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True Champions
Five hospital social workers reflect on their profession’s dramatic transformation

Clockwise from top left, James Kohl, Carrie Vick, Susan Rucker, Carole Seddon and Helen Michalisko.

An affable, often homeless man who lives on Social Security disability, D. is a 10-year veteran of the busy Moore Clinic, an outpatient clinic for people with HIV/AIDS. Practically every day, he drops by. Often, he sees Susan Rucker, clinical manager for the AIDS Services social work program.

Over the years, Rucker has been trying to help. She’s made arrangements for housing, food and health insurance, but D., Rucker says, is willful. “He seeks help, then denies it. At the same time, you know he’s hungry. You know he’s cold. You know he doesn’t have money.”

Sorting through patients’ complex psychosocial issues has always been a significant part of a hospital social worker’s responsibilities. Today, though, those responsibilities have expanded far beyond the bedside. Social workers now take part in key hospital initiatives. They are involved in the business of health care and contribute to the institution’s fiscal and business planning. They educate house staff and students of social work. With it all, they are patients’ chief champions, the care team members who share a true, holistic perspective.

Now, in March, National Social Work Month, of the year 2007—the 100th anniversary of Hopkins Hospital’s Department of Social Work—five senior clinical social workers reflect on the remarkable changes that have taken place in their profession in the last 25 years.

One of the most significant is health insurance. “It’s taken center stage,” says James Kohl, of Psychiatry. “It’s so much of what we do because treatment cannot be rendered unless insurance is guaranteed.”

When Rucker describes D.’s four insurance programs, for instance, she might as well be reciting the letters of the alphabet: “He has Medicare A and B; Medicare Part D for prescriptions; QMB [qualified Medicare beneficiary] to pay the Medicare A co-payment; and MADAP [Maryland AIDS Drug Assistance Program] to pay the co-payment on his HIV medicines and the deductible on Part D.”

Insurance was never this complicated. Furthermore, it used to pay for long hospital stays. Carole Seddon, director of the Cancer Counseling Center, joined Johns Hopkins in 1983. She remembers a patient who spent 364 days in the hospital following a bone marrow transplant. Helen Michalisko started as a social worker on a busy surgical service in 1979. She recalls a 32-year-old man who was admitted to the hospital with Crohn’s disease. He stayed until the day he died—at age 36.

No longer. These days, stays are short. Inpatients are discharged with complicated treatments requiring sophisticated aftercare. More procedures are done on an outpatient basis. Patients and families are expected to do more for themselves. “Often, they can’t handle the high-tech equipment they have,” says Seddon. “We struggle to get specific agencies to help them.”

Social workers work in a variety of settings, and only about 20 percent choose health care. These five say they chose Johns Hopkins because of its stimulating environment. “We have the opportunity to make a positive difference for families we serve, and we can be involved in research and teaching,” says Carrie Vick of the Harriet Lane Clinic.

Up until 1961, the Department of Social Work was known as the Department of Social Service. The name was changed to distinguish it from the government’s social services system. Today, the department is thoroughly integrated into the fabric of the hospital. Social workers sit on ethics and quality improvement committees. They are closely involved with regulatory affairs, emergency preparedness programs and length-of-stay initiatives.

Now decentralized, the department has five divisions that cut across the institutional lines of hospital and University: Medicine/Surgery, AIDS Service, Oncology, Pediatrics/Ob-Gyn and Psychiatry. Master’s-level professionals, social workers are trained as generalists but develop specialties. An oncology social worker, for instance, might specialize in solid tumors or hematologic malignancies.

As highly specialized as they are, hospital social workers share fundamental qualities. They know how to quickly develop relationships and build trust with patients. They can conduct thorough assessments, develop appropriate goals and collaborate with multidisciplinary teams. Above all else, they are resourceful. “We are trained in problem solving,” says medical/surgical social worker Michalisko. “We may not have the answers, but most of the time, we can find them.”

All five seasoned professionals say their work with patients has been nothing less than life-changing. “I never planned to work in medical social work, or in oncology, but I found a job and fell in love,” says Seddon. “The opportunity for growth and experience has been such a gift. The patients I’ve met, the way they fight for themselves, all this has taught me so much about courage and dignity. I’m a different person now, personally as well as professionally.”

What lies ahead? “Even more significant efforts to contain costs,” Kohl predicts. “We will have to work smarter and become more efficient in what we do.” Quantifying the benefit of social work services will be important. So will recruiting and retaining staff who can move easily between the bedside and the corporate office.

But most important, says Seddon, will be maintaining the focus on the patient. “As the pace of care continues to quicken,” she says, “it will be harder for members of the care team to see the patient as a person. Our role will be to help them still do that.”

Anne Bennett Swingle

This concludes our two-part series on the Department of Social Work. Part 1 appeared in the February issue.


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