Episode 115 Transcript: Social Work and Public Health. Is this a career path for you?

Greg Wright:
Welcome to Social Work Talks. I'm your host, Greg Wright. Social work has a long history in healthcare. A century ago, Massachusetts General Hospital was one of the first hospitals to have professional social workers, and today more than 190,000 social workers work in healthcare Today our guest is Jasmine Seville whole health and equity director at Amerigroup dc. She is a rising star in the social work and public health arena, and she's here with us to share her career path and also give you advice on having a career in public health. Welcome to Social Work Talks. Jasmine, how are you?

Jasmin Saville:
Thank you for having me. I'm so excited to be here.

Greg Wright:
Absolutely. So what actually got you interested in a career in healthcare? I mean, was it an experience as a youth or was it an interest that kind of arrived a bit later in your life?

Jasmin Saville:
It actually arrived a little bit later. So when I was graduating from undergrad, I had intentions of pursuing a career in law and I had experiences working at a corporate law firm as a paralegal. And I also spent a year long internship with Legal Aid Criminal Defense Division. And while I was already accepted into a program, I had deferred for a while and actually had started to develop this kind of idea that showing up for clients in the community when they need representation in the courtroom was a little too late. Some of the cases that I was being exposed to, some of the unfortunate circumstances, it was too late. It was a decision between five years or 15 years. It wasn't someone should have intervened earlier. And so I started looking at social work as a possibility. I still wasn't wholly sure if that was what I wanted to pursue, but then I actually had an experience where I took EL, I developed a chronic condition, and during that time it was my medical social worker in the hospital that really opened my eyes to seeing someone engage someone at their most vulnerable point. And I just made the pivot from there on out and pursued a career in social work and healthcare.

Greg Wright:
So you're also a registered nurse as well, so I want know, how'd you go from, well, at first you were in law, then you do social work and then a registered nurse. So what kind of led to that and are they related really?

Jasmin Saville:
So it's interesting because it was rather social work first. So while I had interest in law, I think overall what I recognized was this kind of overarching theme was just advocacy and serving my community. And so I pursued social work and worked in that career field for a while, always under the healthcare umbrella or within the healthcare setting, and then wanted to expand my ability to implement macro level solutions. So I pursued a degree in public health just to broaden my understanding around larger issues, trends, doing studies and research and epidemiology. And then while I've developed my career in healthcare, I just felt like I was getting to a point where there were expectations, some assumptions perhaps being made about my ability to engage clinical information. And so I wanted to show up in that space as a better advocate in different conversations. And so during the pandemic, I was actually being a caregiver for a very close family member and decided to pursue a career in nursing. And that's how we got here to be an RN and P-H-M-S-S.

Greg Wright:
I'm exhausted with all of that. I mean, how does one actually find the time to do a Master's in public health, a master's in social work. Wow, amazing. So being a rn, do you think that you get added respect being a social worker, like having the rn, and is it necessary for all social workers who are interested in healthcare? I mean, are you advising them to also be a nurse as well as a social worker as well, or is it really not necessary?

Jasmin Saville:
I don't think that it's wholly necessary. It depends on what your goals are. I do think that within healthcare, I think social workers as well as the nursing profession could both benefit from some kind of shared understanding. So making efforts to just have this level set around the information and what's being discussed in the work that is being accomplished. I do feel for me that it allows me to just look at an issue or a problem from multiple angles. And I appreciate that kind of 360 view on what's going on. I can look at a case or a trend in the numbers, understand what caused that issue from a clinical standpoint, what kind of upset that can create in that community, or what kind of challenges that patient might experience with returning home and being reintegrated into their community from a social work standpoint. And then when I'm looking at ways to address that issue from a larger programmatic level, then I can engage my public health training to support.

Greg Wright:
So I was wondering if you could offer our listeners an overview of the value that social workers are bringing in healthcare. And I want you to answer both on a micro level because you've actually been at that level, but also a macro level as well.

Jasmin Saville:
So I feel like social workers in the healthcare space are so essential. I think oftentimes social workers just, they're like advocates. They stand in the breach, they're your liaison a lot of times between the patient and then their clinical team, especially when we're talking about, at least in the acute setting, preparing you for a safe discharge to the community and back to home. And so I feel like social workers are essential in that space. I think that social workers on a macro level in the healthcare space are able to keep that line of sight on some trends that they are seeing at the front lines that lets us know that there might be a lack of resources to address a common issue or common problem, or that we need to strengthen our efforts around advocacy or making changes to policies and programs to make sure that they are adequately meeting this defined and validated need. And so I think that's where social workers show up in that healthcare space on a regular basis.

Greg Wright:
So I've heard a lot that nurses are moving more into a social work role where they are acting more as a case manager, and I was wondering if you seeing that happening at all?

Jasmin Saville:
Yes. So there's definitely a case management certification that nurses can achieve and work under that kind of certification or umbrella. And I don't know that it's necessarily that they're trending towards social work as much as it is this effort to integrate care so that it's as comprehensive as possible so that the healthcare that's being rendered has this strong social needs element to it. Because when we're talking about, for instance, you're at the hospital, you've been sick, you're deconditioned, it's time for you to discharge home to continue your convalescence at home. Sometimes the nurse that's going to establish medical necessity around what's needed around skilled care. But in doing so, if they are trying to implement a solution like home healthcare, they also have to look at things like, well, what's Jasmine's environment like? Who are her support people? Does she live alone? Is she getting adequate support? Is it safe for her? And while they can answer those questions immediately in order to secure services, partnering and collaborating with your social worker allows them to make sure that you are, they remain in pursuit of the best outcome for the patient, and that we can help address some of those kind of long-term issues to keep people stable in the community.

Greg Wright:
So you really aren't seeing social work as becoming obsolete in healthcare?

Jasmin Saville:
Not at all. Not at all. I have continued to see the presence of social workers at every level and in every setting of healthcare that I've worked and engaged in.

Greg Wright:
So I was wondering if you could tell us a bit more about Amerigroup and what it does and what is your role there?

Jasmin Saville:
Sure. So Amerigroup DC is a wholly owned subsidiary of Elephants Health. It is one of the managed care programs in Washington DC under the DC Medicaid contract. And so we offer Medicaid services to our enrollees and members, just making sure that they have comprehensive healthcare coverage, physical healthcare, mental healthcare, and that we're also prepared to meet their social needs that sometimes can serve as barriers to be as engaged in care as possible. So in my role as Whole Health and Equity director, I focus on our population health strategies as well as our SDOH initiatives. And so for population health, we are looking at improving the health of our population overall. A lot of times, or at least historically in care, there was this focus on the more patients you saw, the more income you could generate. That's not the way we approach healthcare anymore, that things don't work well that way. We are looking at what kind of quality outcomes that you are yielding for the patient. So the more value, high quality care that you are able to provide, the better for the provider, the better for the patient, the better for the community. And then I also make efforts around collaborating with our community-based organizations so that in the event that we have members that are saying, I know I'm pregnant, but I'm also not really secure in my housing, I like to have those partnerships in place where we can say, Hey, there's a program you can engage. Let me connect you to the right resource at the right time so that you can continue to stay focused on your care, but also continue to address those needs around what you are encountering socially.

Greg Wright:
Yeah. So what are the major health issues that you are seeing? I mean, you're in the DC area. The city now is roughly half African American, half white. There's also a large Latino population there as well. The other thing is that DC is really kind of turning into haves and have nots. You really have very expensive exclusive areas, and you have lower income areas. So what are you seeing are the major health and mental health challenges going on?

Jasmin Saville:
Yeah, so to your point, it's definitely a tale of two cities at times in Washington dc I think that there's a widening wealth gap. There's been a lot of rapid development that's happened in the district. Some of it is great. Some of it makes people feel a little less secure in terms of their place in the community. What I can say in terms of health trends tend to be on par with what you see with Medicaid recipient populations who have lower socioeconomic status or even just lower access to adequate resources. So of course, we see a lot of chronic disease that we want to make sure we're addressing, whether it's diabetes, hypertension, those really lab bowel, chronic disease diagnoses that require really good management in order for them not to be exacerbated or to cause some type of catastrophic outcome. We're also seeing issues around disparities that we're hoping to address when it comes to just maternal health outcomes. A lot of that I feel hinges upon lack of access. So like you said, haves and haves, nots. A lot of times we hear this phrase in dc, well, east of the river, these are the issues, and I don't really care for that term more than one river that runs through the district. Right. So what river are you talking about it about? It almost sounds like you're saying the other side of the railroad tracks. And I always question when I hear people use that phrase they're referencing on the other side of the Anacostia in wards eight and seven areas that are largely black, brown, and poor. Largely, there is still a great viable community there, but they are still lacking resources that are automatically included in other parts of the city. There's no reason why there shall only be one grocery store on the opposite side of the Anacostia. There's no reason why there's not a hospital for you to birth that on the other side of the Anacostia. So those kinds of issues where you lack access to the care and resources you need, you will see disparities, you'll see inequities, and we want to make sure we're positioning ourselves and collaborating, advocating for policy changes so we can show up in a forceful way ready to pose solutions.

Greg Wright:
So Jasmine, I was wondering if you could offer an example of how Amerigroup actually advocates for better outcomes in those parts of dc.

Jasmin Saville:
Sure. So one of the things we always try to do is keep abreast of what's going on in the district in terms of legislation. The district is such an interesting space. I always say it's more than a city, not quite a state. It's got the air of a country at times, and things move super fast here in terms of policy and changes. So if you are able to corral support and really stay engaged with your local elected officials, sometimes you can push forward legislation and see changes happen for the better. Really quickly, I think that we have stayed close in touch with the committee on Health and council member Henderson, council member Allen, around some of their initiatives, especially as it pertains to maternal care. We know that recently DC Medicaid carved in doula services. So making sure that we are building out an adequate network. So doula supports, which not only offer education around maternal and child or newborn care, but also serve as an advocate and mental health support to their patients and families, making sure people have access to those kinds of services. But then also whenever there is conversations around changes that need to happen, say transportation or access studies around food deserts and food solutions, those are spaces we are always prepared to show up, offer testimony, keep that conversation going on in the forefront when we're engaging community partners so that we can find solutions that are working in the meantime and in that long game that we are preparing ways to make that transformational change so we can implement some permanent solutions.

Greg Wright:
Let's talk about doulas for just a moment. Black and brown women, no matter their economic levels are still more likely to die in childbirth than other populations. How would a doula program, because when I think of a doula, I think of a celebrity who has the resources to have a doula coach them all through the pregnancy and the birth process and be there at their home with a whirlpool and a hot tub. They have the baby in. So how are you helping to broaden that service to people who are vulnerable?

Jasmin Saville:
Yeah, so this is a great conversation because doulas are not new. Having community support during your pregnancy and birth and in that early postpartum period is not new. There has been renewed interest in it, and I'm really excited about the ways in which our black and brown communities are kind of returning to their roots, because before doulas became this kind of luxury service, it was our granny midwives and our community that were helping us to birth our babies. My grandmother was one of those kind of granny midwives. She was the person in the community that you would appeal to help you birth. My father was birthed at home, and so I'm excited that we are reviving the focus around having this community element being a necessary part of integrated healthcare. And so doulas are able to show up and kind of help you advocate and support your goals around what you would like your pregnancy to look like, what you would like your health experience to look like. Because a lot of times healthcare can be rather intimidating if you are healthy and young, sometimes the first time you're having a real relationship with a provider where it's like ongoing doctor's visits, imaging lab visits is when you're pregnant and you don't even know what to expect. So having someone from your community that looks like you, that sounds like you, that's familiar with your community and your experiences, being able to show up and say, I'll hold your hand. Let's go in there together. What questions do you have? It's okay. It's going to be all right. I think it's super important. And

Greg Wright:
I think so that kind of leads in, I'm sorry to interrupt you, but it leads to another question that I thought of. I mean, you are a woman of color in a pretty high position with a healthcare organization, and I was wondering what lens are you bringing to it to another social worker? Say like a male or a white male or a white or a Latino female could not bring?

Jasmin Saville:
Right. I think that I bring to it personal experiences. I feel like the role that I'm in, my experiences that I've had either on the front lines or even as a mom, they're somewhat elevated when I talk about them and I say, Hey, I can lend credence to what we're seeing. I've had that experience myself. It's super helpful. I do always try to encourage, especially for black and brown social workers or public health professionals, whether regardless of gender, that they understand that maternal health is community health is public health is everyone's health. So we should all find some way to engage the conversation around what's going on. Because I feel like the black maternal health crisis that we're witnessing is largely due to systemic racism. There is this continued implicit bias, lack of access. There are conditions that have been created historically that still persist, that breed mistrust and fear for people when they want to engage services. And so it looks like under utilization, it looks like I'm just choosing not to show up or delaying my care when honestly, I'm just maybe concerned about how I'll be treated for better or for worse. And I think that's an experience that's familiar that we can all speak

Greg Wright:
To. Yeah, it's really funny. Well, it's actually not funny that you are mentioning that there's lingering racism here. I read an article about a Serena Williams who is a tennis star and wealthy. She's the parent now of I believe two daughters. And she even said that she did not feel like heard by her neonatal or her pregnancy. What's the name of her pregnancy? Doctor Jasmine. The

Jasmin Saville:
Obgyn?

Greg Wright:
Yeah, gyn. Sorry. I'm a male. I mean, I'm a parent, but I remember now. Thank you. So are you seeing that it's like a problem that's really at all levels, that even if you might be a middle class person, because in the DC area there is a large black, wealthy middle class going on, but even there there's issues going on with a level of care. What are you seeing? Yeah,

Jasmin Saville:
I think that it doesn't matter about socioeconomic status. Usually the higher the socioeconomic status, you would expect that people would be able to introduce buffers or these protective factors to any kind of issues. They are able to command more income and more resources are accessible to them, lower socioeconomic status, you tend to see more intersecting vulnerabilities, and so now you have concerns about being able to achieve the best outcomes. But what we see consistent is that when race is coming into play, it levels out. The experiences look similar. And so I want to let people know that it's not always something so overt like that. It's just so egregious that you see it. Sometimes it looks like someone just not listening to you, not regarding you a delay in decision-making or receiving care. And really it requires us as professionals, as well as our healthcare system and healthcare providers to kind of interrogate their assumptions, their responses that they're having. Why did you arrive at that decision when it comes to that patient? And really being brave enough to drill down to see if race is coming into play. Because oftentimes it is, and we don't realize

Greg Wright:
It. Yeah. So I want to talk, and I only have a few more questions for you because I know that you're a busy, busy person, but macro social work. I work for NASW, and there's been a call for us to do more support of social workers who are at a macro level. I wanted to ask you, what's actually keeping social workers from having a bigger presence? There are a lot of social workers who are lawmakers and workers. They are working in state houses all around our nation. But what I've heard is that we really need more social workers there. So how can we get more into that area?

Jasmin Saville:
I think that it comes down to having great mentors for those that are coming fresh out of their grad school programs. Because it took me a while to get footing in my social work career, and it took me encountering this amazing social worker, Dr. Denise Davidson, to expose me to what was really possible with my degree and with my training. I had this very closed lens on what was possible. But when I started working with and interning with her, I saw more research. I saw broader conversations. I saw conference participation that informed those who are making decisions around policies. I saw people moving into those roles. And so it started to help me think like, oh, there's space for me. It makes sense that my work would inform such important decisions. So I think that we really need to make sure that we're preparing the next generation of social workers to be great practitioners, strong in research because we know data drives decisions and strong advocates for the profession that they are supposed to be there, that we're not just resource brokers or those who show up to offer support for crisis intervention. That we have the ability to develop large programs that are evidence-based, that yield great outcomes that you can use when you're drafting your policies as a due north to say it's possible, and we need to scale this up and make this something that we integrate and adopt on a policy level.

Greg Wright:
We did a study a few years back, and we noticed in our data that male social workers are more likely to be administrators to rise up. Male social workers are also more likely to be a professor and academician. So what has it been like because you're at different intersections, like female, a woman of color, how has being a female in a male dominated professor profession, I'm sorry, healthcare field, I mean, how have you parlayed that? Yeah,

Jasmin Saville:
It's complicated because I think, well, so a lot of times in the helping professions, you see that same type of trend in education. You see it in nursing. Men

Greg Wright:
Are principals,

Jasmin Saville:
Men are men

Greg Wright:
Principals, men are doctors. Women are pushed toward nursing.

Jasmin Saville:
Nursing. But even still, even when women are showing up in certain higher skilled areas within medicine or healthcare here at the healthcare company, it's way more women. But when it comes to sometimes that executive leadership, you will tend to see more men, and I think that's just a larger narrative with our culture and country and society just period. So I just try to be aware of that and make sure that I am engaging my team members and my colleagues in a way that allows my voice to be amplified and also amplifying the voices of others just period, just period across the board.

Greg Wright:
So we are talking to Jasmine Seville. She's the whole health and Equity Director for Amerigroup dc. Our final question is this one, I mean, we've asked a few social workers this. If you knew, if you knew then what you know now, what kind of advice would you offer a social worker interested in a career in public health?

Jasmin Saville:
I would tell them, once again, strong mentorship. You have to have it. I do not regret my decision to pursue a public health degree. I probably would've arrived at it later had I encountered some of the career social work mentors that I didn't get to until later on after I had completed that degree. There was, I don't want to say necessarily a redundancy, but definitely there was more that I could have achieved. I think I limited what was possible with my social worker degree, so I'm still super proud of it. I will always maintain my LMSW. I will always pursue continuing education and highlight my experiences, but there's so much possible there. So finding those mentors early on makes all the difference. It makes all the difference.

Greg Wright:
Thank you. Jasmine Seville from Amerigroup dc Thank you for being our guest on Social Work Talks podcast. Ma'am,

Jasmin Saville:
Thank you. I appreciate you having me.

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