The Centrality of Clinical Social Workers in
Providing Geriatric Mental Health Care:
A Spotlight on Service Program for Older People
Nancy Harvey, LMSW, Executive Director, SPOP
Editor’s Note: Behavioral health services to older adults are greatly needed at a time when the population is aging. Currents invited SPOP (Service Program for Older People) to share its program. We note that SPOP primarily employs LCSWs, which is rare in aging services.
Service Program for Older People (SPOP) is a valuable community resource in New York City. Since its founding in 1972, SPOP has improved the lives of thousands of older New Yorkers, offering comprehensive mental health services that enable them to age in place with dignity. The agency works in partnership with hospitals, medical providers, and social service agencies to provide mental health care and related services to 1,000 adults each year. The 20 social workers at SPOP are central to every program and make some 10,000 client visits each year.
SPOP was a pioneer in providing community-based geriatric mental health care. Originally established by a consortium of health and human service agencies, SPOP has evolved from a neighborhood organization primarily serving aging Holocaust survivors to a comprehensive mental health center that includes an Article 31 clinic, a Personalized Recovery Oriented Services (PROS) program for adults with serious and persistent mental illness, and free community-based programs in Bereavement Support and Training & Education (for the staff of other organizations in the region). The client population is generally low-income, and half of all clinic clients qualify for Medicaid. In addition to clinical social workers, the professional team includes psychiatrists, case openers, and a psychiatric nurse practitioner.
“We serve an urban population,” says Robert Tobing, LCSW, Director of Program Operations, “and they have very specific needs. New York City is aging rapidly, and two of the fasting-growing segments of the population are our immigrant communities and the ‘very old,’ who are often very frail as well. In addition, SPOP clients are virtually all apartment-dwellers – an arrangement that enables them to live independently but that also leaves them susceptible to social isolation. Imagine an older woman with diabetes, living in a fifth-floor walk-up apartment, with few family or friends living nearby. Our social workers see a lot of clients diagnosed with depression or anxiety disorders, which is often associated with isolation.”
One of SPOP’s signature programs – and one that has served as a model for other agencies across the country – is Homebound Services, which provides comprehensive treatment in the home for clinic clients who are too frail to travel for appointments. Each client receives a comprehensive initial assessment, including physical and psychiatric screenings, and must meet certain criteria in order to qualify for home visits. Clients range from individuals recuperating from a hospital stay to those who are bedbound or homebound due to chronic medical conditions. The home visit from the SPOP social worker is often their only outside contact and can be a critical factor in averting unnecessary hospitalizations.
A recent grant from The Fan Fox and Leslie R. Samuels Foundation has helped SPOP to expand its clinic staff in order to meet increased demand and to serve the City’s diverse population. “We serve a large Latino community,” says Mary Emerton, LCSW, Clinic Director, “both on-site at our clinic and through our satellite sites at senior centers in underserved neighborhoods. Our social workers all receive training in cultural sensitivity, and half of them are bilingual. We never want language or cultural issues to stand as a barrier to treatment!”
One of the greatest community services that SPOP provides is its Bereavement Support program, which offers peer-led support groups for adults who have lost a partner or loved one. Directed by Carola Chase, LCSW, and offered entirely free of charge, the program has earned the praise and gratitude of hundreds of participants who credit it with helping them to understand their grief and rebuild their lives. “Our groups are incredibly diverse – men and women of all ages and backgrounds – and our wonderful volunteers guide them through the process of grief and healing,” according to Carola. “People leave the program in a much better place – and with a new circle of friends who have shared an important process of growth.” Many bereavement clients go on to serve as group leaders, which entails a comprehensive training program and regular supervision.
Last fall SPOP opened New York’s only PROS – Personalized Recovery Oriented Services – program exclusively for older adults. The PROS model serves adults with serious and persistent mental illness (many of whom had been enrolled in SPOP’s Continuing Day Treatment Program) and emphasizes rehabilitation, skills acquisition, and integration into the community. “By focusing on goal-setting and life skills, we are able to offer an exciting schedule of groups and programs,” said Robert Franco, Director of the PROS program. “Our objective is to keep these adults healthy and independent, and we work with each one to develop achievable life goals, which can range from finding employment to losing weight to rebuilding relationships with family and grandchildren.” The PROS program regularly hosts social work student interns from Columbia University and the Silberman School of Social Work at
The social workers at SPOP represent the agency on a daily basis and provide individual and group therapy, home visits, counseling in multiple languages, outreach through senior centers, and, through PROS, life skills training and intensive rehabilitation.
As SPOP moves into its fifth decade, its highest priority is to remain flexible and responsive. The dedicated social workers and other professionals at SPOP serve a population that is older and more diverse than 40 years ago, at the same time that they face new regulations and procedures in the health care industry. What remains unchanged is SPOP’s commitment to serve some of the most vulnerable and fragile members of the community. As the region’s leading provider of long-term in-home geriatric mental health care and a vital partner with medical providers and senior centers, SPOP is poised to play an important role in caring for many more generations of New Yorkers.