This is part of the series of blog articles called “A Writer’s Guide…” where guest posters share their knowledge of skills and occupations.
These articles are a resource to help other writers when creating characters
Check out this article by writer Celeste Straub on being a Social Worker.
Social Worker / Medical Case Manager
by Celeste Straub
This article is based entirely on my education and experience as a social worker in the state of Pennsylvania in the United States.
I have six years of experience working in the medical case management field. My agency provides medical case management for individuals living with HIV or AIDS.
Experiences of other social workers/case managers in other states and countries may be different from mine.
A social worker is a guide who helps people navigate health care and public assistance services.
Often, but not always, they assist individuals from marginalized populations, such as the homeless, low-income, people with certain diseases or medical conditions, children, etc. The term social worker is often interchangeable with the term case manager.
A medical case manager is a kind of social worker who works collaboratively with other medical professionals and social service providers to ensure appropriate medical care is provided to an individual with a chronic illness, disability, or injury.
Stereotypes and Statistics
In the United States, the vast majority (82%) of social workers are women.
There is no definitive reason to explain this, but it may stem from societal pressures on men to be the “breadwinners” of the family, hence causing them to seek higher-paying professions, as well as a societal notion that women are predisposed to be better caregivers.
This has caused social work to become viewed as a “women’s profession.”
Educational Background and Qualifications
Entry-level social workers require a four-year college degree in a social service field, such as sociology, social work, human services, or psychology.
Many social workers choose to further their education and get a master’s degree in social work, becoming licensed social workers, which provides them with expanded job opportunities and higher pay scales.
Medical Case Managers often have the same qualifications as social workers, in that they need a four-year degree in a social service field. Depending on the employer, medical case managers may also be required to have a nursing or medical degree.
In addition to educational qualifications, social workers also need good interpersonal skills, tolerance for opinions and people different from themselves, strong time management skills, organizational skills, critical thinking skills, empathy, strong communication skills, ability to set personal boundaries, and emotional intelligence (ability to read body language, facial expressions, or to read between the lines).
Many are also trained in de-escalation techniques, mental health crisis situations, motivational interviewing, and active listening.
Researching skills should not be overlooked, as while public benefits are usually easy to locate, sometimes clients require resources that are more difficult to discover.
Social workers and case managers are expected to understand and apply basic psychological theories, such as Maslow’s hierarchy and the transtheoretical model of change. You will also hear many social workers using person-first language.
This is a way of speaking, as well as a way of thinking, that focuses on an individual instead of his or her illness, addiction, or problem.
For example, instead of the term “drug user” which defines the person by his or her use of illicit substances, person-first language encourages someone to say, “a person who uses drugs.”
This is also used in the medical case management field. Instead of an HIV positive person or cancer patient, we refer to these individuals as a person living with HIV or a person with cancer.
It reinforces to the social worker, patient, and others that, first and foremost, this individual is a person.
Social workers don’t usually utilize any special technology. They are expected to be proficient in modern computers, including word processing, spreadsheets, and e-mail.
The almighty Google is practically a deity in this world since it provides resources a client might need at the tap of a finger. They may also utilize tablets while providing services out in the field.
Our case managers also text with clients because many clients find it more private than speaking on the phone, especially if they are worried about being overheard.
Medical case managers may use an electronic medical record system to track their interactions with patients, as well as lookup lab results, notes from doctors, etc.
Places of Employment
Social workers are most often employed by non-profit or government-funded agencies to provide services to targeted consumers.
In the United States, case managers/social workers can be found at most hospitals, public schools, public assistance offices, social security offices, prisons/juvenile detention centers, children and youth services, foster care/adoption agencies, publicly funded mental health organizations, drug and alcohol rehabilitation centers, homeless shelters, domestic abuse or women’s shelters, community assistance agencies, and many other non-profit agencies providing services to marginalized communities.
Medical case managers are most often employed by hospitals (both for-profit and non-profit), health insurance companies, health clinics, nursing homes, physical rehabilitation centers, AIDS service organizations, and many other health-related organizations.
Rate of Pay
This, of course, varies widely depending on location, experience level, educational level, and if the agency is for-profit or non-profit. Because non-profit agencies are usually grant-funded, they may not have the ability to match the higher pay rates offered by some for-profit organizations.
Either way, there is a common saying among social workers: “We didn’t go into this field for the money.” In other words, the pay is crappy.
People who become social workers usually do it because they want to work in a field where they help others. According to Google, the average pay rate for a social worker is about $43,000.
As an agency serving a rural area, our starting pay range is about $6,000 less than that. A starting hourly wage in a more urban area would likely be considerably higher, due to a higher cost of living in urban areas.
Basic Job Duties
Again, this varies widely depending on the employer. One thing that seems universal: there is lots of paperwork involved in social work. A popular saying goes, “if it isn’t documented, it didn’t happen.”
Therefore, social workers and medical case managers do spend a good deal of time filling out paperwork (be it actual paper or electric files) detailing their interactions with clients or patients.
A non-medical case manager might find their daily tasks consist of meeting with individuals in need of a service, either in person or over the phone, and collecting personal information (such as ID, pay stubs, proof of residence, etc) to determine that client’s eligibility for services.
They will often assist in filling out applications, submitting them, and then following up with the clients following acceptance or rejection for services.
Generally, the end goal is to get the individual needed social services, which may include public assistance benefits like Medicaid (publicly funded health insurance), food stamps, financial assistance, etc.
A medical case manager may also do the above activities, but usually, the end goal is to improve an individual’s health outcome.
Additional duties often assigned to medical case managers may include attending medical appointments with patients, reviewing lab results, speaking with the client/patient about medication adherence (understanding of how and when to take medications), following-up with the client after hospitalization or a procedure, and coordinating auxiliary health services.
Challenges of the Job
A common challenge across the field of social work is overwhelming caseloads. This often leads to high burnout and turnover rates among social workers.
Burnout is a term that describes emotional, physical, and mental exhaustion, to the point where a social worker feels like he or she has nothing left to give.
It can result from stressful work conditions, as well as from internalizing client/patient failures as self-failures.
Social workers often work in emotionally charged situations, with persons who may be experiencing some of the lowest points in their lives. They walk a fine line, trying to provide the right amount of empathy and sympathy without becoming too emotionally involved.
I’ve personally had clients who have passed away, relapsed back into active drug addiction, attempted suicide, and simply just disappeared.
It’s very difficult not to say to yourself, “What could I have done differently? Would things be different if I had just approached this client from a different angle?”
Rewards of the Job
So, if social workers and case managers endure low paying, high-stress jobs, why do they do it? Some social workers choose the career because they themselves were helped by a social worker at some point in their lives.
Most of the motivation derives from an internal drive to help people. While it can be easy for a social worker to blame themselves for a client’s failure, it’s also rewarding to see how an intervention or assistance turns someone’s life around.
I’ve received thank you notes, hugs, and had clients cry in gratitude. That’s what makes it worth it.
A note on assisting people living with HIV
I’ve attempted to make this article as general as possible regarding the role of social workers and medical case managers.
However, as I said at the beginning, my experience stems from working with those living with HIV, so I would like to spend a little time focusing on that specifically.
If you don’t already know, HIV stands for Human Immunodeficiency Virus. HIV attacks immune cells in the human body, and if left untreated will cause a condition known as AIDS.
AIDS stands for Auto-Immune Deficiency Syndrome. Someone who has progressed to AIDS has such a weakened immune system that infections a healthy body would normally fight off are able to take hold and wreak havoc.
So, it isn’t the HIV that actually kills a person, but an opportunistic infection.
One of the biggest concerns my clients face, which may not be faced by clients of other social workers or case managers, is stigma.
Stigma, according to Dictionary.com, is “a mark of disgrace associated with a particular circumstance, quality, or person.” For someone living with HIV, social stigma impacts just about every facet of that person’s life.
There is an overwhelming amount of misinformation about HIV, and some people still think it is transmitted through casual contact, that a person “deserves” to get it because of sexual preferences or drug addictions, or that it is a death sentence.
Fear of being stigmatized may make someone living with HIV afraid to disclose their status to family members, thus cutting themselves off from important support structures. It may lead to depression or anxiety.
It may cause them not to see a doctor or take medication, for fear of someone they know seeing them at the doctor’s office or pharmacy. It can completely decimate their social life and turn dating into an anxiety-ridden exercise.
While stigma still exists in urban areas, it is even more prominent in rural areas. The additional atmosphere of “everyone knows everyone” in small towns may make someone living with HIV even more reticent to reveal their status, fearing everyone will soon find out.
As a medical case manager, there is nothing I can do personally to stop the stigma. My organization does community education to try and reduce stigma in the community, but it’s impossible to make it disappear.
The most I can do is assist clients in healthy behaviors to try and combat the stress and anxiety stigma causes them, as well as refer them to mental health providers for additional assistance.
Because of the stigma surrounding HIV, we are highly conscious of where and how we interact with our clients.
Our offices provide a variety of services to the community so that clients don’t have to worry about anyone assuming why they were here. We don’t wear clothing with our agency’s logo or display our ID badges when meeting clients for doctors’ appointments.
If we happen to see a client while we are out in public, at the grocery store, for example, we act as if we do not know them. We will only interact if the client approaches us first.
Additionally, we must have clients sign releases of information forms anytime we contact another agency or provider on their behalf.
We take their confidentiality serious, not only because it is the ethical thing to do, but also because we are bound by law not to reveal their status to anyone.
In addition to stigma, the clients we assist come to us from all different walks of life, with a myriad of different barriers to receiving adequate health care. Some are suffering from addictions, others from mental health illness.
Homelessness, or the fear of becoming homeless, is also a major issue our clients face. If they are worried about where they will sleep tonight, taking their medication isn’t going to be high on their priority list.
For others, just getting to a doctor to get a prescription and then paying for it is the challenge.
We address each client as an individual, with unique challenges that will have unique solutions.
Our medical case managers are trained to develop something called a Service Coordination Plan, which lists short and long-term health-related goals and the steps needed to achieve them.
This is the roadmap used to help ensure our clients have the best chance to be healthy. In Pennsylvania, we are in contact with each client at least month and must meet with them face to face every three months to assess how they are doing on their goal plan, adjust where needed, and continue forward progress.
Another unique challenge to working with people living with HIV is that there are no studies on how the disease impacts the body over a lifetime. Only a few decades ago, HIV was a death sentence.
Medications slowed the advance but couldn’t hold it at bay forever. Now, medications allow someone diagnosed with HIV to live a relatively normal, long life. However, this is the first generation of people to experience that.
Therefore, the medical community has no idea what impact the HIV medications have on the human body when taken for decades, or how the virus impacts the body for that length of time.
So, we as medical case managers in the HIV field find ourselves assisting clients who never expected to grow old and who have no idea what growing old with HIV entails.
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About Celeste Straub
In addition to working in the medical case management field, Celeste Straub is also a romantic suspense author.
She is a hopeless romantic who enjoys plotting the harrowing journeys her characters go on before they finally reach their happily-ever-after.
She enjoys a quiet country life near Bloomsburg, residing on a piece of the old family farm with her husband, four-year-old son, and two lazy cats.
Celeste is also a PRO member of the Romance Writers of America.
When she’s not penning steamy romance scenes in her spare time, her interests include travelling, visiting amusement parks, collecting baseballs, hiking, and reading.
For more info, links to her novel, and social media information, please visit www.celestestraub.com
I hope you enjoyed this article and if you have any questions for Celeste, drop them in the comments below. Check out all the current “A Writer’s Guide” articles on their new page for easy access.
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