A Social Worker Addresses Psychosocial Problems in an Impoverished Community
By Miguelina Espiritu, CSW
Editor's note: The author was invited to submit an article to Currents because her practice exemplifies some of the ways that social workers address poverty.
Working for a mobile crisis service at New York Presbyterian Hospital has given me the opportunity to help combat poverty. I work in Washington Heights, New York City. It is a multicultural and multi-problem population. Many of the residents rely on their SSI, SSD, and P.A. checks for survival. Washington Heights has many resources, however not enough to meet all the problems. The cases below illustrate the ways that social workers can address the needs of the community.
I saw a pregnant woman who was referred for depression and a history of hospitalizations. She had many problems related to poverty. Her father brought her to U.S. three years ago from the Dominican Republic and she was working until 6 months ago. However, because she had a minimum wage job and also has to support a 3-year old daughter in Dominican Republic, she was unable to save any money. She was essentially alone and received no help from her unborn baby's father who was married and had moved to Florida.
This client did not have the money to pay her rent. She did not have any food or clothing. She was wearing a pair of high heel shoes, the only shoes she owned. Also, she had only one pair of pants that fitted. I phoned the social work department to help get some clothes. I was able to get her some jogging pants, a few shirts, and a pair of sneakers. The client put the sneakers on right away. The young woman asked, "Why are you helping me?" I told her, "That is our job to help people. You need help and we are here for you."
It was quite clear that she was under tremendous stress because she could not access the resources around her to meet her needs, and felt extremely overwhelmed. The client seemed low in energy, overwhelmed, tired, worried, and sad. However, her facial expression changed when I provided her with clothing. For the first time, the client's non-verbal language demonstrated 'hope'. Even though I could not instantly resolve the client's issues, I was able to give the hope to go on, comforted the client, and established a positive rapport with her.
As a social worker, I felt concerned for this particular client. However, I knew that there are resources available for this client. I was able to make a number of referral for concrete services and to access entitlements.
During the second home visit, the client was in her small room. She reported that she felt good about herself and her living situation. The client's room had her own small bathroom. On top of her dresser, there were canned foods and cereals.
I felt that I had done my job as a social worker because I was able to help this client to receive concrete services such as food, shelter, and clothing. Most of all, I was able to help the client to regain the hope in her life and to provide social support. As a social worker my heart hurts, however my mind often acts like a computer, full of resources and input to use right away.
Let me introduce you to D. M., a single mother, and her 5-year-old child. Referred by Adult Protection Services, she had psychiatric diagnosis of major depression and a history of suicidal ideation.
During our first visit, D.M. reported many psychosocial stressors. Her public assistance case was closed because she did not keep an appointment. She had no food for her and her 5-year old child. D.M. was being evicted from her apartment. Because of the pressure of not having food for herself and her child and the fear of being homeless, she was thinking about suicide. D.M. stated that she did not want to kill herself but she felt desperate. The pressure was overwhelming. I encouraged D.M. to hold on, and offered psychiatric treatment and a case manager to help with Public Assistance problems. I referred her for a psychiatric evaluation treatment on an outpatient basis. I also called the Hospital Social Work office to get a special fund for 50 dollars.
| I felt that I had done my job as a social worker because I was able to help this client receive concrete services such as food, shelter, and clothing. Most of all, I was able to help the client regain the hope in her life and to provide social support. |
D.M. wrote a shopping list and I went shopping and bought food. When I came back with groceries, the police and ACS were in the process of removing the child because of no food in the house and D.M.'s history of suicidal ideation and depression. The child was holding on to her mother. Both mother and child were crying. I spoke to the caseworkers to allow the child to remain in the household. They phoned their supervisor and discussed my assessment. Meanwhile, the child opened a box of cereal and started to eat it without milk. The police officer, caseworker, and I looked at each other with teary eyes. I consulted with the ACS supervisor, providing my assessment that the mother would be stable with adequate supports and resource. The ACS supervisor agreed to let the child stay with her mother. D.M. appeared hopeful.
In our second visit, D.M. needed money for school clothes, a Con Ed bill and other needs. I accessed funds that were used to buy clothes for her 5-year-old child.
There were obstacles with the public assistance program because it takes them 5-6 weeks to re-open the case. In the interim, I provided D.M. with food pantry referrals and assigned a case manager to help with other services needed.
During the month of July 2001 we received a referral from outpatient child psychiatry, involving a mother and 4 children. Of particular concern was her 13-year-old son diagnosed as oppositional disorder and refusing to go to school. The living conditions observed were horrendous. The client's basement apartment was falling apart. We walked through pipes and dirt floor, mattress on floors, the boy and his sister sleeping on the mattresses on the floors. The boy refused to talk to us. I recommended treatment at the outpatient child psychiatry center. I reported the case to ACS for family Preservation. I also recommended that the client's mother move into a family shelter. Referrals were provided. One month later the boy's mother came and visited me. She reported that the family was doing better and they were staying in a large clean 2-room apartment at a tier 2 shelter. The mother requested $40.00 for food since her public assistance case were not yet opened. The mother appeared hopeful.
As a social worker some of the obstacles I face is waiting lists, and overcrowded agencies in Washington Heights and limited social support systems. When working with these difficult populations with so many problems, one must take the time to self evaluate.
I recently created the acronym with the word "ENTER": E= evaluation; N= needs assessment; T= treatment plan including termination; E= evaluation of self; R= resources for client and yourself. Self-care is essential. I am also a healing touch practitioner at Columbia Complementary Medicine Program, College of Physicians and Surgeons at Columbia University. I have learned to heal and cleanse myself as part of a daily routine. However, the most important part of my day is with God and the strength and energy He provides.
This year I am very fortunate to have a student, Anastasha Wang, from Columbia University, School of Social Work. She is as passionate about the social work profession as I am. Before going out into the field we consider ourselves as Bat-CSW and Robin-social work intern going out in the bat mobile to improve lives.