Social Services Innovations: Social Workers Are Vital to Pandemic Recovery — This Is Why
By Yosmayra E. Reyes, LCSW
Social Work Today
Vol. 20 No. 4 P. 28

It is hard to find solace amid so much suffering, yet there is comfort and power in sharing pain. There are few words to describe the emotion that permeates our environment due to the global pandemic resulting from the novel coronavirus. During these times, when activities have halted and no ending is near, social workers are a critical component to maintaining the ongoing government engine that is health care in America. A multipronged approach, completed via targeted interventions that address multiple service needs and entry points, can help stabilize communities and alleviate system pressure. The progression of this illness has clarified that what we have done in the past cannot sustain our health for the future. We must work actively to address any factors that make us more vulnerable to this disease, or any other after it.

Resources and Long-Term Vision
The devastating financial effects being felt as a nation are difficult to observe. While hopes rose high for a “V shaped” economic turn, those ideas have quickly receded with the pushing forward of multiple stimulus packages created to bear the brunt of this illness, as noted in recent global economic review by Bloomberg news (Holland, 2020). Although a return to normalcy will be a struggle, targeted interventions in addressing behavioral health needs, financial impact and losses, and ongoing psychoeducation about the social determinants of health become key interventional strategies. Through brokering and reallocation of resources, social workers can successfully triage clients, connecting them with multiple needed resources for long-term stability in the community.

Local businesses have closed, creating critical job losses that are crippling the economy and generating substantial financial toxicity. Bigger waves of unemployment have been forecasted in coming months, when companies that could not sustain themselves, due to the freeze of production and output, may file for bankruptcies eliciting further layoffs (Holland, 2020; Clarke, 2020). One consolidation agency in the United States, Freedom of Debt Relief, conducted a pool of 2,335 clients on financial hardship incurred because of the coronavirus, with 45% of members reporting being negatively impacted financially now and 41% stating they will encounter “high” difficulties six months from now with purchasing food items, as well as making rent and mortgage payments (Micheletti, 2020).

Social workers can be particularly adept in assisting state government in mitigating ongoing financial losses at the local levels during this crisis through reintegration of social services, as well as creating routes for providing in-home services with local businesses. Reintegrating ties within the community means that we connect those in need with those providing a service. This hand off is critical, as massive labor losses would hinder community agencies from providing direct services via traditional methods. Highlighting self-sufficiency as a primary financial goal in the provision of care will go a long way in reaching successful health outcomes. It is important to frame services as a temporary aid to alleviate burden with the added caveat of creating income generating strategies. Once clients are on the path to self-sustainment, giving back to the community can become another goal that can assist towards increasing financial stability by ensuring strong ties are maintained, creating long-lasting communal and social resources.

Behavioral Health Effects
Taking a step back from finances and looking through the behavioral health lens, we are witnessing numerous and complex developments of ongoing trauma. Staggeringly, in New York City, there is little noise but the sounds of ambulances. The inexplicable losses are felt like a blanket over the entire city. In the wake of this novel illness are higher reports of anxiety and depression due to aggravation of symptoms resulting from social isolation. During a recent National Alliance on Mental Illness webinar titled “Ask the Experts,” officials state their resource guidelines on how to manage mental health symptoms related to COVID-19 were downloaded more than 60,000 times within the first day of posting online (Duckworth & Gruttadaro, 2020).

Social isolation is proving to be just as detrimental as other illnesses to overall health outcome achievement. Cacioppo and Cacioppo (2018) highlight in their study this growing phenomenon as a public health crisis, associated with a 26% increase in the risk of premature mortality. The Governor of New York, in management of this disease, has created an emergency emotional support line to begin providing mental health support. When social isolation has proven to be just as detrimental as other illnesses to overall health, being alone can create tendencies toward negativity, requiring extra effort to avoid tying negative thought patterns to beliefs (DiJulio et al., 2018).

Proper triaging, identification of treatment needs and development of social and communal support systems to help create balance will be ideal in addressing the impact of trauma. Secondary sequelae identified to date are increased rates of domestic violence and child abuse, as noted in Chicago, New York City, and Los Angeles, with New York City reporting a 20% rise (Taub, 2020). Social isolation can be just as alienating among robust families, where uncertainty about the future creates added stress to family systems. Here, social workers can specifically work on addressing symptom relief through discussion of stress and its impact on overall family health, ensuring ongoing access to food resources and opening dialogue with families in an effort to increase engagement and supervision to children at risk.

Telehealth and Case Management
During these unprecedented times, social workers become the interweaving thread in assisting a nation with getting back on its feet. Social workers are specifically trained to work from low reserves, learning to adequately reallocate resources based on need. This skill is essential, as it alleviates systemic pressure on an already taxed health care system. Although little research has been done on the efficacy of telemental health, there are a multitude of ways available to reconnect socially via this mechanism. Independent case management is one interventional method to consider, as it can create substantial relief to government systems by identifying pathways for distribution of resources and increasing engagement to minimize risk in family and individual settings. This approach has the added benefit of aggregating local resources, thus identifying clear communal needs for further state and federal interventions.

Case management, not a typical framework in independent practice, can quickly identify vulnerable populations that require multiple service entry points in order to receive adequate care. The plethora of clients that will require assistance can vary from first line responders and other frontline workers who may require ongoing assistance in managing symptoms of trauma to families that may have high incidences of domestic violence and/or lack food and other needed resources. The private practitioner can easily assist in providing short-term case management needs in order to connect clients with local supportive services, creating clear treatment pathways for those recently discharged from hospitals and convalescing in the community.

Innovation becomes key when allocating resources. City and statewide agencies are encountering difficulties fully engaging our most vulnerable clients. It is understood that clients with unmet social needs tend to fair worse in achieving optimum health outcomes, encountering higher health related costs overall. Social workers will need to amplify their roles as advocates, a hat that is worn frequently, to ensure red tape is cut and services are provided. Finding cost-effective services will increase the likelihood of improved health outcomes and has proven to be an effective interventional strategy that provides the most long-term gains, as noted by Community Catalyst (2019), a national nonprofit organization with the aim of protecting the consumer in a rapidly changing health care environment.

Critical Role of Social Workers
Integration of behavioral health practices within primary care settings becomes another critical bridge in stabilizing communities. According to the National Cancer Institute (2019), full integration involves the consumer at an intimate level and assistance in equitable distribution of services in order to ensure lowering further health care disparities. Primary care providers, in conjunction with mental health practitioners, should identify and develop long-term health goals and strategies via behavioral interventions. Social workers can shape value-based services, ascertaining that nonmedical health related services and expenses align with free available community health assessments and resources (Community Catalyst, 2019). This entails actively working at using consumer education mechanisms to build understanding as to the “hows and whys” of social and economic needs that affect health-related goals. This integration of mental health and primary care creates added social support networks that reduce further behavioral challenges that impact care. Key points to monitor are ensuring clients maintain their online visits with medical providers, no disruption of medications occur, and long-term health-related goals are established.

We’ve handled epidemics before and seen the devastating effects they may have on communities, such as with the “crack epidemic” of the late ’80s and ’90s. We’ve handled acts of terrorism that crippled the psyche of many Americans, instilling doubt and fear against community members, such as the 9/11 terrorist attacks. We can definitely overcome the coronavirus pandemic, with the help of our social workers. Social workers are in high demand, and we are more than capable of meeting the needs of our clients during these turbulent times. We know what care to provide and the importance of strengthening communities to ensure optimal outcomes.

— Yosmayra E. Reyes, LCSW, is a psychotherapist providing care to children and adolescents with mental health challenges. She works as the weekend supervisor at Bonding Links, Coalition for Hispanic Family Services, a mental health clinic under the Office of Mental Health NY, recently awarded the Community Care Award 2019 for outstanding impact in community health.

References
Cacioppo, J. T., & Cacioppo, S. (2018). The growing problem of loneliness. Lancet, 391(10119), 426.

Clarke, G. (2020, April 8). Covid-19: Impact could cause equivalent of 195 million job losses, says ILO chief. UN News. https://news.un.org/en/story/2020/04/1061322.

Community Catalyst. (2019). Policy principles to guide health care’s role in social interventions. https://www.communitycatalyst.org/resources/publications/document/CC0519_PolicyPrinciples
Doc_Web.pdf.

DiJulio, B., Hamel, L., Munana, C., & Brodie, M. (2018, August 30). Loneliness and social isolation in United States, the United Kingdom and, Japan: An international survey. https://www.kff.org/other/report/loneliness-and-social-isolation-in-the-united-states-the-united-kingdom-and-japan-an-international-survey/.

Duckworth, K., & Gruttadaro, D. (2020, April 7). Ask the experts: COVID-19 and mental health. National Alliance on Mental Illness. https://mcusercontent.com/5ed5d2d79373961d7c441f5ef/files/6b4838cd-bb63-43ca-a975-403f0cd8fb86/Slide_Presentation_NAMI_Ask_the_Expert_COVID_19_MH.pdf.

Holland, B. (2020, March 31). Economists are losing hope in a ‘v-shaped’ post-virus recovery. Bloomberg. https://www.bloomberg.com/news/articles/2020-03-31/a-quick-rebound-from-virus-economists-have-reason-to-doubt-it.

Micheletti, M. (2020, April 2). COVID-19 pandemic strikes at American’s financial health. Freedom Financial Network. https://www.freedomdebtrelief.com/newsroom/covid-19-pandemic-strikes-at-americans-financial-health.

National Cancer Institute. (2019). Financial toxicity and cancer treatment (PDQ) – health professional version. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-pdq.

Taub, A. (2020, April 6). A new COVID-19 crisis: Domestic abuse rises worldwide. The New York Times. https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html.