NASW Social Work Talks - EP 115: Social Workers in Public Healthcare - Is it the career path for you?

Episode Date: May 20, 2024

Jasmin Saville, RN, MPH, MSSW, is whole health and equity director for Amerigroup, a health insurance and managed health care provider that covers older adults, low income families, state and federally sponsored beneficiaries and federal employees in 26 states. Saville talks about how she combined social work and nursing, why public health care could be a good career choice for social workers, and what it is like being a woman of color in the field.       

Welcome to Social Work Talks. I'm your host, Greg Wright. Social work has a long history in health care. 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 health care. 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? Thank you for having me. I'm so excited to be here.

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

Yeah. So you're also a registered nurse as well. So I want to know, how'd you go from, well, like at first you were in like law, then you do social work and then a registered nurse. So what kind of like led to that and are they related really? So it's interesting because it was rather social work first, right? So while I had interest in law, I think overall what I recognized was this kind of like overarching theme was just like advocacy and serving my community. And so I pursued social work, you know, 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 in 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, MPH, MSS family. I am exhausted with all of that. I mean, how does one, like, actually find the time to do a master's in public health, a master's in, like, social work? Wow. Amazing. So being a RN, do you like think that you get added respect being a social worker, like having the RN? And is it like necessary for all social workers who are interested in like health care? I mean, are you advising them to like also be a nurse as well as a social worker as well? Or is it really not necessary?

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 kind of have this level set around the information and what's being discussed and the work that is being accomplished.

I do feel for me that it allows me to just look at 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 and understand what caused that issue from a clinical standpoint. What kind of upset that can create in that community? Or, you know, 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. Yes. So I was wondering if you could offer our listeners an overview of the value that social workers are bringing in health care. And I want you to answer both on a micro level, because you've you've actually like been at that level, but also on a macro level as well. So I feel like social workers in the health care space are so essential. I think oftentimes social workers just they're like advocates. They are they stand in the breach. They're your liaison a lot of times between, you know, the patient and then their clinical team.

especially when we're talking about, at least in the acute setting, you know, preparing you for 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, you know, this defined and validated need. And so I think that's where social workers show up in that healthcare space on a regular

basis. Yes. So I've heard a lot that nurses are like moving more into a social work role where they are like acting like more as a case like manager. And I was wondering if you like seeing that happening at all. 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 health care that's being rendered has the strong social needs element to it. Because when we're talking about, for instance, you know, you're at the hospital, you've been sick, you're deconditioned, it's time for you to discharge home, to continue

your, you know, your convalescence at home. It's 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 health care, 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, you know, 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. Yes, so you, like, really aren't seeing social work as becoming, like, obsolete in healthcare. Not at all. Not at all. I have continued to see the presence of social workers at every level and in every setting of health care that I've worked and engaged in. Yes. So I was wondering if you could tell us a bit more about Amerigroup and what it does and what is your role there? Sure. So Amerigroup DC is a wholly owned subsidiary of Elevance Health. It is one of the managed care programs in Washington, D.C. under the D.C. Medicaid contract. And so we offer Medicaid services to our, you know, enrollees and members, just making sure that they have comprehensive health care coverage, physical health care, mental health care.

and that we're also prepared to meet their social needs that sometimes can serve as barriers to being 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, you know, income you could generate. That's not the way we approach health care anymore, that things don't work well that way. We are looking at what kind of quality outcomes that you are yielding for the patients. 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, you know, 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. So what are the like major health like issues that you are seeing? I mean, you're in the D.C. area. The city now is roughly like half African-American, half white. There's also a large Latino population there as well. The other thing is, is that D.C. is really kind of like turning into haves and have nots. Like you really have very expensive, exclusive like areas and you have lower income areas.

So what are you seeing are the major health and mental health challenges going on? Yeah. So to your point is definitely a tale of two cities at times in Washington, D.C. 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, you know, diabetes, hypertension, those really labile chronic disease diagnoses that require really good management in order for them not to be exacerbated or to, you know, 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 have nots. A lot of times we hear this phrase in D.C., well, east of the river, these are the issues.

And I don't really care for that term because there's more than one river that runs through the district. Right. So what river are you talking about? It almost sounds like you're saying like the other side of the railroad tracks. And it just it just I always question when I hear people use that phrase. They're referencing on the other side of the Anacostia in Wars eight and seven areas that are largely black, brown and poor. right? 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 at 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 will 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. Yeah, so Jasmine, I was wondering if you could offer an example of how How Amerigroup actually advocates for better outcomes in those parts of D.C.? 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. Right. 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 like Councilmember Henderson, Councilmember 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, 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, you know, implement some permanent, some permanent solutions. 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. um how would like a doula program because when i think of um a doula i think of a celebrity who like has the resources to have um to have like a doula uh coach them all through the pregnancy and the birth process and be there at their like home with um a whirlpool and you know a hot tub they have the baby in. So, so like, how are you kind of like helping to broaden that like service to like people who are vulnerable? Yeah. So this is a great conversation because doulas are not new, right? Having community support during your pregnancy and birth and in those early,

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 in our community that were helping us to birth our babies. My grandmother was one of those kind of Granny Midwife. She was the person in the community that you would appeal to 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 Yes. So that kind of like leads and I'm sorry to interrupt you, but it leads to another question that I thought of.

I mean, you are a woman of color and a pretty high position with a health care organization. And I was wondering what lens are you bringing to it that another social worker, say like a male or a white male or a white or a Latino female could not bring? Right. I think that I bring to it personal experiences. Right. 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. It kind of, they're somewhat elevated. Like when I talk about them and I say, hey, I can lend credence to this, 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. You know, 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 underutilization. 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. So and I think that's an experience that's familiar that we can all speak to. Yeah, it's really like funny. Well, it's actually not like 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, like, wealthy. She's the parent now of, I believe, two daughters. And she even, like, said that she did not feel, like, heard by her neonatal or her pregnancy. What's the name of her pregnancy? Dr. Jasmine.

The OBGYN. OB, yeah, GYN. Sorry. I'm a male. I mean, I'm a parent. But I remember that. Thank you. But so are you seeing that it's like a problem that's really at all levels that like even if you might be a middle class person, because in the D.C. area, there is a large black, wealthy middle class going on.

But even there, there's like like issues going on with a level of care. What are you seeing? Yeah, 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 going to be, it's not always something so overt, like that it's just so egregious that, you know, 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 it. Yeah, so I want to talk and I only have a few more questions like 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 like more support of social workers who are at a macro level. And I wanted to like ask you what's actually keeping like social workers from having um a bigger like presence there there are a lot of social workers who are lawmakers and um they are working in our state houses all around um our nation but um what i've heard is that we really need more social workers there so how can we get more into that area 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 my footing in my social worker, my social work career. And it took me encountering this amazing social worker, Dr. Denise Davison, 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 her 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, you know, 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, you know, on a policy level. um we did um a study um a few years back and um we like notice in our like data that male social

workers are more likely to be um administrators to kind of like rise up um male social workers also more likely to be um a professor um an 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 profession, I'm sorry, healthcare feel, I mean, how have you parlayed that? Yeah. It's complicated because I think, well, you know, um so a lot of a lot of times in the helping professions you see that same type of trend in education you see it you know in nursing men are principals men are men men are men are doctors women are pushed toward nursing nursing but even still even when women are showing up in certain

um, higher, uh, skilled areas within medicine or healthcare. There there's here at the healthcare company is way more women, but when it comes to, uh, 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. So we are talking to Jasmine Seville. She's the whole health and equity director for Amerigroup DC. Our final question is this one. And I mean, we've asked a few social workers this. If you knew now, if you knew then,

but you know now, what kind of advice would you offer a social worker interested in a career in public health? 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 have 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 i definitely there was more that i could have achieved i think i limited what was possible with my social worker degree um so i 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. Thank you. Jasmine Seville from Amerigroup DC. Thank you for being our guest on Social Work Talks podcast, ma'am. Thank you. I appreciate you having me. 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. Thank you.