According to the National Institute of Health (NIH), palliative care is medical care necessary to support patients suffering from chronic illnesses such as cancer, HIV, rare genetic diseases, and other disorders in order to help provide the best quality of life. In order for palliative care to work properly, it requires a team of doctors, nurses, and social workers to develop a plan of care to assist the patient and their families. Recently, I had the opportunity to interview Helen McNeal who is the Executive Director of the California University Institute of Palliative Care at Cal State San Marcos. Here is our discussion:
SWH: Could you tell us about your background and position with California State University?
HM: My role is guide the Institute team in accomplishing its mission of educating current and future health care professionals about palliative care, and educating the public about palliative care, its importance, how to access it and advocate for it in the community. We are also charged to do and create a model for professional and community education that can be replicated at California State University campuses and others across the state and around the country.
I have been involved in hospice and palliative care for more than 25 years, beginning with helping to found a hospice in Ontario Canada and from that point forward consulting on palliative care with the provincial and federal governments in Canada, with the Department of Health and Human Services and the National Hospice and Palliative Care Organization here in the U.S. Prior to becoming involved with launching and establishing the CSU Institute for Palliative Care in July of 2012, I was the Vice President and Executive Director for the Institute for Palliative Medicine at San Diego Hospice. As you can tell, palliative care is my passion!
SWH: What is Palliative Care, and what prompted California State University to create the first certificate program of its kind?
HM: Palliative care is specialized care that focuses on improving quality of life for people with serious or chronic illness and their families. It prevents and relieves suffering by addressing pain as well as the physical, emotional, psycho-social and spiritual problems associated with serious and chronic conditions. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, social workers, chaplains and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.
The CSU is the largest workforce development “engine” in the country, graduating 80% of all health care professionals in California. With 1 in 8 Americans currently over the age of 65 and that number growing to 1 in 5 by 2030, the CSU recognized the importance of palliative care to current and future health professionals and, with the leadership of one of our trustees and President Karen Haynes of Cal State San Marcos, created the Institute.
Social workers are a vital part of the palliative care team. There are not a lot of educational options for social workers interested in improving their palliative care skills and the need for palliative care trained social workers is great. Creating the first online palliative care certificate program just made sense. President Haynes is a PhD Social Worker and former Dean of a School of Social Work, so she supported our making this program a priority. Initially, we had thought to make the program a hybrid, with the first of the three levels of the program done in person, but social workers told us to put it all online … and we have.
SWH: How can this certificate benefit social work practitioners and assist them in their career goals?
HM: Social workers are vital to the success of palliative care if we are to address the psycho-social needs of patients and families. In addition, social workers can play a vital role in advance-care planning and in addressing the practical issues that cause pain and suffering for those with chronic and serious illness and their families.
There is a true story that I often share about the impact of social workers in palliative care. A young immigrant mother with advanced breast cancer was suffering intractable pain and nothing seemed to help. A social worker was brought in to speak with her in her native language and learned that she was concerned for the well-being of her two children. She wanted, after her death, for them to be raised in Mexico by her mother instead of in the U.S. with her husband. The social worker was able to work this out with the husband and mother, and from that point forward, only minimal pain medication was required to keep her comfortable. Research has shown that patients who have the opportunity to work with a palliative care social worker have a more positive care experience as this story illustrates.
With 90% of those over 65 having at least one serious or chronic illness, the demand for palliative care trained social workers is going to continue growing. It offers a rewarding career path for both current and new social workers but it requires specialized skills, and that is what our program offers. In addition, with the emphasis on interdisciplinary practice, there are opportunities for social workers to take on more of a leadership role in delivering palliative care than ever before.
For social workers looking for a rewarding career and opportunities for leadership in today’s changing healthcare environment, our program provides the education that can help them achieve their goals. Our program consists of three levels. Level 1 provides participants with a firm grounding in the principles and role of the palliative care social worker. Level 2 enhances their skills in key areas including motivational interviewing, grief and loss, dealing with difficult cases and special populations. Level 3 prepares them for leadership and program building, while also facilitating their completing a project in the form of original research, developing a program or getting an article published. In short, it provides a strong foundation for career success in every dimension.
SWH: Some Social Work practitioners may be skeptical about online education, what can you tell us about the program at CSU that will help alleviate any concerns?
HM: What we hear from social workers is that they don’t have time to take off from work to do an advanced program and that while they want to learn more about palliative care, they need a program that they can do where they are, when they have time … and that is cost-effective. The Institute’s Post-MSW Palliative Care Certificate meets these requirements.
Social workers doing our program will do one module each month, doing one segment each week for three weeks and then have a one-week break. While the work for the week needs to be done that week, it can be done whenever the social worker has time … at lunch, in the evening, on Saturday morning. What could be easier and more convenient? With a maximum of 15 participants in the course, there will be lots of interaction with colleagues as well as with our outstanding faculty.
I understand that those who have not done online learning might be skeptical but as we hear from those who do our other online programs, doing an asynchronous learning program means that you can really bring real world challenges into the classroom, discuss them with colleagues and get rapid responses from your faculty. What participants are telling us is that online education brings learning closer to their daily clinical experience.
SWH: Are there plans to create other types of certifications to support post MSW learning, and are there any key points that you would like to personally relay to potential students interested in this program?
HM: Our focus is on educating professionals in palliative care. We are assessing the need for a post-BSW certificate in palliative care as so many BSW social workers work in hospice and long-term care settings. In addition, because we have certificate programs for all the individual members of the palliative care team, we are looking at doing an interdisciplinary program that would be undertaken by palliative care teams to enhance their skills at working as a team.
In the meantime, we would love to hear from social workers what they would like us to provide in palliative care training. After all, we know that social workers are committed to providing exceptional care to patients and families, and we are here to help them achieve that goal!
For more information on the Palliative Care Certificate Program, please visit using this link.
How Social Workers Can Practice Trauma-Informed Care
Over the past few decades, there has been increasing recognition of the widespread and profound impact of trauma on individuals and communities. The results of an international mental health survey suggest that traumatic events have affected over 70 percent of the population, and can lead to prolonged physical and psychological harm.
These findings have transformed the field of social work, shifting the focus of education and training onto practices that recognize, support, and empower survivors of trauma. Referred to as “trauma-informed care,” this framework is especially important for social work professionals who have a high likelihood of encountering people with a history of trauma in practice settings.
Expanding the Definition of Trauma
Trauma-informed care starts with an understanding of the intricacies of trauma, and how it impacts individuals and communities. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “trauma results from an event, series of events, or set of circumstances that is experienced by an individual physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”
For most people, the concept of trauma conjures up images of soldiers who have survived violent combat. Others may think about people who have been exposed to physical abuse, sexual assault or natural disasters. While these are some of the most distressing experiences that an individual can endure, trauma isn’t defined by an extreme event—it’s what the event means to the individual.
Trauma-informed social workers must take the time to understand a person’s unique perception and response to an event, taking into account the complex layers of identity, power, and oppression that contribute to trauma. Adopting this framework, researchers have expanded the definition of trauma to include the following categories:
- Complex trauma: The result of being exposed to repeated, ongoing, or simultaneous traumatic events, such as chronic neglect from a caregiver or long-term exposure to war conflict.
- Intergenerational trauma: This type of trauma is passed from those who directly experience trauma onto subsequent generations.
- Historical trauma: A type of intergenerational trauma that is experienced by specific racial, ethnic or cultural groups that accumulates across generations. Some experiences most commonly associated with historical trauma include the colonization and forced migration of Native Americans and the enslavement of African Americans.
- Institutional trauma: This is a type of trauma that occurs when institutions take actions that worsen the impact of traumatic experiences; for example, when a university covers up a sexual assault violation.
- Secondary trauma: Many helping professionals experience this type of indirect trauma, through hearing or witnessing the aftermath of a traumatic event experienced by a survivor. In addition to expanding the definition of trauma, the social work field has begun to outline some essential components of trauma-informed care.
Promoting a Sense of Safety
Trauma-informed social workers recognize that clients may have a history of trauma and prioritize creating an environment that feels physically and psychologically safe. Physical safety can be ensured by keeping areas well lit, monitoring who is entering and exiting the building and providing clear access to exits. Psychological safety involves a client’s feelings of trust in their relationship with the social worker, and can be ensured by modeling respect, consistency, acceptance and transparency.
Acknowledging and Reinforcing Patients’ Strengths
Many social service and healthcare professionals focus on diagnoses and interventions, framing symptoms as problems or weaknesses. Trauma-informed social workers, on the other hand, recognize that these symptoms are coping strategies in response to trauma. These practitioners highlight resilience and acknowledge strengths, cultivating hope for recovery and change.
Creating Opportunities for Choice
Trauma survivors often feel a sense of powerlessness, resulting from a loss of control and predictability in their experience of trauma. Trauma-informed social workers attempt to return the client’s sense of control by offering them choices and actively involving them in goal-setting and decision-making. As clients practice making decisions in the social work setting, they develop coping strategies and self-advocacy skills that support their functioning in the outside world.
Applying Your Knowledge
To maximize your impact as a social work professional, you need an extensive understanding of the latest theoretical perspectives, including trauma-informed care. An online master of social work program can help you acquire the conceptual knowledge and hands-on field instruction that you can apply to improve clients’ lives and achieve your professional objectives.
The Adelphi University Online Master of Social Work program brings decades of expertise and a legacy as a leading social work school to a flexible curriculum designed for working professionals. As a graduate student in the program, you’ll have the opportunity to engage with faculty members at the forefront of research on trauma-informed practices. Our graduates complete the program prepared to become Licensed Master Social Workers and fill the need for a skilled trauma workforce.
Project-Based Learning for the Virtual Classroom
Project-based learning (PBL) may not be the first thing that teachers consider when planning for remote or hybrid lessons. However, with a little creativity and an organized approach, project-based learning can engage students in a way that may be lacking during typical virtual instruction. So what is it, exactly? PBL, simply put, is an approach to learning through exploration of a real-world problem or question. Ideally, students choose to investigate a problem or challenge that means something to them – something that impacts their daily lives. Then, through research, collaboration, and exploration, students gain a deeper understanding of the issue or challenge and how they can contribute to a solution. Even more important is the fact that, through project-based learning, students gain a better understanding of who they are as learners and critical thinkers. With being said, let’s look at how instructors can utilize PBL in virtual settings.
How to Organize PBL for Remote Learning
“Embrace the chaos of now” by asking students to discuss what is currently troubling them. When students have a vested interest in their classwork, they will obviously be more inclined to engage in the work and follow through on the assignment. Ask about challenges or problems they’ve been having, such as:
- What has been your biggest struggle with adapting to virtual/remote learning?
- What needs are not being met in this “new normal?”
- How has your daily routine changed since the start of the pandemic?
- What is a problem that you see your peers, neighbors, teachers, community struggling with?
After students have identified an issue or challenge that they personally recognize in their day-to-day lives, ask them to do a little preliminary brainstorming about the problem using a standard KWL chart. The KWL chart is an old favorite in the classroom for any sort of introduction to a new topic, concept, or unit. For project-based learning, the KWL chart provides students with a visual starting point and a trajectory for where their research is headed. The graphic organizer, for those who have not used it before acts as a simple t-chart to organize what students already know (K) about the topic, what they want (W) to know about the topic, and what they learn (L) throughout their research process. This simple visual aid acts as the foundation for critical thinking by visually, yet simply, organizing a student’s thoughts.
Next, you can help students with backward design or backward mapping by outlining objectives first. Again, project-based learning is all about allowing students to explore a challenge and identify a resolution or fix for the problem. In order to adequately lay out the groundwork, students must have a clear and definitive end goal. Therefore, in planning for success, teachers need to help students employ backward mapping strategies by beginning with something like a S.M.A.R.T. (Specific. Measurable. Attainable. Relevant. Timely.) goal—then working backward from there to achieve that goal.
Instructors can also utilize haptic engagement or hands–on learning by encouraging students to physically try out or experiment with their ideas. Teachers can model this experiential learning by choosing their own PBL to focus on while kids are working. Show students that, in order to truly solve a problem, people must occasionally get their hands dirty. It is also important for teachers to note that success stories are almost always trial and error—a sound solution will not come right away. By testing hypotheses and modifying approaches, students truly understand the value of hands–on, experiential learning. Not only are these demonstrations helpful for getting closer to a solution, but haptic engagement also teaches students about grit, perseverance, and strategies around error analysis.
Another great skill set that students may develop while participating in PBL classroom activities involves retrieval practice. Since students are focusing their work on one primary challenge, they are able to hone their focus and truly absorb new information as they learn. Teachers can help foster retrieval strategies with activities such as Cornell note-taking, peer teaching, and Socratic seminars, in which students take the lead in delivering information to one another.
Try some of these PBL strategies out in your next lesson, whether it be virtual or in-person, and see the results for yourself.
New Preschool Program in Oregon is a Model for the Nation—But Challenges Remain
In November 2020, voters in Multnomah County, home to the city of Portland, resoundingly approved the creation of a new, universal preschool program—a program that could serve as a model for desperately needed preschool and childcare investments for the entire country. All three- and four-year-olds in Multnomah county will be able to attend a free, year-round, universal, high quality preschool program that meets their needs as well as those of most families, providers and staff, and local businesses. Key elements include a wide range of choices for families as well as living wages and professional supports for providers and workers. The program is slated to be equitably funded by a local income tax on the highest income households.
Two big challenges remain: ensuring that families with “non-traditional” work schedules are included, and significantly increasing public investment in facilities to allow preschools to expand well beyond church basements and providers’ homes. Those working non-traditional hours are disproportionately low-income, women, people of color, and often “essential workers” without whom our society and economy would not function. Federal childcare initiatives must address the needs of families with such work schedules, or the families that most need public child care will be left out.
A Universal Model that Serves Diverse Needs
Universal preschool programs benefit all children and lead to better outcomes than means-tested programs for the most disadvantaged children. Means-tested programs such as Head Start seek to deliver services only to households with low incomes. Although means-tested programs “target the poor,” universal programs bring children and families from across the socioeconomic spectrum together, challenging ongoing race, ethnic and class segregation that erodes democracy. Universality also inspires broad support to maintain adequate funding. After fifty well-regarded years, Head Start is still available—but only for a fraction of eligible families, and even then, often only part-time and part-year. High quality preschool and child care is out of reach for the large majority of families who already face the high cost of housing, health care, and student debt with stagnating wages. Importantly, universal preschool is both a two-generation anti-poverty program and a powerful boost to economic development, because it returns $9.45 to the community for every dollar spent.
Families raising young children are diverse and need a wide range of options. Multnomah County’s new Preschool for All program will offer choices of:
- language and cultural contexts, including Afro-centric and other alternatives,
- types of setting, including family childcare providers, public schools and free-standing centers, and
- schedules, including school year and year-round, full and part-time, weekend days as well as week days, with up to 50 hours a week for families that need or want longer days
Children with disabilities will be included, facilitating earlier identification of health issues and treatment. Expulsions, now too common in preschool settings particularly for children of color, will be prohibited, requiring that the system provide supportive interventions to meet all children’s needs.
Fair Pay and Professional Support for Providers and Workers
Currently, U.S. family childcare providers, preschool teachers, and childcare workers earn poverty wages with few benefits and often cope with difficult working conditions. The result is high turnover; the loss of skilled, experienced and dedicated workers to jobs that better support their families; and damage to the quality of care. High quality child care depends on the ongoing relationships caregivers develop with families, children, and co-workers.
Multnomah County’s new Preschool for All program will pay teachers comparably with kindergarten teachers, doubling their current salaries. The wage floor for assistant teachers and other classroom staff will be set at nearly $20 an hour when the program starts in Fall 2022, with pay levels adjusted to reward increasing skills, training and experience. Continuing professional development will be geared to the schedules of the low-income working parents who are over-represented among preschool workers. Should workers wish to join a union, employers will be required to remain neutral.
Funding universal high quality child care is within reach. Over the past 40 years, U.S. economic gains have been concentrated on an ever smaller group of the wealthy, while responsibility for paying for our infrastructure and public services has been shifted from the affluent to the working and middle classes. Reversing such trends, Multnomah County’s preschool program is to be funded by a county income tax on approximately eight percent of households at the top. Combined federal, state, and local income tax rates for such households will still fall far below the top tax federal income tax rates in place for the much of the 20th century, from the 1930s through the 1970s.
Multnomah County intends to offer preschool up to ten hours a day and on weekend days, but has not committed to other “non-traditional” hours. Employers demand “non-traditional” work schedules for the three occupations expected to add the most jobs between 2019 and 2029: home health and personal care aides, fast food and counter workers, and restaurant cooks. Many retail and hospitality positions also entail low wages and employer insistence that workers maintain “open availability,” and healthcare, construction, and gig workers struggle with work schedules that make it very difficult to find child care.
Multnomah County will pay fair wages to everyone working in the classroom, but will not supplement the pay of people working in Head Start and other public preschool and childcare programs that pay too little to retain skilled people in the face of a more attractive alternative. The county plans to support some infant and toddler programs, but won’t be able to overcome the severe shortage of affordable, quality care for these age groups, likely to be exacerbated by competition from a preschool system offering better compensation. Finally, preschool and child care is now crowded into inexpensive or public spaces; serving all children well will require a significant investment in physical facilities.
Despite such continuing challenges, Multnomah County’s Preschool for All offers a national model, with its variety of choices to families, living wages for all classroom staff, and an equitable approach to public funding. Each of these aspects needs to be included in any new federal program. In addition, a new federal program should aspire to offer high quality child care to families struggling with difficult work schedules, until labor legislation is revised to place limits on such unpredictable schedules. Strategies will also need to be implemented to improve the wages of workers in Head Start and other public preschool and childcare programs.
Study Shows Immune Cells Against Covid-19 Stay High in Number Six Months After Vaccination
A recent study by Johns Hopkins Medicine researchers provides evidence that CD4+ T lymphocytes — immune system cells also known...
Poverty, Racism and the Public Health Crisis in America
Although extreme poverty in the United States is low by global standards, the U.S. has the worst index of health...
What Do You Know About Disability Cultural Competence?
Recently, I had the opportunity to give a webinar on disability cultural competence to social service workers, but was met...
Five Tips to Ease Kids’ Social Reentry
Pediatric neurologist Jane Tavyev, MD, has advice for parents looking to help their children learn social skills after pandemic isolation....
Mental Health8 years ago
Children Who Experience Early Childhood Trauma Do Not ‘Just Get Over It’
Social Work8 years ago
Ending the Therapeutic Relationship: Creative Termination Activities
Education5 years ago
5 Social Work Theories That Inform Practice
Social Work6 years ago
The Spiritual Social Worker: May Your Spirits Guide You