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— Dr. Matt, DSW (@DrMattDSW)
Jul 6, 2023
from Twitter https://twitter.com/DrMattDSW
PCN Reflection
Sharing here the reflection I shared with my DSW program on the use of professional collaboration networks, in response to a request by Dr. Michelle FK
The Professional Collaboration Network is, at least in theory, a sound tool to gain feedback and input. It sounds nice to have a network of experts who can help guide someone through a doctoral process in which experts may not exist within the School of Social Work. My takeaways from this practice, as I experienced it in this doctoral program, and as I have noted in last semester’s reflection and will reiterate here, are entirely negative.
I have found that, in practice, the PCN process as implemented in our program is one that is – while well intentioned – deeply flawed, borderline unethical and not at all worth the effort that was put into it: by the faculty or the students.
The first take away is that Implementation Mapping, and I would venture to say most (if not all) implementation models and frameworks require the inclusion of stakeholders voices (Eldredge et al., 2016). Full stop. This makes the PCN entirely redundant. Redundancy is wasted time, and wasted time is wasted money.
As I mentioned in my reflection for SW633: the PCN cannot replace a formal implementation team. PCN members do not have the training or knowledge to do so. They are experts in their various fields, not in implementation science. Moreso, they are not (necessarily) experts in the areas of research that we are conducting (on top of the implementation process we are working through). Those of us who plan to use our DSW for its intended purposes will not need, nor ever use a PCN when those of us (myself included) venture out to be implementation scientists in the world. We will include all of those who ought to be included because it is part and parcel of the implementation process. Additionally, those of us who cleave to the principles of trauma-informed care (Butler et al., 2019; Substance Abuse and Mental Health Services Administration (SAMSHA), 2014) would do this anyway.
Students worked to develop a robust PCN at the very start of the program before we – as doctoral students– really had any idea how they would be helpful. This means that I developed a PCN of over 30 people who were ready, and willing to help me…and who mostly had nothing to do but provide blips and drops of feedback as they could. Additionally, the continued use of twitter immediately became untenable with the takeover by Elon Musk.
My impression was that the doctoral program was equallyat a loss to explain exactly how the PCN should be appropriately utilized. I remained hopeful, and yet the class on engaging the PCN in our second year was an effort in futility. I have – never – had a class that I could not find one redeeming morsel of information in until this course. Not once. Not during my BA, my two masters, this doctoral program, or the entirety of my military training and education (which is nearly as extensive as my academic career).
It is clear, upon reflection, that the PCN came about from an academic perspective. This perspective, as it relates to the DSW program and cohort is terribly problematic. All of us in the DSW, with the exception of one of my colleagues, are professionals who work (primarily) outside of Academia. Academia should not have been the guiding light of this program (which seeks to reduce the research to practice gap that has been created by academia). Rather, business, workers collectives, and other lenses should have been used.
Had a literature review been conducted before swallowing the concept of PCN wholesale, the existence of Business Information Networks (BINs) would have – or should have – been clearly evident. Business Information Networks (see: https://www.bni.com; http://BINLI.org; and others) are small groups of working professionals, working in different fields, who meet regularly and who provide one another with leads, resources, information, and support.
It is done in a way that is ethical (from a business perspective) where everyone contributes to the other in a pragmatic, definable fashion, and where no one asks someone else to provide labor that goes uncompensated.
The “I’ll help you, if you help me” quid-pro-quo that exists in academia has subtle payoffs (authorship, potential use for tenure). It carries no water or weight in the clinical, consulting, or corporate worlds in which I exist and function. I would argue that it is also exploitative of professors as well, but I will leave that to the halls of the academy to address.
I found the process distressing, angering, annoying, frustrating, and generally a barrier to conducting my work. It was not a feature, but rather a bug of the program. I will do everything I can, as an Alumni, to help the school remove this deleterious component of the program.
References
Eldredge, L. K. B., Markham, C. M., Ruiter, R. A. C., Fernández, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: An intervention mapping approach (4th edition [Kindle]). Jossey-Bass.
Substance Abuse and Mental Health Services Administration (SAMSHA). (2014). Trauma-informed approach and trauma specific interventions.https://www.samhsa.gov/nctic/trauma-interventions
Amazed
Amazed
I am always amazed that the ‘master race’ – with all its flannel bravado – seems to think that us queer folks are weak.
As if we didn’t grow up in New York or Appalachia or Louisiana alongside you. As if we haven’t served in every war since humans began walking upright and out of their caves. As if we haven’t been steel and rig workers. As if we haven’t worked alongside you on the farms and in the coal mines. As if proficiency in wearing high heels and field stripping an M16 are mutually exclusive things.
We are not, have not been, and will not be afraid of you. We know you so much better than you can ever hope to know us. We are your daughters and sons. Brothers and sisters. We infiltrated you at our birth. We have been watching and learning from you for as many years as we have walked this Earth. We know your tactics. We know the size of your forces. We know you.
For every song lamenting the loss of ‘real men’ and their pickup trucks, there’s a dozen of you scared to go into a drag club, to shop in Harlem, to welcome in refugees, and to heal the sick…hundreds who wouldn’t recognize your Jesus Christ if he asked you personally to crawl through the eye of the needle to escape your narrow and hateful worldview.
For each Bible that’s come crashing down on our heads there are a dozen success stories of our people who made it against the odds, who have found love and community and happiness. We’re as tough as our full set of acrylic nails. We’ve had to be.
Go ahead. Try and silence us. You can’t. We’re loud as fuck. Make our existence illegal all over again. History loves to repeat itself and we know how the history books will remember you. We also know how they will remember us. Try and arrest us. We’re good with bricks and fabulous with spray paint.
Be gay. Do crime. Expect us.
Traumatic Growth & Life Changes
It has been a hard five months. In September my mom had brain surgery to put in a shunt to treat normal pressure hydrocephalus. Then I lost a dear and older friend in the Gay community to cancer (we have so few older gay Men: the Reagan Administration’s handling of HIV, and AIDS largely to blame for that). That same night I found out that one of my family members has cancer, and another is fighting the same kind of cancer that my Aunt Teri passed away from. My Aunt Teri is one of the biggest reasons I became a Social Worker.
I went to the hospital with symptoms of a heart attack (thankful that it came back clear). We had to help my dog, Wiley, across the rainbow bridge. Mom had two E.R. trips in rapid succession, the second was a seizure which saw her in the Neuro E.R. for a few days, before she came home for at home rehab with Neuro O.T. and Neuro P.T. I took a leave of absence from work to take care of Mom and drive her to her rehab appointments.
I also passed my LCSW exam, and somehow managed to get a 4.0 in my doctoral program. Two days after my LCSW exam, mom wound up in the hospital again, after I found her (once again) non-responsive on her bed. Four days unconscious in the Neuro E.R., I can’t recall how many days on the Neuro Floor…we got the diagnosis of moderate/severe dementia.
I have been in full swing ever since: coordinating medical, insurance, financial, mental health, etc. in order to get Mom into a safe memory care unit.
In therapy we call this “traumatic growth.” These moments that are harder than iron, and sharper than diamonds, that mold us, that change us, that educate us. They are often cairns, or markers, on our lifepath.
I realized that I needed to slow down. I have literally been running my entire life (literally before I could walk).
So it was with incredible sadness that I turned in my letter of resignation to Horizon Health Today. My last day of work is on February 14, 2022 (when I come back from my leave of absence – there is still a LOT of work to get done between now and then for Mom’s transition and care).
I can’t say enough positive things, in any of the languages that I speak, about Horizon. It has been among the greatest honors of my life to work at, work with, learn from, and grow with Horizon. I would not be the counselor that I am without them.
As I start my next journey I look forward to parting as friends and maintaining a relationship with Horizon: whether as an outside instructor, or – at the very least – Horizon and the Bailey Team’s biggest cheerleader and champion in the community.
So what’s next? I meant what I said when I wrote about the “Death” of Private Practice. Agency practice has brain trust. The patients’ benefits and outcomes are currently incomparable. There are also downsides (it takes a LOT of energy, caseloads are high because they must be, your schedule isn’t your own, it’s rapid pace which has not gone unnoticed on my body, as I continue to work with my own physical disabilities).
To that end, I am pivoting my doctoral research to find a balance between agency, group, and private practice (what I am currently calling “Networked Communities of Practice”) to create a new model that is both financially and humanly sustainable, that can meet or exceed agency outcomes for patients in terms of achieving their goals and access to other kinds of service providers. We must fight back against burnout experienced by social workers and others in the helping professions, especially as we enter our third year of the ‘new normal.’
I am thankful for a friend and colleague (an incredible attorney) who is helping me setup my practice. I will be empaneled with United Healthcare, Oxford, Oscar, Aetna, Cigna, and Blue Cross/Blue Shield within the next thirty days. I have also partnered with the Open Path Psychotherapy Collective in order to provide affordable services for those without insurance coverage.
More to come.
For now, I am going to make a cup of tea, turn on some music, and slow down, and give myself permission to do and think nothing at all, but to just watch the winter evening and just notice…just breathe.
Gathering Dandelions
I am, in this moment in time, awfully sad. My heart aches in ways that I have never known before. My soul is bleeding, scarred, and bruised. These emotions, however, are profound, and I am allowing myself to sit – not wallow – in them. It is vitally important that I feel them, and rather than view them as an enemy, I must recognize them as a friend.
Because bleeding stops. Scars fade. Bruises go away. The lessons they teach us remain.
These emotions are here for an evolutionary reason: they help us survive, and they help us become better people, they give us a mere glimpse into other parts of our humanity that we don’t often access…because it hurts, and because it’s hard to access.
We cannot change the laws that exist within the universe, they are written by a power far beyond that which we can comprehend or control. We can learn about them, we can try to understand them, but we cannot change them. We cannot undo the past. We, for all we may want to believe, can’t slow aging or prevent our eventual death. We can’t change the stars, nor can we tell a tornado to stop.
Without profound loss, we cannot know the power of total and complete gratitude. Without the depths of despair, we cannot know the true power of hope. Without sadness as dark as the night, we cannot know joy that is so overwhelming our world lights up again. Without a total loss of control we cannot understand or even begin to recognize the boundaries that create safety for us.
These emotions, like all emotions, like all feelings don’t last forever. They help to transform us in a moment in time: whether a second, or a season. The feelings we have directly impact, and help to create, our behaviors. In recognizing, in gathering our feelings, like one gathers dandelions as a child: we can hold them, observe them, thank them, think on them, and then blow them into the wind, where they’ll take flight exactly as the laws of the universe (physics) have destined them to fly.
They will leave, and we will have been better off for having spent some time with them before we gave them flight.
Grieving The Still Living / Modeh Ani
This September my Mom, and best friend, had brain surgery for normal pressure hydrocephalus. She had a shunt put in, and was so excited to be feeling better, walking instead of shuffling, and a number of other symptoms seemed to move by the wayside. This, sadly, did not last long.
I found Fran having a neurological emergency on Sunday, November 14th. I conducted a MMSE (Mini Mental Status Exam). Mom couldn’t pass it: she didn’t know where she was, who she was, who the president was, what the year was, etc. I wasn’t sure what was going on, but I knew it was a neurological emergency.
She was rushed to the hospital, where she would spend a number of days, flittering in and out of being able to remember who she was, and who I was. Eventually much of her returned.
I took a leave of absence from work on November 15th in order to take care of her, to provide her support (caregiver, emotional), and to take her back and forth to Neuro OT and Neuro PT appointments, and to coordinate her care.
On Wednesday, December 22nd I found my Mom on her bed again, once again unresponsive, this time unable to move, unable to speak, unable to see me. The fire department helped get her out of the house, and we rushed to the Neurology Emergency Room, which I am so thankful to have here in Buffalo, and so close to my house, at our medical campus.
It was UTI induced Encephalitis. My mother NEVER had symptoms when she had a UTI, often only finding out during a urine specimen test at the doctors. She spent many days non-communicative and non-responsive in the Neuro ER. Finally, she re-awakened slowly.
At first she couldn’t recognize me, then she could, and slowly it became apparent that symptoms that we had attributed to other things for years (like forgetfulness was due to fibrofog, the stopping of paying her bills depression, etc.) was in fact early signs of dementia that we missed. Much like historians can put a complicated situation together in a narrative that we, decades later, can say “wow that makes sense, why didn’t the people living through the event see it?,” so too are chronic and progressive medical conditions often missed, or misconstrued. It makes sense now, because we can look back knowing all we know.
This last incident sped up her progression to Moderate/Severe Dementia.
My mother is now preparing for a new journey, as am I. The prayer that we as Jews say each morning, the very first prayer, is Modeh Ani. It is the prayer where we thank HaShem for returning our souls to our bodies:
מוֹדֶה אֲנִי לְפָנֶיךָ מֶלֶךְחַיוְקַיָּם, שֶׁהֶחֱזַרְתָּבִּינִשְׁמָתִיבְּחֶמְלָה. רַבָּהאֱמוּנָתֶךָ
Modeh anee lefanecha melech chai vekayam, she-he-chezarta bee nishmatee b’chemla, raba emunatecha.
I offer thanks to You, living and eternal King, for You have mercifully restored my soul within me; Your faithfulness is great.
For whatever reason, HaShem needed my mother’s soul that day, and chose not to return it. Baruch Dayan Ha’emet: Blessed is The Righteous Judge!
So as I say goodbye to my Mom and talk about her in the past tense, I move forward referring to Fran, who I am now getting to know, and help through the process of getting placed into care, very nearby my house, as we work to determine what our new normal will look like in 2022.
My mother worked hard, every. single. day. to remind me how much she loved me, how proud of me she was. I have had the privilege of having her live with me for the past six years, and my memories of her are love and laughter (in that order). She loved so many of you. She spoke of you often to me, she saved your triumphs as screen shots on her phone, she speaks of you now, introducing many of you to those who surround her, those that can only be seen by her.
I am grieving trips that we had planned to take together (largely interrupted by COVID) and that we now won’t be able to. I will still take them, because I know she would want me to (her joy of life was contagious). I am grieving the incredibly brilliant mind that unravelled before my eyes: the first female systems officer at Citicorp, the woman who came up with the contingency plan in the late eighties/early nineties that Citicorp put into place on 9/11. The woman who read more books than I have ever seen, and who was an awarded fencer (ambidextrous). The woman who was so happy that ALL of her French returned to her the last time she visited Paris, so much so that airport security tried to move her to the citizens line at the airport. I am grieving the woman who ensured I had an education before the Americans With Disabilities act and who made sure I was at the table for my special ed meetings before that was even a thing. I am grieving the woman who made sure to find a synagogue with a special ed class so I could have a Bar Mitzvah. I am grieving the woman who loved science, as much as she loved getting kicked out of fine establishments (once by dancing on the bartop). I am grieving the end of 37 years of guidance, friendship, and of unconditional love as I have known it. I am grieving.
I also know that I will be okay, because my very existence was manifested by acts of revolutionary and unconditional love going back hundreds of years, through countless generations, which eventually lead me to this very point in time, and that because of our collective memory the loss of Fran’s memories are not the end of hers, but rather, now the responsibility of ours to keep.
This is what it means to be a Jew…we pick up the shards of our broken glass and turn them into mosaics. I will not eulogize my mother now, but I will mourn and grieve the mom that I have lost. I will also wait with excitement, and joy, and awe to meet and become friends with Fran, the new woman that she is becoming.
בָּרוּךְ אַתָּה, יְיָ אֱלֹהֵינוּ, מֶלֶךְ הָעוֹלָם, שֶׁהֶחֱיָנוּ וְקִיְּמָנוּ וְהִגִּיעָנוּ לַזְּמַן הַזֶּה
Social Work Futures: Beyond Virtual Reality
Virtual reality (VR) has garnered attention over the past several years within the social work field as a way of connecting students with experiences that they may not be able to have in the classroom; and to orient them with the communities that they are likely to serve both in field placement and eventual practice (Huttar & BrintzenhofeSzoc, 2020; Lanzieri et al., 2021; Trahan et al., 2019).
Virtual reality on the surface is an appealing choice of technology to prepare students in a culturally humble way to work with clients or patients on any number of issues, making use of simulations that can provide immediate feedback to learners within the safety of their home or classroom.
While virtual reality might be appealing, especially as a new piece of technology, it is not without its limitations. Virtual reality carries with it a cost – not only for the consumer to invest in the headset and associated software – but for those seeking to develop interventions as well, and the agencies who would like to utilize, adopt, and implement existing intervention or training software to meet their populations’ unique needs.
There also exists little data as to how effective virtual reality is when compared to traditional classroom instruction (Huttar & BrintzenhofeSzoc, 2020). In a systemic review, Huttar & BrintzenhofeSzoc (2020) were only able to find onestudy examining the comparison between virtual reality and in-classroom instruction. There is also a dearth of evidence to how virtual reality compares in the short, medium, and long term, to interventions provided as they currently are.
Beyond cost, are other concerns surrounding accessibility. These include overall accessibility under both Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, as well as accessibility for those who are unable to bear the weight of a VR headset due to the natural aging process, or skeletal, or neuromuscular disabilities (Schwartz, 2020). Additionally, finding ways to include those who are blind, or those with neurological diversity concerns that prohibit their use of virtual reality as it is presently implemented remains an open question that has not been addressed (Schwartz, 2020).
While we are years away from the concept of a holodeck, (Star Trek’s ‘magical’ experience room where one’s wildest fantasies can become a reality) progress is being made toward more inclusive VR experiences. There is hope on the horizon. Whether or not it is in the distance remains an open question.
Until these barriers of cost and accessibility are mitigated and resolved not to the satisfaction of the technocrats but rather to the most excluded user, it remains a choice at odds with Social Work’s stated values as espoused in the NASW Code of Ethics. However, we do not have to throw the baby out with the bathwater. There is a middle, accessible ground, and one likely far more beneficial, far more convenient, and with far more longevity than VR headsets: Augmented Reality (AR).
Augmented reality is, perhaps, a hidden gem overlooked in social work and the helping professions. While many may think of Pokemon Go, or using Amazon.com’s “see it in your room” feature when they hear the term, AR technology is waiting to be unlocked by social workers engaged in technology development. It is waiting to be harnessed as a more meaningful, more accessible (and likely more realistic way) to engage social workers and social work students with their patients and their communities.
Katz et al (2012) were utilizing augmented reality as early as 2012, along with GPS positioning, in order to create applications that assist those who are blind with navigating based upon geolocation and visual landmarks. There are cellphones for the blind, and a variety of options and adaptations across both iPhone and Android devices that reduce barriers for those who are disabled or neurodiverse, which also reduces the cost burden currently associated with VR as it currently stands.
As Katz et al (2012) assisted the blind community to navigate their world, this technology can be utilized to assist students in navigating their communities and populations in safe, meaningful ways where learning and engagement can occur. Not only this, but it can allow students to exist within virtual space and real space at the same time, allowing them to remain oriented to the real world and the lessons they are working to learn in order to make a difference in it.
Social work education has seen the value of providing training to students to brief them on the communities, populations, and agencies that they will be attending to beyond the typical interventions courses. In Israel, Even-Zohar (2020) studied students at the baccalaureate level of social work education. The students were trained on a specific intervention, and sent out into the community to provide the intervention; largely they reported feelings of self-efficacy, and success having seen their work in practice (Even-Zohar, 2020).
Imagine, now, if these students were provided an augmented reality platform similar to that created by Katz et al. (2012). Students could – without VR headsets – take their cellphones into the community, and through the use of augmented reality point their phone – whether they can see or not, regardless of ability or disability – at the bank and see, or hear, or feel an overlay not of floating heads and disembodied cartoon avatars so often associated with VR, but of actual people interacting in a simulated situation, right in front of their eyes, interacting and playing out before them, while they could be fully present in the moment: taking in the sounds, smells, sights, tactile sensations, and more (whatever senses their body affords them). Imagine being able to enter a hospital and be guided around with an augmented reality tour guide, who shows you around, and then lets you have a session, in an actual hospital room (empty) though filled with augmented reality characters portrayed by real actors who can respond and interact with the students based on artificial intelligence.
Augmented reality has much to offer social work, in combining our digital worlds with our physical ones, in connecting students to scenarios where they actually occur, and by widening the tent of social work education to those who have been largely excluded due to their disabilities, and schools of social works’ inability to be inclusive by design, far beyond ‘accommodations.’
Rather than invest in a technology that is unproven, non-inclusive, expensive, and difficult, we should instead turn our attention to what, on the surface, may seem lest robust, but in fact can increase and open our worlds, in a manner far more consistent with our values, than virtual reality can ever hope to achieve.
References
Even-Zohar, A. (2020). Social work students acquiring tools to help families manage their household finances. Journal of Financial Therapy, 11(1). https://doi.org/10.4148/1944-9771.1199
Huttar, C. M., & BrintzenhofeSzoc, K. (2020). Virtual reality and computer simulation in social work education: A systematic review. Journal of Social Work Education, 56(1), 131–141. https://doi.org/10.1080/10437797.2019.1648221
Katz, B. F. G., Dramas, F., Parseihian, G., Gutierrez, O., Kammoun, S., Brilhault, A., Brunet, L., Gallay, M., Oriola, B., Auvray, M., Truillet, P., Denis, M., Thorpe, S., & Jouffrais, C. (2012). NAVIG: Guidance system for the visually impaired using virtual augmented reality. Technology & Disability, 24(2), 163–178.
Schwartz, M.L. (2020). Inclusion and equity through universal design vs. ableism and inequality through accommodations. SocialWorkDesk. https://www.socialworkdesk.net/blog/2020/10/20/inclusion-and-equity-through-universal-design-vs-ableism-and-inequality-through-accommodations/
Trahan, M. H., Smith, K. S., Traylor, A. C., Washburn, M., Moore, N., & Mancillas, A. (2019). Three-dimensional virtual reality: Applications to the 12 grand challenges of social work. Journal of Technology in Human Services, 37(1), 13–31. https://doi.org/10.1080/15228835.2019.1599765
Jumping Down The Waterfall
When I was emigrating from the United States to Israel I remember the feeling of jumping from a waterfall. I could provide the inertia and forward movement, but the laws of the universe (physics, God, your preferred higher power) would guide me down safely. I had to have faith, courage, and trust.
It led me on an incredible adventure. I saw joy and sorrow, had a few near death experiences. Made family. And learned a lot about leaning into my fears and growing as a person.
I am once again at a major waterfall in life. I have those same fears and concerns I had in my chest when I boarded my plane to what was then my unknown. I once again feel God’s presence holding me, saying “you got this.”
Once again I am being asked to take a leap of faith. Once again I am jumping down the waterfall. Once again into the unknown with only the knowledge that no matter what it will work out.