Guest Post by Kathleen Osborne (Dec '18)

Kathleen Osborne, MSW/MPH student (Dec '18)

When I am asked why I chose to pursue two Masters Degrees rather than one, I frequently include the importance of interprofessional competence in my answer. All too often in my life, I have interacted with individuals who are unable to approach problems from a variety of perspectives, therefore limiting their ability to help create lasting solutions. Because of this, I have always strived to be the most dynamic thinker possible when approaching both my education and my work. By collaborating with experts in a variety of fields with a multitude of competencies, students and professionals alike will not only become more successful in their careers, but more effective and empathetic people as well.

In the field of public health, preventing avoidable harm or suffering for all people is the top priority. By utilizing scientific research, observational data, and immense economic resources, public health professionals develop lifesaving programs and procedures every day, all around the world. This mission strongly complements, and arguably demands, the ethics and goals of the social work profession. While some may view the passion for social justice as a limitation in the working world, I view it as a personal perspective that has led many to develop an emotional resiliency that allows them to assist the most vulnerable people in our society.

“Public health social workers approach their work from an epidemiological and a social perspective and have the benefit of training in both prevention and intervention. Public health focuses on prevention at the community level, and social work focuses on intervention at the individual level” (Van Pelt, 2009). To me, this emphasizes that one profession cannot possibly be wholly successful without the other. Because human beings’ needs are ever evolving and multifaceted, it makes logical sense that there would continue to be an increased need for professionals with a variety of qualifications and proficiencies to serve modern needs. For example, while social workers predominantly aid marginalized individuals and families living in poverty who are in need of governmental assistance, those same individuals are most likely facing food insecurity, chronic illness, and negative mental health outcomes; all issues that should concern public health officials who work in and for those same communities. “Poverty reduction and achieving a minimum set of development goals are recognized as a global priority. The sense of urgency comes from awareness of the magnitude of suffering, disease, and premature death in the world today that are caused by social factors and widening inequalities” (Jong-wook, 2005). In my opinion, it is no coincidence that the rise in demand for public health social workers in this country is coming at a time where we are experiencing heightened political adversity and resentment (Van Pelt, 2009).

I am immensely proud to be pursuing a dual-degree. I look forward to marketing myself as having both the compassion of a social worker and the technical skills of a public health practitioner, while recognizing that those two qualities are not mutually exclusive. Because of this interprofessional dual-degree program, I have developed a willingness to authentically understand the struggles of my peers, a humble desire to make life better for those in need, and an unrelenting passion to give back to my community.

- Kathleen Osborne, MSW/MPH candidate, expected graduation December 2018

Visit Kathleen's LinkedIn profile.

References

Jong-wook, L. (2005). Public health is a social issue. The Lancet, 365(9464), 1005-1006.

Van Pelt, J. (2009). Social work and public health—perfect partners. Social Work Today, 9(1), 28.

Social work and public health: United by principles of prevention - Guest post by Abby Burns (Dec '18)

Abby Burns, MSW/MPH Student (Dec '18)

"The major health problems to be solved today are those which require social work intervention" (Watkins, 1985, p. 17).

Social work and public health are complementary perspectives for analyzing and addressing disparities in mental and physical health outcomes. Being a dual-degree professional in these two fields enables us to integrate their perspectives in flexible and dynamic ways. Possessing both an MSW and an MPH also comes with the responsibility to support the value of each perspective in our future careers. In a public health-oriented setting, an MSW/MPH professional can emphasize the importance of cultural sensitivity and tailoring interventions to match the needs and strengths of a specific group. In a setting that is dominated by social workers, an MSW/MPH professional can advocate for the use of evidence-based interventions and can push for the incorporation of rigorous process and outcome evaluations into an organization’s activities.

Social work’s focus on vulnerable populations can benefit from the prevention-oriented perspective of public health, and vice versa. In public health social work, prevention can take the form of preventing either the causes or sequelae of vulnerability. Take, for example, the vulnerable population of people with cognitive disabilities. Public health social workers can develop and evaluate programs to serve pregnant women with alcohol use disorders, which would constitute primary prevention of in utero alcohol exposure, the leading cause of cognitive disabilities of known etiology (Paley & O'Connor, 2011). Public health social workers could also create and implement transitional housing or educational programs for emerging adults with cognitive disabilities.  Such programs would constitute secondary prevention of the social and health consequences that occur when these emerging adults are unable to integrate into their communities.

The overlap between social work and public health is evidenced by the many similarities in each discipline’s code of professional ethics—the “Code of Ethics of the National Association of Social Workers” and the “Principles of Ethical Practice of Public Health,” respectively (National Association of Social Workers Delegate Assembly, 2008; Public Health Leadership Society, 2002). Both documents identify meeting the basic human needs of every community member as a fundamental goal. They both include advocating for the representation and allocation of resources for disadvantaged and disenfranchised groups. Both documents also discuss the importance of confidentiality and trust, and describe the balance that must be struck between individual autonomy and the exercise of power for the good of a community.

The public health document mentions the importance of prevention, which is not mentioned in the ethical code for social workers. Primordial prevention is a framework for improving population health by addressing the economic, environmental, social, and cultural conditions which act as risk or protective factors for a variety diseases. Primordial prevention creates living conditions that are conducive to healthier communities, thereby addressing the common root causes of diseases. These conditions are already the targets of social work interventions, even if the stated goals of those interventions do not explicitly mention primordial prevention. One example would be a program that aims to increase high school graduation rates by mentoring students who are considering dropping out. This would constitute primordial prevention because having a high school diploma is associated with a lower risk for many different health problems.

Social work organizations often struggle to secure funding for programs that address these root causes of poor health. Dually-trained professionals in public health and social work can use their understanding of disease causation and epidemiology to strengthen the case for these programs. Their public health training enables them to incorporate data, in forms such as community needs assessment and correlational analysis, into grant applications or presentations to policymakers on the local, state, or federal level. Using their social work training in communication skills and stakeholder engagement, they can tailor this evidence base to the values and characteristics of the intended audience. In this way, they can secure funding and obtain buy-in for their prevention efforts.

Their interdisciplinary training further equips MSW/MPH professionals to understand the intersectionality of the social determinants of health. A study of birth outcomes among middle class women living in Chicago illustrates this intersectionality. Researchers found that women who lived in racially mixed census tracts tended to have superior birth outcomes compared to women who lived in predominantly African American tracts. The researchers cited superior socioeconomic contexts in less racially segregated neighborhoods as a possible explanation for this finding. However, the direction of this effect was reversed for African American women, such that these women had poorer birth outcomes if they lived in a racially mixed versus a predominantly African American neighborhood. The researchers concluded: “The positive effect of a better socioeconomic context may be countered for minority women by adverse effects of racism or racial stigma” (Pickett, Collins, Masi, & Wilkinson, 2005, p. 2229).

The unique challenges that face older adults who are LGBTQ provide another example of intersectionality among the social determinants of health. Maddux (2011) found that two thirds of LGBTQ adults over the age of 65 live alone. Many are estranged from their families, so they do not have the option to rely on a family to provide care and assistance later in life. They are likely to hold off longer than non-LGBTQ adults in seeking help, often until a medical crisis occurs. When accessing home health care services or entering a residential care facility, they often re-enter the closet to avoid discrimination and abuse. Sometimes, LGBTQ older adults are forced to cycle through several home health workers or care facilities before they find professionals who will treat them with dignity and respect (Maddux, 2011). MSW/MPH professionals are ideally trained to grapple with this issue by working within community-based organizations and programs. In Boston, the LGBT Aging Project conducts trainings and workshops for health care professionals, case managers, and others who wish to improve their competence and sensitivity in working with LGBTQ patients (Fenway Health, 2017). Other community organizations provide safe spaces for LGBTQ older adults to gather and socialize. These organizations help their clients to create networks of social support, which increase the likelihood that they will be adequately cared for when the time comes that they can no longer live independently. Public health social workers could contribute to both types of programs, and thus work to eliminate the health care disparities that LGBTQ older adults experience.

Dually-trained practitioners in social work and public health are uniquely equipped with the knowledge and skills to understand and intervene in the intersections between health and social conditions, like those described above. They are powerfully positioned to not only comprehend the causes and sequelae of a health problem, but also to implement prevention or treatment programs through direct practice. These programs could be delivered to individuals, couples, families, groups, organizations, or even entire communities, and could be administered within private, public, or non-profit settings. Regardless of their client level or work place, public health social workers bring an invaluable perspective to addressing the most pressing health problems that face our society.

- Abby Burns, MSW/MPH student, expected graduation December 2018 

Visit Abby's LinkedIn Profile.

References

Fenway Health. (2017). LGBT Aging Project. Retrieved from http://fenwayhealth.org/the-fenway-institute/lgbt-aging-project/

Maddux, S. (Writer). (2011). Gen Silent [Film]. San Francisco, California: Kanopy Streaming.

National Association of Social Workers Delegate Assembly. (2008). Code of Ethics of the National Association of Social Workers. Retrieved from https://www.socialworkers.org/pubs/code/default.asp

Paley, B., & O'Connor, M. J. (2011). Behavioral interventions for children and adolescents with fetal alcohol spectrum disorders. Alcohol Research & Health, 34(1), 64-75.

Pickett, K. E., Collins, J. J. W., Masi, C. M., & Wilkinson, R. G. (2005). The effects of racial density and income incongruity on pregnancy outcomes. Social Science & Medicine, 60, 2229-2238. doi:10.1016/j.socscimed.2004.10.023

Public Health Leadership Society. (2002). Principles of the Ethical Practice of Public Health.   Retrieved from https://www.apha.org/~/media/files/pdf/membergroups/ethics_brochure.ashx

Watkins, E. L. (1985). The conceptual base for public health social work. In A. Gitterman, R. B. Black, & E. Stein (Eds.), Public health social work in maternal and child health: A forward plan (pp. 17-34). Washington, DC: Division of Maternal and Child Health.

What it means to be a dual professional - Guest Post by Kenrica Sands (Dec '18)

Kenrica Sands, MSW/MPH Student (Dec '18)

Functional, versatile, inconspicuous (as in other professions may not understand your purpose), and innovative accurately describe a dual professional, also referred to as an interdisciplinary professional. This individual simultaneously identifies in two different disciplines - public health and social work. This dual identity affords an individual the opportunity to develop and enrich skills in two different fields that share a common principle - prevention. “Prevention, by definition, enhances human well-being by preventing major problems of living” (McCave & Rishel, 2011). A dual professional embodies a multi-method approach to combating social health challenges such as “globalization, increased migration, natural and manmade disasters, persistent chronic diseases, and resulting health disparities” that affect domestic and international populations (Ruth, 2008). Further, both “professions values and goals, such as reducing health disparities among oppressed and vulnerable populations, are consistent with a preventative approach to practice” - the beautiful commitment that marries the two professions (McCave & Rishel, 2011).

One can visually relate a dual professional to wearing a skort. The professional may appear as having one skill set and pedagogy but truly there is another set of skills and pedagogy unseen. Dual professionals have the advantage of wearing multiple hats at once or switching hats when necessary. These individuals have mobility, flexibility, and opportunity to impact lives on a micro and macro scale. In regards to the academic jargon around dual professionals, one can attest to “ public health social work as [being] based on an epidemiologic approach to preventing, addressing, and solving social health problems” (Ruth, 2008) . In academia, a dual professional embodying public health and social work has greater functionality and skillset that equips them with a different perspective when approaching various social health problems. Professionally, this individual has the capacity to work in multiple service arenas such as federal, state, and local. The individual also has both leadership and teamwork skills required to work on multidisciplinary teams. Dual professionals withhold a special characteristic of being able to serve in different ways on a team from collecting and synthesizing data to conducting bio-psycho-social-spiritual assessments. These dual professionals make for great team members that bring a unique quality and drive that brings forth justice socially, economically, and
environmentally.

I believe that dual professionals, more specifically public health social work professionals, are unique tools that many people do not understand how to use. Dual professionals are trained and equipped to work towards eliminating inequities and bringing homeostasis to communities in efforts to increase quality of life. As this field grows, innovative approaches will be the cutting edge sword fighting back systems of oppression and discrimination.

- Kenrica Sands, MSW/MPH student, expected graduation December 2018

Visit Kenrica's LinkedIn profile.

References
McCave, E. & Rishel, C. (2011). Prevention as an explicit part of the social work profession: a systematic investigation. Advances in Social Work. 12(2), 226-240.
Ruth, et al. (2008). Public health and social work: Training dual professionals for the contemporary workplace. Encyclopedia of Social Work. 20, 1-11.