Community Healthcare Association of New York State (CHCANYS),
Neighborhood Health Center Social Workers, and
The Healthcare Policy & Practice Network of the NYC Chapter of the National Association of Social Workers (NASW)

Joint Meeting Summary - May 3, 2001

Changes in Staff Size

More NHC's lost than gained social work staff in the past few years. Two social workers reported an increase in staff size. In one site, the staff increased from 1 to 12, and in the other, it increased from 11 - 100. These increases occurred in sites with specialized case management programs and specialized services for which there are funding streams. In five other agencies, however, a significant staff decrease has occurred due to a loss or decrease in funding or managed care. In one site, 8 workers had to be laid off in a new program because funding was recently decreased. Other decreases in staff size included:

1. 29 social workers to 4 social workers;
2. 12 social workers to 4 social workers; and,
3. 30 social workers to 10 social workers.

In response to decreases in staff size, one participant reported that her agency is trying to define her role in managed care terms for reimbursement. Several reported that the social workers no longer do one-on-one work and have developed many groups to meet the needs of their clients. Another stated that they just have to do more with less. Yet another pointed out that the Bush Administration has given more money to Community Health Centers and social workers need to think about how they can get a piece of this increased funding.

Social Work Roles, Financing and Outcomes/Evaluation of Effectiveness

Roles, finances and outcome are closely linked and were major threads throughout the discussion. Social workers were identified as those most qualified to help bring medical and nursing services together in the community to ensure that clients are using health care efficiently. The State Government and many agency personnel outside social work, however, do not identify social workers this way because they do not understand the role of social workers, except in specialized programs where their roles are defined and paid for such as in PCAP, HIV/AIDS, etc. One participant stated, "if you are not careful other disciplines will define for you your role." And another said that we cannot expect others to understand our roles when we have not clearly defined them for ourselves. The medical community's lack of understanding of our role and the contributions social work makes was seen as a reason for a lack of funding streams to support our work.

A second reason given for our inability to increase funding was our inability to show in dollars how our work is effective and valuable. Data are not consistently collected, or collected in a manner that can demonstrate cost effectiveness. One respondent said, "We need to document, document, document." Another reported that his being accountable in money terms has given him purpose; and, he and agency personnel can see in black and white that what he does is effective. Few agencies have databases to document the work that social workers do. Collecting data consistently and using it to show effectiveness were identified as among the ways to open funding streams. As presently constructed, funding streams significantly limit the roles social workers can play in health care settings. Reimbursement from Medicaid is only available for mental health services for those with a diagnosis. Social workers however, are creative as to how they use the funding they receive to attempt to meet the myriad needs of patients.

Unmet Client Needs

Several participants reported that specialized services and programs met the needs of their clients especially in the areas of domestic violence, prenatal care, behavioral health services and asthma.. One worker reported that in a recently developed asthma program she expected ten families to need the service and over 200 families wanted to join the program. However, other social workers stated that their clients were "in dire need of social work services" and "these patients do not know how to navigate the system." Some frustration with the fact that these case management functions are not funded was evident.

For more information, call Terry Mizrahi, co chair (212) 254-7574 or tmizrahi@nyc.rr.com; Jerry Beallor, co-chair, (718)-796-7185 or gbeallor@earthlink.net.

Recruitment and Retention of Qualified Social Work Staff

Eight of the participants identified the retention and recruitment of social work staff as a major issue even when there are positions available. Turn over, lack of experience and a drastically decreased pool of qualified social workers interested in health care were cited as reasons for these problems. Social work positions in some places, particularly in public facilities are going unfilled because some social workers do not have the cultural competence to work with the populations served; they need to be bilingual (in at least another language besides English). There is a need to interest social work students and new social workers in health care. The most important deterrent is low salaries. When a qualified social worker is hired, s/he does not stay long because s/he can make more money in other fields of practice. Suggestions to address this problem included:

• Marketing in high schools to get students interested in the profession early.
• Loan payback programs for students who work in neighborhood health center settings when they graduate.
• School of Social Work efforts to recruit and encourage students to enter the health care field.
• Advocate for increased salaries
• Pay more attention to cultural competence.
• Increased salaries.

Despite the issues raised by the participants, many of them verbalized that they were proud of the work they were doing. Furthermore, they reported that they were developing new programs and groups to meet the needs of their clients. They also reiterated a commitment to demonstrating the effectiveness of their work and advocating for the continued inclusion of social workers in neighborhood health centers to meet the psycho-social needs of their clients. They felt that CHCANYS and NASW could be of assistance in communicating the needs and helping them convey the contribution professional social work is and could be making at the primary health care level.

Laura McBarnet, the CEO of CHCANYS and Terry Mizrahi, Co-Chair of the HCPPN and President (as of July, 2001) of the National NASW agreed to publicize the findings of Terry's study and to develop a strategy for increasing the visibility of social work contributions. They also urged the social workers present to identify allies within their centers and in their communities to work with them. Every one felt it was valuable to have social workers come together and it was suggested that another meeting be held that focuses on some of the skills and strategies discussed above.

Prepared by Vicky Rizzo, Research Associate on the NHS Study from SUNY-Albany
For more information on the study, email tmizrahi@hunter.cuny.edu. 212-452-7112

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