Hello, everyone. Thank you so much for sticking with us on this Sunday evening. Really appreciate it. I also feel like we've built a pretty good team here, so we'd probably rock it if we had our own clinic. So I'm Megan. I'm one of the clinical social workers at Boston Children's Hospital. I have nothing to disclose. The following objectives that I'm hoping we'll work on today are that you'll be able to describe the various roles a social worker may hold as part of an interdisciplinary epilepsy care team, that by the end of this, you'll be able to practice the clinical perspectives of person in environment and client self-determination, and that you'll be able to demonstrate how to search for and identify community resources to support vulnerable patients managing a variety of psychosocial challenges. So I'm both going to cover an overview of what I do as a social worker, but also some considerations of how you might navigate care if you don't have a social worker, or maybe it's not feasible for you to add a social worker in the near future. But hopefully you can, because as you'll see, we're very important. So I wanted to start out by highlighting the training and practice that we go through to get to be able to work in a clinic. So typically a social worker holds a master's level degree. This is approximately two years after obtaining an undergraduate degree. And then within that, a social worker may choose a few different paths. Two of the most common are clinical and macro. So the clinical social worker requires field placement, internship hours, additional supervision hours in the field post-graduation, as well as a licensure exam, and then CEUs every few years to maintain that licensure. A macro social worker is someone who's focused more on the kind of larger systemic policy advocacy thing. So you may find a macro social worker in government relations. Social workers in general are employed in a variety of settings. So our training can really help us adapt to working in a lot of places. So some of those include schools, hospitals, private practice. You know, a clinical social worker can practice therapy and have their own patients. And as I mentioned, they may work in government agencies or nonprofits. Some are even in management roles. Something else that I wanted to highlight as well is the role of the social worker versus a patient navigator. Both are very important, and it's lovely if your team can have both. But sometimes you can't. But I wanted to comment on this because especially the highlight at the beginning about having all of our disciplines be able to work to the top of our licensure. So a patient navigator can be really helpful to have for the healthcare navigation, connecting patients and families to those basic needs resources, helping with transportation, meal vouchers, those kinds of things. And while a social worker can certainly do all of these things, the distinction between these roles is that a social worker has the clinical training and expertise to manage these really complex, nuanced cases, you know, like a suicidal patient in clinic or a child protection issue. And we can also add a lot of value and richness to our programs because we can also practice therapy. So we could add in some additional interventions, you know, like doing CBT with PNES patients, you know, if we have more bandwidth and support from having a patient navigator. So thinking about the values and approach that social workers are grounded in, I think this is really important so that you all understand kind of the way that we approach our work and how we work within a team. So social work is a profession devoted to helping people function the best that they can in their environment. And so this highlights the person in environment perspective. You know, we're really trying to bring attention to and understand the environmental forces that may create the issues that our patients are dealing with, or, you know, really by looking at things more globally rather than seeing the person in the vacuum, you know, there are one issue that you might be treating them for. And we try to peel back those layers and kind of consider all areas that may influence their engagement in their care, their lived experience. And one way that we can better understand them in their environment is through a comprehensive psychosocial assessment, which gets at things like their financial status, their insurance, what's their support system like, where are they living, and like literally their environment, what do they have access to. And this can really help us to better understand, you know, why there may be challenges with engaging in their epilepsy care, managing their epilepsy. Something else that's really important is considering client self-determination. And so recognizing that our patients and families are autonomous, we want to work with them to empower them rather than doing for them. We also want to try to meet them where they're at. And so priorities between clinician and patient may differ. So we want to make sure that we're really honoring what our patient values, what their priorities are, and also what their skill level and ability level is, and working together with them in collaboration. So thinking about the role of a social worker within a multidisciplinary team, the training, the competencies that we hold, as well as our perspectives and values can really add unique insight into a patient and family's situation. So combining the perspective that we might get from our assessment with, you know, your medical assessment can really add a much richer understanding and a fuller picture of a situation that could then help with determining the best and most feasible treatment plan for a patient. This can also help us to explore potential barriers to care, access issues, and then can ultimately help with improving medical outcomes related to these barriers. We also have a really strong social justice mindset. And so this helps us to be, you know, really strong advocates, whether that's advocating, you know, within the hospital system or within the community to help our patients access services that they need, whether that's housing or mental health care, school accommodations for pediatrics, you know. And with that, we also have a really strong knowledge of systems and how to navigate them. So we can really serve both to provide that education to our families and kind of help them through it, but we can also help the teams that we're working with to better understand what it might take to get someone a therapist or what the reality is of the current housing situation in our country, that we're not going to find someone housing tomorrow. But we can try to help, you know, mitigate some of the stressors and navigate them as best as possible. We also, you know, we implement best practices. We try to keep up with research and, you know, what's going on in the field. And one of those aspects is considering social determinants of health. And so, again, that's a huge kind of like no-brainer for social workers considering social determinants of health. It's ingrained in everything that we do. So we're really looking at like, you know, what are all the things impacting our patient and how is that going to then impact their decision-making and their ability to, you know, take care of themselves. So kind of dialing in to specifically what does a social worker on an epilepsy team do, we can do a variety of things. As I highlighted, we, you know, our training is pretty adaptable. Two of the kind of most, I think, what I do the most are these clinical interventions and serving as a consultant to the medical team and collaterals. So we're really, you know, the psychosocial subject matter expert in these types of situations. And so we can really kind of help teams to navigate the nuances there as well as navigating, you know, the systemic challenges that exist. So there's not always going to be an answer or a tangible thing that we can provide, but we can help to balance, you know, what does exist and what the reality is with helping our patients to access care and to be safe and to be managing their medical needs. Within the clinical side of things too, you know, we, just as an example, at Children's, phase one admissions and keto diet initiations are both automatic social work referrals. So we do a complete assessment pre-keto and then during the phase one, which then we contribute to surgery conference, the psychosocial data, and then the keto team meetings we contribute there, which then gives the team some idea of, you know, what is the reality of this patient situation? Like how feasible is this surgical intervention and, you know, what are some things that we need to consider? You know, maybe the family is unhoused or maybe it's a teenager with like some really serious mental health issues that maybe need to be managed before considering, you know, some of these other things. So we can really add some more, you know, data points to work together as a team to come up with the best treatment. We also can help with like health and resource navigation. So insurance, you know, basic needs like food access and like SSI. We can help with transition to adult care, guardianship, all those kinds of things. And then something else that I feel really lucky that we're able to do, which actually part of our education, you know, we do have to take a research course. And so that's part of, you know, contributing to the field and contributing to best practices is also participating in these research and QI initiatives and program development. So we have some projects that we're leading or, you know, closely collaborating on. And then thinking about just the complex situations we can face with our families. So epilepsy is kind of, you know, what you're doing and it's like what you're here for, but we all know that that's not the only thing that our patients are dealing with. We're all human. We all have a lot going on. And you know, we all were in this work because we care and we want to make a difference. We want to help someone improve their health care and their quality of life. And in doing that, you know, taking a trauma-informed approach is really important. And that's something that social workers, again, it's just an automatic thing that we do and that's something we can help our teams to do better. So that's about, you know, creating a safe and collaborative environment for our patients. It's empowering them and it's remembering that, you know, priorities may differ. Our values and like what we're finding important or what we would recommend may differ from what the patient feels is important to them in that moment. And so maybe, you know, thinking that they need, you know, a certain medication or surgery or something and they're feeling ambivalent, it's really important to kind of lean into that ambivalence and try to understand, you know, where that's coming from. Maybe they have some medical trauma. Maybe they're worried about getting time off work or there's other access issues or understanding issues. So really working with them, shifting, you know, from just being frustrated or, you know, wondering like what is wrong with you, why are you not, you know, working with me on this to thinking about maybe what happened to them and what has their lived experience contributed. One thing that I wanted to do that hopefully adds just some color, I guess, I reached out to some families that I had worked with and sent a word cloud and asked how a social worker has helped them. And I also sent it to my team and asked why are social workers an important part of a multidisciplinary team. And these are the clouds that were produced. And you can kind of see some similarities, you know, support, connection, guidance, advocacy are all kind of big things. And hopefully that reinforces, you know, what I've been talking about and helps to understand, you know, why social work is an important part of a multidisciplinary team. And something I wanted to leave you all with, because as I mentioned, you know, having a social worker may not be in the cards right now for your clinic, but hopefully at some point it would be or, you know, you're wondering how you can work with your social worker on some things. So considering creating a resource guide that you can have on hand to refer to, you know, is really beneficial. This is like very generalized just because I know we're from all over, but most of these links you can go to and find what's actually in your, you know, your state or region. So for housing, looking at local housing authorities, finding, you know, there's a shelter locator if you have someone in office that's homeless, you know, and by going through both of those resources, learn what the housing situation is in your area and know kind of maybe what you need to do in a crisis. For basic needs support, community action agencies can be really beneficial. And some of those agencies have social workers at them that can, you know, help these families and patients to navigate some of the things that they might be dealing with, whether that's food insecurity, transportation needs, insurance challenges. And within that too, our, you know, our epilepsy-related foundations also have a lot of those resources. So I know the Pediatric Surgery Alliance has a social worker. Hope for HIE has a social worker. Epilepsy Foundation has community health workers usually, depending on where you are. Thinking about mental health and substance use, which we know is very closely related to things that we need to consider with epilepsy care. So SAMHSA and NAMI are really great resources that can help give education for you as a provider and also things that you can give to your patients. They have hotlines and they can also point to, you know, local resources as well. And actually AES has some great practice tools for mental health that both you can use and also give to collaterals that I've found to be really helpful. Transition and transition. There are parent information and resource centers across the country and you can find, you know, what's in your area and they're super helpful with navigating, you know, IEPs and things like that. The ARC is great for transition to adulthood. And then something called Kids Waivers is a great resource for state by state, what exists in each state for secondary Medicaid, which can be a really helpful supplement for some of our families. So to conclude, just to wrap, to summarize. So social workers offer a valuable perspective, hopefully you learned that. They have a really important role and can support patients in a variety of ways. Often epilepsy is just one of the stressors that our patients and families are navigating. It's really important to educate yourself and your teams regarding trauma-informed care and being able to meet patients where they're at. And it could be very beneficial to familiarize yourself with the protocols and resources available in your region. So consider creating some type of resource guide. Those are my references and thank you very much.

social workers

interdisciplinary care

psychosocial assessments

trauma-informed practices

holistic care