Social Workers as Leaders on Palliative Care Teams: A Podcast with Barbara Jones

Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, who do we have with us today?

Alex: We are honored to be joined by Barbara Jones, who is professor and associate dean for Health Affairs at the School of Social Work at UT Austin and chair of the Department of Health Social Work at Dell Medical School. Welcome to the GeriPal Podcast, Barbara.

Barbara: I am glad to be here with you.

Alex: And we’re also-

Eric: And the list of accolades would just continue and continue. Can I just acknowledge one? Founding board member of SWHPN? Is that right?

Barbara: Yes. Pretty proud of that one. Yes. Yeah.

Eric: How long ago was that?

Barbara: Oh, I think it was 2013. Now, my SWHPN friends will get mad at me if I got that wrong, but I think it was 2013.

Alex: And we also like to welcome-

Eric: I see another familiar face, Alex.

Alex: Yes, Anne Kelly, who is a palliative care social worker who has been a frequent guest host on this podcast, and for a long time, did the introductory voice of the podcast. Welcome back, Anne.

Anne: Hi, thanks for having me. And thanks to Barbara for giving me the opportunity to be a SWHPN member.

Barbara: Yay.

Eric: So we got a lot to talk about today. A lot of this is going to be revolving around social workers as leaders in hospice and palliative care. But before we dive into that topic, we always ask our guest, do you have a song request for Alex? Barbara?

Barbara: I do have a song request. Yes. So I would like to hear You Gotta Be by Des’ree.

Alex: And why this song?

Barbara: This is actually a great leadership song because she talks about you’ve got to be strong, you’ve got to be bold, you’ve got to be calm. And she ends with, love will lead the way. So that sums up my leadership style right there.

Alex: Yeah, that’s great. All right. There’s no guitar in this song, but we’re going to try adding some guitar and we’re going to see what it sounds like. Here we go.

Barbara: Cool.

Alex: (singing)

Okay, that was one of the biggest challenges I’ve had. I love it.

Anne: Great job.

Eric: Well done, Barbara.

Alex: Good to be challenged.

Barbara: I loved it. I’ve never thought about that song from the perspective actually of social work leadership, and as you were singing, I was like, “Yeah, that’s actually pretty much perfect right there.” So that little bundle of words sums it up. Thank you for that.

Eric: All right, Barbara. So in preparation for this, I read a couple articles about social work leadership in palliative care. One of them came to mind was Jason Davidson, who’s out of the UK, works at Marie Curie Hospice as a researcher and a leader. And the title of his article is, does culture of modern day palliative care social work leave room for leadership, where he interviewed six leaders in palliative care, five or six for social workers. And I’m just going to give you one quote from one of the leaders. And I just would love to hear your reaction to it.

I don’t know if this person was a social worker or not. And this is not me who’s saying this. Here’s the quote, Sicily Sonners conceived the idea of palliative care when she was a social worker, but then had to become a doctor to make it happen. What’s your reaction to that quote?

Barbara: My first reaction is word, that’s really what happened. When you think about leadership and we think about health care, we still live in a healthcare system that has a hierarchy. And so there are different levels of power within our healthcare system. So if we’re going to have a shared leadership model, that means that some of the folks that have more power have to share the power and invite in those of us that may not have as much. In fact, most of the leadership opportunities that I’ve had in the interdisciplinary interprofessional space have happened exactly because somebody made a conscious choice to say, “You know what, I’m in a position of power. We need social work’s voice in here. Let me open the door.” Then of course, I jam my foot in the door and drag Anne and everybody else in the room with me. But it starts because there’s a differential hierarchy and somebody is intentional about sharing that.

Eric: Yeah. And it also feels like for a lot of play … Well, let me ask you this, was your story, you think, common or uncommon in the field?

Barbara: I mean, I think I’ve been very fortunate to have a lot of leadership positions, but again, most of that occurred early on because there was somebody who was a partner, often a physician, who said, “Barbara, I think you should be in this conversation here. So why don’t you join me at this meeting?” Or “Why don’t you come over here with me?” or “Why don’t you write a grant or whatever?” And it helped me think beyond where maybe I was in the first place. So having that interprofessional partnership was part of my leadership strategy. And I would think many of my social work colleagues would say the same.

Now, we’re at a place where we have a lot of social work leaders. So I think we do that for each other now, but that wasn’t always the way.

Eric: Yeah. Can you tell me a little bit about your story, how you got into palliative care and …

… where has it taken you?

Barbara: Well, like any good GeriPal Podcast, one must begin with my story, which begins in pediatrics. So I’ll just find a way to get pediatrics in there everywhere. But I did, I started in pediatric oncology.

Eric: Yeah. You’re going to be asked to be on PediPal after this.

Barbara: Exactly, exactly. So I love it. In fact, I’ve always joked through the years that some of my best friends are gerontologists because I’ve been in palliative care all along. But I started in pediatric oncology and really had the opportunity to work in some fantastic teams, the teams that it’s beautiful when you have, where you end up going to work with, in my case, kids and families. And we ended up being the same team that would show up for some of the most difficult conversations. And this was before peds palliative care really had traction. And so it was like, poof, you’re the palliative care team because you keep showing up and you keep having these conversations.

But the team that I got to work with, physician, nurse, myself, child life, we work so well together that we finish each other’s sentences. And so when you have that, that’s so good for the family. That’s so good for us. And it taught me what the power of interprofessional palliative care really, really could be. And I think that’s when I got hooked on how do we improve care, in my case again, for kids and families, but also for us, the providers. And I know that when I’m in the middle of a great team, I thrive and I feel more supported. So I’m going to last longer in my position and I’m going to seek opportunities to grow and to help families and patients more and more.

Yeah. So that’s how it began was really at the bedside of kids and families and was a bit of an accidental academic, didn’t quite intend to end up in academia. But again, with a colleague, a physician colleague, suggested that I submit a grant to PDIA back when they were funding lots of different people, but they had the PDIA social work leadership scholars. And I was fortunate enough to get one of those early awards and meet all the other … And there weren’t that many at that time, but meet other social work leaders and meet a lot of my, again, physician, nursing friends and colleagues. And that really just busted the door open for me in terms of having people to talk to about what I had been seeing at the bedside and in my own practice.

Eric: And how long ago was that?

Barbara: I think I got the PDI award in 2002 and I was teaching at that time adjunct at the school of social work where I had attended. And I’m glad they did, but the dean of that school talked me into entering the PhD program, which I hadn’t had on my agenda, but I’m glad she did because it opened other doors and allowed me to do some studies of pediatric palliative care.

Eric: And back then, was there a thriving palliative care social work and network in scene?

Barbara: Not really. I mean, it started from those PDIA social work scholars. That was actually the origin story for SWHPN was PDIA social work scholars who found each other, learned from each other, lifted each other up. And then when that funding stream stopped, we thought we can’t stop this. We need to figure out how to create this community of palliative care social work scholars. And that was really how SWHPN started.

Anne: I’m wondering also, Barbara, when you think about that early experience with such a cohesive team and you think about other social workers that you knew, was that a common experience that you had? Was everyone surrounded by team? Yeah.

Barbara: Not necessarily. I mean, I think that in some cases, it was, but it was about both having the luck to be in a good team and then having the confidence in your own skills maybe to represent the field and stand in conversation with our colleagues and say, “Here’s what I have to bring to the team. Here’s what social work does.” And to both deliver and expect the respect. So it was reciprocal.

Now, my job in pediatric oncology wasn’t my first job after my master’s. That probably helped because I had a little bit of traction and had a little sense of who I was as a practicing social worker, but it varied. Now, I was the only social worker, so that was a place of missing. And when I first started to find my people was when I first started to go into the Association of Pediatric Oncology Social Workers. And then I found other folks that were practicing like I did. A lot what I think SWHPN does for our colleagues now, right? It creates that community where you’re like, “Oh, I’m not alone. I can talk with you about this. I can figure out how to provide care in this way. And I’ve got a whole community of people to support me.”

Eric: So I got a question. Probably in a lot of places, when a physician joins a palliative care team, there’s not a lot of talk about, “Oh, what’s the role of the physician on the palliative care team.”

Barbara: Right.

Eric: But in my reading last night, there’s a lot of talk about what’s the role of a palliative care social worker. Why do you think that is?

Barbara: Well, first of all, I’m delighted that there is reading about social work leadership and palliative care now. So can I just acknowledge that that is also an advancement in the field. So I’m glad you had things to read. Like that just make …

Eric: I did. I did. There’s stuff out.

Barbara: … my little social work heart happy. And I know it’s my dear colleagues that are writing these things. Again, I think it gets back to … And social workers think about systems. It’s one of the ways that we’re trained, that we never think just about a person. We think about a person in their environment. We also think about ourselves in systems. And so when you look at the system of health care, that’s why I keep coming back to this, the person who has the power to define what is going to be health care has more power.

And so if there’s always been physician leads, then we know exactly what physicians do. And then as they hire social workers, they may define that role differently. And I think now we’re at a place where we are taking back the ability to say, “No, actually, this is what a social worker does. And we’ll tell you the scope of practice, and this is top of license, and this is how you can best utilize a social worker and, no, actually that skillset belongs over here.” But you have to have some critical mass there to be able to do that and you have to have some growing leadership, which we have in the field now.

So in the past, I think our roles have been defined by other professions and we’ve shown up and done the work, and I’m biased, but I think social workers are great team members. But the way that we often fill into teams is we don’t walk in and knock everything over and say, “Here’s how it’s going to be.” We fill in water. We just like, “Where’s the need and how do I go and fill it?” But we may or may not draw attention to ourselves in doing so, right? We’re just like, “Okay, I see this patient has a need. Okay, I see this team member has a need. Let me just fill right in. Let me just fill in the spots like water does.” And again, biased opinion of social work, but I think that’s how we enter spaces, and we’re getting better now at maybe creating form and saying, “This is the role of a social work and this is how you can best benefit from our skills and expertise.”

Eric: And how much of it is … So when we think around the evidence base for palliative care social work, so August 19th was the 12th anniversary of the Jennifer Temel study. And when I think about some of the … There was actually a meta-analysis looking at specialized palliative care studies, only half of the 10 randomized control studies had a social worker as part of that team. Jennifer Temel study did not have a social worker as part of the clinical team. A lot of the studies coming out of there don’t have a social worker as part of the team. How much of this is around the evidence base that we’re generating?

Barbara: Well, that’s a great question. So I have a couple thoughts about that. One is, sometimes there are social workers on the team, it’s just not listed and/or we’re not on the studies and we’re not in the authorship. So a challenge to my colleagues, if you’ve got a social worker on the team and you’re writing about interprofessional care, it’s great to find a social worker to be a co-author with you. Now, I’m not saying that happened-

Eric: Is that because there’s so much advocacy for others than social worker that you’re not really advocating for yourself sometimes?

Barbara: That’s some of it. And again, I’m not saying that that’s what happened in these studies.

Eric: Yeah.

Barbara: So it’s possible that all of these studies didn’t have social workers on them, but I have also seen occasion where there was a social worker and yet there was not a social work author or a social work contributor or the social workers listed as an acknowledgement. And part of that is because the way we fund health care, too, right? So we’re fee for service and we look at social work and we’re like, “Well, that’s an added,” if we’re even lucky to be bundled, right? So then the social worker is running uphill, trying to meet all the, remember the water analogy, just trying to fill in all the cracks. Doesn’t really even have time to know we’re doing a study, right, much less take time to read and even make comments on the final conclusions of it.

Eric: Yeah.

Barbara: And so we need to think about, how do we make sure that we’re hiring, funding, and staffing appropriately so that you have enough people on your team where you can get social work voice in these conversations. And because social workers are systems thinkers, they have a lot to say about how an interprofessional team might function and how the conclusions from a study might impact patients and families. You’re missing a really important voice when you don’t have social work on those studies or when you don’t include the social worker as part of the team.

So again, it’s hard to tell on some of these studies. I just did … With a doctoral student and some colleagues, we just did a scoping review of social work interventions in health writ large, right? And we’re very proud that we got that done. It was so hard to tease out from various interventions in health care. Was there a social worker? Wasn’t there. Did they name it? Did they say behavioral health? Did they say other? Did they say, “Please help us don’t say this allied?” What did they … Where’s the social worker and do we even pause long enough to count the social worker?

Eric: It reminds me of … So we did a podcast with Arden O’Donnell on her social work-led palliative care intervention and heart failure. So …

Barbara: Yeah.

Eric: … social work-led research, social work-led clinical program. And I love that podcast. And also, it was great to see that the lead author in there was a social worker and it was a social work-focused intervention.

Barbara: And that’s rare to see that. And again, Arden was able to produce that paper when she was both practicing and studying in a PhD program, right? So she had some time …

Eric: Yeah.

Barbara: … to conduct the research, write the paper, do the thing that creates a publication. I am constantly talking to clinical social workers about what are the ways that you can be contributing to research, to publications, to scholarship, to presentations, even if it’s a reflection paper? What are the ways that you can tell the story, the practice that you do? And then I work with my interprofessional colleagues, as you heard me before, to say, “What are the ways that you can bring the voice of social work into the papers that you’re writing?”

Anne: Barbara, it makes me think about how much time it takes to be able to dedicate oneself to achieving something like research, project, or publication. And when you look at the average social work job listing, it usually doesn’t include time built in to participate in research or publications or projects like that. And so just wondering if you’re noticing that in terms of people having to use personal time to, if they’re not in school, really having to use their own personal time to pitch in in this way or contribute to the literature in that way.

Barbara: That’s a great point, Anne. And I think that is a problem. And then we can get to the power differential because not only are we seeing social workers using their personal time, but typically they’re paid less than some of their colleagues. So there’s a less financial reimbursement for what they’re doing. And then they’re using their personal time just to get their voice into the literature. I feel like that’s an equity issue. I think that’s a problem. I’m not saying that we should … I mean, different professions can be paid at different levels, but we need to find a way to carve out time for our clinical social workers to be able to participate.

I’m a big advocate for, can you even find a way for there to be 10% scholarship time for all of the members of your interprofessional team? If you have one member of your team that’s got some carved out scholarship time, why don’t the other professions have that, too? And I know that that ends up being how we pay for health care. And that ends up being, you want the social workers to see all the patients, but I think we have more retention and longevity if we lift up each member of the team to their fullest potential. And sometimes that means contributing to the scholarship or teaching, even if it’s teaching the residents that come through the hospital or guest lecturing in the class, these things are sustaining to us as professionals. But then I like to also see there be time for scholarship and a recognition of that.

I have this wonderful opportunity right now where I chair this Department of Health Social Work in Dell Medical School. It’s a first Department of Health Social Work in a medical school in the country. Again, it happened because the dean of the medical school at that time said, “We were teaching interprofessional education and we were quite successful with it and we’ve been doing it for years.” And he said, “If we’re going to be truly interprofessional, then we need to be interprofessional all levels, including leadership. So let’s create this department.”

I don’t think either here, I knew what we were getting into and it just has expanded and it’s wonderful, but I’m still working every day to work with my colleagues and clinic leads to say, “I know you want this clinician to be available 100% clinically.” And what are the ways that they can be contributing to research and education that will not only sustain you, but will help us create a better, more well-rounded medical education for everyone? And that’s something we have to just think about. And I haven’t solved for it. I’m working on it every single day. And I have a leadership role and I have really good buy-in and really good colleagues who respect and trust me, and respect and trust social work.

So … But it’s hard to let go of that clinical time. And sometimes social workers feel intimidated by it, too. They get some training in their master’s program on research and they get some training certainly on writing papers, but then you get into clinical practice and it’s like a language. If you’re not continuing to use those skills, it’s hard to know how to apply them.

In our own department, I created a position called director of research, and that person’s job is actually to be the scaffolding behind the clinical social worker. So she … They want to study something, she does the lit review and puts it in front of them. She helps them think about, this is how you design that study. This is how you create a paper that goes into publications. So we’re doing professional development, but there’s an actual person with a PhD, whose job it is to literally scaffold all those clinical social workers.

Alex: Can I ask about terminology?

Barbara: Yeah.

Alex: There are a lot of terms for part of what we’re discussing here today, interprofessional … Oh, boy. Can we just call them out? What are all-

Eric: Transdisciplinary.

Anne: Interdisciplinary.

Eric: Interdisciplinary. Multidisciplinary.

Alex: Yeah. And you said the one that you want to avoid, Allied Health Profession.

Barbara: Yeah.

Alex: Could we just talk about what term … In your opinion, I love Anne’s thoughts on this, too, what are the better terms? And are there terms that we should avoid? Not because they’re pejorative-

Eric: I’m guessing it’s not a doctor saying, “Oh, she’s my social worker.”

Alex: Yeah. Yeah. So that one avoid, avoid, listeners.

Barbara: Yeah, avoid, avoid, avoid, avoid.

Eric: Why avoid that? Let’s just be clear to everybody.

Barbara: Oh, we don’t own people.

Eric: That’s good.

Anne: Nor am I actually your social worker. I’m not providing social work services for you either.

Barbara: Yes.

Eric: Yeah.

Barbara: Right. If you have any social worker of your own, congratulations [laughter]

Anne: Right.

Eric: That’s on the bottom of words to avoid.

Barbara: Words to avoid. Yeah. It’s interesting because I was talking with, again, a group of interprofessional colleagues. In fact, it was my sojourn scholars, friends, and they were creating a paper on interprofessionalism that came out great. And we just were riffing about, why don’t we think about these terms? And I remember talking about them and here’s how I think about it. I think about interdisciplinary … Interdisciplinary is we coexist. You have a collection. You have … It’s one in one.

Multidisciplinary, it probably means we communicate, right? Transdisciplinary gets back to that piece I was talking about earlier, where you finish each other’s sentences, where you find a way … I’m not going to prescribe for anybody, although I do have a funny story about Ativan, but I’m not going to prescribe anything. I’m not going to go out of my scope of practice. But working long enough with my physician, nurse, pharmacy, colleagues, child life, I’m going to get to know them well enough to know where they’re going next. And I might be able to … We communicate together. We almost literally finish each other’s sentences.

I’ve been using interprofessional a lot. It’s used a lot in the education world. It seems to mean that, again, we have all of those pieces worked together. But I think the main goal is that you want to think about true collaboration. That, to me, is the goal. The activity, the behavior is that you have true collaboration. And that doesn’t mean just I’ll call the social worker either because I don’t want to deal with it or because I have to leave the room. You know what I mean. But I want the social work … I’m going to call Anne because her expertise is different than mine and equally valued. And I would like her to come in here and help me think through either with the family or separately, what’s the best course of action? What’s your perspective? What did you learn? What do you know? So anyways, I think give Anne a chance.

Alex: I got a … In terms of finishing each other’s sentences and people learning from each other in that transdisciplinary way, my favorite is when I’m on the wards with Anne and she’s able to make suggestions about clinical care. For example, there was one time when a patient had hiccups, it was like, “I don’t know what to do about this.” And then Anne said … Was it Thorazine, something that could be used for hiccups. I think it was that. I think it was something like that. So, wow. This is amazing.

Anne: Before somebody comes after my license, let’s be clear, [laughter]. It was probably just parroting back the things you hear over and over and over again from the various providers that you work with and you go, “Geez, I think other people talk about this sometimes.”

Barbara: Yeah.

Alex: Right.

Anne: You’re right. It’s that level of exposure to each other where you pick up each other’s stuff.

Barbara: Yep.

Alex: Yes, exactly. Now, I really … Barbara, please share the story about Ativan.

Barbara: Well, I want to hear Anne’s thoughts on … I mean, I talked a lot there. I want to hear your thoughts, Anne, on this idea about these different words. And then I will … I did tease you with that story so I will.

Anne: From a really candid place, I think for me, personally, the words have mattered less. So what you call our team or how we function has mattered less than what we do day to day. And so I find that I’m less emotionally connected to … Or the words, the names, interdisciplinary versus interprofessional, that feels less charged to me. And I think in part, call this what you will, as long as this is working well. And I think … And to me, working well speaks to what you describe as the transdisciplinary definition. And so I think even if we don’t necessarily call ourselves that all the time, if we’re functioning that way, that’s what matters most to me, if that makes sense.

Barbara: Yeah.

Eric: Yeah. And to jump in on that, I wonder how important is it, how we call things or what we think about it versus how we structure things, too. I’m just thinking outpatient palliative care because Anne, Alex, and I were talking about this yesterday. In a lot of palliative care clinics, you have a physician doing the visit, maybe doing some basic assessment and then calling social work for particular patients, usually because the social workers have … We have less FTE in clinics for social work than physicians versus a social work first-driven model, where social workers are seeing them first and then thinking. What are your thoughts on … You’ve done some research on that, right?

Barbara: Well, yeah, actually, I think that’s really exciting. And I’ve had the opportunity to participate in a couple of models where we call it a flipped model, right, where you begin with what matters most to patients and families. And you begin with who are they in this world. Again, that person and environment perspective. You begin with psychosocial assessment and care. And you feed the medicine in. So you never don’t have the medicine, but you start with, who are you? What matters to you in this world? What does this diagnosis mean to you? Who’s important to you? And then the medicine is joined to that. And that’s a really interesting model.

And so I’ve had an opportunity to participate that at our Livestrong cancer clinic here at Dell Medical School. My colleagues in Dell Children’s have a pediatric hospice model that they’re working on that starts with a social worker. Of course, this is a … In my classic way, I just was visiting with them earlier this week. And if they listen to this, they’ll laugh because this social worker is somebody I’ve known for a long, long time, used to be my student. And so she brought this great project and idea to me and I said, “Well, you know what you should do, you should write that up.” And I left and the position that she works with said, “Rachel said if I mention it to you, you’re going to say you should write that up.” I said, “Well, I guess I’m just known to, you write that up, it’s really interesting.”

So I think there are models that are evolving that say, “What if we flip the model a little bit?” And we started in this way. Yeah.

Eric: And I think that’s really interesting … Oh, go ahead, Anne.

Anne: Well, just to add, and I think the way the healthcare system is structured is that if we did want to try it that way, my guess is, Barbara, we’ve got to have enough buy-in from the medical providers to give it a go.

Barbara: You do. And we have to have a different funding stream, frankly. We really probably need to get more the value-based care where we say, “Again, we’re starting with what matters most to patients and meeting them there.” And we have a way to pay for that that isn’t so driven by fee for service.

Eric: How is it working there at Livestrong?

Barbara: It’s working, it isn’t working. You know what I mean? It depends on the day. It depends on the provider.

Eric: Yeah.

Barbara: It’s an iterative work in process. I will say I had the real honor to help build out this model. Now … I think it was 2017 that we began that. And this is an adult model. Look, I’m talking about adults, not peds. Look, I’m in a line talking about grownups here. It’s good. So proud of myself.

But in very personal disclosure, I had the opportunity to build that model out. And then my mom was diagnosed with lung cancer and she was treated there. And what a situation that is to have somebody treated by people you adore and to adore you, and then, of course, adore your mom. I know everybody gets good care and we got really good care. And one of the first things they asked her was, what matters to you and what’s important to you? And she said, “I want to go see Hamilton with my granddaughter.” And so they worked her treatment around her getting to Hamilton with my daughter.

And it was one of the proudest memories of her life. It’s one of mine and my daughter’s still favorite memories. And we hold onto that. She died three years ago. And we hold onto the experience that they gave her and us of her getting to take her granddaughter to see Hamilton.

Eric: Wow.

Barbara: So … I mean, that’s care that matters to patients and families. So it works.

Eric: Yeah. And this podcast came about because you gave a talk at UCSF. It was titled, Leading from the Heart.

Barbara: Yeah.

Eric: And it just made me think in a traditional healthcare setting that is often dominated by physicians and nursing, that probably wouldn’t have gotten started, right? You actually need social workers to be leaders and program developers to have something like that start.

Barbara: Well, I think you need to engage them. I got to give a shout out to Gail Eckhardt, who’s the leader of our com clinic, a physician, an oncologist. And this was her idea. So we co-created, but I got to give the shout out.

Eric: Yeah.

Barbara: Not just me and her, the whole team co-created. I don’t want to … But, yes, she did invite voices in, but I got to give her the shout out.

Eric: Great. I guess, following up on that, are there specific qualities that you think social workers bring to that leadership table that are unique or, in particular, a strength of social work?

Barbara: Yeah. I mean, I think one of them … Although I just interrupted you, but one of them is a power for deep listening, the hearing what matters and the listening to what needs to be done. So that ability to listen, the systems thinking, the equity focus, this idea that we always think about people in their context, that means their racial context, their political context, their community context. We don’t just think about, “Hey, here’s a prescription. Good luck.” And then again, not that everybody’s saying that, what I’m saying is we immediately go, “Does this person have the capacity to fill this prescription? Do they understand this prescription? Do they have a house? Do they have people to care for them? What will be the outcome of this? Are they caring for three children?” And we just gave them a prescription that’s going to really change how their ability to function.

We don’t … That ability to think about people in their environment helps us create models of care, I think, that are particularly relevant. But, yeah, I think it’s leadership, compassion, listening, collaboration, all of those things are strengths that social workers bring.

Eric: Yeah. What do you think, Anne?

Anne: I mean, I really like the way … Barbara, I really like the way you are able to cohesively put together those qualities because, as you were saying earlier, I think sometimes it can feel like a struggle to really put into words the way we want to see our value and how we can offer value. And I think that you describe it in a way that really gives words to people’s experience. And with those words, people can then go engage others in these conversations and have a leg to stand on when they’re trying to find that courage to talk to leadership around how to elbow their way into the table.

Barbara: Well, thank you for that. I think we’ve got a lot of colleagues who’ve done some good writing, too, on this. And even recently, there was a National Academy of Medicine report that came out integrating social care into health care. And there’s some great language there. In fact, I’m often asking my colleague, just go to the executive summary and carry that to your executive leadership because it talks about the power of integrating social care into health care, and it was funded by social work organizations and produced by the national academy.

Eric: Yeah. I mean, wouldn’t it be amazing to see what this healthcare system would look like if it was built around social work leadership and the importance we know about the social determinants of care?

Barbara: Exactly.

Eric: I got another question then, feeding on that, thoughts on how we can promote leadership in palliative care social work.

Barbara: Yeah. I’ve got a lot of thoughts on it. I mean, the first thing is look for opportunities to … I’ve described a few opportunities that I’ve had, right, where somebody’s invited me into a dialogue and then trusted my opinion, respected me, said, “We actually really want your contributions and we’re going to create off that.” Given me a leadership position and let me jam my foot in the door and drag somebody in with me.

Eric: Yeah.

Barbara: So look for opportunities to put social workers in leadership roles, ask them their opinion, then credit them for their opinion. And that’s one way that I think we really can do that. And then there are the … We know that in academic medicine, academic healthcare scholarship is one of the ways that we lift up voices. So that’s why I’m really passionate about trying to get clinical social workers involved in scholarship, as well as academic social workers. But I think it’s important that we are always thinking about ways that we can bring their voice into the dialogue that we’re having.

And sometimes we write in our own journals, which is great, but I’m also often encouraging my social work colleagues to write in medical journals and interdisciplinary journals because otherwise we’re just talking to each other.

Eric: Yeah. Anne, what are your thoughts on the leadership part?

Anne: I think that what Barbara said makes a lot of sense. And I think in some ways, I’ve found over time that there’s also not just talking about it, but doing it and showing people, enabling them to have a real-life experience of how we can make impact on a team can then lead to people being more motivated to see what the role is and see the value added that we can offer. And so instead of just talking about it, we can illustrate it and show it. And I think that, over time, I’ve noticed for not just myself, but for others I know, has allowed them to gain trust of the people around them and show their worth and get more people to back them to say, “Yes, we need these people as part of our teams, they’re essential and central components of good care.”

Barbara: And then I think the challenge to our social work colleagues … Because I’m telling you all the things that I think everybody else should do to get us in the room, but the challenge to our social work colleagues, and it’s hard because our clinical social work friends, and I’ve been one, are exhausted. And now, we’re at a place where the emotional and empathic strain that we’ve been carrying, particularly social workers, is really heavy. So it’s hard to muster energy, but when you’re invited into leadership, show up, represent, go ahead and walk through. And then when you get in there, we have an ethical responsibility to mentor others to come into the room, too.

I think … I knew one of my favorite things that I get to do in my career is mentor and I’ve been fortunate to do interprofessional mentorship. So I don’t just mentor social workers, but I think it’s my ethical responsibility to figure out how to lift other people up.

Eric: What’s the role of SWHPN?

Barbara: Oh, well, I think SWHPN’s had a huge role. I mean, we had the academy, we had HPNA, incredible leaders, but to have a profession that is social work specific has been really great. And the growth of SWHPN has been tremendous. We have hundreds of members and, really, we have our own space now where we’re able to talk to each other, both in a clinical way, a research way, our own state of the science and what’s happening. We’re able to do that now and do that annually and bring in colleagues to come talk with us and share our knowledge with others, and then SWHPN really becomes an incubator for leadership, educational development, clinical development.

And I love that we’ve iterated, too, that first group of leaders aren’t the ones leading now. It’s other folks leading and they’re leading beautifully. And so I’m really proud of SWHPN and what it’s been and what it’s become.

Eric: Yeah.

Anne: And Barbara, when you think about what lies ahead for palliative care social work and social work leadership, are there things that you’re really hoping to see on the horizon?

Barbara: Yeah. I mean, I definitely would like to see more social workers in leadership roles in their healthcare institutions. So not just to the one-off, but actually being the chair of this or the department of that or the leader of the ethics committee. I love to see those types of things. I love to see social workers leading in some of our clinical care. We should not assume that only one discipline can lead a family meeting. Social workers are wonderful at that. That’s a maybe closer to home way for clinical social workers to think about taking leadership. Could you be the one leading this family meeting or every family meeting? I don’t know. How do you step in and say, “That’s a skillset I have, I can lead that.”

Eric: Barbara, can I ask, how do you change the culture of that? Because I think you get so used to what you’ve done in the past. And then often, you have palliative care fellows, MD trainees, they’re often trying to practice their skills. How does one change a culture to more of a transdisciplinary family meaning?

Barbara: I think that’s great. I mean, some of it is just mentioning it, right, because there’ll be somebody who will hear this and be like, “Oh, I didn’t realize the social worker could lead the family meeting,” right? So hopefully that one.

The other thing … And I really appreciate that you brought up our residents and our medical students. I mean, part of the reason I’m so passionate about interprofessional education is that I know that I learned how to provide care because I worked with really great teammates. I probably worked with some that weren’t so great, too, but I’m telling you the good story. But I learned how to … What they did and what I did and how it interfaced, I learned that at the bedside. I want to get ahead of that. I love … I have an opportunity to teach our medical students in an interprofessional team. And I want medical students, pharmacy students, nursing, social work students to learn who they are and how to talk to each other before we get to the bedside because that equalizes some of that hierarchy.

So then when they go to practice, they say things like, “I would never practice without a social worker.” And I think …

Eric: Yeah.

Barbara: … “Okay, I’m going to teach this class again,” because I got another group of med students or residents who feel like, “Hey, I saw what … So I now understand what social work does and I really am a fan and I want one on my team.” And so when I’m in a position of power, I’m in a higher one. So I think we are seeing culture change, but it does require those of us that are in a field like social work to step up when we can. And it requires others to bring up and the medical school, Dell Medical School’s early motto was rethink everything. And sometimes we have to rethink it.

Eric: We actually did a podcast with Bridget Sumser who had a wonderful book, but we talked about the role, especially, and primary palliative care social work. What are your thoughts about primary palliative care social work?

Barbara: Well, I want to give Anne a chance first and then I’ll jump in because I feel like I’ve been doing all the talking. You’re closer to the actual provision of care than I am.

Eric: Yeah.

Anne: Well, I think that probably many social workers who are caring for seriously ill people are providing some degree of primary palliative care without even knowing that and having a shared language around that. And I think … So just to say, I think that there’s a lot of social workers who don’t identify as palliative care social workers who are doing really hard work around this all the time and not necessarily seeing themselves in that way. And I can also see that people who really have a concentrated focus in this area can help augment that social work care. And that’s where the role of specialty palliative care, I think, can really enhance the care plan. But just to say … And I think social workers everywhere are really using the tenants of palliative care in their work day to day.

What are your thoughts, Barbara?

Barbara: I definitely agree with you. I think that it’s interesting they’re … When you think about the skillset of social work, right, listening for what matters to patients, reducing suffering and proving quality of life, it’s not even really a Venn diagram. It’s more of a stack, especially in health care, about how that stacks with palliative care. And I know that in health care, we’re talking a lot right now about whole-person care with very similar tenants. I’m not going to break it to everybody, but that’s palliative care.

Eric: Yeah.

Barbara: That’s … We’re talking about the same things in many times. So I think we need both, but I do think we need to acknowledge that when we have the broad brush of what palliative care is, a lot of us are providing it in a variety of settings.

Eric: Right. Last important question. Tell us the Ativan story.

Barbara: The Ativan story. So again, luckily … Let’s see who I can get in trouble with this story. No, but it was in pediatrics, it was a long time ago at an institution that will not be named. And it was a weekend and we had a crisis call and it really, in many ways, was a palliative care crisis call. And I’d gone in with a physician colleague and we were responding. She was really responding to the medical crisis and there’s a lot happening really fast. And at one point, she threw her stethoscope … And again, you’re just working. So I just grabbed it and threw it on my neck and she’s talking and she hollered out, “I need Ativan, stat.” And so I walked out to the floor and I heard her said to the resident, “So I need Ativan, stat.” And they began to fill it.

And they brought it in and later we were laughing. We were like, “Did I just order the Ativan?” I mean, she just said it with a fair degree of authority. Again, I felt, I heard her. She needed Ativan. I felt the distress of both the child, the mother and my colleague. And so I ordered Ativan.

Eric: That’s great.

Barbara: So I happen to have a stethoscope on and let’s just say it was July or something as early, but new residents maybe, but we laughed about it for years actually. Remember the time that Barbara ordered the Ativan. Yeah. It’s like that song we began with, you got to be bold.

Alex: That’s right.

Eric: That is a perfect segue to the song.

Alex: Perfect segue.

Eric: Let’s hear it again, Alex.

Alex: Little bit more.

(singing)

Eric: Thank you, Alex. Barbara, big thank you for being on here. You, too, Anne.

Barbara: Thank you.

Anne: Thank you, Barbara.

Barbara: Thank you, Anne.

Eric: Absolute pleasure.

Barbara: Thank you, Alex. Thank you, Eric.

Eric: And as always, thank you, Archstone Foundation, for continued support and to all of our listeners. Thank you very, very much.