Aliah Wright:
From the National Association of Social Workers, I'm your host, Aliah Wright, and this is Social Work Talks. Thank you so much for joining us for this episode, which focuses on how the coronavirus pandemic is changing how social workers approach treatment for substance use disorder.
Today, we're chatting with Boston-based social worker Carla Monteiro. Carla is a member of NASW's Massachusetts chapter. She is also the founder and president of the Cape Verdean Social Workers Association Incorporated and a member of the Greater Boston chapter of the Association of Black Social Workers. She also engages in various volunteer activities in the African American community. Welcome, Carla.
Carla Monteiro:
Thank you for having me. I really appreciate the invitation.
Aliah Wright:
So, Carla, tell us about your role and how that has changed.
Carla Monteiro:
I'm the founder and president of the Cape Verdean Social Workers Association in Boston. Our mission is to raise awareness and provide psychoeducation about mental health, mental illness, and substance use disorder in the Cape Verdean community and connecting community members to Cape Verdean clinicians. Typically what we would do in our organization is go out and do presentations in person at workshops and things like that, to educate people about the symptoms of mental illness. But since the pandemic, we haven't been able to do that. We've been able to post some tips on our social media sites, and then also I have been doing a lot of community panels and podcast interviews on Zoom, and volunteering, delivering food and essential items to community members.
As for my other role, I work in a local substance use clinic in a hospital in the Boston area. The clinic was designed to fill in the gap in care for patients with substance use disorder. The clinic provides rapid access to services so that patients can see psychiatrists, medical doctors, and have access to medication therapy, recovery coaches, and other resources. Our patients are an extremely vulnerable population, they have a lot of underlying mental illnesses. In addition to the substance use disorders, some of them are also experiencing homelessness and lack of transportation and access to meals.
When the pandemic initially began, we reduced clinic hours and rotated staff members to decrease the risk of infection, but quickly transitioned to virtual visits. We eliminated toxicology screens so that the patients wouldn't have to come into the hospital. We also identified patients who are at higher risk for relapse and that would need more support during that time, and so we were prepared to give that added support. We were also scheduled to be in the clinic a couple times a month to provide injectable medications, like Sublocade and Vivitrol, to support patients with recovery.
Aliah Wright:
What were some barriers to care prior to COVID?
Carla Monteiro:
Some of the barriers, as I mentioned earlier, were lack of transportation, and so patients would miss appointments at a higher rate. Most insurance companies didn't compensate for telehealth visits at the same rate as in-person visits, or they didn't cover it at all. In addition to that, doctors could not prescribe medications if the patients were not seen in office. But a lot of that has changed post-COVID. Insurance companies are a little bit more flexible, medications can be prescribed at their virtual visits. And telehealth has been widely used since COVID and has been deemed an effective and sustainable solution for treatment during the pandemic.
Aliah Wright:
Do you see that becoming the norm now?
Carla Monteiro:
I definitely see it becoming the norm for therapy. Our lives are becoming more and more chaotic, and so signing in with telehealth just makes things just so much more convenient. There are many other factors to consider that create barriers to care. For example, not everyone is tech savvy, nor do we all have access to hardware and technology needed to have access to telehealth services.
Aliah Wright:
Are patients still able to access services, such as detoxes? And can you explain what that is for our listeners who may be unfamiliar?
Carla Monteiro:
Sure. Detox generally refers to the process of removing toxins from the body. In most cases, people use a detox facility when they are detoxing from substances, like opiates or alcohol. It's a little bit safer to be somewhere where you can be monitored.
Aliah Wright:
Are patients still able to access those services?
Carla Monteiro:
Yeah, they do still have access to detoxes, but many of them are not accepting new patients or are closed. And some require COVID clearance, meaning that the patient would have to go to the testing site, get tested, and provide a letter to the detox facility stating that the results were negative. Some of the challenges that have emerged post-COVID is that people cannot meet in person. So people who are in recovery, it can be very difficult for them when they heavily rely on AA meetings or other recovery support groups. There are online options, but again, not everyone has access. This disease is very isolating and it can exacerbate [inaudible 00:05:25] when proper supports are in place, and the pandemic is just not making it any easier.
Aliah Wright:
Are people able to detox at home, and maybe get advice over phone or through those telehealth options, because of what's going on?
Carla Monteiro:
People often will consult their providers, and they can do that, and then the provider can determine whether or not they need to go into an in-patient detox. But typically it depends on what their risks are. It depends on the person's age, if they have other pre-existing conditions. There's a number of different factors that would help a provider determine whether or not a person needs to go in for detox or if they could detox at home.
Aliah Wright:
We're living in unprecedented times. Is there an increase in substance use because of the added stress of job loss or being required to shelter-in-place?
Carla Monteiro:
Yes. I believe that there is an increase in substance use disorder during the pandemic. People have lost family members, jobs, and their social connections. Also, people who have lower income status, loss of job security, insecure housing, and people who are post-incarceration often use maladaptive ways to cope with stressors. Therefore, they are at a higher risk for increased levels of substance use.
Aliah Wright:
Now, what are some things social workers should be mindful of when it comes to patients with substance use disorders?
Carla Monteiro:
I think it would be helpful to keep in mind that the COVID-19 pandemic has presented unique challenges for people with substance use disorders and for those in recovery. Like I said earlier, a vast majority of AA meetings and support groups have been stopped or have been moved virtually. So most patients may need some sort of additional support from their provider.
Aliah Wright:
Listeners, we'll be right back.
Announcer:
NASW Press is the leading scholarly press in the social sciences. Our publications reach faculty, practitioners, agencies, and researchers in social work and related disciplines. Visit NASWPress.org for scholarly books, reference works, brochures and periodicals.
Aliah Wright:
So, Carla, we've talked about your job, but how has your volunteer activity changed?
Carla Monteiro:
I'm a self-proclaimed super volunteer. I love volunteering in my community. And before, I could go somewhere and we'd be in close proximity. But now, we're picking up food and essential items and delivering them to families, but not going in their homes, just meeting them on the porch and delivering there. We all have to wear a mask, have to wear gloves.
Aliah Wright:
Do you think that by wearing a mask and interacting with people, that you're losing that human connection?
Carla Monteiro:
We have discussed this when we're out, because often I'm smiling, and when I'm talking to people, I'm like, "I don't know if they know I am or not." Smiles and things like that go a long way for people. I think people just really accept the gestures, and they are very happy that we are there to provide services. I think they take that as something that they really appreciate, and so they're not focusing on the mask.
Aliah Wright:
What issues are COVID illuminating, that have already existed in your community?
Carla Monteiro:
I think it has magnified the health disparities stemming from structural racism. It has been reported that black people have a higher risk of death from COVID. And those results are due to lack of access to testing and treatment in communities of color. We are already experiencing disproportionate economic stressors, food insecurities, and racism. Black people are being stopped in the stores for wearing a mask, even though a mask is required. All of these things are contributing factors to mental health issues. It's just been really stressful for a lot of people in our community. Unfortunately, because there is just so much stigma around mental health and seeking help from a therapist or taking medication in the black community, folks are at higher risk for poorer mental health outcomes.
Aliah Wright:
How can community members support each other?
Carla Monteiro:
I think that we, as a community, those who are interested and are able-bodied people, should be assisting the elderly, like going grocery shopping for them, just dropping it off on the porch and not having contact. I think we really need to support our loved ones, our neighbors, and we all have to come together to get through this. This is the only way that we're going to get through this safely, is by using the proper precautions, but also supporting each other in any way, whether we're just calling to check in, seeing what additional things they need. And people of color have to make sure that they are taking it serious and wearing their mask when they go out, whether they're going to the stores or visiting family members. I think it's important for us all to just take the proper precautions to support each other.
Aliah Wright:
In addition to that support, do you think it's important for social workers to maybe pause and take some steps to exercise self-care for themselves? Because you guys are actually seeing a whole lot on the front lines. What do you think about that?
Carla Monteiro:
Yeah, I strongly believe that social workers should be getting some sort of mental health support. It is a lot. I know we often talk about nurses on the front lines and watching the death tolls at the hospitals. But we also have hospital social workers who are also delivering the news to people's families that they're dead, or holding the phone on FaceTime while somebody who is dying, and speaking to family members. That's really hard to sit with, knowing that this patient's going to die and they're saying their final goodbyes. It definitely takes a toll on social workers. It doesn't matter how much you've been trained and how many skills you have. We're human at the end of the day, and so this affects us, too. It's very important for us to take deep breaths, for us to stretch, go for walks, and lean on each other, and find our own social supports that can be supportive of us and in validating our experience as well.
Aliah Wright:
Do you have any additional tips? And what are some other things you think people should know?
Carla Monteiro:
I think people should not rush this process. I think that we all adjust at a different pace. It may take somebody two weeks to adjust to being home, it may take somebody a month or two. It's important to take breaks from watching the news, also social media. Go for walks, eat healthy, and get some exercise. Because we have to take care of ourselves, mind, body, and soul. I think those are all really important ways that we can try to stay ahead of the pandemic so it doesn't take too much of a toll on us.
Aliah Wright:
Carla, thank you so much for spending the time speaking with us today.
Carla Monteiro:
Thank you so much. I really appreciate it, Aliah.
Announcer:
You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. And don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode.