, why wouldn't we grieve them forever? We want to take off the pressure on people to find "closure". We talk about not finding closure; there are no timeframes of when you should be feeling better. People I have worked with have struggled with having a nice evening out or going out to dinner with friends, and feeling guilty because they weren't home thinking about their son or daughter.

The thing that I've come up with is that you're not betraying your loved one, you're betraying your grief. You know, your grief is always going to be there. It doesn't matter what you do. If you leave your grief for an hour, it's not going to miss you. It'll be right there waiting for you at the door when you walk in. You have permission to leave your grief. When you can offer different angles or perspectives, it is helpful. 

I also like to use the word "and". You can grieve and go out and have dinner with your friends. It is like anxiety; we say you can be anxious and you can still go to that interview. They aren't mutually exclusive. You don't have to leave one to be part of the other.

Dr. Ben Bencomo: I think that's quite profound, that idea of you're not betraying the loved one, but rather you're leaving the grief for a little while. It will still be waiting for you, but it's okay to allow yourself those moments of healing and joy. 

You talk about post-trauma counseling and how important it is to build those support systems for clients in the aftermath of grief and in the years to come. One of the ways that you have done this for people who are experiencing traumatic grief is through Grief Relief. Can you tell us about Grief Relief - what is its mission, and what services are provided?

Lisa Zoll: The tagline is, "Looking back, living forward." It's that "and". We want to be able to look back but we also want to be able to live forward so we have to make space for both of them. Our mission is to join with members of our community in a space that allows them to navigate stressful life events they've experienced at their own pace.

Part of the goal is to facilitate the healing journey by identifying ways to process past experiences and embrace the possibilities of the future. Sometimes that's hard to find for people. Our vision is to provide expert and customized services to meet the unique needs of the individuals, families, groups, communities, and organizations that we serve.

I'm trying to be a footprint in our community to the extent that is possible. One of the ways that we're doing that is by getting involved with a first responders' assistance program in our county. As a former firefighter and EMT, I am really excited about this.

We have partnered with On the Job and Off, which looks at mental health for first responders. They send their first responders that are in need of counseling to us. We work with first responders, police and corrections officers, paramedics, EMTs, firefighters, dispatchers, etc. It's ever-evolving, what we're doing.

We have a couple of different platforms. Grief Relief is the individual platform for individual counseling, Living Forward is our training and presentation platform, and GRIT (Grief Relief Intervention Team) is our crisis intervention platform. Most recently, we added GROW, Grief Relief on Wheels. We purchased a teardrop camper that is our mobile office. I haven't used it yet but I can take this teardrop camper, hook it up to my car, and we can be on-scene and on-site as needed. I am excited about how this is evolving.

One of the impetus to do the EMDR training was to help first responders get back on the job as soon as possible. I've also seen some amazing things happen with EMDR. I was a skeptic at first. I had an intern that did EMDR training and after I watched it I didn't think it was right for me. When the first responders started to come, I started to identify that we are really working with trauma on so many levels. Then I knew it was time, so I started the EMDR training last fall and finished this past January. Even if I don't use the full process, there are different parts of it that are really helpful. They help people identify first, worst, and other events in their lives that connect to these events. Two therapists in the practice as well as I recently completed the EMDR training, and now I have added this to my wheelhouse.

Dr. Ben Bencomo: Can you say a little bit more about what EMDR is, in case there's anyone listening who isn't familiar with that type of treatment? 

Lisa Zoll: EMDR is the eye movement desensitization reprocessing, founded by Francine Shapiro back in the late '80s in Canada. She took a walk one day, she came back, and she felt better. She wondered why she felt better after the walk.  As a researcher of sorts and a clinician, she realized she was scanning the environment back and forth with her eyes. She started researching that. She found bilateral stimulation was the thing that helped.

The idea is to create some sort of bilateral stimulation, such as following my finger as I move it back in forth.  Or, you can use light bars, pulsers, or a headset where the sound goes back and forth between both sides.

When I took the training they compared the fact that while they do not know exactly how it works, we are really not sure exactly how talk therapy works, either. We just know that it does. There's a specific protocol for EMDR and you develop this calm, safe place first, and then you go into treatment planning. People come up with a target incident, the image that it represents, negative cognition about themself, how true they believe that is, the validity of the cognition, and a subjective unit of distress (SUDS). Then, you get into processing in order to take the charge out of the traumatic event and the memory that people are sitting in. To use the volume control analogy mentioned earlier, we are trying to turn the volume down.

Bilateral stimulation is having one foot in the present when you're not processing, and you say, "Stop, open your eyes, or tell me what you're noticing." The other part is in the past when you are in the processing and your brain does the work. It's really fascinating to watch, and I don't know that I'm doing it justice in terms of defining it. They talk about how you get on a train, you make frequent stops, you tell me what you noticed, and then you go with that. The famous line from EMDR is, "Go with that." 

Dr. Ben Bencomo: We discussed some things in your toolbox like EMDR and animal-assisted support work. Are there any specific modalities that you have found either more helpful or less helpful in your practice experience, in terms of supporting people who are living with traumatic grief and its effects?

Lisa Zoll: I think it's often a combination of things that we pull from our toolboxes and our experience, both professional and personal. I think that narrative therapy and storytelling can be very helpful. We may have people write, journal, or write unsent letters sometimes. I think there's also a place for cognitive behavioral therapy. We work on cognitive distortions that people have, such as "I could've done more, I should've done something differently." Sometimes there is not a lot of basis for those beliefs. I have a therapist that is a certified drama therapist, and he uses different modalities. We may find many effective approaches, and sometimes our clients lead us to where they need to go, too. I like the solution-focused aspect of trying to find what may have helped in the past, and apply it to the present and into the future.

Dr. Ben Bencomo: I often have the conversation with my students that there will be some theories and practice modalities that seem to jive with the way that you see the world. And there will be others that some clients do not find helpful at all. Some will help connect with how they are seeing their lived experience with their own perspective. I think having a variety of treatment options and a variety of different modalities available to support people absolutely can be very helpful.

We know that the scale and the frequency of traumatic events, unfortunately, in our world seem to be growing ever more quickly. We have a lot of people who are experiencing traumatic grief today, whether that is a result of losing someone during the COVID pandemic, or due to natural disasters, suicide, addiction, violence, mass shootings, or other reasons. Regardless of whether a social worker is working in one area of specialized practice or not, I think that we all should have a good understanding of where to start when it comes to supporting people. People will be experiencing traumatic grief in all of the different settings where social workers find themselves, right?

If a social worker is interested in learning more about how to support survivors of traumatic grief, what would you recommend?

Lisa Zoll: Two social work publications that I know of that often have information about traumatic grief are Social Work Today and The New Social Worker. They often have articles there that are pretty relevant to things that are going on now. In the fall, I wrote an article that's going to be published in Social Work Today about traumatic grief. I think that they're trying to keep on top of what's going on, by letting clinicians and practitioners know what we're seeing and what we're doing.

I think, more so than ever, we are experiencing parallel processes with our clients today. We also experienced COVID in many of the same ways that our clients have experienced COVID. We have had the losses and the uncertainty and lived in that limbo during the pandemic. We watch the news and can't help but be impacted by seeing the school shootings and the acts of violence. We talk so much about self-care and it seems we're so bad at it.

Dr. Ben Bencomo: Thank you for that. You mentioned not taking care of ourselves as often as we should. What do you do for your own self-care, Lisa? And how do you keep having that positive attitude and creating that safe space for the clients that you're working with? 

Lisa Zoll: I spend time with Riley, our dog who is on our website. I listen to a podcast called "True Crime Obsessed" which may sound odd but it's well done. The podcasters talk about crimes, and they use humor, which I think is so important. It's never at the expense of the victims, but at the people that didn't do what they should've done and made more of a mess of things. I saw Top Gun as soon as it came out. I do a lot of reading that is not necessarily professional reading. Those are a few of the things I do.

Dr. Ben Bencomo: I think we all could use a Riley on the couch to be able to reach out to for support.

Lisa, our time is up for today. I think that this topic is one that a lot of our listeners will readily relate to, either because of their own personal experience or their professional experience. I think it's important for all of us as social workers to have an understanding of traumatic grief. We need a good level of understanding to know how to support people, and what to look for as others experience trauma and feel the aftereffects of traumatic grief. Thank you so much for sharing your experiences and your expertise with us.

Lisa Zoll: I appreciate the opportunity to have this discussion with you. Thank you.

Editor's note: This text-based course is a transcript of the EDI and What it Means in Anti-Racist Social Work Practice & Education Podcast, presented by Candice Beasley, MSW, DSW, LCSW, BACS, Warren Graham, MSW, LCSW, ACSW, CASAC, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes

After this course, participants will be able to:

• Identify the importance of diversity, equity, and inclusion in social work education and practice.
• Define anti-racist social work education and practice.
•  Associate social work's core value of social justice with anti-racist social work education and practice.
• Examine the use of authenticity in applying tenets of Anti-Racism and EDI to Practice.

Podcast Discussion

Ben: Hello, my name is Dr. Ben Bencomo, and you are listening to the Continued Social Work podcast. I want to thank you for joining us today. I am very excited. I have two guests joining me in the podcast, two colleagues and friends that I've had the opportunity to get to know through work on the Council On Social Work Educations Council On Racial, Ethnic, And Cultural Diversity. My two guests come with a wealth of lived experience a wealth of professional experience, and I am sure that you will enjoy getting to know them as I have in this upcoming podcast. The podcast for today will be part one, and we will continue the conversation with my colleagues during the second hour of our podcast.

So without further ado, I would like to introduce my two guests today. I am joined by Dr. Candice Beasley and Mr. Warren Graham. Candice Beasley is currently a clinical assistant professor at Tulane University's School Of Social Work in New Orleans, Louisiana. Candice is the practice sequence co-chair of MSW courses at Tulane University and is also a committee member on CSWEs Council On Racial, Ethnic, And Cultural Diversity. Her scholarship and research interests include anti-racism, oppression, safety in social work practice, anti-racism, and equity-mindedness in social work field education, emotionally focused couples therapy, risk assessment for witnesses of non-domestic violent crimes, and self-care/emotional wellness in African and African diasporic communities.

Candice earned her MSW from the University of Oklahoma at Tulsa, her DSW from Tulane University, and is a licensed clinical social worker and board-approved clinical supervisor in the state of Louisiana. Thank you so much, Candice, for joining us today.

Warren Graham is currently the assistant dean of field education and a clinical assistant professor at Stony Brook University's School Of Social Welfare, teaching in both the BSW and MSW programs. Warren is the lead instructor for the integrating seminar and fields of practice courses. His scholarship has included anti-racist oppressive practices and teaching identity and social justice, diversity and oppression, and clinical practice utilizing a global perspective, power, privilege, and oppression and social work, oppression, diversity, and human rights, contemporary social justice, and understanding white fragility and Black rage.

Warren has an MSW from Fordham University, BA from SUNY at Old Westbury, and is a fourth-year Ph.D. student at Adelphi University. Candice and Warren, thank you both so much for joining me today. I am looking forward to our conversation.

Candice: Thank you so much for having us.

Warren: Thank you. 

Ben: To start, if you would not mind, can you tell us a little about your path to social work? What brought you to this profession, a little bit about maybe your social work practice experience, and then your path that led to social work education and Candice, if you would not mind starting us off?

Candice:  Well, sure, so I ended up on the path to social work, personal experience, social work, personally worked for my family, but also Ben, I did not like nursing school, actually. And so when I went into my psych rotation and noticed social workers, I honestly wanted to do that, and I wanted to help people. I didn't really have a concept of what social work was, although I knew social workers helped greatly with my family in the past. And so, finally kind of stumbled into social work. Dare I say I started in social counseling. And realized that I did not like pathologizing people and that it had to be a little bit more than that. And so I had mentors along the way that said social work might be a better fit for you than counseling.

And they kind of pushed me into that arena. And then again, through mentors  telling me, “you are kind of good at teaching people, people kind of get you, and so you need to move from maybe training to teaching, have you ever considered that?” And so here I am. And so that is kind of how I moved into social work education. I did some adjunct teaching through the doctorate program and loved it. And so that is how I had kind of moved into social education.

Ben: Well, thank you. I, for one, am thankful for your mentors and for the people that helped lead you to our profession. I think that the profession is better for it, so thank you, Candice.

Candice: Thank you, I appreciate it.  

Ben: Warren, tell us a little bit about your journey.

Warren: So social work found me. I did not really stumble upon the profession as much as the profession came and smacked me over the head. So due to personal experiences, I was never exposed to social work early, but I always was interested in helping people, and I did not know what that looked like. I thought that only could be done when you are trying to understand behavior and the ways in which people treat one another and act and exist in these kinds of lived spaces. I thought that could only be done as a psychologist. So that was my plan until my last semester of undergrad, and my academic advisor said, so what do you want to do?

And I thought that was an odd question, considering the timing of my last semester. But when I told my academic advisor that I wanted to help people, I wanted to help people who are struggling with life on life's terms and in ways that are influenced by the world and the community around them. And my advisor said, oh, no, you do not want to be a psychologist. You want to be a social worker. And I said, well, what is that at? So that was the beginning of my journey to really uncover the depth and breadth of the profession and what that meant. At the time, I was working in substance use. So starting with addictions and doing addiction-specific training.

There was a certain point where I just realized I can only do so much for some of the clients I am actually working with. And a coworker said, yeah, you should go back and get your MSW because that would give you this skill set that you need to be more effective as a helper. So that is exactly what I did. I enrolled in a MSW program at Fordham University. And what I realized is this journey was not just about learning how to help other people, but it was also helping me because of that personal connection that actually brought me to the field.

So after that, I fell in love with the profession. I worked in addictions, I worked in mental health, and I worked in various community-based organizations until my mentor called me one day and asked me if I was interested in teaching a course on diversity and oppression in clinical social work, utilizing a global perspective. And I had just begun this kind of emerging scholarship in anti-racist practice, so I am thinking, yeah, that definitely aligns with where I want to go and how I see myself, and that allowed me to take my practice experience and what I've learned up until that point and really bring that into the classroom. And I have been in the classroom for 10 years since and loved every minute of it.

Ben: Thank you, Warren. I think that idea of the profession finding us is common. I think a common part of many of the stories that I share with my students as well as the idea of demystifying what social work is and is not. I think it is important for us as social work educators, especially because I think that students sometimes do have an idea of what social work is and is not, and once we realize that maybe it does align with our passions and what we want to do, that it opens so many doors and we all find a lot of alignment in that way with the profession. So I am also very thankful that your journey led you to social work and even more thankful that our three paths crossed and our shared passions led us to the Council On Racial, Ethnic, and Cultural Diversity for CSWE.

Now in that capacity, I know that we have had many conversations related to our topic for today, many conversations about our own experiences as BIPOC social workers and BIPOC social work educators. And so I, again, am just so thankful that you both agreed to join me for this conversation today. Now I know that many of those conversations have mirrored conversations happening in the profession, across the board from professional practice areas, agencies, and definitely in social work classrooms across the country. So in those conversations, this idea of anti-racism, this idea of anti-racist social work, practice, and EDI, I am going to let you two define that for us. And EDI has emerged. How would you define these terms, and in your opinion, are these terms, are they simply buzzwords? Are they buzzing trends, or are they terms that social work professionals need to be attentive to and need to pay attention to? Either of you would like to start. 

Candice: So I think that, well, I know, that anti-racism was a term that was kind of brought to the forefront by Ibram X. Kendi. And Ibram X. Kendi basically said that to be anti-racist is to be deemed to be the more appropriate antonym for racist. Right, and so you can't just say, well, I am not racist. The appropriate antonym is to be anti-racist. And so, for social work to be anti-racist is that active micro, mezzo, macro, that self-transformative work that our profession calls us to do. And it is actually embedded within our core principles of social justice. Right, and so anti-racism, it resides in our NASW code of ethics, actually standard 1.05, which tells us that we are to demonstrate an understanding of culture and act against oppression, racism, and discrimination inequalities, while also acknowledging personal privilege and engaging in critical self-reflection right.

And how are we supposed to do that? And so part of it is we are kind of negligent of that in a way. I think we believe ourselves to do that. You know, I think there is a difference between intent. I do not think, as social workers, we intend to not do that, but our impact is that we do not do that. Right, so I think. Finally, there's a word put on that for nuanced professionals entering schools of social work, our accrediting body of social work programs, which is the Council Of Social Work Education (CSWE). It requires that both implicit and explicit curriculums, through intentional design has to allow social work students to engage in diversity and difference in practice.

So once again, we are coming back to anti-racism as well because, unfortunately, our country is so deeply rooted in racism, and so it springs up once again, in our thoughts, it springs up in the way that we do things, it springs up in our values. And so anti-racism, I hope, is not a buzzword it is become that kind of buzz because of what has happened in our construct. But nonetheless, I think it is something that's going to solidify itself within social work for a very long time. And it is something that we need to be attentive to, not just BIPOC folks within the profession; everyone has to be attentive.

Ben: Absolutely, so more than just intent to do this, but actually living it out, living it out and following it through to who we are as social workers and our practice. Warren, anything that you would like to add to that?

Warren: Absolutely, and when we think, and Dr. Beasley talked about the difference between intent and impact, and as social work educators, we really need to take that to heart. What does that mean as we talk about the difference between implicit and explicit curricula? What does that mean when we are actually in the classroom? You know, what does it mean for us to challenge the lived experiences and the self-reflection of students in front of us so that we can reinforce these, the code of ethics and the requirements by CSWE to kind of disseminate this information. EDI as equity, diversity, and inclusion is, for me, just basically removing barriers for equitable treatment, even if that is in the classroom, even if that is in an institution of higher learning. You know, we do need to decolonize social work education if our intent is to actually teach students how to be agents of change in the communities that we serve.

One of the things that Ibram X. Kendi said, which I love, is it is not just enough to be not racist, right, you have to be anti-racist, and it requires an active fight against personal, political, and institutional barriers to oppression and policies that support marginalization and subjugation. And I will respectfully disagree with my colleague in that I do think it is trendy now, and that is not good. You know, I think in this woke cancel culture, it is becoming the thing to claim to be anti-racist. It has become boutique in a way that is performative. So if we are really going to do this meaningful work, then we need to do it very thoughtfully.

Candice:  I completely agree. I do not disagree that it is trending. And I guess what I am saying is it should not be because a word has now been given to it, but since the inception of social work, this is what we should be doing. However, a word was not given to it. This is what was implied all along. That we should have been doing, it is just that we have not been acting upon it. You know, I would even say that I believe June 26, 2020, the American Academy of Social Work And Social Welfare also initiated the Grand Challenge For Social Work, right? So let us go past the Academy for those people listening, who is like, well, maybe that's some higher institution stuff that these social work educators, that stuff, that's their stuff.

We are calling social work as a profession. So whether you are a researcher, whether you are a practitioner or anyone who is holding themselves out as a social worker, who has the terminal degree of MSW, this is for you as well, so the American Academy Of Social Work And Social Welfare, basically the Grand Challenge For Social Work to eliminate racism by promoting prevention and intervention programs, to eradicate racist policies, bias, and discriminatory practices within American society and called social workers to do that. So this is not about those of us who are in higher education. Anyone with the MSW terminal degree are called to participate in the Grand Challenge Of Social Work. And this was in 2020. So this is not for those who are new to social work like, oh, let us leave this to the young people to do.

This is not, oh, let us leave this to the higher education people to do. If you hold yourself out as a social worker, this is for all of us to do because these are the tenants of social justice. And if you hold yourself out to be a social worker, it is for you to do as well, all of us, and no one is removed from doing this.

Ben: Absolutely, and I think that from the inception of our profession and as our profession has evolved over the years, we have sort of become a bit passive. I think this idea that I am not racist and my social work practice is not racist, but when we allow ourselves to get complacent in that way, then we aren't being true to this idea that Ibram Kendi gives us this idea that the grand challenges give us of being actively Anti-racist, not only not engaging in it, but what are we doing about it, right? And so a little bit ago, Candice, you mentioned this idea of social justice. Now, considering that social justice is a core principle of the social work profession, why does our profession need to have this conversation?

Why is it important that we extend this from this podcast to wider areas, this idea of anti-racism, this idea of equity, diversity, and inclusion, and also, should this understanding and application of these tenants not come naturally or instinctually for all social workers? I'd love to hear your thoughts on that.

Candice:  So we would like to think so, I mean, we would like, we would like to think so, but you know, so we, as a profession, unfortunately, are reflective of our construct. And although it may not, again, be our intent to be explicitly harmful, the impact of our harm is there, and we can look at any genre of social work. We start seeing these little things creep up, right? We see this in child welfare, for example; every so often, do not we see this, where we have to call people to the carpet, like, what are you doing? You know, once again, we have this disproportionality and what's happening. We call social workers back to the carpet about discriminatory practices in child removal, right?

And medical social work. Then we have these issues where we are calling people to the carpet about disproportionality and how discharge planning is happening, right? And so all of these kinds of different issues within practice. So if we want to say that these issues of discrimination and racism are not happening in social work practice, then we are not being honest with ourselves because if that were not the case, then we would not have these little things that are constantly creeping up whereas a profession, we have to call ourselves back. This is not just happening in medicine. This is not just happening in other fields; this is social work. And the reason I am bringing this up, and I am not picking on child welfare. I am bringing up child welfare because that is the genre of social work that is basically controlled by social work.

And that is where you see a large number of disproportionality of BIPOC children. Right, and so once again, we have to give credit to the fact that our profession is reflective of our construct, but furthermore, in 2015, CSWE found that if we were to analyze our profession overall and what people do not realize, it is 70% white, it is 70% white, 70% status quo. And so because our country functions in a system of white supremacy, according to CSWE, the social work profession functions in a system of white supremacy. And so again, who is it that social workers are helping us? Social workers are helping, and I am air-quoting BIPOC folks, but who are actually the people who are controlling the social work profession, and who are social workers made up of?

Status quo people, and who are the people at the top, like who are the deans of universities, who are the CEOs of social work agencies, who are the people who make it, they're actually white men. And then right under you have white women, that's who's actually running it. You understand, so, I mean, let's be honest, Ben, myself, you, and Warren, we are not the main people who are making up, you know, folks in the university, and I am going to just be candid. We are the people who are blessed slash lucky. And let us just be honest, you understand? So most of the people who look like us and who are reflective of us are in the trenches working. The people who look like us are not the decision-makers. They are not the policymakers in the social work profession, and here lies the problem.

Warren: And to add to that, when we identify the problem, you know, we are extensions of an existing construct, right, to use your words. And for some, that means we lack legitimacy, as we are talking about some of the challenges that we see. It should not have to take I. There was a time when I oversaw the adult and juvenile drug court programs in my community. And all of a sudden, CPS said, Child Protective Services said, maybe we should do blind removal meetings. So that as we are talking about taking children out of the home, we are doing it in a way that is sensitive to diversity and sensitive to identity and not punitive. You know, so as you pointed out, Dr. Beasley, like these mandates have always been part of our profession, why did it take in the 2000s for us to say, maybe we should wake up and start paying attention to disproportionality in the ways that margination marginalization is affecting communities of color, and maybe, and I found a study, a workforce development study maybe seven years ago that said is as high as 87% of social work are white women. So how are these white women being socialized to understand the difference? How are they being socialized to understand the nuances of working with differences in different cultures and different racial ethnicities, and what does that actually look like? Because if these are the decision-makers, and there's a lack of familiarity, which hasn't been reinforced by articles that are being used in schools of social work, by practice experiences that aren't connecting these student learners to diverse populations to learn from, then we are absolutely failing. We are absolutely failing the future of social work. And we are failing those communities that rely on us.

Ben: So, are we listening before we are helping? Are we actually engaging in social work practice that seeks to bring people in and understand their lived experience before we engage in that social work practice that we have been taught in that way? I actually, I'd be interested to hear from both of you as BIPOC social work practitioners and later BIPOC social work educators. Can you remember a time when you felt that the social work profession didn't fit with your own worldview, with how you viewed the world, and in what way?

Candice: It does not. Warren, you want to go first?

Warren:  You know, I am reminded almost daily how my being a BIPOC social work practitioner and educator in the field of social work, the profession of social work, has not kind of fit into my worldview because I see the world through systems and I see systems of domination and subjugation and oppression, and I see how these systems affect those who already marginalized, those who are already for lack of a better word damaged, who have been abused by these systems. So you know, we can do psychotherapy, we can do counseling, we can do case management. We connect individuals to systems but well to services. But if we do not pay attention to the systems that govern and oversee these individuals' lives, then what are we really doing?

You know, it is putting a bandaid on a gaping hole. And I used to think that my being a BIPOC social worker an educator would balance the scales. But you know, I have been, I have been in conversations with peers who not only did not understand concepts like implicit bias and microaggressions but didn't subscribe to them. So for me, those moments were wake-up calls that just because you are a social worker, just because you are going through a CSWE accredited program, just because you've been socializing what I thought was the same way that I would socialize to see the profession, that your lived experiences balance that scale. And you know, you can actually see the world quite differently.

So I have been reminded as an educator, as a practitioner, and as a student all across the social work institution that I have attended that I have been made to feel like my perspective was that of a minority. And it has been suggested that this is just my thing in air quotes, this is my thing. This is my hang-up. Not that I am speaking for untold amounts of BIPOC social workers, who are struggling with these ideas and experiences in the same way that our clients are struggling with them.

Candice: Yeah, I would have to agree with Warren, and it becomes kind of difficult. And I know that you all can relate to that because you are expected to do a job, correct? So you go in, and you are expected to be that practitioner for an agency, or you are expected to be the instructor or professor within the university, but then you find yourself also having to be a translator. And you are expected to be a protector because you are now working for a system that was not meant for you to be in, and you are working for a system that was not meant for your BIPOC students to thrive in, but yet, and still they've allowed them to enter into this system and what are you to do, right?

And do you let them fail because they do not understand how this construct is set up? They do not understand how it is made, yet they are brilliant in their own right. It is not set up for them to succeed because they do not understand how to take tests. CBT does not quite fit how they are to process things, you understand, strengths perspective or brief solution focused. The miracle question while I just got the hell beat out of me, and you want me to foresee what?. I do not know if I will be living tomorrow, but you want me to foresee something five years from now? I mean, so those things start becoming quite different, you know, for people of color.

And I am not saying every person of color, but that is a very Eurocentric construct, you know? And then, we move on to licensure, which is a very white construct. So it starts becoming very difficult, you know? And so I think for the person of color who is also the practitioner or the professor, we start getting very worn very quickly because we have numerous, numerous responsibilities that most white instructors or white practitioners do not even have to consider, and I am not saying, please, I want it to be understood. That does not mean that I do not have status quo instructors who stand in solidarity with me, who get it and understand it. And who will walk with me and walk on the side of us, you understand, and who fights the fight with us?

But I am just saying there are few and far between. Very far and few between because, as Warren said, some people just do not understand it. They do not see things the way we see it. And I will even extend that, Warren, not only do they not understand, they do not see things the way they see it. They will disagree with you, and they will turn around and still micro-aggress you. They will do it because they do not even understand. They do not even understand that concept, and they will harm us, and we get harmed. And what are we supposed to do? They are our colleagues. You know, and I have been harmed. And  I will say this, even working at Tulane University, you do not think it is difficult working at a university named after someone who was a slave owner.

That is difficult, you know, and so, but I mean, I am not saying that the university is not trying to change that narrative, but we are well aware of who Paul Tulane is. We are well aware of that, you know? And so when that goes back to what we were talking about earlier, Ben, when you are working in a construct that is so very deeply rooted in white privilege in white supremacy, and people will say, well, if you have a problem, somebody is going to listen to this, if you have a problem, then go work at an HBCU if you have got such a problem with it, go work at an HBCU, but then you do that. If all of us leave this construct and go to an HBCU, then what happens to the BIPOC students who are there? Then who helps them and who is there for them because they deserve to see someone wholooks like them as well. So it is difficult.

Ben: Absolutely. And not only just those students who are looking for that identification in their instructor but the other students who need to have that experience and learn from it as well. If we are sheltering ourselves within a community that already lives this, that already understands this, and we are not extending this conversation to those people who live outside of that reality and who have no idea what it is like, I think that in that way, we many times can do more harm than good because it is comfortable for us, and we are told that it should be comfortable to stay within these constraints and in these environments, because then it does not make other people uncomfortable, right. I know that, for me, in my experience, part of it has also been in, what is the end goal, what does that finish line look like, and who decides that?

Right, from social work practice as a BIPOC practitioner, what does success as a social worker look like? And then, as a social work educator and looking at tenure and promotion and looking at all of the things that we experience that are expected of us, who sets that end line, and what does that look like? And then if I turn that to look at clients that I have served in communities that I have served when we talk success, and when we, thankfully we are moving away, the conversation is moving away a bit from the idea of competency, but who decides competency and who decides what success is and whose lived experience is absent there? So when we are working to support our students, when we are working to support our clients to be successful, to be, to reach that finish line, who is the one that decides that finish line, I think, has to be a part of that conversation as well.

Candice: Absolutely. I agree.

Ben: Yeah. So in that, to continue the conversation a little bit, in addition to our social work profession's ethical commitment to diversity. The profession also calls us to recognize the importance of human relationships to respect the dignity of each person and to practice with integrity, right? These are our NASW core values. Now in a few conversations that the three of us have had before, I know that we have also reflected on this idea of authenticity in our social work practice and authenticity in our social work education. Can each of you discuss what this idea of authenticity means to you, and how does this impact the idea of equity, diversity, and inclusion in social work?

Warren: So, if I may, I think it is so important when we think about the importance of human relationships and what that means and respecting dignity and practicing with integrity that we show up and being authentic means showing up as my most honest, real self in a way that's helpful for either students and helpful for helping to clients. You know, we can all sit in classrooms and who will teach us when to disclose, when not to disclose, what to disclose, and teach us a very sanitized way, interacting and engaging in ways that do not allow us to share our sense of self with the people that we are working with. And find that to be a disservice, a disservice to the individuals that I am sharing space with. I think it is a disservice to me, stunting who I am, not bringing that into that space because my experience is the sum and substance of who I am. That is the third person in that space that I could lean on.

And I think it is important that the programming that clients are exposed to that students are exposed to, which reinforces these ideas of marginalization. They are not just reserved for, lets say, our students of color or our clients of color. You know I, it is likely that I have experienced some of these things too. And that might be a powerful bonding moment between myself and a client or a student, especially if I can then make that cycle educational to talk through what I did to cope, what I did to weather the storm, what I did to survive in some of these conditions and experiences. So authenticity, I think we really need to expand what that is. I think we need to challenge what that is and really promote a way of interacting with and meeting clients where they are, but also remembering that they are meeting you where you are as well in ways that can actually support their growth.

Candice: Right, I believe it was Carl Rogers who pointed out about authenticity being integral to have any kind of meaningful therapeutic environment, any kind of meaningful, purposeful environment, so whether that is in practice, whether that is in research and whether that is in the classroom, it's being one's genuine self. And I think that what professors have issues with, researchers or practitioners, is also saying that I do not know. And it's okay to say. I do not know because you do not know one's lived experience. How could you know? And I think that BIPOC folks understand status quo folks because we have no choice. We are placed into a US construct where if we do not know the status quo's story, we will not survive in this construct.

We must know it if we are to be successful in any way, and that is what status quo people must understand. We must be very fluent in a status quo construct if we are going to survive. If we are going to be successful, we have to. However, status quo, people do not need to know our story. Our story is minimized, right? And it is meaningless in a status quo construct in some way, right, unless one is just simply curious. And the reason that I say that is because now when it comes to people of color, black and brown or Asian folks telling their story, it is almost like prying. And that's very important to understand, so this is why some people of color are seemingly put off or become angered when people are inquiring about our story because it is not authentic, it is almost prying, or it is almost kind of like picking or it is kind of, you know, trying to like pick open a wound that's not ready to be opened yet.

And I will say that part of authenticity; if one comes with decency and genuineness, I am really trying to understand, then maybe one will be more open to sharing that story. However, you also have to understand something. I do not owe you anything. I do not owe you my story either, right, because my story is mine. And so I think this is when, in discussions where people just have to be decent with each other, if someone wants to share their story, then take that story and honor it right, and be decent. But you know, I consider myself African American, I have other stuff thrown into that, Warren, African American Warren as other stuff, but Warren and I do not have the same story.

Although we have shared stories, we do not have the same story. So if Warren shares a story and I choose not to, then it would be a misnomer to just extend Warren's story to mine. That is not fair, and it is not right. And we find that people do that often, but at the same time, if I do not want to share my story, please do not think me to be combative. You understand. I am not sharing that for a reason. Right, maybe my story is too raw. You know, then I tell my students, if you look at my story, I do not mind saying it. because I think I look amazing for my age, right? I am like I am 44 years old, but on one side of my family, do you know, I am only like six generations out of slavery and five generations out of indentured servitude. On the other side, I am five generations out of slavery, four generations out of indentured servitude, and you want me to sit here and have a discussion of slavery as if it happened 300 years ago?

Not for me, maybe for someone else, but not for me. And I bring that to students' consciousness and awareness. That is something that you may feel happened so long ago hasn't happened so long ago for other people, you know? And so that is why authenticity, I think, is so important because it helps us stay human. And that is one thing that, despite white supremacy and discrimination and oppression, one thing that we all have in common if you want to get past anti-racism and DEI, that I hope that one day we all find we all are human. And if we all can find that connection of humanness and decency, then maybe we can be our authentic selves. Maybe we can sit down and have these conversations and understand one another and having these conversations with each other.

Ben: Absolutely; practicing from our authentic self takes work. It is not something that necessarily just happens, but something that we have to be conscious of. I know that in a lot of social work classes that I teach, and I am sure in many of your classrooms as well, I try to instill the importance of this idea of authentic self-reflection and self-correction to my students. This idea of reflecting on that old idea of cultural competence, do not even get me started on that, that's one of my, one of my, this conversation will shift if you get me going on that, on that term cultural competence. But the idea of reflecting on that on that, that old idea of cultural competence and engaging in a true and pure effort at self-reflection in a more meaningful way, I think, is also a big part of those current grand challenges of social work and those challenges for us as practitioners and those challenges for us as social work educators. Can you say a little bit more about why this is so important?

Candice: Which part?

Ben: This idea of authentic self-reflection, this idea of authentic self-correction and thinking about it in a different way, and why now is the time, now that we are engaging in the grand challenges, why is this authentic self-reflection and self-correction so important right now?

Candice: Well, it is one of those things; if not now, exactly when? I mean, we have been a profession for quite some time, and we haven't done it yet. I mean, at what point are we going to do it? You know, and social work, we have done so much harm, and one of the things that we need to call ourselves to correction is what is dangerous about social work. Social work is a beautiful profession; it really is, but what is dangerous? Social work is also a very dangerous profession. Because we cause, harm people do not see. Unlike medicine and in other professions, you know, if you write an incorrect script or you cut, you know, somebody the wrong leg off, well, my goodness, you are going to notice that one, but when you severely harm somebody, and you hurt someone so deeply, and then that person goes home and harm themselves who will know that?

No one will know that story. And we do that to people. And how many of us have done that to people, that deep-rooted harm, you know? And I tell my students it is a harm to the human spirit that we do to people all the time, day in and day out. And we go home, and we pat ourselves on the back, and we think we have done great work in social justice. And we have annihilated people's souls over decades. So at what point exactly are we supposed to start this work, if not right now? And as a profession, we are so quick to look at other people and look at other people's professions we are quick to say, oh, Mr. President, you need to do this. And we are quick to say oh, this group needs to do that. And then, when it comes to our group, we need to be aware. We need to start working on it.

No, at what point are we not going to hold ourselves accountable? You know, and at what point do we maybe push people out of our profession? I am going to say it there are some people that do not belong in our profession. There are some people who do not belong here. And I know they thought they meant well, but I am going to just say it. If you cannot move with the flow of what we are supposed to be doing, maybe you need to, what do they say, free up your future. Maybe you need to free up your future and do something else. I mean, look, we live in the United States of America, we got so many racist professions you can be in. Go find one of them because social work is not one that you need to be in, you know? And we just need to do better. There are too many people hurting in the world. So I think that authentic self-reflection is part of what makes us human, and let us be one of those professions to be human and to show humanness, that that is my personal take on it. 

Warren: Oh, I love that. So yeah, what she said, but. When I think about self-reflection and self-correction, and self-assessment that requires vulnerability and no one, even the racist student, I do not think they even go into this profession to fail at it. So the idea is that they cannot be vulnerable because that, for them, means failure. I think that is also really important. In order to heal the hurt, what is being done is students and future social workers, and existing social workers are causing harm from a place of deficit. And to bring up that there is a deficit, for them, attacks this self-concept and attacks self-esteem when it does not have to be.

So just as a brief story, overseeing field, we interview students for their placement choices, and we ask them about their lived experiences and how those experiences might contribute to the work that needs to be done in any given organization. And I have had students say that their ultimate goal is to become a psychotherapist. So we talk about how that is not social work, but it is service delivery, right? And just on probing, why psychotherapists to have students say, I have never grown up around diversity in difference. And for me becoming a psychotherapist, I can control for diversity. I can control who comes in that door. So the idea that we are practicing out of fear, the idea is that we are moving away from the grand challenges, the code of ethics, and everything else that would suggest we are preparing students to be able to work with everybody, with the foresight knowing that they are coming in with a very narrow view of where they want to go.

And even their field placement choices reflect that, you know, put me in private practice because, ultimately, that is where I want to go. Well, how is that going to help you with understanding all nine core competencies? And what they look like and may help with engagement or maybe assessment, but what about the others? You know, so it is, that self-reflection is, I think, what is lacking, and I think in order to adequately and inappropriately address that, we have to literally envision ourselves as gatekeepers for the profession. Like Dr. Beasley said, not every student sitting in that seat needs to graduate, and not every professional who is already in the field needs to stay in the field.

Yeah, I received an email when I started private practice from someone who found me online and wanted help. And the email said, N-word, you do not belong in this community. And when I shared that with the social worker I shared space with, she did not initially understand why that was a problem. So the idea that someone was on a website who needs help and is looking for help, and my picture triggered that person to the degree that they would then reach out and send me an email, that is problematic, right, and it is problematic that would not and did not outrage everyone who actually heard that story. So we need to do better in encouraging self-reflection and actually moving towards self-correction for students and colleagues.

Candice: And I agree with that, and I agree with that one, and I do want to throw in because I am that person who always wants to be fair, right. But I would also say, and we would be remiss if we did not say, that people of color and colleagues of color and students of color must also be patient when there are status quo, people who are trying to authentically and genuinely understand and go through that process, that we cannot hold people to the fire and accountable when they're really authentically trying to understand, because we do that as well, that when people are in space, and they are like, please help me, I am really trying to understand, and I am trying to do better.

And I am recognizing that I come from a place of white supremacy, and I am recognizing that I do not understand this. Can you please just try to help me? Although it is not our work to do, but whose work is it? And so they are like, I am really trying to understand and how very hard we condemn those people and how very hard we come down on those people. And so I will also say because we would be remiss if we did not do that, we also play a part in running people who are authentically trying to understand and grasp these concepts and are authentically trying to do introspection and self-reflection and change. We are also scaring them away as well because then we lower the boom on them, and we start yelling and fussing.

I have seen that happen in classes as well, where I actually have to back the students of color off of a very well-meaning status quo student who just really do not understand, and they're really trying to understand, and people are yelling, why do not you understand this concept? And they really just do not. So once again, going back to being authentic, decent, and human and having patience with one another, working with one another to understand these concepts, and all of us are hurting in some kind of way. And to be honest, racism, discrimination, oppression, and white supremacy is hurting all of us. It's destroying all of us as humankind, it's it really is, you know, and it's taking away decency from all of us. So I think all of us need to do a little bit better by each other.

Ben: Absolutely, and so along with that, can this idea of self-correction exist without authentic connection that you are speaking to now?

Warren: Absolutely not, because I do not think that allows you to treat the people around you and the people in your space as human. I do not think it respects who they are. It does not respect the relationship between the two of you. So how are you going to kind of get in touch with who you are and your experiences, and even understanding your limitations around self-reflection and self-correction. If you do not build an authentic, real relationship with the other person, you may be engaged in a conversation with? Like I said, that requires vulnerability. It requires someone to say; you know what? I do not know; I do not know how to help you. I do not know what that means. Can you help me help you, right?

And it sounds hokey, right? But literally, help me to understand because I have no frame of reference. Actually, that admission comes from a place of power, and we should not minimize that. We should not make students feel less than because they do not know. Going back to what Dr. Beasley said earlier with backing BIPOC students off of their peers who may not understand what it is to live under the constant weight of oppression. We have to do better, and we have to start encouraging first faculty to start having these authentic relationships with students so that students can mirror having these relationships as interns. And hopefully, they carry this with them into their professional life.

Candice: Absolutely, absolutely. I completely agree with that. You know, and that is another problem. I think in practice, if you have the practitioner who is scared to have these conversations fearful, and now in the classroom, you have the instructors fearful to have honest conversations. And that is another problem for a whole different webinar, you know, fearful of having these conversations. Then, of course, and I have seen practitioners who are fearful of asking their clients, well, tell me about your lived experience or clients saying, you know what, I am hurting because this is what's happened in the world, or I am hurting because these things are triggering me and just practitioners glancing over that. And then coming back and saying they will not even acknowledge that.

And I am telling them that this is what is causing discord in my home. Can you help me find another therapist? Because they won't even acknowledge that this is what's hurting me. And it's really because the practitioner is uneasy about even having these conversations as well. And then they just want to go back to, well, tell me about you thinking about divorce. They just want to jump right back into CBT and those types of things. And it is just not going to work. I think as social workers, once again, we have got to be okay with not being okay and having these conversations. Racism is just something that is part of the U.S. construct, whether you like it or not.

And it has to be something that we, as professionals, have got to be comfortable with discussing and speaking about with one another and all of us who are currently living right now. We did not produce it, we did not create it, but we sure perpetuate it. And we are the ones that must deal with it if we want life to be better for those of us coming after us.

Ben: Right. Right, so with that, I just want to thank you both for joining me for this first hour of the podcast for those of you that are listening. I do hope that you'll continue this conversation with us in the second hour of our podcast because this is just the beginning. And this first hour, we have discussed what equity, diversity, and inclusion are and what anti-racist social work practice is. We have talked about who we are as a profession, what our core values are, those ideas of social justice, those ideas of an ethical commitment to diversity, those ideas of human relationships and respect for dignity, and why this idea of anti-racist social work practice and anti-racist social work education is so important.

In our second hour, we are going to hopefully continue to make ourselves feel a little bit uncomfortable because we are going to talk about why we fear change, why we fear that status quo homeostasis that we have been socialized into in our social work profession. And we are going to talk about what we can do with that. How can we truly commit to this idea of anti-racist social work practice, to this idea of authenticity, this idea of authentic equity, diversity, and inclusion, and where do we go from here? How can we then take that commitment and mobilize it into creating action. Warren and Candice, thank you so much for joining me on this first hour. And I look forward to continuing with part two of this podcast conversation.

Candice: Thank you so much for having us.

Warren: Thank you.

References

A complete list of references is available in the course handout. 

Editor's note: This text-based course is a transcript of the A Call to Action: How Can Practitioners and Educators Engage in Authentic EDI Guided Social Work Podcast, presented by Candice Beasley, MSW, DSW, LCSW, BACS, Warren Graham, MSW, LCSW, ACSW, CASAC, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes

After this course, participants will be able to:

• Consider the difference between workplace/classroom safety, therapeutic safety, and the use of safety as a critical conversation avoidance tactic.
• Evaluate social work's commitment to anti-racist social work education and practice.
• Decide on how best to create space for brave conversations in social work education and practice.

Podcast Discussion

Ben: Thank you for joining us for this second hour of our podcast on equity, diversity, and inclusion in social work practice and education. Since you are back for part two, we did not scare you away. I am joined by my wonderful guests, Warren Graham and Candice Beasley. During our first hour of this podcast, we discussed the idea of anti-racist social work practice and the ideas of equity, diversity, and inclusion. We demystified the idea that this is something new in the social work profession.

We talked about our experiences as BIPOC (Black, Indigenous, and other People of Color) social workers and social work educators. We also discussed the idea of authenticity. If we are going to engage in anti-racist social work practice and be faithful to the ideals of equity, diversity, and inclusion in moving our profession forward, we have to be authentic. We must be authentic with our lived experiences, self-reflection and self-correction processes, and conversations with colleagues and those outside the social work profession. We can invite them to listen and learn from our experiences to move this conversation forward.

If we are going to do this, we have to be okay with being uncomfortable and courageous. I encourage my students to engage in courageous conversation. Courageous conversation means that we have to be uncomfortable and okay with knowing that we do not know, and we have to be okay with the understanding that to learn, we have to be able to be courageous enough to put aside our fear of change and the homeostasis in which we live.

I want to start there, if we could, Warren and Candice, with the idea of addressing the fear of change and homeostasis. What are your thoughts on that?

Warren: When I think of homeostasis, I do not just think about equilibrium but the status quo. The status quo has not worked out well for us so far. We have to challenge what homeostasis means. What is our benchmark, the foundation, or the norm? We may find that we have been operating from a place that is already broken. Perhaps, we do not go back to homeostasis that was already created for us, not by us, and take an honest look at where we are, where we have been, what we have done, and what has yet to be done. Then, we can create a new standard that becomes a foundation for that homeostasis.

Candice: Absolutely. As social work professionals, we cannot ask others what we are unwilling to do. As researchers, do you not ask people to participate in your research, and as practitioners, do you not ask your clients to change? As professors, we ask our students to engage, change, and meet a learning curve, yet sometimes, we are unwilling to change anything. Nothing comes from staying stagnant. We may be comfortable in our space and how things have always been, but the world is changing. The people who do not move forward get left behind. I do not know about all of you, but I am not near retirement, and I think social security is moving the retirement age.

I tell my students you can think however you want, as we are all human and have discriminatory beliefs. Suppose your values are a little archaic and behind. In that case, when you step outside your door threshold, you are now a social work practitioner for humanity and do not have the authority to be racist or discriminatory. Those who have been in the game a long time have to change our thinking unless we do not want to do this anymore. Life is changing, and technology is advancing with Facebook, WhatsApp, videoing, live streaming, et cetera. It is only a matter of time before you get caught if you are being harmful, and this is not even about getting caught. Things have been happening for a long time, but it is now coming to people's conscious awareness due to this technological advancement.

We need to hold others accountable for things like racism, DEI (diversity, equity, and inclusion), hegemonic masculinity, and discrimination toward people with different abilities. Even if you do not ascribe to the whole racism thing, unless you are a white male, you will fit into one of those categories. If you want people to understand the fullness and totality of that and move the profession forward, you have to be a change leader into whatever category you fall.

Warren: I want to add something to that because you said something important. You talked about us being social workers for humanity. When I started teaching some of this content, it was under the guise of social justice. I was late to the party, understanding that social justice was a component of human rights. I have to become educated to be introduced to the universal declaration of human rights and what that means. If we reframe how we view social justice and socializing students to the profession, we may do it from a human rights perspective. And if we do that from a human rights lens, then perhaps we will not be so hesitant to change because we have already been changing.

Our language in the field has become a lot more inclusive for individuals like those in LGBTQIA or differently abled. We have been changing to accommodate the different ways in which people show up, but we still do not embrace change as it relates to issues of racism, power, privilege, and oppression. I think that is the last stronghold that we need to conquer. Without change, there is no growth. The world around us is ever-changing, and we need to be fluid to change with it if we continue to work in this field.

Candice: Absolutely. The intersectionality of race and those other issues of oppression (e.g., differently abled and race and LGBTQIA and race) becomes highly convoluted.

Ben: If we ask others to be comfortable enough to listen to our story and lived intersectional experience, we must be open to change and learning from others. We have reflected on how pushing through feeling uncomfortable is vital for social workers. What are your thoughts on how this relates to social workers with privilege?

Candice: Social workers with privilege do not have any problem with people feeling uncomfortable when they tell their stories. For example, a privileged social worker may be comfortable with a certain "uncomfortability." What do I mean by that? Let's take a social worker with a research agenda or a dissertation on violence and rape. Some people are very uncomfortable with violence and rape, especially if that is their issue. Professors with privilege will walk into a classroom and freely discuss rape, a sensitive subject. They will infer you need to get over that because this is their research agenda. They may say, "What will happen if you have a client that comes into your office, and they have been raped? You need to gain some comfortability about that because we are part of the helping profession, for goodness sake." If you have a client who has been raped, you have to do everything you can to help that person, and that is completely true. But if you have someone related to the George Floyd family who comes in and wants to discuss that, then this is when the world will end. What if you have someone struggling with addiction because they are a descendant of a member of the Trail of Tears, you understand that is now a different issue, but the same tenants apply. Just because someone comes from status quo privilege does not mean they do not have problems, but they are free to tell their story. I think people of color do not appreciate that they are forced to be comfortable with others' stories, while those of privilege do not want to hear theirs. They have the power to control policies and silence stories. We are told we are combative or our stories do not fit their curriculum. 

In academia, they often say, "You need to focus on helping students pass the licensure test?" Why are we talking about that, Ben? Let's not talk about that. Diversity and oppression are not on the licensure test. Many universities offer only one DEI course, yet we expect them to be this expert on diversity and oppression. Unless they have a very learned professor and this content trickles throughout the curriculum, and in other classes, we cannot expect them to be experts. I will say that the privileged force others to be comfortable with differences that they are comfortable with, but they have the power and privilege to silence differences that they are uncomfortable with; there lies the problem.

Ben: As social work professionals, we no longer have the privilege of being silent. We have an ethical mandate to speak up when we know that people are being harmed in any way. When we apply that same thinking to our profession and us as the privileged few with education, licensure, and all those fancy letters after our signatures, what do we do? One of the very first responses I received from a good friend after defending my dissertation from a good friend and fellow BIPOC professor was, "Remember Ben, we lift as we climb."

How do we use our position to continue to invite others to this same level of professional privilege? How can our listeners, who might be social work educators or practitioners, draw upon our privilege to invite BIPOC students or clients into these conversations?

Warren: I think being able to draw on our privilege has to be done very delicately. I am thinking about race-based microaggressions in the myth of meritocracy. When I lean on my privilege, I need to be mindful that at some point, someone will say there are no glass ceilings for people who look like you because you have achieved a certain status. I frame leaning on my privilege or using my positionality to support who I am and what I do by discussing this carefully to avoid race-based microaggression before they happen. We need to be intentional about the language we choose.

Additionally, let's lift as we climb. We must understand that there are people who do not occupy these spaces, and there are rules created for them that do not reflect their needs and wants. I think, where possible, we should level the playing field by using our positionality and identity to sometimes speak for those who have no voice. It is not just a matter of having a seat at the table, but it is also having voice and power at the table. I think that is part of our obligation to use what we have to advance a larger agenda.

Candice: I will also say having an education with an education. I usually do not share this with many people, but when I was in high school, I was placed at a "status quo" high school, not my choice. I remember my elders telling me, "You are going to this high school, and you won't like it. But you're going to go because they will teach you what they know." Although my elders were not well educated, they knew I had to become "bilingual" in this different educational construct.

As a BIPOC faculty member and practitioner, one of the significant roles I take very seriously is educating students on navigating white social work. Many do not understand that we are in a white social work construct. When you are brought up in a BIPOC environment with BIPOC jargon, it is hard to understand, even for knowledgeable people. They do not know what is meant by silent coding and innuendos. I never bothered or cared to ask, but I am unsure if some status-quo people understand that BIPOC people do not always understand what they mean by certain things. I am very well-versed in understanding certain looks and ways of doing things, and I have taught my eight-year-old son what kids mean when they do and say certain things. It is a whole different construct than how I was brought up.

I use the word construct constantly, but BIPOC people live in an entirely different world than white folks. Again, I do not know if they fully understand that we must navigate both worlds. So I view our position within academia and as clinicians as responsible for teaching our students and clients how to navigate those worlds. I genuinely mean this. If we do not learn that, we do not survive. We are here because someone taught us how to navigate those worlds. For instance, I am from the south, and we are animated and loud. When I entered the university, I had to tone that down because I would be seen as disruptive, angry, or combative when I was only loudly laughing. I have learned how to lower my tone, soften my voice, and say things in a certain way so I will not be viewed negatively. I have to teach my black female students how to lower their voices, change their intonation, and ways to say things so that people will give them a chance. I tell them that if they say things the wrong way, they will not have the opportunity to see their brilliance.

An example is that you say, "Hi, Dr. Bencomo. How are you doing?" rather than, "Hey, Ben. What's up?"  This is the learned behavior of navigating through these different constructs; unfortunately, we have to do that and not be our authentic selves. There is authenticity for survival, and then there is authenticity within the profession. For people of color, we also have different meanings of authenticity, but that is a whole other podcast.

Ben: Many conversations with my students look more like the latter in your example, but I get your point. I understand what you are saying because I think we all do that. We all learn to exist in spaces where we were not meant to live. When we find ourselves in those places or in "mixed company," as my mother would say, why is this intergroup dialogue so vital? As social workers, how can we lead those conversations to engage in that intergroup dialogue that is so vital?

Candice: As we share a profession, I think we speak the same language. We also come from the same place of understanding about our core values. However, it is different when we are having that conversation with psychiatrists, psychologists, and counselors involved. Social workers have a shared understanding of why we are doing what we are doing. On the other side, some people think this is ridiculous. What are we talking about? They want to keep things as they have been done, or that "status quo" thinking. I think one reason is that many people are fearful of having these conversations. They do not want to lose friends and colleagues and do not want people to think of them differently. Or they do not want to be honest about what they do not know. I also believe that some people with research agendas do not even understand their research agendas or what they are writing. I think people are scared to be exposed.

I, too, have a fear of exploitation. I do not take what I say in this space and want people to use that against me later. I do have a fear of that. I do not mind being vulnerable, but it is like the green mile. What I say in this space, I am going to leave here. Do not stop me in the hallway and say, "Oh, Candice, when you said this, ..."  I do not like that. 

I do not understand why academia is so competitive when it does not t have to be. Some people of color are scared of exploitation, and I am one of them. People of color are afraid because they have been pushed down and beaten by the white supremacist agenda. People go along to get along, and it is safer for them. Perhaps they fought the fight at one point in life, and the fight did not work, or the institution, agency, or whatever threatened them. They may have been fired or missed a promotion. People also get close to retirement and take a backseat and coast.

It is good to have these conversations together, but I also fully understand the varied reasons why these conversations do not happen. The people responsible for keeping us safe do not always do their job. They do not want these conversations to happen and want to maintain the status quo instead.

Warren: I think what you said also connects to a previous comment about safety. It is safe not to have these conversations or adjuncts teaching some potentially inflammatory content. This way, they can let the adjunct member go instead of a tenured faculty member. We should not play "keep away" and contribute to students' vulnerability.

This intergroup dialogue can be constructive in guiding conversations for individuals from differing backgrounds. You can create new levels of understanding and relation and create a collective vision that upholds the dignity of one another and advances an agenda of wholeness. In that conversation or dialogue, you can teach other social workers, non-BIPOC social workers, what it is to be bilingual and bicultural and why code-switching is a thing. You can also teach why these conversations are so vital in the context of historical trauma and emotional unwellness. These conversations can easily connect to competencies and engagement. So when a student walks by and says,  "Hello, Dr. Graham," and another says, "What's up, Dr. G?" I should not have to defend to a peer why I allow that level of communication. At that moment, that was a safe space for that student. I will not police those safe spaces because not every space is "safe." I stopped saying that my classroom was a "safe space" long ago. As wonderful as I think I am, I am not that powerful to create the reality of safety for some of our students, especially the BIPOC marginalized students. It is an illusion, and I will not perpetuate that in my classroom. However, I ask them to be brave or, to use Ben's words, courageous. "I want you to be courageous, move past your uncomfortability, and contribute to the conversation because someone will learn something from it." Intergroup dialogue can be helpful by removing some assumptions that contribute to prejudice. We do not utilize it as a tool all the time. Ignoring it contributes to some of that exploitation and exacerbates the historical trauma of BIPOC students of color. Like clients, BIPOC faculty go through a similar experience.

Ben: Warren, you speak of this idea of safe spaces. We, as social workers, are often trained and socialized into the idea of creating safe spaces. As you said, we talk about that in our classrooms and group settings. How can it hinder engaging in courageous conversations when we encourage people to exist in a "safe space?"

Warren: First, we must challenge what a safe space looks like or means. Comfortability does not mean sensitivity. Like I tell students, I will be sensitive, but I have no problems making you uncomfortable because it is in that uncomfortablity that the learning occurs. Some students think uncomfortable means unsafe, and we need to challenge that. Being my class does not mean I am not going to disagree with you or that I am not going to call you on your stuff when it manifests. I may call to your attention a thought or behavior contributing to white supremacist behavior. I would be remiss in my responsibility as a social worker and educator if I did not. I bring this to your attention because you may not even know that this is how you are presenting.

Everyone wants to be politically correct, and nobody wants to offend anybody. You cannot even listen to comedians anymore because someone is going to say something about someone, and suddenly, you will see it trending on social media. When we say a safe space, it means safe to express differing opinions and engage in discourse that may or may not be satisfying and pleasing to the eye but necessary for growth. We have to do a better job as either the quarterbacks in the classroom and lay the foundation for students.

Candice: I think safety utilized within the classroom is starting to become a complete misnomer. The social work pioneers were neither safe nor were the people of charity organization societies (COS). They were pounding the pavement. We are not to give social workers the promise of therapeutic safety that we provide our clients. That is not the same thing. Social work instructors are creating harm and entering into a dual relationship when they promise that. You are going to be their therapist, or you are their instructor. You cannot do both. We should not be promising our students therapeutic safety. So let's get that off the table, as students are not our clients. We are asking our students to engage in a transformative process to become a professional. Therefore, they are not paying us to give them therapeutic safety.

Secondly, NSAW as a profession does not allow that safety. They tell us that we have safety from violence only, so we must follow the profession. Our profession says that safety is talking about violence. When I promise my students' safety, I will have them expelled from the school if I ever find out that you have physically harmed or bullied another student. However, I will never offer them safety, which means that I will not protect them from being uncomfortable, as that hinders the transformative process. I have a responsibility to do my job. I have been teaching for seven to eight years, and I have never once had a student report me for making them feel uncomfortable because I tell them in the beginning that it is their responsibility as it is mine.

Remember, change hurts. Change is questioning everything you have been taught in the past. If students are not transforming, I am not doing my job, or they are not doing theirs. If you explain to people why you are doing something, and they know you are comfortable about being uncomfortable yourself, they will follow suit. Clients, as well as students, rise to your expectation of them. Again, this falls back on us as professors, instructors, and social work professionals having an issue with difficult conversations. It is not the clients or students; it is us. We have the issue, and we have to do better.

Ben: We have to change that narrative. Moving from creating safe spaces, how do we create brave spaces? How do we develop courageous conversations and safety parameters in which to be uncomfortable? I will stop using the phrase safe spaces, Candice, and instead say brave spaces. Where do we go from here? How can we contribute toward an anti-racist social work education and practice?

Candice: That has different layers. In a classroom, you must be intentional and start with a conversation about your expectations. School is an investment that takes time, hard work, and money. If you explain what and why they have to do something initially, they want to do it. You cannot walk into class the first day and say you cannot be racist anymore.

Nobody likes change. If you question my values and tell me I cannot be Christian, Muslim, or whatever, that will not go over well. That is a trans-theoretical model of change. You better give somebody a good reason why they must change. People they have looked up to their entire life may have told them one thing, and now you are trying to change them. It would be best if you had good data and reasons they can no longer think like this or need to think differently. This is something we must change ourselves. We must explain why we must shift things and look at this idea of humanness.

I tell students they do not have to change today. They may come in as black-and-white thinkers, but the beauty of our profession is they will move into some gray thinking. "Is it wrong to hurt somebody?" This is a question I like to ask and then give this example. I had a client who came home and found her significant other severely sexually harming her five-year-old daughter. At that moment, she killed him. Now, let me ask again, is hurting someone or homicide wrong? This is a gray area and a shift in values and thinking. We ask them to consider humanness, not change the core of who they are. I am not asking them to love BIPOC people, but I am asking for their consideration. You can have discriminatory thoughts about me because I am black, but you also need to know that I am a mother, daughter, friend, and part of a family who loves me. I am a human being as well. You can have whatever thoughts you want of me, but I am also human, and can we start right there?

You can start dropping these nuggets in class. We all have basic needs. We are humans that want respect, to be loved, and to be left alone. If you do not care for us, get out of our way and leave us be. Ben, when you are talking about change on a macro level, I am not even trying to fight that one. I do what I can in the classroom. We all have our spaces. Some people can fight the big macro wheel, while others are meant to fight that meso wheel. I do what I can on the meso front but find my space in micro-level work. After eight years, some of my students are working in Washington doing policy work. They called me and said, "Candice, I changed this policy, and I thought of you," or "I remember what you taught me, and I changed ...". I think this is where we can influence others with power and privilege. Because guess what, Ben, it is the white men I have taught who are going and getting those jobs and making change by remembering what I taught them. I am utilizing their power, which I do not have myself, to make changes. I am tired, and I am passing the baton.

Ben: I will ask here in a moment about other practice settings and how we can do that, but first, Warren, how do you create those brave spaces and contribute to anti-racist social work practice in your classroom settings?

Warren: Contributing to anti-racist practice is almost easier of the two to describe. There are some concrete things we can do as professors and instructors that make a difference for students. As I mentioned about decolonizing social work, we can start by decolonizing our classroom because representation matters. I discuss what I am teaching and what articles, textbooks, videos, and podcasts I reference. Are the authors of these materials reflective of everyone in the class? Am I teaching students a theory created by white men, presumably for a white population, or am I using works by Bell Hooks or someone else so that students can see themselves reflected in their scholarship and in the literature that I am asking them to learn?

For those in charge, who are we selecting to teach some of this content? Again, this is important for the student sitting in the class wondering, "Why am I here?" They may feel that they do not deserve to be there or that their peers think they do not deserve to be there. Having a professor who looks like them and may have a shared historical traumatic experience navigating some of the same hallways they are now navigating is crucial. And it is not a heavy lift, per se. Changing some of the material you are using and putting people in front of students who may look like them or, at the very least, are not representative of the status quo forces them to look at the different levels of identity. Can we also tweak the assignments we are giving students and create self-reflective assignments, which will force students to lean into these learning edges that will contribute to that self-reflection that we talked about earlier? We do not have to give students multiple-choice quizzes because it is easier for us to do that. Sometimes, we must be willing to make ourselves uncomfortable to contribute to student learning. For those sitting on committees, how are we contributing to integrating this content and concepts across the curriculum?

I have to be mindful of my little piece of the pie or my little space in the universe, but I can also mention that someone else's course is whitewashed and does nothing for students of color. Schools do not have to be an extension of the same oppressive conditions in our students' backgrounds. There are things we can do, including having encouraging conversations among our faculty and students, because it is a parallel process. Conversations faculty are having with students should be the same ones students are having with field instructors, and field instructors should be having with their field advisors, and so on.

Ben: Many of our listeners are current social work practitioners. How can we then extend these conversations, whether at that micro agency practice level or in those meso spaces, and yes, even in those macro-level advocacy spaces? How can our listeners engage in these conversations and contribute to anti-racist social work practice?

Candice: We need to allow the client to tell their story. We are so quick to get into the issue of why the client is there and maybe not connecting with the client or examining how race and oppression play into their problems. People do not like to discuss it, but during the incident with George Floyd, the emergency rooms were filled with people having exacerbations of heart problems, asthma, and other conditions. What happens in the world affects our health, psyche, and how we deal with our families. Whether you are a status quo practitioner or a BIPOC person, we do not know everyone's story. Just because I am a person of color does not mean I know all the stories of brown people, nor do all brown people know my story. The BIPOC population may not all understand each other, either. I think allowing clients to tell their stories and asking, "Has anything happened in your community that you want to discuss?" is an essential first step. You will start to find that many may have lost jobs or other issues intrinsically connected with race issues. You can help that person navigate and process those issues. That is how you embed those tenants of anti-racism and DEI within a practice. However, we often want to jump immediately into CBT or Bowenian concepts instead of educating people about navigating white supremacist harm. Some people think this is foolish. As a person of color, white supremacy has harmed me more than other things, like divorce or family issues. Thankfully, I have my way of working through that, but not everyone does. Helping people navigate these issues will provide better outcomes than whatever current intervention you are utilizing.

Warren: I would also add that if we consider using a trauma-focused orientation or lens to encapsulate some of our work, we can probably identify how harmful white supremacy is. It is not only dangerous, but there are actual threats against black bodies. An adverse childhood experiences (ACE) approach may be helpful if you have a diverse client population. It is essential to consider how posttraumatic slave syndrome and historical trauma can manifest in generations and generations. We can also consider Resmaa Menakem's work, My Grandmother's Hands, where he talks about how trauma stays in the body. These experiences of trauma live in the body and can be connected to social determinants of health and physiological issues.

Maybe the fixes require practitioners to go a little bit deeper into the work that they are doing with their client populations. Not all the clients who appear before you know exactly why they are there. If we consider the differences in CSWE EPAS (The Council on Social Work Education and Educational Policy and Accreditation Standards) from 2015 to 2022, there are some significant differences. The 2015 competency advanced human rights and social, racial, economic, and environmental justice. In 2022, it says to engage diversity and difference in practice. This is what we need to do as practitioners, engage diversity and difference and maybe ask for these understandings of people's lived experiences.

Ben: We have a couple of minutes left. I wanted to end by looking toward the future. What are your hopes for equity, diversity, and inclusion in the social work profession in the coming years?

Candice: I hope we understand and internalize this content and are not doing anything nuanced or different. I want us to use our profession's ethics and stand on the truth of what our profession calls us to do. If this happens, difficult conversations will not be so hard. Truth is truth, and fact is fact. If someone says two plus two equals four, no one falls apart. We have to have these discussions. Talk about it, as this is what our profession tells us we must do, and all of a sudden, these conversations will not be so daunting. This is what we must do. If we stand upon what we discussed in segment one, it automatically is an aversion to people who do not want to ascribe to this, but it will draw close the people who do amazing work within our profession.

Ben: Absolutely, thank you. Warren, what are your hopes for EDI and social work?

Warren: I hope that these conversations become the norm and become passe. I hope we incorporate these values into everything we do and that DEI and the corresponding work are not adjunctive to social work. I want this content to be ingrained in everything we do in the profession, whether in practice, teaching, or supervision. It needs to be a part of our professional orientation and how we socialize with the profession. This also means holding our social work organizations accountable for making that so. I would love to see a CSWE mandate that schools of social work have to weave this content throughout their curriculum and have a standalone course speaking to this specifically. We need to do more to support the uncomfortable people in the classrooms by having these conversations because they have never been forced to have them.

Candice: And how the profession will hold people accountable who do not ascribe to these tenants. 

Ben: There you go. Thank you both for having this brave conversation with me and the listeners in this two-part podcast. I hope we can continue to move forward and expand upon these brave conversations in all of the spaces in which we exist, those that were meant for us to exist and those that were not. Thank you again to both of you, and thank you to our listeners.

Warren: Thank you for having me.

Candice: Thank you.

References

Available in the handout.

Editor's note: This text-based course is a transcript of the Nephrology Social Work: An Emerging Clinical Social Work Specialization Podcast, presented by Tiffany N. Brown, MSW, LMSW, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes 

• After this course, participants will be able to:
  • Define nephrology social work.
  • Describe the patient population served by nephrology social workers and identify the needs associated with this population and the barriers to working with this population.
  • Identify basic nephrology social work assessment tools and interventions.

Podcast Discussion

Ben: Hello and welcome to this Social Work Podcast. I am Dr. Ben Bencomo, and I am very excited to welcome our guest today, Tiffany Brown. Tiffany Brown will be speaking to us today about nephrology social work. I am very excited to learn more about this area of practice. If I am being completely honest, until I connected with Tiffany, I had never heard of nephrology social work. There are many specialization areas of social work, and most are well-known. Nephrology social work is a super specialization within the medical category. I am very excited to learn more.

Tiffany Nicole Brown is a licensed master-level social worker who found her calling in the nephrology specialty in 2013. Originally from San Francisco, California, Tiffany found her new home and place of social work practice in Texas. She has worked for a dialysis company for nine years, where she has advanced into leadership positions, leading a team of social workers spread throughout the Dallas Motorplex, training other social workers and coworkers, and working in advocacy for the social work profession. She has served in leadership roles within the North Texas Nephrology Social Work Council of Dallas, Texas, as well as planning committees for patient advocacy events with the National Kidney Foundation. She is a Texas College and Howard University alum and is currently pursuing her clinical license in social work. She plans to provide additional adjustment therapies for dialysis patients through professional, private practice in the future. Tiffany, thank you so much for joining us today.

Tiffany: Thank you for having me. It is an honor to speak with you and the Continued family about nephrology social work. I have been waiting all week to tell you all about it. I told many colleagues about the experience that we are doing right now on this platform. This area of social work is my passion and niche. 

Ben: I have been excited about it as well. I am always interested to learn about people's path to social work and how social work found you. Can you share your path to social work, your educational background, and a few of your professional practice experiences?

Tiffany: Social work started for me as a young church and community girl. My parents were always giving back to the community through the church. I remember collecting shoes for kids who were in need at my church. "Social work" was instilled in me from a young age, thus, pursuing a degree in this field came naturally.

As you expressed, I went to Texas college and had a mentor, Rosalind Russell. She saw that I was a natural at helping people at school and in the community. I received my bachelor of science degree in social work at Texas College in Tyler, Texas. Rosalind and other mentors encouraged me to go further with my educational pursuits. As social work has grown, so have the requirements of working on a certain level. I chose to go directly into master-level study at Howard University, but I was not clear about where the direction I wanted to go. At the time, there was a big press for mental health. Although I received training in this area, as do all master's level candidates, I saw myself working in a healthcare setting. Something kept drawing me back to the hospital. My big goal was to get to the VA Hospital.

I took different opportunities that were connected to healthcare. My first job out of graduate school was in mental health at a community behavioral health agency. I was there for five years doing intense crisis services, which led me to my current path of crisis intervention in nephrology care. That was the foundation. I also worked in women's health in Fort Worth, working alongside the police department and connecting women to resources. Many of these women suffered from substance abuse, homelessness, prostitution, and things of that nature. I was out in the trenches, speaking to these women one-on-one, which is true direct service practice.

From there, I got into substance abuse prevention education with students in middle and high school. It was fun providing that education to them.

A year later, an opportunity opened up at a dialysis facility. I knew nothing about dialysis. I knew nothing about dialysis but thought it was another step toward my medical goals and the VA. I learned much about the fascinating treatment modality, dialysis, and how it keeps people alive. This unique population is trying to live despite all the barriers they experience, and it fascinated me. I found that nephrology social work was my niche that provided great learning opportunities. I have now been at this facility for almost ten years in September.

Ben: That is fantastic. It is always interesting how different social workers find their way into the profession and their niches. I am happy that you could follow your passion. Can you define nephrology social work?

Tiffany: Nephrology social work is a service that maximizes psychosocial functioning and adjustment to chronic kidney disease in patients and their families. Throughout our conversation, when I am speaking about chronic kidney disease patients, I am talking about patients who have end-stage renal disease and are on dialysis. There are different types of renal social work, including transplants, but my specialty is the direct service practice in the outpatient unit of a dialysis center.

The Council of Nephrology Social Work is under the National Kidney Foundation and has a standard of practice for nephrology social workers. They define the role of the nephrology social worker as a professional licensed in their applicable state and holds a master's degree in social work with a specialization in clinical practice. 

Ben: That answers some of my next question, which is the basic education and licensure level requirements of a social worker in this area. If someone is interested in the specialized area of nephrology social work, they need a master's degree in social work and a license within the state where they are practicing. This would be an LMSW or an LCSW.

Tiffany: Correct. To give a little more detail, you have to have at least two years of social work practice and one year specifically in a dialysis unit or transplant program. This requirement came about before September 1st, 1976, for the federal guidelines of ESRD social work professionals. Social workers must be in the dialysis unit per the Center for Medicare and Medicaid Services, and these requirements are standard for all dialysis units in the country.

Ben: I did not know that. How has nephrology social work evolved over the years?

Tiffany: When I started in nephrology social work, there was no considerable focus on the mental health aspect or barriers the patients experience. It was more about case management, referrals, and psychosocial assessments. It was about referring to the state, local, and federal agencies to help break the physical and psychiatric barriers of dialysis. There was also assessment, treatment plans, and meetings to determine the need for transportation or food stamps. We also looked to see if there were problems with access to care and connected them to medical homes if no one was coming into the unit.

Social workers are now the behavioral health professionals in the units, and we are respected as such. Before, our focus was on case management and putting out fires. We were not using our master's level behavioral training and diving into the root cause of the patient's experiences, such as poor patient outcomes, mistreatments, or lack of motivation/adherence to treatment regimens. As social workers, we deal with the whole person and have the opportunity to be behavioral health professionals.

Ben: Yes. As social workers, we have a holistic approach where we look at a person's biological, psychosocial, and spiritual aspects and how we can support them. Nephrology social work has enabled you to see more holistic support for people.

Tiffany: Oh, yes. We have come a long way. Social workers know this was coming through our training, especially with the National Kidney Foundation. We knew that we would be held accountable for that piece. We are looking into why they are at this stage and not adhering to the doctor's prescribed treatment regimen. The cognitive theory says that our thoughts control our feelings, which influence our behavior. We utilized this theory heavily in the dialysis unit and are being charged to use our clinical skills. I am excited about the change. We are not just professionals who collect and file applications. Instead, we are clinicians. 

Ben: How do you see that continuing to evolve based on the needs of today's patients and our expertise?

Tiffany: One piece of it requires the clinicians to be present in practice and in licensure. For example, some states now require that nephrology social workers have an LCSW instead of coming in with the LMSW. Florida requires social workers to come in with that LCSW to prove they are ready to go as we continue to walk in that walk of the behavioral health professionals in the unit. I also think we will see changes in outpatient dialysis units as more people do home dialysis and receive transplants but still need support. We will most likely be transitioning our services to outpatient and home care.

Ben: Do you feel that, in some ways, the COVID pandemic helped to accelerate not only outpatient dialysis but in-home dialysis as well?

Tiffany: Oh yes. That was a key conversation with many patients who were in the center at that time. It overwhelmed many people, and we saw an increase in anxiety. During the pandemic, social workers were first responders. We had to ensure the patients could get behavioral health and regular standard psychosocial services. COVID-19 significantly impacted how dialysis was being provided and the increase of home dialysis as well.

Ben: Could you walk us through a day in the life of a nephrology social worker? 

Tiffany: The dialysis unit is a large room with many recliner chairs, each next to a dialysis machine. Each patient has a time slot for when they come into the unit to receive their treatments, which can be up to four hours. Imagine sitting in a chair for four hours and keeping still while blood is transported through these lines, into a machine, and back into the body. One role of the social worker in this environment is a patient educator. We educate patients about their treatment options, facility rules, and conduct and responsibilities. We are the professionals who also check into health literacy with our patients. Do they understand what is going on with their diagnosis? Do they know why they are there? Do they understand the importance of adhering to their treatment regimens?

Social workers are also advocates. Patients have rights that need to be respected and upheld in the unit. Dialysis is a very vulnerable, trusting process. A person is allowing something to happen to them so that they can survive. It can also be anxiety-filled, especially when it comes to change. And there are always changes going on in the unit. We are there to advocate for that patient to make their voice heard.

We are also there to provide cognitive and behavioral interventions to increase the quality of life for patients in that unit. We want them to perceive and feel confident that they are getting quality care when they come into the unit. How do we do that? We are coaches and educate the team on how to have positive interactions with our patients. They all come from different cultures, backgrounds, and levels of understanding. We are there to encourage them to promote a calm environment. A dialysis unit is a place of healing, and we want it to reflect that.

We need to assess our patient's ongoing needs because we know that this lifestyle is new to them. It requires an adjustment process. We constantly evaluate new patients at certain intervals, like 30 days, 90 days, and annually through our plans of care and measure-based assessment tools.

We see each patient at least once a week and assess their barriers. We also build rapport with our new patients to help them adjust. As social workers, our relationship is crucial to maximizing the therapeutic process. We collaborate with the interdisciplinary team, including the nephrologist, registered dietician, and nurses. We also collaborate with other care partners in the community, like those from the American Kidney Fund, caregivers, and clinical providers outside the unit.

Ben: You have talked about ways social workers help increase positive patient outcomes. How do you interface with support systems that your patient might have, whether formal or informal support?

Tiffany: I like to tell my team to use those old genograms with the circles of support around the patients. We look at the patient's family, social contacts, and community resources. We also should add the cultural context as well. Most dialysis patients are people of color so being culturally competent is very important as a nephrology social worker because we want to know what works best for a particular patient. One of the interventions that a social worker may use is leveraging family as a support.

In addition to our measured-based practices, such as screening for depression through the PHQ9 and using measure-based practice tools, we can use the Distress Thermometer (DT), which was famously used for cancer patients. It also works very well with dialysis patients. 

Per CMS requirements, our original tool was the KDQOL, the Kidney Disease Quality of Life Instrument, which assessed several different aspects of the patient's life, whether it was mobility, depression, feeling like a burden, and the symptoms and problems that go along with being in dialysis. Nausea, itchiness, and dry skin are some of these problems. They have other concerns like pushing a vacuum cleaner, traveling, and being intimate with a partner. We use some of these tools to identify concerns and ways to decrease these barriers.

Ben: It sounds like a lot.

Tiffany: It is a lot. I want to go back to our earlier discussion about clinical practice, as you can now see how this impacts a positive dialysis outcome. Social workers are there for our patients, as this is our number one responsibility. We also work for dialysis companies with policies and goals in mind when working with our patients. With that being said, we also want to be effective contributors to the positive, quality outcomes for our dialysis facilities and clients by gathering information.

Ben: What are the most common mental health barriers you see, and what interventions do you utilize to help decrease some of those barriers to achieve positive patient outcomes?

Tiffany: Undoubtedly, depression is one of the most common mental health barriers at the ESRD dialysis outpatient facility. Patients who are on dialysis also have anxiety. Many patients also have co-occurring diagnoses, like substance abuse, bipolar disorder, schizophrenia, and dementia. The social worker's role in a dialysis facility is to gain information and collect symptomatology via the PHQ9 and other measures. If the person scores over five on the PHQ9, we can refer that information to the nephrologist, psychiatrist or psychologist, and other team members. We can also connect with family members about how the patient behaves at home. This may lead to further interventions like counseling or medication.

Ben: Interesting. Over the last few decades, more and more social workers have transitioned into private practice, especially at the clinical licensure level. This appears to be slowing down a bit lately. Do you see social workers transitioning into private practice from nephrology social work?

Tiffany: I see both. Many social workers transition to private practice, but I see them utilizing their LCSWs in the unit to impact clients. I have seen social workers pass their test and say, "I am going to go onto private practice," and that is okay. I have also seen social workers go from nephrology social work to establishing their private practice and seeing dialysis patients. There is much work for clinical social work in a dialysis facility, which is rewarding.

Ben: A little bit earlier, you spoke about the need for advocacy for patient rights and advocacy for services that your clients need. Can you discuss some of the ethical dilemmas you have experienced in nephrology social work?

Tiffany: The Center of Medicare and Medicaid Services is promoting and encouraging dialysis facilities to transition our patients from in-center dialysis into home peritoneal dialysis, hemodialysis, or a kidney transplant. The ETC model leads this five-year initiative, an incentive value-based program that rewards dialysis facilities and providers to transition or educate patients over to a home modality. Our places of employment may see this as a great thing. While there are pros to home dialysis, the pricing choice is something that this social worker has to always keep in mind. We must give patients information so they can decide what they need for their quality of life instead of what someone else might think is best for them. We must ensure that we are advocating for what a patient would like, as opposed to what others would like to see, whether it is the nephrologist, facility, or family member. We want to respect the patient's decision.  

Ben: What does ETC mean?

Tiffany: ETC stands for end-stage renal disease treatment choice. 

Ben: Can you speak more about what ETC intends to do? 

Tiffany: ETC is a model intended to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD. One of the goals is to utilize home modalities and transplants more than outpatient dialysis. The third goal is to reduce Medicare expenditures because we know that dialysis is a big chunk of the CMS budget. There are over 700,000 dialysis patients in the nation. In 2018, they paid about $30 billion in dialysis treatments. The government decided that something had to be done.

Another goal is to decrease the disparities in access to care for different treatments, as most clients are black and Hispanic. Patients need to be educated on the different types of dialysis and the types of modalities available.

According to the National Institution of Diabetes, Digestive, and Kidney Disease, nearly 786,000 people in the United States live with end-stage renal disease, with 71% of them on dialysis and 29% with kidney transplants. For every white person who develops end-stage renal disease, three black people develop end-stage renal disease. There are four Hispanic persons who develop end-stage renal disease for every three non-Hispanic persons who develop end-stage renal disease. As you can see, there are disparities among the races. Regarding home dialysis and transplants, cultural implications might serve as barriers for these minorities. There is also fear of the medical community and decreased access to care for these populations, especially those of decreased social and economic statuses. Now, we see that clinics are encouraging patients to be educated about what type of dialysis they receive.

Ben: In one of our other podcasts, I spoke with the guest about the social determinants of health. In your professional experience, how do you feel those social determinants of health impact some of the disparities you are seeing?

Tiffany: It significantly impacts care, the perception of access to care, and what good care looks like to our patients. When the patients come into our facility, they are usually sick and may not even have insurance or know how they will get to dialysis. Many clients are not educated or have good health literacy, so the social implications are hefty.

I also wanted to revisit transplants. Transplants are now considered the number one treatment for end-stage renal disease. We want patients to apply and get transplants, but I wanted to mention that there is a disparity in wait times. The median wait time for a black adult is about 59.9 months, while for a white patient, it is about 41 months and 55 months for a Hispanic client. A non-Hispanic patient's wait time is about 47.4 months. As you can see, their access is different for these two communities. 

Ben: Why do you think we are seeing those disparities that we are not seeing in other patients?

Tiffany: The perception of healthcare, in general, is to take care of yourself and ensure you are checking in and have appropriate access to care. However, I cannot only blame it on "access to care" because there are hospitals and health workers in most communities. There are many different variables, so it is difficult to isolate one cause. Social workers need to ramp up our advocacy and ask more questions. It deserves a conversation on several different platforms.

Ben: Absolutely. Regarding nephrology social work, what are your beliefs on how social workers will be utilized in this specialization area in the future? 

Tiffany: I joke with my patients about home dialysis and transplant and say, "I may not have a job in the future." As patients become more aware of their options, these conversations are happening not only at a facility level but also at a patient level, even with their first occurrence. When kidney disease is first diagnosed, and they are in the hospital, there are conversations about what dialysis modality would be more appropriate. As we start to have those conversations at the hospital level, we may see fewer patients coming to our unit over time. Social workers are going to have to learn how to pivot. We may even have to go back to home visits. They are even talking about robotic kidneys.

Ben: Interesting. We are responding to changes in that need, and there is a cyclical pattern that the social work profession follows. I know you are also engaged in a great deal of macro social work practice in this area, like leadership roles with the North Texas Nephrology Social Work Council. You have worked to help plan for patient advocacy events and have done a lot of work for the National Kidney Foundation. Can you tell our listeners more about some of those advocacy efforts?

Tiffany: Working with the National Kidney Foundation and engaging with the dialysis community has been a pleasure. It is fulfilling to recognize patients who have been successful in their treatment options, getting transplants, and organizing different workshops for patients and their caregivers to hear about the progression of dialysis.

We know now that care partners are essential, especially for our ever-growing population of home patients. Recognizing that piece, there need to be services for them as well. They need to have support groups and places of respite. They need to have services available to them to be effective caregivers. They often have anxiety and worry about what will happen to their loved ones, so organizing these workshops for caregivers is crucial.

In addition to the National Kidney Foundation, there is also the ESRD network in almost area of the nation. They are patients' advocates and liaisons between the state and federal government and the facilities that provide dialysis treatment. They also offer support to caregivers.

Ben: Absolutely. I cannot imagine how much that need continues to grow year after year. Are these networks a combination of different state and federal entities working to raise money to support patients and their families? Are there other agencies working toward research, like robotic kidneys?

Tiffany: I am constantly communicating with the ESRD Network, and they often provide research-based quality improvement initiatives. They always offer mandated, research-based programs, some of which may be patient advocacy, caregiver engagement, or transplant education. Some instructions may be how we deal with our patients when referring them to home dialysis.

They also monitor how we are doing in the facility regarding transplant goals and patient complaints. The ESRD Network and the National Kidney Foundation have a fundraiser to raise money for advanced treatments for ESRD. There is also the American Kidney Fund which has a part in the continuum of care and assists patients financially by paying for their insurance premiums and emergency grants to patients with financial trouble. These are a few examples, but the ESRD Network is a large piece of patient advocacy and ensures that the facilities respect CMS guidelines.

Ben: It sounds like there is an opportunity for people interested in nephrology social work to engage in many different micro, meso, and macro practice areas. Many of our listeners may be interested in learning more about this specialized practice. Where can they go to learn more about this?

Tiffany: I would say a great place to start is the National Kidney Foundation. There is a link for the Council of Nephrology Social Workers. The standard of practice for nephrology social work is listed there. It will give you a comprehensive education on what ESRD is, chronic kidney disease, nephrology social work, et cetera. The great thing about nephrology social work is job security because we are mandated by the Center of Medicare and Medicaid Services to be in that unit. You cannot have a dialysis unit without having a nephrology social worker if they are receiving funds from Medicare and Medicaid, which makes our job unique. It is a multifaceted specialty that I love.

Ben: Nephrology social work, as you have described it, seems like it could be taxing physically, mentally, and emotionally. What do you do for your self-care to help you continue to be healthy and effective in working and supporting people in this field?

Tiffany: Nephrology social work is a very flexible specialty as we can create our schedules around our patients, and the work-life balance is there. For self-care, I like hiking and spending time with my family. You need to know your boundaries. When you are home, you are home; when on the unit, you are on the unit. Nothing goes on in the unit that cannot be connected to social work, so that is why self-care is so important. Even if a machine breaks down, that still relates to the patient's rights. If someone sticks a patient wrong and the patient complains, we may need to get involved. You have to know how to go home and have that boundary. 

Ben: The work-life balance is vital.

Tiffany: Yes.

Ben: I want to thank you for sharing your expertise and some of your practice wisdom in this specialization area. I have learned much about nephrology social work, and I am sure our listeners also have. Thank you for the work you continue to do with patients and their families.

Tiffany: Thank you for having me. It was such an honor to talk about this topic.

Ben: Thank you again.

References

Available in the handout.

Editor's note: This text-based course is a transcript of the Social Workers' Role in Supporting Homeless Youth Podcast, presented by podcast host Benjamin T. Bencomo, DSW LISW, LCSW, and podcast guest Cheryl Pooler, DSW, LCSW.

Learning Outcomes 

After this course, participants will be able to: 

• Explain what youth homelessness is and how it is defined by the federal government.
• Determine the role of social workers in supporting homeless youth.
• Identify evidence-based interventions for addressing youth homelessness.

Podcast Discussion

Ben: Thank you so much, and welcome. I am very excited to have our guest expert today, Dr. Cheryl Pooler. Dr. Pooler is a licensed clinical social worker. She has over 20 years of experience in community mental health as a therapist and psychosocial rehabilitation specialist for adults with severe and persistent mental illness. In 2009, Dr. Pooler accepted a social work position in the Homeless Outreach Department at Waco Independent School District in Waco, Texas. Dr. Pooler is also one of the co-founders of The Cove, a teen nurturing center for homeless youth. The Cove is a trauma-informed and exclusive environment where local youth expect to be welcomed and served with respect and dignity.

Dr. Pooler joined the Garland School of Social Work faculty full-time in 2017 as a full-time lecturer. Dr. Pooler also earned her DSW degree from the University of St. Thomas, St. Catherine, in 2009. She continues to advocate for homeless youth and families in her home community of Waco, Texas. Dr. Pooler, I am excited about our conversation today. It is good to see you again, my long-time friend and colleague. I have learned so much from you over the years, especially concerning working with homeless youth. Thank you for joining us and sharing your experience and expertise with us today. 

I always start our podcasts by asking our guests to share a little about their professional practice experience and path to social work. How did social work find you? And how did your path lead you to work with homeless youth in particular?

Cheryl: The thing I love about social work is there are so many different paths within the profession. You can have a broad range of experiences within the degree.

I have primarily worked in community mental health. I started working with adults with severe and persistent mental illness (SPMI). I spent fifteen years of my community mental health experiences working with SPMI adults. I did some work with children and youth during that time. I loved being a therapist and eventually worked my way into a management position and oversaw an extensive program for a mental health center in Louisville, Kentucky. We moved around a good bit after that in the name of higher education, which is how I ended up in Waco, Texas, but we are glad to be here.

Until we moved to Waco, most of my work had been in community mental health. On the side, I did some international adoption home studies. I have led anger management groups for men getting out of prison as part of their parole arrangements. Social workers are good at finding little gigs on the side to pad their pockets. After we moved to Waco, I became a parent later in life. My husband and I built our family through adoption. I worked at Waco Independent School District as a social worker, knowing I could be on the same school schedule as my children.

That was a serendipitous moment because I ended up in the homeless outreach office and found a new passion in social work that I would not have chosen for myself. After this, I began to work with homeless families and children. On the high school campuses, there were homeless youth who were unaccompanied and couch surfing, which led to my work with starting The Cove. Another organization I partner with is Unbound; it is an anti-trafficking endeavor here in Texas. A lot is happening in Waco and Texas in terms of advocating for our youth. I am happy to be a part of it and even lead some of it. It has been more than I could have ever imagined.

Ben: Thank you for sharing that. You and I share a passion for working with young people. A lot of my practice experience involves working with youth in juvenile justice and working with youth aging out of foster care. A lot of your work has involved direct practice work with homeless youth. The idea of a homeless young person who is still school-aged is very unsettling. From your experience, why would a person that young become homeless?

Cheryl: The reasons are very complex. Many times people might think that it is because the kid does not want to obey the parents' rules, or they did not like a parent's decision about curfew, and they ran away. Sometimes that does happen, but they may return pretty quickly. 

We are talking about youth on the streets or couch surfing for months at a time, or maybe a year or more. Those reasons look very different and can be domestic violence, child abuse, or substance abuse.

Sometimes poverty pushes a child out. Families are living doubled up or tripled up. As kids get older, they are told they are old enough to fend for themselves. "You've got a job. Good luck!" They still attend school every day, which is how I find them.

My learning curve was very steep and very hard. Social work gives you many tools to think about problem-solving and funding solutions. I used my tools and started working here in Waco, and we have created some pretty interesting solutions.

Ben: Absolutely. We will get to those solutions here shortly. What are some of the most common misconceptions or assumptions people have about homeless youth?

Cheryl: I think most people automatically assume that school is not essential to these children, and it is. They are often transient because transportation is a big issue for them. Most youth want to be in school and finish. Quitting school is not a decision that is lightly made. The data for the youth who do not have high school diplomas is very concerning.

When we automatically assume that school is not essential to them and do not include them in the conversation, we are undercutting them and creating a challenging future for them. Even if it is not our intention, the impact is still felt.  

Ben: Yes. We have had some other conversations about the prevalence of homelessness among youth populations. Even though I worked in child protective services and juvenile justice, I did not grasp or understand the prevalence of homeless youth in all our communities. We hear a lot of different competing numbers. Can you tell us a bit more about the data side of this issue? 

Cheryl: I will give you the data I use most in my research through Chapin Hall. Their data collection is through the federal government. It often also encompasses the various definitions of homelessness.

These are scary numbers, but I will just read them off. Homeless youth had a 346% higher risk than their peers of not completing high school. It is so difficult to finish school when you are homeless.

Another is that youth reporting a household income of less than $24,000 yearly had a 162% higher risk of reporting homelessness.

Hispanic and non-white youth had a 33% higher risk of reporting homelessness than white youth. The numbers are even worse for our youth who are minorities and LGBTQ, and LGBT youth had a 120% higher risk of reporting homelessness. We know that family rejection is a big part of that, which is tragic, heartbreaking, and traumatic for the youth. This is our world, and we must pay attention and ask the right questions. They are very vulnerable. African American youth had an 83% higher risk of reporting homelessness.

The last data I can offer is that unmarried parenting youth have a 200% higher risk of reporting homelessness. These youth are vulnerable, to begin with, but then you add that layer of homelessness, and it is a whole different set of problems and concerns.

Ben: Many of these populations are already at risk and two and three times more likely to experience homelessness as a youth. It is eye-opening to think about all the different struggles these young people are living through while trying to finish high school, which we know is a difficult time for all of us and our development. In your experience, what are some of those challenges that you have seen in youth experiencing homelessness?

Cheryl: Most homeless youth report feeling unsafe at least half the time. Sometimes they can find space to welcome them, even temporarily, but they feel safe there. Finding a safe place to land is a big challenge. The data shows that homeless youth experience higher rates of bullying and being trafficked, which is a far greater demon to battle than most of us want to admit. Social workers need to understand how to recognize human trafficking, sometimes referred to by youth as survival sex. However, please make no mistake; it is human trafficking.

Ben: Definitely. A disconnection from the educational setting where people have daily contact with them can compound those dangerous situations. Many people may find it surprising that education can play a significant role in positive outcomes for homeless youth, keeping them connected and providing safety in an age-appropriate way. When you were working as a homeless liaison for Waco Independent School District, can you tell us a little about McKinney-Vento's law and how youth are eligible?

Cheryl: Sure. McKinney-Vento is federal legislation that officially became a mandate for public and charter schools in the United States in 1987. It has been around for a while and covers the time I was in my social work training. Sadly, I never heard of it until 2009, when I started at Waco ISD. We have to change our social work education to do a better job of helping social workers understand what McKinney-Vento is because it is a policy issue. McKinney-Vento requires that every school district in the United States has someone appointed to identify the youth who are homeless or are being fostered.

There are given some entitlements because of that designation. Only the homeless liaison can "code" a student as homeless. No one else can go into the computer and change it, and sometimes school administration would not agree with my decision to identify someone as homeless. The federal terminology is very clear. McKinney-Vento includes students who lack a fixed, adequate, and regular residence. I like to use the acronym FAR, which stands for fixed, adequate, and regular. If they are living in someone's camper, that is not fixed. It is on wheels, moves, and, most of the time, is not meant for long-term human habitation. Other examples include homeless shelters, transitional housing, or on the street. If they are living apart from their parents, that is considered unaccompanied and homeless. Many of our youth live with people that do not have legal guardianship or custody and may not have seen their biological parents in years; they have to be coded as homeless within the school district.

Part of my job as a liaison was to assess students' status and figure out how to help them. Many attorneys in this area would gladly support families who want to work on that for pro bono or low cost, depending on their financial situation. It is in the child's best interest to have an appointed guardian if they are unaccompanied, but that is not always possible or safe. You need to do your homework and ask the right questions to assess what is happening.

There are a few more things with McKinney-Vento legislation. It provides complimentary breakfast and lunch every day for the student and also provides school supplies, uniforms, and other equipment and fees if they are in marching band or sports. Additionally, transportation to and from school is covered to keep them in their school of origin. Every time a student changes schools and bounces around, usually due to homelessness, they fall behind six months or so academically. To keep them in their school of origin, you may have to have buses meet halfway across county lines to maintain the child's stability, as it is best.

The sad thing about McKinney-Vento is it is an unfunded mandate. The government is good at telling school districts and social workers what to do, but they do not give us a lot of money to work with to make all those things happen. These services are not cheap, especially transportation. We applied for some grant funding, but those are competitive funds. I feel like we should not be competing for funding around these kinds of needs as they should just be provided.

Ben: I appreciate that because I know that many people have probably never heard of McKinney-Vento, but parents, community members, and especially social workers need to know that this exists. Before having these conversations with you, I did not realize that it was a mandate that every school district had to have a homeless liaison. It is vital for all of us.

Cheryl: With our high school seniors, it is crucial that the counselors also understand how things work because they have to do a FAFSA, which will ask for the students' parents' financial information. As a social worker, I had to educate the school counselors to help them understand that the student can still attend school, as there are ways to answer the FAFSA questions so that they can still get the funding they need to go to school.

Ben: Absolutely. I hope you can help clarify some of these definitions for us. I know that in my area, we currently have many families displaced because of wildfires, flooding, and other natural disasters. We also have a significant immigrant community that moves around to different places. Could you tell us about the various definitions of homelessness? 

Cheryl: It is tricky. For McKinney-Vento, that is a Department of Education definition. It is a federal definition, but it applies to school-aged youth, for the most part. Many school districts also have preschools within them, so they start as young as three. When I was in the school district, I coded three-year-olds, four-year-olds, and five-year-olds, but it was still within the Department of Education.

The other definition we must consider with this population is the Runaway and Homeless Youth Act (RHYA). This act defines youth experiencing homelessness as individuals not more than 21 years of age. It exceeds what school districts consider school age and those with no other safe, alternative living arrangements. This definition includes only those youth who are unaccompanied by families or caregivers.

The other definition is the HUD definition, which tells the federal government how many kids are homeless at any point in time during the year. HUD uses four categories, and a few that I disagreed with when I was a homeless liaison. I will tell you why in a minute. The first are individuals and families who lack fixed, regular, and adequate nighttime residences. It is a subset for individuals who resides in an emergency shelter, a place not meant for human habitation, or those living in an institution temporarily. They do not own the place. The next category is individuals and families who will imminently lose their primary nighttime residence, so they are considered homeless already. This category can be helpful for a homeless liaison because we can go after HUD funding to find resources. The next category is unaccompanied youth and families with children and youth who are homeless under federal statutes and do not otherwise qualify as homeless under this definition. The last category is individuals and families fleeing or attempting to flee domestic violence, dating violence, sexual assault, and stalking. Kids living in domestic violence shelters are also included.

Those are the three main ones: HUD, RHYA, and McKinney-Vento. HUD provides point-in-time data, RHYA is different age-wise, and then McKinney-Vento has some key provisions built within it that are not mentioned in any other definitions.

Ben: These are the different definitions of what constitutes homelessness. I think it is more apparent when we realize that there are many ways that a young person could struggle with housing insecurities, either on their own or with the entire family.

This morning, a conversation I was having with students in one of my classes involved the many different places where we find social workers. At face value, we may think that this is a conversation to have with school social workers. However, you mentioned the possibility of working with families fleeing domestic violence. Social workers working in that environment must know that these children could qualify under McKinney-Vento. Additionally, this information could be pertinent for social workers working with immigrant populations, in crisis response to natural disasters, helping displaced families, and in child welfare. We, as social work professionals, can support these homeless youth.

What are some ways these social workers can work to support homeless youth?

Cheryl: One way is to learn the numbers. The Department of Education shows over 1.3 million homeless youth in the United States. That number has not gone up or down significantly in the last five or six years. I keep seeing the ballpark of that number. There are many avenues where medical social workers and other professionals intersect with these families. Ask the right questions to ensure they are getting services through McKinney-Vento if they are school-aged and aware of their entitlements. If they do not know them, help them understand how to access them. You can also connect them with their homeless liaison at their local school district. 

Ben: I want to pause for a moment to think about ethics. We should all be well-versed in the NASW code of ethics, as they play a significant role in our social work practice across all settings. What are examples of ethical dilemmas that have come up in your work with homeless youth, and how do you approach these?

Cheryl: I think the biggest lesson I have learned is that to do this work ethically, you have to include the voices of the youth. Not including the voice of your client is very disrespectful. Many times if a child is unaccompanied, we do not ask them how we can help and instead impose what we want on them. I see this often in meetings.

Even with my work at The Cove, accessing mental health or medical care is tricky if a child is underage without the consent of their parent. Every state has different rules. You have to do your homework and know your state's laws. We have a doctor who comes to The Cove and works with our youth. Thankfully, he understands Texas law very well. He knows where his boundaries are with what kinds of medication he can give without parental consent. Even with mental health, we understand what can be done for the youth before we need parental or guardian consent.

Ethically, you must stay on your toes and be aware of what the laws say. You do not want to risk losing your license or putting the client in harm's way, but you want them to get the resource. How do we make that happen ethically? One of the grand challenges of social work is homelessness, and many ethics are involved with that.

Ben: You mentioned encouraging the voice of homeless youth in guiding their processes. I wonder if you might give us an example of what homeless youth are saying they need.

Cheryl: I will use The Cove as the example because I do not think school districts have a lot of latitude with some of that. Often, the administration calls the shots. I will stick with more of what this can look like in the nonprofit sector or other partner organizations that serve youth. In The Cove, formerly homeless youth are on the board, and their vote counts the same as mine. They may have received services three years ago, and now they are sitting across the table with the rest of the lawyers, social workers, and business people on the board. They are valued as deeply as anyone else sitting in that room. Youth are also included in the program committee because that is where we talk about what services will look like and how they will be delivered.

While I have an idea of what it might look like, the youth will surprise you almost every time and give you something even better. You are selling yourself short if you do not include the voice of the youth. I cannot emphasize this enough. A youth's self-esteem is built when they are welcomed into the conversation about their treatment or progress. It also builds trust when you include them, and they know that you will not spring something on them. Finally, they take pride when something programmatically starts to happen that was their idea. For example, we brought a fitness program to The Cove because our kids wanted to be physically healthy.

Ben: Thank you. Now, I think it is natural to transition our conversation a little bit because you mentioned The Cove. I want our listeners to learn a little bit more about this program. You were one of the main driving forces that started this nonprofit in Waco, Texas. Can you tell us what that was like and more details about the program? 

Cheryl: The Cove is an afterschool program that is open from eight to eight because we serve graduates of The Cove, or "Cove scholars." After they finish high school, they can come back and receive support and services. From four to eight o'clock at night, the school bus drops youth off at the door, and they get an array of services like computers and internet access. They can meet with a mentor or tutor, get a haircut, see the doctor, or see a therapist. They can also sleep if they have been working since early morning. We can accommodate whatever they need.

We also provide substance abuse services if they desire, but being free of substances is not a requirement at The Cove. We do not want them to use or deal substances while they are there, but honestly, if a student comes in and they are high, The Cove is the safest place for them to land for a bit. I cannot imagine turning them out to the street in that condition.

When I started working with this population in Waco, I remember talking to our city council members about the numbers in our school district. They were shocked and did not believe me. They said, "We don't have homeless youth in Waco. However, this was not true, as we had about 335 unaccompanied youth between two high schools in Waco at that time. These are not things you see on "Fixer Upper" while watching HGTV. Waco looks like a fantastic place, but there is homelessness and poverty. I started with educating from the top down to get funding because our city budget paid for only one of our staff salaries when we opened.

Since then, we have become self-sustaining through grants and fundraising. Even with COVID, we have thrived financially. It takes a lot to help people understand what homelessness looks like for kids. There were many challenges with starting The Cove as a nonprofit, especially the business end of it. That is not my forte. I had to find qualified people with passion that matched mine to partner with me. Those people came alongside me quickly, and so it worked. We were able to work magic in a way that I could have never imagined. I am keenly aware that this was the efforts of a tribe of people who supported and encouraged our youth.

Ben: Thank you for that. I specifically had you on the podcast to raise awareness of homeless youth. The more people we can get involved with and understand the prevalence of this problem, the more people we can get to support these efforts. Thanks for sharing your experience about mobilizing people and raising money, as it is not easy. Many times nonprofits have that multi-pronged approach and have support from the city governments or school districts. Did this happen in your case? Did you also have private donors who were willing to support these efforts? Nonprofits often use different approaches to try and find support for these types of programs.

Cheryl: Yeah, very much so. I feel like I was on the preaching circuit before we even opened. It was an idea, and we did not know what it would be called or what was involved. It was just a dream I had. I went to many churches in Waco and gave my little speech, but it worked because I gained volunteers, donors, and employees from these informational sessions. So it was worth all of that time. It was a labor of love, but it took excessive time and effort. You have to hang in there.

Would I have done it if I knew how hard it would be? It is probably better that I just learned as I went. I had no idea what I was doing, so I kept moving. It was like Dory, the fish; I kept swimming, and we got where we needed to be.

Ben: I love that. I think it is sometimes better if we do not know all the challenges ahead because I do not know if we would walk up that hill. We face challenges one at a time by being passionate and persistent. How are things going for The Cove today?

Cheryl: We are doing great. We had 19 youth graduate last May and August. Our graduation rates with homeless youth are higher than the non-homeless graduation rates in Waco ISD. We have now expanded to serve five different school districts surrounding Waco ISD. We started serving one school district, but other districts kept approaching us, saying they had youth who needed services. We moved to a larger location and now serve five different school districts in this area. It is growing, and we see its benefits.

One example is a 19-year-old who came in around November. He had been off the radar since COVID, and we had no idea where he went. This young man was still coded as a freshman at 19, but because of how The Cove can operate after school hours and with online working, he could get caught up. He showed up daily and worked from when he walked in until he left. He graduated in May with his class with a regular high school diploma. I would say this is highly unusual, but it is doable. It was inspirational to his peers. He motivated everybody else to get busy and take things a little bit more seriously. Peers have a beautiful relationship in the program and support one another.

Ben: That is an incredible story of resilience and shows that when we can bring in the right supports for people, amazing things can happen. You mentioned COVID and how youth can access the internet at The Cove. We know this was an incredible barrier for many young people during COVID because they did not have access to technology to do online schooling if their school district had to go all online. There were other difficulties during this time, like social isolation. I imagine this was a significant hardship for a lot of homeless youth. How did The Cove approach that?

Cheryl: We pivoted so many times. We would have a plan, and then something would change. When things shut down, we did not know where the youth went, where they were staying, or if they were okay. We eventually found them within a month or two. At first, they were taken back in by family members or friends, but then the longer things went on, those arrangements were not sustainable, and they returned to the street.

We ended up putting them in hotel rooms. They cannot sign for themselves to get into a hotel, and it was an expense that our budget was not expecting. Some local, generous people helped pay hotel bills for our youth during that time. Many churches fixed plates of food because you cannot cook or grocery shop while staying in a hotel. They did not have money or a car, and public transportation was not running. There were many barriers, but we figured out what we needed to do. We were very successful with finding safe places for them to go. I wish every kid had a warm house like mine with access to the internet, a pantry full of food, and a loving adult who cared about how they were functioning. However, we did deliver laptops to them provided by the school district, and there was free wifi through the hotel. Tutors and social workers did home visits at the hotels and cared for those youth, including taking them hot food and sometimes cold. Once they were spoiled with hot dinners, they always wanted hot food. They handled the situation better than you can imagine. The resilience in this population is profound. They would laugh when the rest of us were stressed out and crying. They could find humor in situations and turn my day around.

Ben: How did you find the homeless youth, especially when everyone switched to online learning?

Cheryl: It was a snowball effect. You find one, and they would have connections to another. Eventually, we found everyone. We had contact numbers, but these youth often have burner phones or phones that run out of minutes very quickly. It can be hard to call or text them. Some reached out to us. They knew The Cove had support, so they would call when they were in trouble. Some waited for us to find them.

Ben: That is amazing. You are right. The best way to get a hold of a teen is to get a hold of their friends. If you had to identify the single most difficult part of navigating COVID-related challenges, what would you say that was?

Cheryl: The social isolation because their mental health is already vulnerable. Our youth struggled during this time and needed some extra support. They needed to be around people like many of us do. I was fortunate to be cooped up in my house with three dogs, two cats, a spouse, two children, and neighbors that we could yell to across the fence. These kids were alone in the darkest way. Predators became a big problem during this time because the minute everything went online, so did the predators. Youth were being contacted by traffickers and dealers. I felt like we were constantly trying to stay a step ahead of the next big disaster waiting to happen.

Ben: Like you, I had family and other social supports, but social isolation was even a difficult time for my mental health and well-being. How did you support young people through that difficult time of social isolation?

Cheryl: We checked on them every day and sometimes twice a day. We would drop off breakfast and lunch in the morning and then a hot dinner later. Tutors and mentors were checking regularly and ensuring their phones had enough minutes, so if they needed to talk or call someone, they could do that. We educated them about the internet and how not to trust everyone on there. We encouraged them to reach out to us before interacting with anyone and take screenshots. It took some deep commitment and creative thinking around how to safely support them because we were masked.

Another challenge was with vaccinations. We had to figure out how to get permission for those since they were minors. When starting a nonprofit to serve homeless youth, you do not think about a pandemic strategic plan, but we have one now. 

The hardest part was when a child was sick or positive for COVID. They needed to be with a loved one who could care for them properly. We partnered with Waco Health, our community health partnership, and they would send folks out to check on our youth. If they tested positive, they educated them on mask use.

We learned as we went. If you go onto some federal websites, one of the key topics is surviving COVID with youth. We are still trying to figure out how to do this with some restrictions still in place. Our numbers went up recently here in Waco, and we are back to a mask mandate in The Cove as our community numbers are so high. 

Constant evaluation and assessment are what we have learned from this experience and how that helps us to move forward. We also realized that school is much more than the educational component. For example, for young people struggling with food insecurity, this was a genuine concern when they did have that access to breakfast and lunch every day. They also did not get a typical adolescent development experience of being around their peers.

Ben: I know that you have varied experience, both clinical and macro community practice experience. In what ways did both of those aspects of your professional social work practice benefit you when starting this nonprofit? Was your social work experience helpful in that process?

Cheryl: Yes, no doubt. The most beneficial thing we use in The Cove is a trauma-informed model. It has been a few years since I completed my social work master's degree, but we did not use trauma-informed care then, as it came much later. Now, I cannot imagine functioning without it. I believe I was an effective social worker, but once trauma-informed care gets embedded, you begin to realize how critical it is to stick to that model when working with vulnerable youth. They have many layers of trauma, loss, grief, rejection, challenges, and vulnerabilities that were magnified a million times by the pandemic. That is probably the most valuable tool I had because it gave me the language I needed to explain it to donors. Using the language of a trauma model helps folks understand that the intervention we can offer at this age will help them thrive as adults.

If you want healthy adults, you have to address unhealthy youth. Youth carry heavy loads, and trauma creates medical and mental health vulnerabilities. If I was talking to the Waco Family Health Center or community donors, I spoke of the trauma model, which worked on every level. I also used my clinical experience of mental health and how to connect with folks. Building trust, finding value in them, and treating them with respect and dignity are essential. Sadly, they are not used to that sometimes. A core belief at The Cove is that everyone is valuable and deserves to be treated with dignity.

Ben: I love it. This speaks to the idea that there is a place for all of us as social workers to support homeless youth, whether we are micro-direct practice social workers or more macro-oriented community-focused social workers. Is there anything else before we close today that you would like to say to our listeners? How can social workers in every area help to end youth homelessness?

Cheryl: We have training that helps us on a macro level down to a micro level. Most professions do not have that scope of training at their fingertips, so I believe we are the best equipped to begin addressing this. We can do that with advocacy, researching laws, speaking up, and staying engaged with policy. What does that look like at a national level versus a state level? It took a while for me to help our school districts understand that federal law trumps state law. State law said they had to have certain records and documents, and McKinney-Vento says they do not and have 30 days. The homeless liaison can assist with that.

Social workers know how to get birth certificates, shot records, replacement social security cards, and anything else that gets lost as they couch surf. And then when you get down to the nitty-gritty of the micro piece, the mental health aspect and dealing with the trauma of being trafficked, the LGBTQ population is super vulnerable. We must create specialized spaces and services, help them feel welcome with pronouns and bathrooms that are non-gender, and provide access to doctors that will understand their needs. 

Ben: Absolutely. If anyone wants to learn more about youth homelessness or programs like The Cove, where can they go?

Cheryl: For The Cove, you can go to thecovewaco.org. My email is my name, cheryl_pooler@baylor.edu. Other organizations online I would recommend would be NAEHCY, the National Association for the Education of Homeless Children and Youth, and SchoolHouse Connection, which is a great resource to get resources for homeless youth. Chapin Hall is housed at the University of Chicago, but they have a ton of data, resources, and good information on their website. There are many great places out there.

Ben: Definitely. There are many avenues to pursue. I hope that this conversation has helped to bring light to social workers the plight of youth who are homeless and experiencing housing insecurities. Thank you so much for joining us today, Dr. Pooler. We appreciate you sharing your experience and passion for working with these young people. We wish you and The Cove well in continuing to provide outstanding service for the youth in your community. 

References

Alter, Adam L. (2018). Irresistible: The rise of addictive technology and the business of keeping us hooked. Penguin Books.

Erbacher, T. A., Singer, J., & Poland, S. (2014). Suicide in schools: A practitioner's guide to multi-level prevention, assessment, intervention, and postvention (school-based practice in action) (1st ed.). Routledge.

Freedenthal, S. (2018). Helping the suicidal person: Tips and techniques for professionals. Routledge.

Flemons, D. G., & Gralnik, L. M. (2013). Relational suicide assessment: Risks, resources, and possibilities for safety. W.W. Norton & Company.

Joiner, T. E. (2005). Why people die by suicide. Harvard University Press. 

Shea, S. C. (2011). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. Mental Health Presses.

Twenge, J. M. (2017). iGen: Why today's super-connected kids are growing up less rebellious, more tolerant, less happy--and completely unprepared for adulthood--and what that means for the rest of us. Atria Books.

Editor's note: This text-based course is a transcript of the Social Work Practice and Opioid Overdose Outreach Podcast, presented by Allison Stone, MSW LMSW, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes

• After this course, participants will be able to:
  • Explain social work’s role in the opioid epidemic.
  • Dermine how best to implement an opioid overdose outreach program in their community.
  • Identify positives and negatives associated with overdose outreach programming.

Dr. Bencomo: Hello, everyone, and welcome. My name is Dr. Ben Bencomo, and I am thrilled to host this Continued Social Work podcast. I'm very excited about my guest for today. About a month ago I had the pleasure of attending and presenting at an NASW conference, and my guest today was one of the presenters, along with her partner at that same conference. The incredible work that she and her partner are doing to serve her home community of Las Cruces, New Mexico I  found to be incredibly exciting and inspiring and ahead of its time. After getting to be present and witness her presentation I just knew that I had to reach out to Allison to ask her if she would join me on the Social Work podcast. So without further ado, my guest today is Allison Stoner. 

Allison is a licensed master social worker in the state of New Mexico. She works with the Las Cruces Fire Department as a leader of the opioid overdose outreach program under the mobile integrated healthcare umbrella. This program identifies overdoses through the 911 system, then offers in-home outreach to patients and their impacted support systems. She and her partner, a paramedic, follow up with those involved to provide Narcan, Narcan education, community resources, and even make referrals to treatment if needed.

The aspect of the job that Allison values the most is being able to meet people where they are, both emotionally and literally in their homes or in the field. She believes integrated healthcare holds immense opportunity for social workers. Allison has previous practicum experience with the mobile integrated healthcare program and as a high school social worker. Prior to coming to New Mexico for graduate school, Allison also served as a Peace Corps volunteer in Ukraine. 

Allison, thank you so much for being here. It's a pleasure to have this conversation with you today.

Allison: Thank you so much for having me, it's a pleasure to be here.

Dr. Bencomo: Thank you. Allison, I guess if you're ready, we'll just jump right into it. Would you be able to share with our listeners a little about your path to social work?

Allison: Sure, I am actually originally from California. I grew up in the Bay Area and I went to school in California on the Central Coast. I got my undergrad degree in sociology.  I originally chose sociology because I really didn't know what I wanted to do. I had no definitive career path at that time, but I had to declare a major, so sociology seemed like it would open doors for teaching, for social work, for just a variety of opportunities, which is really what I was looking for at the time. 

I didn't know exactly what to do. So, I had the opportunity through sociology to declare kind of a concentration in social work, and that really was sort of the catalyst for my interest in potentially the opportunities that social work had. When I graduated, I was still not quite ready to sort of define a career path, so I ended up applying for the Peace Corps and going to Ukraine for two years. 

Over the course of that experience I thought a lot about what would I want my next step to look like, a potential long-term career. I then settled into the idea of social work and came to New Mexico State for graduate school. I am so grateful that I did because it's been wonderful so far. I am new to the field. I just graduated in May of last year but it's been moving forward ever since, no looking back. It's been more than I ever could have hoped for.

Dr. Bencomo: That's awesome. Well, on behalf of the social work profession, and I'm sure the community that you serve, we're glad that you found your way to social work.

I often discuss or have conversations in my classroom with my students about the multitude of practice options available for social workers. However, I must say, your current position and setting isn't one that comes up a lot. I think it isn't one necessarily that a lot of social workers even think of as an option for a practice location or social work practice opportunity. So is your current position with the Las Cruces Fire Department something that you envisioned as a possibility when you began your studies in social work?

Allison: Not even a little bit. I had no idea that this sort of an opportunity would come up and would come up so quickly in my career. Really all of my past experiences working have been focused on youth. If I had any idea of what my long-term career would look like, I absolutely would have said, "Oh, I'll definitely be working with youth or with little kids." But after I did my practicum year as a school social worker, that was kind of the benefit for me of not really having, I didn't really know too much about the Las Cruces community yet, since I was new here for grad school. And one of my, you know, practicum coordinators said, "Oh, the Las Cruces Fire Department takes social work students. Are you interested in that? It is a really unique experience." And having, for me having really no background of, or idea of what that might look like, I was just intrigued at the possibility of doing something so different. And so, yeah, I did not know that I would end up doing this work. Even when I started as a practicum student, I had no idea that I would find this to be a longer-term work, but I am just very glad that I did. And yeah, it is definitely an integrated experience for sure.

Dr. Bencomo: Absolutely, that is fantastic. Allison, one of the experiences that I and many of the attendees at the conference where you and your partner spoke at, were surprised to learn that this was even an option that this opportunity for social work intervention in communities. I think it is so ahead of its time that now the specific program that you had is the opioid overdose outreach program. I heard you and your partner refer to it as the Triple O program, which may be a little bit easier off the tongue, but the Triple O program with the Las Cruces Fire Department, I think that it's been celebrated really as a forward-thinking initiative, partnering social workers and firefighter paramedics. Can you tell me a little bit more about the Triple O program and how it came to be?

Allison: Yeah, so the Triple O program, it really started actually as an offshoot of the Las Cruces Fire Department's mobile integrated healthcare program. I know it gets pretty complicated, there's a lot of acronyms. But mobile integrated healthcare started about five or six years ago by one of our paramedic firefighters who was tasked with the job of addressing frequent 911 utilizers. When the program was first coming to fruition, he looked at addresses that had repeat calls. We have had some folks in the community who call 911 close to a 1,000 times a year. Then he sort of started doing some analysis of what was driving the calls, what is being overlooked for these folks that they are needing to rely on the 911 system for their basic needs is what was happening pretty frequently. 

And so that program worked for, you know, again a couple of years, and then they brought in social work students to that program. And it has sort of just blossomed and has become a very, I think, fundamental program for the community. And so with all that being said, the Triple O program is actually a grant-funded program. And so mobile integrated healthcare a couple of years ago, looking at just the opioid epidemic said, "What can we do to address this now growing, ever present problem also in the Las Cruces community with just the amount of overdoses that we're seeing?" And so they applied for that funding and it was really sort of, the grant was kind of placed in Los Cruces Fire Department's lap because they were looking to provide funding. It is a grant through SAMHSA and they wanted to offer funding to first responder agencies to really do this work and to, you know, they already have kind of boots on the ground, have pretty good rapport in the community. And so to be able to provide funding for this sort of work and for the overdose outreach, that is really how it came to fruition.

Dr. Bencomo: That is fantastic. It seems like just one of those programs that was meant to be, I am glad that you were able to be there. So, were you completing your social work internship during that time when the program was first launched?

Allison: So COVID did end up throwing this program really out of whack. That funding, we received that funding prior, a couple years prior, but then there was, because of COVID it just got delayed and it got pushed back. And so I was sort of, I was not really a part of writing the grant application, but I knew that it was being talked about, and then it did start, really boots on the ground started in January of this year. So I did get to see it sort of taking off while I was a student and now I am fully, fully immersed.

Dr. Bencomo: That is fantastic, thank you. What are the main aims of the Triple O program?

Allison: You know, something that I love about it is how dynamic it is and that those goals are sort of ever changing to really meet the need of the community. But I would say that in general those goals are to reduce and prevent overdose-related deaths by offering Narcan, Narcan education, building rapport with individuals in the community, both in terms of clients and stakeholders. A huge goal of our program is to just continually approach folks with no judgment to lessen the stigma that surrounds use of opiates and other substances, and then to refer and connect individuals to treatment services if that is something that they are looking for. I talk about it pretty frequently. I know that for me, as somebody who has a lot of privilege, it can be difficult for me to navigate the healthcare system. And so to be able to really work with stakeholders in the community, to have a good understanding of, these are our treatment options, these are the processes, these are some of the barriers. And then to be able to take that information to clients and to really serve as an advocate is a huge goal of this program. And if somebody is looking for that level of service, that we are able to advocate on their behalf, that we hopefully have some answers to some of those ever present questions of how to navigate the systems and those, so that that is really what drives our service and our practice.

Dr. Bencomo: That is great. I think that having you as an advocate and an ally during really a, one of the most critical moments in a person's life when they have reached out via 911 because of an emergency related to overdose, not only for the client that you are serving, but for those around them as well, I think is probably incredibly powerful to be able to be there in that moment and serve as their partner and advocate in that way. That is fantastic.

Allison: Yeah, and I would also say that even though it is not necessarily one of our definitive goals, just being a part of mobile integrated healthcare, we are also able to really address other needs of individuals if there are other needs present. So the mobile integrated healthcare side is really intensive case management. And we as kind of an offshoot of that, whether that is us referring somebody to that program or doing the work ourselves, if we respond to an individual initially because of a potential overdose, but we quickly come to find that they are also lacking consistent housing or access to food. We really try to meet as many needs as we can, assuming that it is within our scope of practice. And if it is not, then again, those connections to service providers are so beneficial that we can refer to other services that those individuals might need.

Dr. Bencomo: Absolutely, yeah, thank you. You mentioned a little bit earlier that the Triple O program is grant funded through a SAMHSA grant. Would you be able to provide just a little bit more detail? Is that a multi-year grant? Is this, are there plans for this program moving forward in the years to come? Or what are you and your colleagues thinking in that regard, in regard to funding of the program?

Allison: Yeah, absolutely. So through SAMHSA the grant that we received is a First Responders-Comprehensive Addiction and Recovery Act, it is FR-CARA is the name of the grant that we receive. And it is multi-year, as I said, the implementation of the program really started at the start of this year, but had been sort of in programmatic in growth, I guess, for a little bit before the start of this year. And we are funded through October of 2023 through the grant, and it is definitely, we are talking all the time about how are we going to make sure that this is a program that is sustained because of the benefit for the community, because of just the response that we have had from folks in our community to be able to do this work. 

We are a little bit undefined at this time if we will continue to pursue grant funding for it, or if it's something that can pretty easily just be absorbed into city funding for the fire department. Both are on the table, and I think both are viable options. You know, it is really a benefit that there is not too much cost to this type of work. It is the grant, you know, we are so fortunate to have the grant and the grant provides the funding for the Narcan that we are able to distribute. The grant funds my position currently. The grant funds cost for the paramedic who is partnered with me. That being said, the fire department is definitely looking to make these positions full time. And that is something that the city of Las Cruces has responded well to. And we think that would be, you know, that it would be long-term sustainable to just make these positions full time and to ensure that the work continues to happen.

Dr. Bencomo: Yeah, that is great. I am glad that you all are already having those conversations and looking about long-term sustainability. When we talk about opioid addiction and opioid use, and we look at long-term cost, cost savings, cost analysis, I hope that this is something that is able to be sustained long term in that regard. Because, you know, like you mentioned, this really is a low-cost initiative that not only is a great service to the community, but also one that could possibly be cost saving in long term for the community.

Allison: Absolutely.

Dr. Bencomo: Allison, would you be willing to tell us a little bit about the structure of your team, about the staff within the Las Cruces Fire Department?

Allison: Sure, yeah. So again, I would start back, it is kind of a tiered program and I would go back to initially referencing mobile integrated healthcare. So, what started as one paramedic firefighter grew to a paramedic firefighter with two master's level social work interns, and now has expanded and has two paramedic firefighters full time. One of which is sort of, he really is our coordinator. That was my partner who spoke with me, Paul, at the conference. He is our overseer and also really responsible for the creation and initial implementation. And then I have a paramedic partner who has partnered more full time with me, specifically doing the work that I am doing.

I was the first social worker hired full time by the fire department, which is quite an honor, but I have been very fortunate that we have hired on another full-time social worker in, it was the end of last year. And so she is really working, still focused with the mobile integrated healthcare program. I am working very specifically with the opiate overdose outreach program, and then we do continue to have social work interns as well. And so that really is the extent of our staff, which I kind of flip flop back and forth. If you think about the growth that we've had in the past couple of years, it seems exponential. And then when I also talk about, "Well, this is, you know, a four to six person staff," for the amount of visits that we are doing within the community it is still a pretty small program. And so we do anticipate and will be seeing more growth, which is very, very fortunate. The city of Las Cruces did sort of task and request that the fire department heads a mobile crisis response team. So that is also in the works and will be implemented out from underneath the mobile integrated healthcare umbrella. But so then in terms of just sort of my day-to-day practice, I am partnered, as I have mentioned now a couple times with a paramedic firefighter and we are a two person team. And that is really, we are doing the work for the opiate overdose outreach program.

Dr. Bencomo: That is great. Itis great that you have been able to so quickly add another social work position. And I hope that that momentum keeps moving forward to where you can continue to expand the program and serve even more members of your community. Allison, so you and your partner go out and begin your day. Can you tell us what does a typical workday look like for you working in the Triple O program?

Allison: Yeah, I think part of what I enjoy so much is that it is hard to say if there is ever a typical day, but there are a few pieces of our day that are pretty typical every day, if that makes sense? Most mornings we will come into the office and we will use the 911 call data to actually look for potential overdoses. So one of the huge benefits of being within the fire department is that, you know, anytime that there is a call to 911 for a potential overdose, fire crews are responding. And so then in our program we look at those calls from the day or a couple days prior, and we look

through the patient care reports anytime there is a call that is maybe an overdose related. And so we are looking at CPR calls, we are looking at unconscious and unresponsives. 

We are looking at calls that get labeled as overdoses, definitely. And then we sort of read through those reports and we get a general idea of when overdoses did occur. We then sort of formulate that as our target population for the day that we will try to make visits to those folks that we have now identified these potential overdoses. And then we do just go into the field and make contact, whether that is at that person's home or whether we are responding to, you know, a community agency, whatever it might be, we are then trying to make contact with the individuals involved. And so sometimes that is knocking on the door and saying, "Hey, we saw that this may have happened." And the person that we're speaking to is the client or the patient themselves. Sometimes it is a family member, sometimes it is a friend. And then just depending on what sort of contact we do make with those folks will impact or influence what services we are offering.

If somebody is ready and willing to chat with us about the use that they have been experiencing, then we will go from start to finish of, "Would you like Narcan? Would you like this list of resources? Would you like us to call a treatment provider?" And then it is really just dependent on kind of our work together in collaboration with them as the individual to decide what the next steps will be. And that might include, you know, us literally driving somebody to an intake somewhere. It could be a phone call that we make with that individual, or it can be as simple as just handing a Narcan kit that has a dose of Narcan, it has a rescue breather mask. 

We give the training on how to utilize the Narcan. The paramedic will, you know, sort of walk somebody through what rescue breaths look like, how to position the person's body if they are experiencing an overdose, and really just give sort of that education that is hopefully lifesaving if the person were to need those services again. So that is kind of, that is the basis of what we do. And then from there, you know, sometimes as I mentioned, our work can be, it can be a five minute interaction, or we can work with somebody for a month at a time trying to get them linked into the services that they are interested in and are wanting. So then we have some days where we are making phone calls on behalf of somebody to agencies, or as I said, you know, taking somebody to an appointment in order to get a medical clearance before they can go to the next step. So every day is different. And that I think is part of what makes this job so enjoyable is the variance of interactions that I get to have with community members, with service providers and always working, you know, kind of towards a common goal.

Dr. Bencomo: I did not fully realize the first time that I was able to listen to you and your partner speak the amount of follow up that you all are able to do. And so if you would not mind a little bit explaining, so after you make initial contact with a family, with a person in crisis, then, and you offer your contact information, then they are able to contact you. And I did not realize that you were able to help with transportation to treatment and different opportunities like that. Is that something that is also included in the grant? Is it something that the family would be responsible for paying for, or is it just that continued supportive services? Is that built into the Triple O program?

Allison: That is a great question. That is again kind of one of the benefits of being with the fire department is that the Las Cruces Fire Department at this time does not bill for any services. If somebody in the community has a heart attack and the squad ambulance responds and they transport an individual to the hospital, currently there is no bill for that person, and the same applies for our services. That includes the Triple O program, that includes mobile integrated healthcare. So yeah, there is no cost associated. The Narcan is free. That is sort of just the beautiful nature of the fire department services at this time. And so, yeah, that is definitely a benefit. It makes the barriers to our service a lot less than can sometimes happen with service providers. And then in terms of the transportation we can, and we do offer that, as I mentioned, we're only a two person team with one vehicle. So we will almost always try to link folks in with other transportation services, if at all possible. But we do have the immense benefit of being able to provide those rides if, you know, sometimes transportation is the biggest barrier. And if we can eliminate that by giving somebody a ride to a treatment provider, then that is something that we are very fortunate to be able to do.

Dr. Bencomo: That is great. That really is fantastic. What a service to your community. Allison, can you tell us about a call that you remember responding to that you think might have had a different outcome had you not been there as a social worker to assist in that moment?

Allison: I think one specific call is tough, but I think that I am continually impressed, overwhelmed by, influenced, all the full spectrum of emotions and feelings that go along with the integration of a paramedic and a social worker, that it just surprises me every time how we see the same situation, the same scene in very, very different ways. And so I think of just kind of in the natural nature of our response, the way that our team operates, you know, we might go in and as I said, the paramedic will say, "Okay, this is how you use your Narcan. This is how you use the rescue breather." While I am thinking, "Well, okay, what maybe caused this, right?" What are maybe some of, we think about person and environment perspective. And we think of ACEs and we think of trauma. 

I feel so fortunate that we are able to really holistically work with folks because of the scopes of our difference, the differences in our scope of practice. And so I think that there are a few clients that maybe stick out, specifically where we had gone in with sort of the initial goal of, "Okay, we're going to give Narcan, we're going to give training." And then, and we're going to assume that that's kind of what this person wants. And then to be able to do that and having the fire department logo on our uniforms, it really, I think provides a sense of security and openness to folks to have conversations with us. 

And then the social work perspective for me, I start asking a little bit, not, start asking more questions that are aligned with that person environment perspective, that are aligned with knowing that, most folks who are using substances are using substances because of trauma or because of underlying conditions. And so then to be able to ask those questions of individuals to help us create a more holistic treatment plan. I really think that that is the beauty of our integrated teams.

Dr. Bencomo: What a great example of partnering between the professions. Whereas your partner has their expertise and their knowledge and their own really goals for supporting the client in that moment, you bring the social work piece and you bring that side of being able to look at what are some of the environmental factors, that systems' perspective, that person and environment, what's contributing to the challenges and how can you provide support on more of an ongoing basis to the client and to the people around them. That is fantastic.

Allison: Thank you.

Dr. Bencomo Ben: Allison, what would you say are a few of the challenges that you have experienced associated with this work?

Allison:  It is a good question. First and foremost, I just feel so fortunate, you know, kind of going back to some of the discussion that we had earlier if I ever expected to be in this position. And the answer was, I had no idea. But to be sort of involved in this program that has a big influence in terms of medical systems, because it is the fire department and they are running constant EMS calls. So it just immediately opened my mind and provided me so much education on barriers within the medical system. And that I would say is one of the constant and consistent challenges of this work is the systemic barriers. 

I think that there have been so many situations and so many clients where we walk into a situation, that individual is more than willing to talk with us. They give us so much information about themselves, about what they want, their autonomy, their choice, whatever services it is that they might be interested in. And we say, "Okay." And it looks like initially there should be such a clear path that this person is in this situation. Maybe they are mobility limited and they want to continue living in their home. And it seems like, all right, easy breezy, we link in personal care services and everybody wins. And then you have the barrier of, "Oh, but this is a person who is on Medicare. So personal care services are not going to be covered. So how are they going pay for it?" 

There are definitely times when I have felt we have just watched sort of a perfect outcome snowball and spiral and slide out of our reach. And that is very frustrating. So I think that that is definitely one of the continual challenges, and there are so many of those instances, right? The medical systems in general can be difficult to navigate, and so the systemic barriers are definitely one of the most consistent challenges. 

I think this is also just emotionally difficult work at times. I think that the systemic barriers contribute to that. I never expected to be, something that I didn't mention in terms of a typical day. We are not responding immediately at this time to any 911 call for overdose. But if we happen to be out and about in the community, which we are for a large chunk of most of our days, and we hear that there is a call for an overdose or an overdose-related situation, then we will typically respond. I am working with a paramedic. So the paramedic has their full scope of practice to be able to provide care in potentially life threatening situations. And I really admire that that is something that both of the paramedics that I have worked with, their sort of sense of duty to respond to those calls while we are in the community is very high. And I really respect that. 

I think that responding to a call as it is occurring, it's a very vulnerable time potentially for the patient or for the folks on the scene who are maybe involved, maybe it is family, but that is also a really good time to have conversations about what are the next steps. But in that nature, you know, we are responding at times to calls that are occurring and are very heavy. And there is a lot of loss involved with overdose-related work. And so I am just so fortunate to have clinical supervision that helps me sort of process through things that I am seeing that I did not necessarily anticipate that I would be seeing when starting a social work career.

I am very appreciative of our team and the way that we can consistently check in with each other, making sure that we are supporting one another. That is a challenge, but then again the flip side of all of these challenges are some of the joys. And so being able to maybe impact or have influence in terms of thinking a little bit bigger than just within our immediate team. I have had the opportunity to be sort of a piece of the peer support program within the Las Cruces Fire Department, and to enhance the care that we are providing for ourselves, providing for our clients, providing for the Las Cruces Fire Department, and then ultimately all of those pieces having a positive impact hopefully on the community is something that is an opportunity for me to be a part of that.

Dr. Bencomo: Absolutely, yeah, thank you. You spoke about the systemic barriers. I think that that is definitely something that should serve as I think a call to action for all of us as social workers is looking at what are those barriers to treatment and to support, and what is keeping the members of our community from accessing those services and being able to really engage in their own recovery in a meaningful way when they are ready to do so, right? And so, I think that that is a good reminder, a good reminder for all of us as social workers that there's still quite a bit of work to do in this area. You spoke about the emotional toll as being a challenge. I am happy to hear that you are able to reach out and get really good clinical supervision and have good support from your team. Allison, what do you do for your own self-care to help just keep your batteries charged to keep going the next day?

Allison: This is actually something that I heard from one of my professors when I was in  sociology, in my undergrad, and she was a social work practitioner and she said, "Every day I come home, and the first thing that I do is I take my uniform off and I change into something that reminds me of who I am as a person that is not associated with the uniform." And that is something that I have absolutely maintained. 

It is a very therapeutic process for me to say, "Okay, my uniform from today is going in the wash. And if I have to pull it out tomorrow, I'll pull it out tomorrow. But for right now I am getting home and I am removing the work day from myself. And I am starting my home day." That feels like a very important separation for me, and it is something that I have really valued to have that sort of guidance from that professor years and years ago. 

I have a dog that I love and is the best emotionally. She absorbs any of my sadness or my bad feelings and greets me with joy every day when I get home. That is  a huge benefit for me. My dog and I really like to do a lot of things outside. That is where I certainly feel the most grounded; hiking or walking. It is a good physical, mental, all around activity for us to sort of end the day or process the day in those ways.

I also reach out to friends. I talked earlier about the stigma with substance use. I think that there is still an immense amount of stigma, even in the social work community to talk about burnout and to talk about those really heavy days. So, I feel very grateful to my community of friends and supports that if I really do feel something weighing on me after a tough work day, that I have places that I can go and process that safely. Again,  clinical supervision is huge, but also to just sort of process that as a human with friends who I care about and who care about me.

Dr. Bencomo: Right, what a great self-care regime that you have going on. I think that a lot of times we can get so encompassed in the work that we are doing and it becomes such a big part of who we are, but not losing sight of the fact that we are people first, that is I think one of the lessons that I have taken from one of my professors many, many years ago, we will not say how many years ago, but lets just say several years ago. 

I remember one of my professors came in, introduced himself and then said, "This is my name. I'm your professor for this class, but I'm not a social worker." And being the little arrogant undergrad that I was, I think at the time, I thought, "Well then why are you teaching my class, my social work class?" And he went on to say, "Social work is my profession, and I love it. And I love doing it, and I would not choose to do anything else in the world. And it is why I get up every day, but it does not, it is not who I am. Who I am is a friend and a father and a member of my community." And just went on to talk about all the different aspects that made him who he was. And so I appreciate that that is something that, a similar experience that you had with your professor of the physical reminder of, "Okay, well, I am taking my uniform off and I am back to who I am." And so taking care of yourself I think is something that is going to help, not only with your longevity, but the quality of your work and everything that you are continuing to do. So good job, great work.

Allison: Thank you. That was a beautiful sentiment by your professor too. I enjoyed that very much.

Dr. Bencomo: Allison, a little bit earlier you talked about stigma. I wonder, have you encountered a lot of community support or pushback from the community for the Triple O program? I know that stigma is something that is a part of the national conversation when we think about supporting people who are struggling through an addiction. And so that is my question for you is, have you encountered a lot of community support? Have you felt that pushback from the community in any way?

Allison: That is a good question. I think overall this program has been supported probably even beyond what I could have hoped for. That is not to say that there are not still moments or challenges also associated with, yeah with addiction works with substance use disorders. I am hopeful that we as a society will just continue to move away from that, but it certainly still exists. But overall the support from the community has been really incredible. And I think another kind of, not necessarily a daily focus of our work, but one of the most enjoyable focuses of our work, we oftentimes, I mentioned that we use the 911 system and the 911 data to sort of find our list of individuals or our list of clients. We also get fire crews who respond to these scenes, who then come to us and say, "Hey, this is what we saw. This is the position that this individual is in, can you go and respond? We think that they have a lot of unmet needs." 

I have learned, and I only have such a brief time in the fire department, but learning about fire department culture has been a really unique and valuable experience. I really appreciate the moments where from the social work perspective, I can maybe challenge a little bit of the stigma that might exist for some of our fire crews. And if somebody comes to me and says, "This frequent flyer, this, you know, this, this and this," I feel very privileged to have this space to hold how it feels for them as a responder who has responded to a really tough situation for the sixth time, and to wish that that was different. And then also hold the space to say, "You know that there are immense barriers in our community. Let us sort of reframe the way that you are maybe talking about this person and let us see if we can sort of meet in the middle." 

I love those conversations. I love learning about their perspective versus my perspective. And yeah, so all of that to say that the community in general has been very supportive. The fire department has been immensely supportive and there will always be areas of growth to continue having those conversations to address stigma, to always use people first language, and to just continue to enhance the care that we're offering for folks in our community. And I would say that the same applies to treatment providers and service providers in our community. I am, again, on that two-sided coin. I am one, always wishing that we had more, more services, more, yeah, just more opportunities for treatment, that the wait lists were not so long, et cetera, et cetera. But then also saying, "Wow." Like to talk with the service providers in this community to see the care that they have for these individuals to always also want to be providing more, has been something that is just, it really fills my cup at the end of the day to know that even though there are those systemic barriers, even though we might always be wanting or needing more, the work that is being done and the folks that I am so honored to work with who are doing that work is just incredibly wonderful. And that is usually what I am left with at the end of the day.

Dr. Bencomo: That is great. What a great example of that cross profession collaboration and being able to share your perspective while honoring the perspective that your partners within the Las Cruces Fire Department have as well.

Being able to look at things in a different way and have those courageous and respectful conversations in a way that helps really everyone to continue to grow in regard to their ability to serve their community. 

I am happy to hear that that has been your experience and that you have had that experience within the community as well. That I feel like you are a really good ambassador for this type of work and for the social work profession in general, and a good example of how this can be successful when we honor that and respect the different professional abilities of all of our colleagues. And then what we can bring to the table as well, and helping to maybe to have that conversation on the larger community level, I think is going to be really impactful moving forward. So thank you for that work as well.

Allison: Thank you, I appreciate that very much.

Dr. Bencomo: Allison, I wonder, while maintaining confidentiality, of course, I wonder if you would be able to tell us about a particular case that you were able to follow from response to outcome just over time, and how that case played itself out?

Allison: Sure, I thought, I have been thinking about this and if I wanted to end with a, a client that really highlights some of the challenges, or if I want to choose a client that really highlights the success. So I might give you a little bit of both.

Dr. Bencomo: Little bit of both, I think that is okay.

Allison: Yeah, so we had an individual who was referred to us from a fire crew and they referred this individual because they said that they have financial concerns. Also, I am surprised with myself that this has not come up earlier. Although we are the opiate overdose outreach program, we are really serving as the overdose outreach program, because we do have a lot of folks in the Las Cruces community who are using opiates, but most of our services and most of our treatment providers will address any range of a substance use disorder. And so we quickly said why we are very grateful to have the resources to do opiate-specific work, but why would we keep ourselves limited to just that when we can provide services to anyone experiencing any substance-related disorder or concern or difficulty, and lets make sure that we are responding to anyone who is potentially in need of these services. 

So this particular client had an alcohol use disorder, financial concerns, housing concerns, mobility concerns, and this crew was just genuinely concerned about their overall wellbeing. So we responded and quickly sort of identified a needs assessment and where some of the greatest areas of risk were. And then working with this client ultimately came to the conclusion that, "All right, we want to address the substance use disorder first." That this individual was really wanting to detox from alcohol, go to a longer term treatment, and then come back, you know, maybe for themselves feeling a little bit better equipped to address the financial concern, the housing concern, et cetera, et cetera. 

So talk about barriers. This individual had very limited mobility in their legs. And so we did call to a couple of the service providers in the Las Cruces area. Both of which said, "You know, we maybe can take this individual, but it sounds like there is such a potential for medical need that we do not really think that our service can provide the level of care that they may need." And so we said, "Okay, let's look into the greater state of New Mexico." And I then spoke with four different facilities in Albuquerque. Three of which said the same thing, "That the mobility is going be too much of a risk, that we cannot accept this individual." And then one who said, "The level of mobility is no problem, but are they having an acute psychiatric need?' And having done this work for a while, I understand that that is really a question that is asking, "Is this person immediately having a risk to themselves or others," to which this person, you know, fortunately was not, but then that made that facility inaccessible at that time. And so then we said, "Okay, we are almost out of options. How can we still meet the need of this client with, with them asking for detox?" And so then we turned to the hospitals and we said, "We have this person who is actively seeking this treatment, who this person has been in the ICU for detox-related symptoms before, can we please bring them, knowing that this is a needed service?" And they said, "Well, you absolutely can bring them, but this person is going to have to have an immediate medical need when you do." Meaning that they will already have to be having symptoms of withdrawal, tremors, seizures before they would be able to admit them for detox. So that is a really hard conversation to have with a client. To say, "Hey, you've been in this before, you know your body, you know how your body feels. And, you know, we are essentially asking you to put yourself in pain, in potential harm, in order for us to get you the treatment that you really need." And so with the absolute strength of the client, it did take a little while, but we did get there and they did end up going inpatient in the hospital to receive that service.

Dr. Bencomo: That is awesome, that is amazing. I am glad that that was the final outcome. I think that it speaks to many of the systemic barriers that you were speaking to earlier, but also to the fact that you all were not willing to give up on that and you were willing to continue to advocate for what that client needed.

Allison: Yeah, absolutely. That really is one of the joys of the job is to be able to meet people in the middle and to provide that advocacy, like I said, and, you know, to hopefully just sort of soften the edges of how sharp and how difficult these institutions can be at times.

Dr. Bencomo: Yeah, absolutely. Allison, what are your hopes for the Triple O program moving forward, and what are your hopes for maybe how social workers across the country can learn from this experience, can work alongside first responders to respond to the needs of people that are living with mental health and addictions in their own communities? So first, what are your hopes for the Triple O program? And then, what are your hopes for how similar programs can come to fruition in communities across the country?

Allison: Sure, I think for the Triple O program, especially, I am hoping for sustainability. And again, however that comes to fruition, I would say that I am open to, but to make sure that this work continues. I do not think that this is a problem or epidemic that is just going to dissolve. So to continue these services for folks, to continue and to grow the amount of outreach, that is certainly one of my hopes. 

I am also hopeful that with the potential for more social workers there will be potential for more in-home treatment versus in-home connection to treatment. I think that to be able to provide a little bit more counseling services, that would be a skillset that I have, and that I could utilize, but that we just currently with this two person team, you know, I cannot realistically have every client that we take on devote an hour a week to therapeutic services. So I would really like to see an opportunity for that. And I think an opportunity for in-home treatment of any kind is something that I hope to see, whether that is through the Las Cruces Fire Department or a growth of service providers in the community, whatever that might be. I am such an advocate for in-home in-field services, meeting the individual where they are, that is, I think so beneficial and I have seen that work so well. So that is definitely something that I am hopeful for. And then in terms of my hopes for social workers working alongside first responders, I think that collaboration is absolutely beautiful. I think that it has grown me so much as a social worker to learn from the first responders and it has offered them a lot of insight from what I am able to provide. 

I strongly believe that the integrated approach to healthcare and to individuals offers the most holistic treatment. I think that is what everybody wants for clients and for individuals to really be able to address extensive concerns, all within one team. That’s the goal. And yeah, so that is a hope of mine. 

I would just really advocate for anyone who is interested in this, for social workers, especially, who are interested in this type of work to take that step, however scary it may be. I think that this is sort of a natural trend that is occurring across the nation, for social workers to be a little bit more involved in things like crisis response, to be involved in fire departments and police departments. And so just knowing the experience that I had, I would really advocate for anybody who thinks this might seem unattainable, but really, really cool to take the potential risk and just even propose it as a concept. Because, I do think that we are moving towards this type of service as being more of the norm, which is really exciting to me.

Dr. Bencomo: Absolutely, I think the excitement is something that I share as well. It is in listening to your story and in listening to the work that you all are doing. I think it gives us hope for how we can continue to collaborate with our colleagues from other professions to continue to serve our communities in a different way. I think finding that common ground that you spoke of, because we all have the same end goal that we are trying to work toward.

Being able to remember that and respect each other's way of looking at and supporting the communities, I think is where we start. Where we start to have these conversations and where we start to look at, how can we replicate these? I hope that this is a program that is replicated in communities across the nation. It is really exciting to think about that, to think that this could be a possibility. Allison, what is something that you wish you knew when you started working in social work, or what guidance would you offer to others knowing what you have learned so far?

Allison: That is a good question. I think that I wish that I would have been a little bit more bold. I think hand in hand with what guidance I would offer, I know that I still feel a lot of imposter syndrome, being new to the profession.

I think that I am constantly questioning myself. I think that that is good, but I also think that that is something that we all need to talk about a little bit more. What is it that makes us feel that way or makes me feel that way? And so I think that sort of my guidance is to address that and own that and say, "Even if I am new to this profession, even if I have worked with kids my entire life and now I am working with substance use, that does not devalue the experiences that I can contribute and that I can bring to the table." So, I would really encourage everyone in social work to take those risks and to honor yourselves and the skills that you have and that you are continuing to develop. 

And, I think, especially because I am so recently graduated, I really would speak to students and say, 'If you are feeling anxious about your practicum experiences, that you have to just take the risks now and you will absolutely learn from them. And if it does not fit, move on to something else."

Dr. Bencomo: What great advice, yes. I think that we all, regardless of whether we are new to the profession or have been social workers for decades, we are all lifelong learners. And so we all can continue to grow in regard to our professional skills and abilities. But yet we all have something to contribute, and contribute is something that you definitely have to the Las Cruces Fire Department and to the city of Las Cruces. And for that, Allison, I want to thank you for the work that you are doing, the incredible work that you are doing through the Triple O program and with the Las Cruces Fire Department. 

And I also want to thank you for being our guest on this podcast today, what a great conversation. And I wish you and the program continue growth moving forward. Thank you.

Allison: Thank you so much for having me. It was really enjoyable, and I appreciate the conversation so much.

References

Please refer to the outline and handout.

Editor's note: This text-based course is a transcript of the Social Work Practice and Domestic Violence Podcast, presented by Jeannette Baca, DSW LCSW, LISW, and Benjamin T. Bencomo, DSW LISW, LCSW.

Learning Outcomes

• After this course, participants will be able to:
  • Define domestic violence and explain the social workers' role in working with domestic violence.
  • Identify misconceptions among the general public as it relates to individuals living in a domestic violence relationship.
  • Determine how best to deliver trauma-informed services to survivors of domestic violence.

Dr. Bencomo: I am Dr. Ben Bencomo and continue to be fortunate enough to share conversations with social work colleagues on this Continued Social Work Podcast with you. I am very excited to welcome my guest today. She is a longtime friend and colleague. We get just to sit and talk about our social work practice and social work expertise very often. Dr. Jeanette Baca is considered an expert in this field, a licensed clinical social worker, and a licensed independent social worker in New Mexico.

She also is an assistant professor of social work in the Facundo Valdez School of Social Work at New Mexico Highlands University. Dr. Baca consults with the New Mexico coalition against domestic violence, providing training and technical assistance to domestic violence programs regarding best practices for providing trauma-informed and family-centered services for survivors and their children. Dr. Baca has over 30 years of clinical social work practice and leadership experience with organizations serving families affected by domestic violence and adult and child survivors of sexual assault.

Dr. Baca, Thank you so much for joining us today. Can you share about your professional practice experience, especially as it relates to working with domestic violence, and how you first became interested in serving this population?

Dr. Baca: I have worked in a number of different organizations throughout my career, and I have found that I am continually drawn back to working with survivors of trauma. I've worked in domestic violence shelters and adolescent treatment programs. One of my earliest jobs was working with elders, which I loved, but honestly, working with trauma survivors and their children has been an amazing opportunity that I have enjoyed. While my main job has been teaching at the Facundo Valdez School of Social Work, I still love staying connected with the domestic violence programs in my state. I provide training and technical assistance, and that's kept me connected with this population.

I first became interested in domestic violence during my first BSW field practicum in the late 80s; that's maybe dating myself. I was extremely lucky as I grew up in a home where there was lots of affection and love between my parents and my sister and me. So I was a little bit ignorant of the abuse and violence that could occur in homes until I was in college. I remember a neighbor in our student housing had an abusive boyfriend. I remember reaching out to her and asking how I could help, but I could not understand why she didn't just break up with him. I remember talking specifically to one of my social work instructors about the situation and wanting to be an advocate for this situation.

At the same time, I had a cousin who was living in Alaska and who was in an abusive marriage. I was witnessing abuse in two different contexts at school and in my family. Ultimately, my cousin was able to leave that marriage, but in doing so, lost custody of her six children. This was a steep learning curve for me to understand the complexities of domestic violence and how that plays out within the family welfare and the court system. It was also looking at what services are available and how families and systems respond.

Life learning and academic learning happened at the same time for me. I was so grateful to my BSW advisor for recommending that I do my field practicum at the local domestic violence shelter to learn more about advocating for survivors of domestic violence. I remember riding my bicycle over there. Initially, I was holding babies and occupying toddlers with games while their parent was going to support groups. As I received more training and got more involved, I started answering the hotline and providing supportive services. That was it, as I was hooked. This is amazing work, and I'm grateful to have spent the last 30 years being involved with serving survivors and their children.

Dr. Bencomo: Amazing. Thank you for sharing that with us. It's interesting how a combination of personal and professional interests channel us as social workers into areas where we enjoy practicing professionally and maybe are meant to be.

Oftentimes, students will confuse the different terms that are used to refer to domestic violence or DV. I know that sometimes some of the literature will refer to domestic violence by calling it interpersonal violence or intimate partner violence. I wonder if there is a difference between these terms, or are they used interchangeably? How do you define those different terms?

Dr. Baca: Great question. I think they are oftentimes used interchangeably, but I'll try to break it out a little more. Intimate partner violence (IPV) is abuse between a couple who's married, was previously married, is dating, or was dating, and domestic violence is a little more all-encompassing because it includes children, other family members, pets, relatives, and those who are residing within the same household or that have previously cohabitated. I believe that the term domestic violence takes into consideration the multi-generational household members. Intimate partner violence, in contrast, may not take into account the aunt who lives within the home and watches the babies. In general, interpersonal violence incorporates violence that occurs between people and is a little bit more general.

Domestic violence is a pattern of intentional behaviors by one partner using tactics of abuse, control, and coercion to control their partner, previous partner, children, family members, or others in the home. Domestic violence is a purposeful use of intimidation, threats, or emotional, psychological, economic, physical, or sexual abuse.

The Power and Control Wheel, with which some of you may be familiar, was created through the domestic abuse intervention project in Duluth, Minnesota. It details the various forms of abuse tactics and shows how power is used by abusive partners to control others. We know that the severity and frequency of domestic violence vary but ultimately, it can result in psychological trauma, physical injury, and even death.

Dr. Bencomo: Thank you for clarifying that. I know that those are terms that I have often confused. That helps me to understand the differences and that the terminology is important. Many areas are encompassed under the umbrella of domestic violence. Do you have any statistics available that you'd be willing to share with us that might give us an idea of the current scope of domestic violence?

Dr. Baca: Domestic violence is evident in every community, and it impacts all people, regardless of nationality, socioeconomic status, gender, sexual orientation, or religion. About 10 million people experience domestic violence each year in the US. I also want to offer that one in 15 children is exposed to domestic violence in their homes each year. When we break that down, sometimes you'll see things like one in four women and one in 10 men experience sexual and/or physical violence or stalking by an intimate partner during the course of their lifetime. We also know that those who identify as part of the LGBTQ+ community are at greater risk of violence by intimate partners. The World Health Organization also offers international statistics, showing that one in three women will experience physical and sexual abuse by a partner during her lifetime.

Dr. Bencomo: Think about how many people have or are currently experiencing the trauma related to living through domestic violence-type situations. The numbers are staggering. And I know that a lot of times, instances of domestic violence often go unreported or underreported. So these numbers may not be accurate. Is this a sentiment you would agree with, given your experience working in this field?

Dr. Baca: I think that researchers do their best in terms of collecting the data. There is a concerted effort to make sure that data is coming not only from domestic violence providers, whether that be shelters, hotlines, or non-residential counseling and support programs, but also from judicial systems, law enforcement, and child welfare. But yeah, I think the numbers give us an idea of the scope of the problem. I think it's important to recognize that the numbers are probably underreported. There is also only a percentage of people who are physically injured from domestic violence that reaches out to a medical provider and receives medical care for their injuries. 

Dr. Bencomo: That is a lot to process as the numbers are quite concerning. And even with those numbers, the incidence is probably much higher because of the fact that it goes unreported or underreported so often. What do you believe are some of the biggest misconceptions among the general public regarding those who continue to live in domestic violence relationships?

Dr. Baca: There can be lots of misconceptions about domestic violence. One of the biggest ones I spoke of regarding my neighbor is assuming that someone can and should leave an abusive partner. Those working with survivors in the field recognize that leaving an abusive partner can be complicated and dangerous. Leaving isn't just about walking away. As social workers, it's essential to listen to victims of domestic violence when they are considering leaving an abusive relationship because they may have tried before. We need to know what happened previously, how it went, and support them in safely leaving. Social workers are good at staying curious and asking questions about the strategies that worked.

Another misconception about survivors of domestic violence as it relates to them leaving abusive relationships is how it can be challenging to leave when you have low self-esteem from prolonged emotional abuse. It makes it difficult for them to feel like they have agency over their lives or that they can effectively make decisions for themselves and their children. Survivors trapped in abusive relationships may feel they don't have any options or that the risk of leaving far outweighs the risk of staying.

Love and the progression of domestic violence are sneaky. No one would ever be in a relationship with someone who hurts them on a first date. So there is a foundation of connection. Abusive relationships do not start abusively. They start with a connection and deepen into caring, like all relationships. Maybe there are some warning signs in the beginning, but more controlling patterns and emotional abuse develop as the relationship continues. I've worked with many survivors who stated the physical abuse didn't begin until years into the relationship. By then, a commitment may be made, whether it be a marriage, children, or purchasing a home together. So it just gets more complicated. What may start as an occasional argument escalates into regular name-calling, frequent put-downs, and insults.

Another misconception is that domestic violence is more associated with specific cultures or groups of people, like families that are lower income. This is not accurate at all. Domestic violence happens across all socioeconomic groups; it is non-discriminating. And it happens in all communities. I had a colleague who used to say that we are all just one unhealthy relationship away from being the victim of domestic violence.

Dr. Bencomo: Many of your points are impactful about the stigma of people remaining in domestic violence relationships. I never fully ever considered the risk of leaving versus the risk of staying. I think that that's important for us to know why some people choose to remain in some of those situations and the progressive nature of domestic violence. I also liked the point that these relationships start like any other, but as time goes on and those controlling behaviors continue to intensify, things change. We need to remind ourselves of that fact when we're engaging in conversations with the general public about domestic violence and the stigma associated with it.

In recent years, the conversation in the social work profession has focused on a trauma-informed approach to serving our clients. When we apply a trauma-informed lens to this conversation, in what ways do you feel that a social worker can respond to those in a domestic violence situation?

Dr. Baca: I think the trauma-informed approach care perspective has gained more traction in the last 20 years had has become part of the social work language. Our approach has important core principles from a trauma-informed standpoint of safety, trustworthiness, choice, collaboration, empowerment, and attention to cultural, historical, and gender issues. But for me, it's especially meaningful when thinking about our work with survivors of domestic violence. I want to give a shout-out to the SAMHSA website, as I frequently go there, and it is an excellent resource on trauma-informed approaches.

It's essential to recognize that for families experiencing domestic violence, this is one part of their family's story. We understand that domestic violence can have a traumatic impact on adult survivors, their children, their relationships with each other, and extended family and communities. Survivors and their children may have experienced other forms of violence and abuse in their lives. It may be community trauma, or other things that are going on that are even more cumulative. I am thinking about intergenerational trauma that is collective, historical, and ongoing.

A trauma-informed perspective allows us to recognize and reflect. Trauma-informed domestic violence work acknowledges that the relationships we form with survivors and their children are at the heart of our work. This relationship is the place where survivors and their children can start the process of healing and remembering their resilience. Social workers can inform adult survivors about how domestic violence and other traumas can pose a risk to their children and their children's development. We can share information about what's going on with other systems like a school or other people involved in their lives to help people understand survivors' and their kids' capacity for self-regulation, learning, and how they relate to others and the world at large. 

Dr. Bencomo: That was spoken like a tried and true social worker looking at different systems and how these interrelated systems can respond to the needs of people living in domestic violence situations in a trauma-informed way. Maybe that's an area where we can continue to grow and lead the way in looking at how trauma can be multifaceted. How can we provide a multifaceted approach to responding to those needs? And along those same lines, how can organizations ensure that they provide trauma-informed services?

Dr. Baca: This is an important question, Ben. I want to emphasize this aspect of being trauma-informed because often, when we think of trauma-informed services, we think about how it relates to clients and the services being delivered. I believe the organizational support for the social workers providing the services is sometimes neglected. Organizations may say they are trauma-informed, but what supports are in place for their workers if that is true. For a trauma-informed organization to be sustaining, there must be a recognition that secondary trauma is part of doing this work. Trauma-informed organizations are grounded in understanding the pervasiveness and impact of trauma, not only on the individuals and families they are serving but also on their staff members and social workers.

Organizations that are truly trauma-informed hold a commitment to developing the resources needed to minimize retraumatization, support healing, and resilience, and address root causes of violence. Trauma-informed organizations recognize the impact of this work on their workers, and they strive to create working environments and policies that support their staff. Supports might include flexible scheduling, adequate coverage, backup plans, and regular and consistent supervision. Social workers need personal strategies for self-care and organizational support to stay balanced. I often think of self-care as a vital part of organizations being trauma-informed. It's not only about self-improvement but also about engaging in activities that restore us and promote a sense of well-being.

Sometimes self-care is offered as something to do outside of work. That's terrific, but I think that self-care practices can look different for each one of us. Caring for oneself can be part of actively engaging in a change process for our organization and the culture of our work environment. Often, employees are praised for their hard work. "She never took a day off!" This may inadvertently discourage other social workers from taking care of themselves and using their vacation days and sick leave. The individual employees' health and wellness can impact the organization's overall health. And in turn, the organization, when trauma-informed, can directly impact the wellness of its social workers.

Dr. Bencomo: Absolutely. I think that support is often missing from the conversation. We think about trauma-informed care for clients and miss trauma-informed support for the employees.

Dr. Baca: Yeah. It is a missed opportunity. I think that organizations can do much more to support the potential impact of our work on ourselves. 

Dr. Bencomo: Absolutely. Self-care, both at work and in our own lives, is so important. While we're on that topic, are there any activities you recommend for self-care initiatives for social workers serving people in domestic violence situations?

Dr. Baca: Yes, I use some micro practices throughout the day. I've heard others say that self-care is a necessity, not a luxury. It's the fuel that makes our cars run. For this important work, I take deep breaths, stay hydrated, and go outside if able. Those things can make a difference in my day so that I can stay present, engaged, and curious with everyone. Outside of work, I like to quilt and ride my bicycle, as these are the things that fuel me. Individuals need to identify what can be supportive to them.

Dr. Bencomo: I agree. It is vital to find ways to refuel ourselves, I think that many people think of self-care as being selfish, but I hope we're starting to change that conversation. Self-care is one of the most selfless things we can do because it makes us better versions of ourselves, better social workers, and better able to provide for our clients. Thank you for that reminder and for sharing that with us.

If we could, I'd like to reflect on earlier when you were talking about some of those impacts of domestic violence. I wonder if we can expand on that conversation just a bit. What are some short-term and long-term effects of domestic violence on an individual and a family's overall well-being?

Dr. Baca: Sure. Our first relationships are formed with our primary caregivers; depending on that caregiving environment, it could be a child's father, mother, relatives, or other caregivers. We know that caregiving practices vary from community to community and culture to culture. The foundation of a child's development is a predictable relationship with those primary caregivers. If we think a little bit about babies and attachment, we can lay down a foundation to think about how domestic violence impacts children and adults. Attachment is more than a loving bond between baby and caregivers. It is a hardwired biological process between infants and their caregivers designed to meet that infant's basic needs.

We can also touch on attachment theory and how certain behaviors like babies like crying, smiling, and reaching are all hardwired attachment behaviors. There are corresponding caregiving behaviors hardwired into the parents or caregivers to keep close to the baby and protect them from danger. As attachment is so closely tied to protection for infants and young children, the attachment relationship is the main organizer of a child's response to danger. Babies and young children depend entirely on their caregivers to detect safety issues, decide what's safe and dangerous, and then take action for protection when necessary. So when a baby is distressed, they have no way of knowing when that distress will pass.

With consistent attention from a protective and nurturing caregiver, a baby develops a sense of trust that someone will respond to their distress. Distress in little ones can be that they are hungry, need a diaper change, or need to be cuddled. This caregiving back and forth builds that secure attachment between baby or very young child and their caregivers. These attachment relationships are critical because they help to scaffold children's ongoing healthy development, including their capacity for resilience, self-regulation, and relationships. We learn about relationships from our early relationships. I'm getting back to your question, I promise. Knowing all this, we can more deeply understand how domestic violence creates a hostile environment for children that can emotionally affect children of all ages.

Domestic violence is unpredictable and can be overwhelming. Children, teens, and adults can feel worthless and powerless in abusive relationships, and the relationships between children and their caregivers are undermined for many reasons. One reason is the protective caregiver, or the survivor of domestic violence may be overwhelmed trying to manage safety for everyone in the household while also dealing with an abusive partner. They may not be able to respond to the child's needs in a consistent way or the way they usually do.

We can also think about children's relationships with the person who is wielding power and control and using violence towards the family members. That relationship is also impacted because children are confused by that abusive behavior. They're concerned for themselves, their siblings, and their parents. It's important to remember all children experience stressors as that's part of this existence of being a human. But in the case of domestic violence, the stressors and trauma might also include child neglect, child abuse, parental substance abuse, and mental health challenges with their parents. Under these circumstances, there can be elevated stress hormones and altered levels of brain chemicals disrupting the developing brain. Although responses vary among children, these reactions can impact their learning, memory, and overall health and well-being.

It's important to consider not only the nature of the stress or the trauma, like domestic violence but also the availability of adult caregivers, especially when that protective parent is the person who's helping a child manage their stress. We want to educate them on coping skills to strengthen their capacities and manage stress as they grow older. Many children raised in abusive homes learn that violence is one way of dealing with complicated feelings or conflict. This can be problematic because these children are more likely than their peers to have issues with school, conflict, bullying, other violent behavior, and be in abusive relationships in the future. They are more likely to be in abusive dating relationships, either as a victim or as an offender.

This makes me think about adverse childhood experiences (ACEs). There could be a whole podcast on this topic. Children who have experienced some type of adverse childhood experience, which includes domestic violence, have poor health outcomes later in life, like an increased risk of heart disease, diabetes, depression, substance use, and even early death. 

Dr. Bencomo: Yeah. I don't necessarily think about the combination of those effects with learned behaviors and how that can manifest in all those different ways. Thank you for that, as that's helpful. When thinking about those short and long-term effects, what strategies would you recommend for a social worker working with families and children where domestic violence is present?

Dr. Baca: There are many strategies. For babies and toddlers, we want to help individuals with regulating, soothing, and calming their infants and young children. We also want to encourage the protective caregivers to help little ones anticipate what will happen next. We can encourage caregivers to establish predictable daily routines and help with transitions and changes. They should also give choices and provide reassurance to help little ones identify and respond to their bigger feelings. For older children and teens, their trauma responses can be misinterpreted by parents and well-meaning adults. Social workers can help teachers and caregivers understand what might be going on for children and teens.

When children are afraid, they may act in ways to defend themselves from feeling helpless. As I mentioned earlier, this can include acting aggressively towards peers or younger siblings. Caregivers may not understand children's difficulty regulating strong feelings related to trauma. Social workers can educate parents about what happens as a result of ongoing exposure to traumatic stress and not in a blaming way. This education can help caregivers shift their perceptions about children and teens misbehaving.

For teens and older children, we always want to give choices but set limits while providing reassurance. We must be open to listening to their concerns and answering their questions honestly. Maybe we can help older children and teens find ways to express their feelings through various creative avenues such as journaling, poetry, and art. We can help them connect with activities and interests that promote self-confidence and mastery.

Dr. Bencomo: The developmental level of teens includes emotional angst as a natural stage of development. Then, we add in all these complicated feelings resulting from domestic violence. In what ways can we help them to identify these feelings?

Dr. Baca: I think it's imperative. Kids are responding to violence in the ways that they can. We used to say that children were "witnesses" to domestic violence, but children are more than witnessing. They are doing what they must to care for themselves and their younger siblings. Teens sometimes intervene and try to protect family members. We must figure out how to support them. Ben, I would like to say something about safety planning here.

Dr. Bencomo: Absolutely.

Dr. Baca: Safety planning is vital to recognize across all ages and developmental stages. I remember working with this terrific child welfare investigator with our local child protective service office. She was hesitant to do safety planning with the children, who were like eight and 10. I remember saying that these kids had already been engaged in safety planning for many years. For example, they kept themselves safe by hiding and other things long before we got involved.

We can learn a lot from children when we listen to what they have been doing. We can build off that and reinforce it in that more formal process. It is valuable when social workers can involve children with their protective parent's permission in safety planning. It may be an immediate issue because survivors and their children may return home to abusive partners. Still, I also think we need to consider that families may be involved with their communities, extended families, religious traditions, and extracurricular school and community events. So there are opportunities to do safety planning with families so they can continue to be involved with their social networks. This can also be helpful for visitation exchanges, daycare, school drop-off, pick-up, and play dates. And obviously, safety planning and what that looks like needs to be explored a little differently if firearms or weapons are in the home. 

Dr. Bencomo: What are some ways social workers can support parents in DV situations?

Dr. Baca: Parents who are survivors of domestic violence bring front and center the importance of being client-centered. This means honoring and respecting the survivor of domestic violence's self-determination, which aligns with the social work code of ethics. Survivors of domestic violence know what's best for themselves and their children, and we can trust and learn from them. Survivors of domestic violence benefit from social workers' understanding of the complexity of domestic violence and validating their concerns. We can also acknowledge how that violence may impact survivors' mental health. It could be a contributing factor to the misuse of alcohol or substances. When we can have a greater picture of what is going on, we can support and advocate for them within other systems.

Another strategy for supporting parents who are survivors is breaking through that isolation and helping them reconnect with relatives and their community. They may have been separated from them, which can be a significant step in creating those non-formal support networks that will be there long after we are no longer involved. We are temporary support for survivors and their children, so we recognize the importance of reconnecting them with those natural supports.

There are also domestic violence programs that provide comprehensive services.

Dr. Bencomo: Absolutely. Specifically looking at those people who will continue to be in the lives of these survivors, are there any strategies or recommendations to ensure long-term support for those survivors?

Dr. Baca: Good question. Sometimes, there have been many challenges. Let's go back to that misunderstanding of domestic violence. Family and friends may have offered support in the past when the survivor was struggling. For instance, they may have offered them a place to stay, but the survivor and kids returned to the abusive partner. After this happens repeatedly, families and friends don't understand the dynamics involved and may emotionally cut off the victim. In these cases, they may not have spoken with parents, sisters, brothers, and best friends for years. Thus, we may ask survivors, "Who was support for you? Who have you missed having contact with?" There may be a way to safely use social media to try to contact loved ones, as sometimes people move and change phone numbers.

It is essential to give them some language, perhaps with the Power and Control Wheel we discussed earlier. Once survivors can see a concrete way that domestic violence has impacted them, then they can share that information with their family and friends. "Here's why I haven't reached out to you," or Here's why I kept going back." This is an opportunity to reconnect and see if there is a way to re-establish those connections.

Dr. Bencomo: I want to shift gears to talk about some of the current climate with domestic violence. We all know that the current COVID pandemic has had an immeasurable effect and will continue in the years to come. How has COVID impacted domestic violence prevalence, severity, or recovery? Is there any indication of what some of those effects have already been among survivors of domestic violence?

Dr. Baca: Yeah. During the initial waves of the COVID pandemic with the lockdown and stay-at-home orders, many survivors of domestic violence and their children were trapped at home with abusive partners and unable to safely access any services. Many were not able to use the telephone without surveillance. Children couldn't disclose any abuse they were experiencing at home because they were doing remote learning. There is some conflicting research. Some research shows increased calls to law enforcement, while others show decreased calls to domestic violence organizations. We know from previous events, like natural disasters, that community-wide stressors often contribute to increases in family violence.

Many families also experienced economic strain and concerns about homelessness due to COVID. The pandemic didn't cause domestic violence, but the additional stressors may have escalated abuse in the household. In year one, many programs tried to ensure that there were media campaigns about programs that were open and available to help. Advocates and programs had to get creative as they recognized there were only a few places survivors might be able to go during those lockdown periods. As everyone could get groceries or go to the pharmacy, there was an additional push to ensure that outreach and educational material was available at these venues. 

I think we're all realizing the need to pivot, and there were increases in telephone and video conferencing. Additional training and attention to confidentiality and safety planning have to be done when interacting remotely, so there was extra networking on how to best support survivors during this time. Collaboration with agencies and community organizations was vital.

Now that those stay-at-home orders have been lifted and children have returned to in-person learning, there are more opportunities for survivors and their children to reach out for support. However, I think we're still understanding what families went through during this period and will continue to be experienced in years to come.

Dr. Bencomo: You have transitioned in the last several years into teaching social work full-time and continuing to serve on different boards and consulting for various agencies. How has your professional experience in domestic violence informed or impacted your teaching of social work students?

Dr. Baca: I love being a social worker and a social work teacher. I think I have a greater understanding of what many of my students bring when learning social work skills and participating in field practicums. I acknowledge that some of them have had experiences with family violence. I'm conscientious in applying trauma-informed pedagogy that comprises those same core principles we spoke about earlier from a trauma-informed perspective. Due to the ongoing pandemic, on top of the stress of just being a college student, I recognize that my student's cognitive presence might be adversely impacted because of COVID.

From my experience with domestic violence, I recognize that stress and trauma impact self-regulation and executive functioning, which may interfere with our students' concentration and ability to focus and learn new material. It might look like exhaustion, confusion, or forgetfulness. I try to be mindful of that when a student asks me for the fifth time when an assignment is due, even though I know it's written in my syllabus, posted on the learning management system, or talked about in class. I try to be sensitive and compassionate about that. We have been doing brief contemplative practices, like deep breathing or mindfulness, to center ourselves in the online learning environment before diving into the content.

It is crucial to create a safe environment for students to discuss current events that are impacting them. It can be helpful to initiate those discussions with questions and prompts for deeper dialogue when students are in a state of calm.

Dr. Bencomo: Wow. Thank you for that. That's interesting to see how you've used your experience to inform the content you're teaching and approach interactions with students as they navigate their own lives and their social work education. I know that recently you worked with some colleagues to develop a family-centered toolkit for domestic violence programs. I wonder if you could tell us a little about what that toolkit entails.

Dr. Baca: The scope of this toolkit was shaped by domestic violence service programs and the staff who identified complex needs and challenges in supporting families. It reflects the voices, stories, and perspectives of adult survivors and their children. It was a labor of love that my colleague, Susan Blumenfeld, and I developed to help domestic violence programs envision and implement a more integrated approach. It supports caregiver-child relationships with various culturally responsive, trauma-informed, and developmentally sensitive services and activities. During the last 20 years, we have become more aware of the effects of domestic violence on children's healthy development and well-being. We recognize that a more integrated approach that centers on those relationships between adult survivors and their children is the way to do this. There are 13 sections with lots of great stuff. Can I give another plug for a website?

Dr. Bencomo: Please do. 

Dr. Baca: It's www.nationalcenterdvtraumamh.org. This is a good place for someone to learn more about how they can support survivors of domestic violence.

Dr. Bencomo: Are there other places you recommend?

Dr. Baca: The National Center on Domestic Violence Trauma and Mental Health is fabulous for social workers wanting to further their learning regarding domestic violence. The toolkit is published and available for free on the website. In addition, they have multiple other toolkits, a webinar series, and many other resources that can support social workers in furthering their knowledge. Again, it is understanding the complexities. There is also specific information about domestic violence survivors, spirituality, mental health challenges, and substance misuse. It's an excellent resource for social workers.

Dr. Bencomo: Thank you for sharing that. I like to ask people about their self-care regimens. We know how heavy that can be for social workers working in the area of domestic violence. What recommendations do you have, and what type of self-care activities do you engage in?

Dr. Baca: I encourage people to think about self-care in two different ways. One is micro-practices that they can do during their day. Like with my students, I ask them what are some self-care practices that can support their resilience during schooling? If they like nature, they can go outside, look out a window, or engage in light breathing throughout the day. They can also breathe deeply and stay hydrated.

Then what are the more significant things we can do on the weekend? I mentioned earlier that I like quilting, riding my bicycle, being outside in nature, and being with friends and family. I have a beautiful little granddaughter that keeps me centered.

What are the things that can fill your cup? I love being a social worker and want other social workers to stay in the field. I also want my students to love being social workers after graduation and in 30 years. Ben, what do you do for self-care? Can I throw that back at you?

Dr. Bencomo: Absolutely. I live in a very rural part of the country, which works well for me as I love hiking and camping. I have found these activities to be incredibly grounding and helpful with regulating myself and giving me the space to continue to support myself and others. I love being outside as much as possible.

I want to thank you so much for your time. I appreciate you sharing your experiences, knowledge, and expertise with all of our listeners. And I appreciate that you are a fellow social work educator out there helping to prepare the next generation of social workers for this vital work. 

Dr. Baca: Thank you, Ben. It's been a pleasure to talk with you. 

References

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