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How Will SWHPN Change in Response to the Killings of Breonna Taylor, George Floyd, Riah Milton, Dominique Fells, and Innumerable Others?

As social workers in this pivotal moment, there are key lessons from the field of social work, and particularly the field of palliative and hospice social work, that we at SWHPN can apply to help some of us become better both in our work and our day-to-day lives.

1: listen more than you speak. 
It is very easy for those of us who have any privilege to think that we can speak on an issue, but this is often where we misstep. The opportunity for people in positions of privilege to speak and write with words that contain microaggressions is frequent, especially if those of us who have privilege do not acknowledge that privilege. Acknowledging out own biases can be difficult, but doing so without a defensive response is one way to help in this moment.

2: do not expect those who would be hurt by your questions to respond to them.
Just as you would not ask extremely vulnerable patients such as those who are in extreme pain, those experiencing extreme existential suffering, or those who are vulnerable in other ways to participate in a research study, do not expect black, indigenous, and people of color to teach you about diversity, equity, and inclusion if you are a white person. As one person put it: “That is the oppressed teaching the oppressor." While there may be opportunities to learn in webinars and other formal settings, for white social workers, it’s important to remember that some of our friends and acquaintances may be emotionally exhausted right now, beyond what you are feeling, and you will need to respect that when reaching out to them.

3 (this one’s a challenge from our Vice Chair, Karen Bullock): think outside the box.
During the last SWHPN Summit we had an open networking session where Karen made an excellent point about language and how she does not like to be put in a box. She didn’t suggest that anyone else follow her lead particularly, she just suggested that we all think critically about the language that we use for ourselves and for others. As we know in this field, language can be fraught. A “difficult family” can be code for many things, particularly when race or ethnicity are applied. When we’re talking about language such as "cultural competency", "white fragility", "anti-racist", it is important for us to explore what these terms mean to us, as well as to unpack what they may mean to others and to examine why we may want to use them, if at all. Before the last SWHPN Summit, a SWHPN member reached out to ask if “Cultural Competence” was the name we wanted to use for the Summit right now and my honest answer was, “I don’t know." Being open to discussion without defensiveness and without taking things personally but recognizing that there are deeply emotional issues around these issues is an important part of how we face up to making changes in our organization.

4: keep your ethics in check
I have seen several posts now on NASW discussion boards, Twitter, and various listservs where social workers have harkened back to our professional ethics and values. Recently, social workers Lauren Schmidt, MSW, LICSW, APHSW-C, Daphne Lindsey, LICSW, Elizabeth Julian, LICSW from Seattle Children's reached out to express their disappointment that SWHPN had not posted any resources exploring the intersection of racial inequity and COVID-19. This was after their colleague Arika Patneaude, MSW, LICSW, APHSW-C, EMMHS had reached out to express a similar disappointment a few weeks back. All of this is to say that we should be doing better, and they are right: this is in our bones as social workers. Here are just two of our core values that we should be turning to right now (and really, always) as we engage in conversations about inequities across all intersections:
  • Value: Social Justice
  • Ethical Principle: Social workers challenge social injustice.
  • Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers' social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. 
  • Value: Dignity and Worth of the Person
  • Ethical Principle: Social workers respect the inherent dignity and worth of the person.
  • Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity (National Association of Social Workers [NASW], 2008).
SWHPN is ethically obligated to educate about social justice and to speak on the dignity and worth of each and every one of our members, as well as each and every one of the patients and families that we serve, as well as those who we do not yet serve but who are eligible for our service. In truth, we recognize the dignity and worth of all persons, and we would like to work together with our members to highlight the work we are doing to improve our work in showing that we do care about these ethics, as well as in highlighting the incredible resources that are out in the world.

With that in mind, below are the steps we have taken so far to change the organization and the steps we plan to make in the coming months:

  1. At the July board meeting, we are discussing our strategic Equity, Diversity, and Inclusion (EDI) plan. This will include embedding EDI strategic plans within each committee (rather than creating a new committee specifically for EDI). 
  2. We will be asking all educational presenters to include EDI materials in their presentations. 
  3. We will start an Equity, Diversity, and Inclusion Special Interest Group (SIG) within the next few months, while also asking all SIGs to embed EDI within their goals and action planning.
  4. We will share new crowdsourced resources every Friday about 3 topics: Grief and Bereavement, COVID-19, and EDI. If you have read a great article, listened to a thought-provoking podcast, or watched an illuminating webinar on one of these topics, we want to hear about it! You can submit these on this form until 5:00 p.m. EST to include it in that week’s SWHPN Shares post.
Here are a few recent resources we're drawing some learning from; we know there are many more and hope you'll submit those here.

  • Code Switch: Why Now White People: in this episode, hosts Gene Demby and Shereen Marisol Meraji discuss theories for why the country, and specifically white people, appear to have responded to George Floyd’s killing when so many others have gone unanswered.
  • Income emerges as major indicator of coronavirus infection, along with race: this Washington Post article describes who is getting sick in the pandemic. This won't be surprising information to medical social workers, as poverty is a social determinant of health and a lever of power, but it will be important to note, especially for our patients who live in places of intersectionality.
  • Suggested by social workers Lauren Schmidt, MSW, LICSW, APHSW-C, Daphne Lindsey, LICSW, and Elizabeth Julian, LICSW at Seattle Children's:

To our members, we ask that you make a commitment to equity, diversity, and inclusion both with your colleagues and with your patients. If you’re white, commit to listening to colleagues and patients who are hurting. Tell us when we make a misstep (and when it doesn’t take too much energy). This is going to be a difficult period of change and I can’t promise we will be perfect; but I can promise we will try as hard as we can, and that we will try to apply the above principles.

Allie Shukraft, MSW, MAT, APHSW-C | SWHPN Board Chair

A Way to Respond: Learn and Share Your Voice

We know there is a lot going on. In just the past twelve weeks, we’ve seen the COVID-19 pandemic blaze through our communities, resulting in more than 100,000 deaths. We’re seeing the related economic downturn affect workers, businesses, housing, food security, and more interrelated systems. We’re sharing the righteous anger from thousands of people across the country as they protest the impunity with which racial, ethnic, and xenophobic hatred and violence has been allowed to flourish. We echo the statement cried out on the streets and emblazoned across social media that Black Lives Matter.

Through it all, hospice and palliative care social workers have faced changing norms and practices head-on. We’ve grappled with determining who is considered an “essential” worker eligible for PPE. We’ve learned how to conduct family meetings in our living rooms and parking garages via videoconferencing and new apps. We’ve figured out how to show a smile behind a mask, how to show concern without being able to hug, and how to record memories and share presence for loved ones who couldn’t be physically present. 

AND we’ve done all of that while also grappling with the social justice issues that, due to hundreds of years building up layers upon layers of structural racism and inequities, are suddenly split open for all to see. Of the COVID deaths, we see the disproportionate impact it has had on Black people, Native Americans, Latinos, LGBTQ+ people, incarcerated people, and other marginalized communities, due directly to historical factors including redlining, unequal access to  to jobs, healthcare, and insurance, and stigma from healthcare providers. In the economic downturn, we see the same factors at play again, affecting those already struggling; and again in the police and judicial systems that overwhelmingly harm communities of color. It has been a lot to take in and process, even more for our social workers who are living it as a reality.

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It Starts With Us: SWHPN Statement on Racism and Structural Inequities in Hospice and Palliative Social Work

The Social Work Hospice and Palliative Care Network (SWHPN) wholeheartedly rejects the killings of black and brown people by police. As social workers helping ease suffering at end-of-life, we cannot let racism and disparities in care go unchecked. We are here to support a more just, equitable system for all.

Our organization is comprised of nearly 1,000 hospice and palliative care social workers throughout the country. Our core work focuses on providing professional development, amplifying evidence-informed best practices, and advocating for improved policies and increased funding, so that all patients and families experiencing serious illness receive expert psychosocial care which alleviates their suffering, improves their quality of life, and facilitates their dying in accordance with their wishes.

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SWHPN Supports Day of Mourning and Lament

Today, the Social Work Hospice and Palliative Care Network (SWHPN) joins religious communities throughout the United States, as well as the U.S. Conference on Mayors, in support of a nationwide Day of Mourning and Lament. On this day, we recognize and mark the collective suffering faced by individuals and families throughout the country as we passed the 100,000 deaths due to COVID-19.

We recognize that COVID-19 has disproportionately affected African-Americans, Native Americans, Hispanics and Latinos, Asian-Americans, and other people of color. From the higher death rates among communities of color, to the pandemic-related job losses and lack of healthcare access and insurance, to the increasing rates of the disease among the incarcerated, we are seeing the ongoing impacts of COVID expose the lasting effects of racism in our country. The suffering felt by African-Americans and people of color cannot be minimized.

Further, COVID-19 is having a lasting impact on how we grieve these losses. Towards that end, we are proposing the creation of a National Grief Strategy. We are advocating for the development of a comprehensive plan to support and expand grief services and resources throughout the country. We want to proactively identify and address the health and mental health effects of grief due to the COVID-19 pandemic, so that we may begin the process of collective healing.

We encourage you to join us today in recognizing a Day of Mourning and Lament. Read our Call for a National Grief Strategy, and then add your name to support it. Then please share with others.

For questions and comments, please email us at [email protected].

SWHPN Shares: Being a Hospice Social Worker in a Time of Crisis

A few months ago, a Child Life Specialist who I work closely with and I discussed talking about feelings. She assumed I'm good at this because I talk about feelings all day long—most days at work, and often with colleagues and friends who come to me to talk through difficult emotions. I laughed and said, "Yes, I spend all day talking to people about their emotions; that's easy. Talking about my emotions is something else altogether." If I were to gather a room full of social workers together, I'd be willing to bet the same would be true for many of us.

But now that a worldwide crisis has hit, we're forced to face at least some of our emotions on a daily basis in order to manage our own mental health and coping. For me, as someone with a mental illness (major depressive disorder), I have to be conscious not only of my treatment (medication and therapy adherence on a routine schedule) but also how I am tapping into my own coping mechanisms. As we ask in our field, how are they working for me? In addition to the struggles with depression I typically deal with, which can be amplified by isolation and hopelessness if I let them, I also struggle with a feeling that many people are confronting now, especially those with disorders: anxiety.

One tool we can use to help us manage anxiety is mindfulness, as it can help us to focus on the present moment and stop perseverating on the past and the future. There are a number of free tools out there right now that can be helpful with this: Mindful.org has a page of free resources, including articles and meditations. MindwellU has a 30-day mindfulness challenge that can encourage you to slow down a few times a day.

Another tool that can be helpful is to put the experience we are all having in a cognitive frame that makes sense for you. In the first episode of her podcast, Unlocking Us, Brene Brown speaks about something she labels "FFTs" for "_______ First Times", and she shares that the ability to normalize experiences that are foreign to us, like going through a pandemic, helps us realize that our responses, like anxiety and fear, are typical. This helps us put the experience into perspective and reality-check our expectations. In this way, Brown gives us a tool with which to respond to the FFTs we keep experiencing during this crisis, so that we can stop reacting to the experience and start living again.

Since we talk about going back to the social work basics in times of crisis, it doesn't hurt to mention the self-care basics when dealing with feelings of anxiety, stress, and worry:





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Goodbyes in the Time of COVID

As COVID-19 has changed visiting policies in hospitals and other facilities, it has also changed how people say goodbye to the ones they love, and how we as social workers support them in saying those goodbyes. Anticipatory grief is happening virtually and in isolation, and part of our work during this pandemic is connecting families with patients, supporting them as they say goodbye, and acknowledging the loss of saying that goodbye in person. As a palliative care social worker, I have encountered many instances in which family members could not be present to say goodbye to the patient. Some family members are COVID+ themselves, are immunocompromised, or live across the country or world. While one healthy visitor is allowed to visit a patient who is imminently dying, predicting someone’s final hours and minutes can be difficult to do, and sometimes family are concerned about coming to the hospital and putting themselves at risk.

Technology has allowed us to support families in their grief, and for those who do not have access to a video camera, telephone communication has proved vital. There are some roadblocks to connecting families with patients- clinicians working remotely, a limited number of staff who are allowed to enter a COVID+ patient’s room, a high number of palliative care consults, limited technology that staff and family members have access to, and ever present technological glitches. Despite these barriers, my palliative care colleagues have wielded creativity, compassion, and collaboration to facilitate goodbyes, and share messages of love in a time of overwhelming death and despair.

Over the past several weeks, my team has been able to coordinate Zoom video meetings so that families can see their COVID+ family members at the end of their lives. We have set up Zoom meetings, disseminated the login information, and our physicians and nurses have brought iPads to patients so families could see their hospitalized family members. In instances where the physician cannot enter a patient’s room (either to limit exposure or to conserve PPE), and the patient cannot hear their families on the iPad, we have invited those in attendance at these meetings to write messages in the chat box, or to say messages out loud with the promise that we would deliver these messages to the patient. Over Zoom, families have joined together in grieving the loss of their family members who have meant so much to them, sharing memories and gratitude, and saying their goodbyes.

After these meetings, I have transcribed their written and spoken messages so they could be placed by the patient’s bedside. The physician on my team suggested I compile them into transitional documents for families, which they could continue to reflect on as the patient transitioned. I have emailed the documents to families with space for additional messages for those who had been unable (either logistically or emotionally) to join the call, and placed one-page abbreviated versions by patients’ bedsides so physicians and nurses entering the rooms could read brief messages to patient from their families. This interdisciplinary intervention aimed to facilitate connections between patients and families, and we hoped it would provide opportunities for care providers to connect with their patients as well. Working within the boundaries we had, we hoped to provide support, and were grateful that families could connect with patients and with one another through video and written text.

Another intervention we have used with caregivers for patients who did not have access to a video camera or smart device, and were unable to visit at the end of life due to visitation restrictions, was to pass on messages verbally. In circumstances where bringing a phone to the patient is not possible, I have asked friends and family members what they wanted to say to patients. They have shared messages such as “You are not alone” and “I love you.” These messages are then imparted to the patients by physicians, nurses, and social workers. It is so important for friends and families to know that, though they are not with them physically, their messages will be delivered.

Collaboration has always been inherent in palliative care, though I have never been as grateful for it as I am now. As families and patients remain in quarantine, healthcare workers are bringing people together virtually in a number of creative ways, and palliative care social workers are uniquely positioned to provide anticipatory grief support to the families and friends of patients with COVID-19. As we navigate the psychosocial impact of COVID-19 on grieving families, we can continue to explore new ways of facilitating communication and share our newfound interventions with each other.


Kasey Sinha, Palliative Care Social Work Fellow at Mount Sinai Beth Israel in New York, NY. SWHPN is accepting guest submissions on COVID-19 practice and interventions at [email protected].

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Statement on Hospice and Palliative Care Social Work Practice In Times of Health Care Crisis

The words "essential" and "non-essential" may become two of the most repeated words of 2020. We hear them in press conferences, read them in work e-mails, and see them on chyrons posted across the bottoms of our TV screens. For many of us in the Hospice and Palliative Care Social Work (HAPC-SW) field, these words have also been applied to our jobs in ways that, as many of us have discussed at our nightly support calls, have provoked conflicting feelings of both guilt and relief (when labeled non-essential) or fear and pride (when labeled essential).

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