The Big Picture: Policy Careers Help Social Workers Effect Change from the Top Down

By Josette Keelor

In 1992, Hurricane Andrew left 15-year-old JaNeen Cross and her family homeless. While waiting for help to arrive, their community had no electricity. Her town of Homestead, Fla., was considered a devastation area, she recently recalled.

Then the Red Cross came, moving through the streets in large mobile homes and vehicles, giving out blankets, tissue and water. They had medical bags of supplies to hand out, as well as immunizations and tetanus shots. 

“I remember at the time being so appreciative,” said Cross, now a social worker and HEALS policy fellow teaching in the Department of Social Work at Howard University.

The Red Cross workers were strangers to her, but “they were making sure we were all right.”

Opening packages of soaps and toiletries, she found cards written from people all around the country who had donated items to hurricane relief. It was those acts of kindness and the rescue efforts of volunteers that inspired Cross to pursue a career in social work. 

“I want to do that,” she recalled thinking. “I want to be that for somebody else. I want to be that beacon of light when they’re at their lowest point.” That experience “gave me a purpose and direction for the rest of my life,” she said. 

She earned her MSW from Temple University and MBA with a health care concentration from Rosemont College.

Now an assistant professor at Howard University, Cross teaches her students how they can have an impact on policy issues that affect Americans most in need.

Social workers have various ways of pursuing careers in policy—whether working in the private sector, choosing jobs in administration, or working on Capitol Hill. It’s a path they can take on at any point in their careers and to whatever extent they wish. 

Lisa Carr, senior adviser with the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) Office of Communications, also developed an interest in social work early on, and quickly found herself boarding the policy train as well.

Achieving a bachelor’s degree in political science and public policy from Trinity College, Carr took on three internships, all in policy, and later earned a master’s in social work from Catholic University of America.

Carr landed a job on Capitol Hill and recently recalled the fun of learning how policy works, from how it’s created.

“Working in a House office was just fascinating,” she said. “I was able to see how we can change the laws as consumers and as social workers.”

While attending night school, she took a job as a lobbyist with Catholic Charities USA. She enjoyed the work, but also the clinical side of policy. If possible, she wanted to be a therapist.

Her first field experience was with foster care and adoption with Fairfax County in Virginia, and her second was with Bethesda Naval Hospital in Maryland, counseling people who were HIV positive or had AIDS.

“I loved helping people, but I wanted to help more people, and policy helps me help millions of people every day,” she said. Through her work, she can help those in poverty and those who are most vulnerable. She can help entire populations, “not just the person in front of me.”

Policy makes a difference in people’s lives, she said. “[It’s] advocating and assisting those most in need and those most vulnerable in our society.”

Change Agents

While Carr figured out her career path early, social worker Samantha Koehler said her transition into policy work took longer.

“I never really thought that I wanted to pursue policy,” said Koehler, now a senior policy aide for the Special Committee on Aging. She’s been working with her “small but mighty” staff of 11 for about two years under Sen. Bob Casey Jr., D-Pa.

Koehler said she long expected she would go into direct practice, and she pursued a master’s degree in social and public health. She also knew she wanted to work on issues related to older Americans. She worked in social service with a focus on care management, and her caseload included arranging medical appointments for older Americans. 

After finishing graduate school, she landed the Presidential Management Fellowship. It’s a difficult fellowship to get, and she says she was honored to be chosen. But it was still a leap of faith for her to leave a job she loved to head down a new path. She feared her skills wouldn’t be enough for her to be successful.

“I couldn’t have been more wrong,” she said. 

“I’m so glad I made the switch.”

Koehler began working in the executive branch for the Centers for Medicare and Medicaid Services, on the Affordable Care Act, and the fellowship helped her make connections with what she’s doing now.

“I think when you’re in direct practice, you feel really limited by a system you don’t have any control over,” she said—such as income limits or the number of people who can be served under a program.

Working with the Senate, she can see how the programs she works on and the policy changes happening in Washington also effect change around the country.

“The work that I do broadly impacts seniors [nationwide],” she said. “I never imagined myself in policy and so I’m really loving the work that I’m doing right now.”

Carr, who has worked with groups such as the YMCA and United Way, enjoys how her career in policy has helped her share information like CMS materials and policy changes with organizations that, in turn, distribute the information to the communities they serve.

“Now being with the administration, I can see how the law is actually implemented.”

One big initiative she worked on recently was providing new Medicare cards to seniors that would help keep them better protected from potential fraud. 

The old Medicare cards contained users’ Social Security numbers, posing a risk to identity theft if they gave their information to the wrong people or if their cards were stolen, Carr explained. 

Through her work, she helped implement a law changing the information provided on the cards, printing and sending new Medicare cards to more than 60 million seniors. She helped ensure recipients knew how to destroy their old cards, how to use the new card, and how to protect against fraud and abuse. The new cards have an ID number instead of a Social Security number.

“The opportunity to work with that issue that impacted so many seniors was really exciting,” Carr said.

She said working through the CMS’ 10 regional offices demands a certain amount of trust from the community, and that’s a privilege she doesn’t take for granted.

Many of the people she helps struggle with low income or health problems, and they’re distrustful of government workers and agencies. But they trust their social worker often as much as they would a pastor, because they can meet face to face and know who they’re working with.

“If we want to see the world be better, we need to individually play a role in that,” she said. “I think about how social workers are that change. They are part of the change agents that make the world a better place.”

Talking a Big Game

The thought of changing minds can be a big motivator for social workers who go into policy careers, but the act of implementing that change takes some strategy.

Talking with congressional offices is “kind of a big puzzle,” said Beth Prusaczyk, a postdoctoral research fellow at Vanderbilt University who’s been working on the Senate Special Committee on Aging to reauthorize the Older Americans Act. She works remotely from Nashville and travels to the Hart Senate Office Building in D.C. once a month.

Policy, she said, is about making sure everyone involved can get something they want, while knowing not everyone will get everything they want.

It’s a challenging process that requires patience and experience, but she said it’s worth it to her because of the changes that come from a lifesaving bill being authorized for another three to five years.

It’s been three years since advocates have been able to ask for new things through the Older Americans Act, she said. “It’s a big, messy health care system.” 

She and her staff could work all day and night, and there will still be problems, she explained, but until problems get fixed at a higher systemic level, lobbyists won’t get anywhere.

“It’s been great to see social workers on the Hill,” she said.

Before working for the Senate Special Committee on Aging, Prusaczyk was on the opposite side of the policy table.

“I knew the advocacy side,” she said. She has a journalism background, which she said has made her skilled at researching topics to bring before Congress.

But while passion and research might drive a career in policy, she said achieving success is also about knowing who to approach and when, and supplying those people with the right information.

A former HEALS fellow, Prusaczyk said the Hill can be intimidating and that it was helpful to her when she learned how to frame her message to those working in Senate and congressional offices. She realized some of her assumptions about changing policies had been wrong, such as who to approach on the Hill and when to approach them.

For example, congressional staffers are easier to reach when Congress is not in session. She also said it was important to adjust her pitch, depending on who was available to hear it. Often she would end up talking with staffers instead of senators, but she said they can have as much influence on bringing important issues to light.

Once reaching the right person, she said the best way to make an impact is to give lawmakers the exact wording they’ll need to enact policy changes. “It’s helpful to know how to frame a message,” she said.

Congressional staffers are hardworking and smart, she said, but “they have so much work. They are just going nonstop, and whatever advocates can do to make things easier for the staffers [helps].”

They need specifics, she said. Staffers are likely to ask advocacy groups to give them the language of what they need, not just an idea.

“It’s not that things can’t get done,” she said. “It’s just impossible if you go into an office and say, ‘We really need to do something about Alzheimer’s.’”

Successful advocates frame their message more directly: “I want this concrete actionable task to be done, and here’s the legislative language you would use.”

“[These] are the groups that I think have the most success,” Prusaczyk said. “[Staffers] will listen and they absolutely want that expertise.”

Now, she said, “I can go up to them and I can make real world change … because I know now what needs to be done.”

Writing New Stories

Social worker Randi Schmidt was studying creative writing in college when she picked up a second major in social work. 

A child of two alcoholic parents with little money, she had a lot of stories to fuel her nonfiction writing, and she soon found that other students would seek her out to share their own experiences of childhood trauma and struggles. One day, approached by a peer in a brick stairwell, she decided she wanted to do something to prevent future stories of abuse. She walked over to the school of social work and signed up.

“From that moment in the stairwell I knew, because it was the way to help the most people, that I wanted to be an advocate and do public policy and make social change,” Schmidt said. “My entire career since then has been in advocacy and public policy.”

Schmidt majored in social work at the University of Wisconsin-Madison, but because her social work school was heavily focused on direct practice and not policy, she designed her own program. A third of her classes were at the school of social work, a third at the school of public policy, and a third at the law school. 

“I wanted to create a program that would allow me to talk to clients but also talk to elected officials—I wanted to be able to navigate both worlds. That type of program was not available, so with the approval of the school of social work, I created it.”

Schmidt pursued a career in federal-level policy, most recently as executive director of the Children’s Leadership Council, which closed on December 31. The CLC was a national children’s coalition of 57 organizations dedicated to improving the lives and opportunities of children around the U.S. Its members included national coalitions, policy and advocacy organizations, and direct-service providers.

“The CLC was solely dedicated to supporting federal investments in the nation’s babies, children and youth,” she said. Its focus included children’s health and nutrition, child care and early care and education, preventing and ending child abuse and neglect, youth development, and economic security for children and families.

Schmidt is taking a break from her 20-year career in macro-level social work and public policy, but she plans to get back into the fight soon. What happens in Washington can seem so removed from people’s lives, she said, but she hasn’t found that to be true.

Public policy, both at the federal level and in general, is about speaking out and supporting legislation or 

funding priorities that improve lives, she said — such as legislation to address violence against women and children, raise the minimum wage, address the high costs of health care, or support funding for Medicaid, food stamps and education programs.

It’s also about “preventing harmful things from becoming law.”

She gave the example of President Trump releasing a budget that recommends cutting funding for Medicaid, Medicare, Special Olympics programs and after-school programs for kids. 

“Those programs help millions of children and adults, and without these programs people will suffer,” Schmidt explained. “People think that cuts to programs like these would never happen, but if people don’t speak up, they can and do happen.”

“Success is possible if people speak up,” she said. The president, for example, just backtracked on cutting funding for the Special Olympics “because so many people spoke out against it.” 

Moving Forward

Through her work with the HEALS Fellowship, Cross represents NASW on topics of policies, oversight regulations, and questions that help direct leadership in terms of health care focus.

She has been researching the topics of maternal child health and health outreach for impoverished patients, helping decrease patients’ chances of having to make trip after trip to emergency rooms because they can’t afford preventive care to stay healthy or treat chronic conditions.

Recently she was appointed by Washington, D.C., Mayor Muriel Bowser to be on the Maternal Mortality Review Committee within the Office of the Chief Medical Examiner. (Read about the Maternal Mortality Review Committee Establishment Act of 2018.)

At Howard University, Cross leads Social Work in Health Settings Care parts 1 and 2, Psychopathology, and a course in interventions and planning.

Cross said she tries to translate her work with the HEALS fellowship to her students, whether they’re on the direct practice track, working directly with patients, or plan to go into policy work.

The Social Work in Health Settings courses are equally popular for both types of students, and Psychopathology shows students how mental and physical health are very closely linked.

If you have a mental health problem, it can very easily turn in to a chronic health condition, or vice versa, Cross said. “I feel very fortunate that I can educate them on theoretical perspective but also bring my experience to my teaching.”

Learn more about the Social Work HEALS program.