 I'm telling you this show is going to be a tonic for you. You're going to enjoy this in the time of COVID. There are so few things you can enjoy. All right. This is Think Tech. Of course, I'm Jay Fidel. This is Community Matters because community does, in fact, matter profoundly. And this is Lana Leip. And she's a social worker. We like social workers. I told her before I have never met a social worker I didn't like. I'll explain that more later. Welcome to the show, Lana. Thanks for having me, Jay. Appreciate it. Happy to be here. Yeah. So, you know, social workers are like, I mean, in my limited perception of it. Social workers are like psychologists are like psychiatrists, but there's got to be a difference. How do you see those other professions? Yeah, that's a great question. And we often get that, you know, in everyday life, you know, okay, well, how are you different? What do social workers actually do? It's a really, really common question. So social workers, we have a framework that we operate on that's very unique to our training and to our career field. And the framework is called the person in environment framework. And so what we do is we look at how people, you know, impact their environments and how their environments impact them. And so we look at the person holistically, a pandemic is a really, really great opportunity because you're going to have mental health issues, you're going to have job loss, you're going to have increasing rates of violence and, you know, child abuse, you know, all of these different things, not to mention the whole health aspect. So it's like this reciprocal relationship that we always try to look at and, you know, fill in like the gaps, like, okay, well, here's the challenge that's coming from the community or coming from a social situation, coming systemically, and how can we help them, you know, go forward to kind of fill that gap, you know, work alongside them. Psychologists and psychiatrists are absolutely necessary. We as social workers, we do not prescribe medications, psychiatrists can do that. And then psychologists, you know, they work, you know, alongside us, you know, in hospital settings, in community settings, but they tend to focus more on the psyche, the mental piece. You know, I know that there are some who do go over and, you know, it kind of bleeds a little bit into asking, you know, what's your home situation like that kind of thing. But yeah, for us, it really is that person in environment framework that we pride ourselves on. But you think of psychological concepts, though, you have to, there must be a connection there. If somebody is doing, you know, projection or acting out in a certain way, it's irresistible to try to put a, I don't want to say diagnosis, but at least a description of it now. Absolutely. And so we also operate under the DSM-5, which, you know, other providers also operate under. And many of us are clinically trained as therapists. We provide private practice, we provide counseling, grief, all of, you know, all of those kinds of services. And we can diagnose, depending on your level of licensure, because that is absolutely a huge piece is, you know, if someone is, you know, living with depression or anxiety, you know, what kind of barriers is that going to, you know, create for them and is our system set up to actually help these people, you know, get through this and cope. What's your training? So my training, I have a bachelor's degree, I got my master's degree from the University of Maryland School of Social Work in Baltimore. While I was in the School of Social Work, I had some amazing teachers who are social work colleagues, you know, out in the field, experts in the areas that they're working in, providing us this really in-depth training. While we're getting our training and the instruction, learning about theories, learning about the DSM, all of these different things, we also are doing practicums. So they put us out in the community, you know, help us get that hands-on training to really specialize our work. After you graduate, you're required, if you want to go on to get additional licensure, to do two years of supervision and case consultation, get ongoing, you know, education and credits and all of that stuff. And then you got to pay a ton of money to sit for this exam and, you know, pay for your license. So currently I am a licensed clinical social worker, which is the highest licensure I can get for where I am. And what that means is that I can do a lot of really cool things. I can do private practice, I can bill for service, you know, I can assess things in a higher way, I can provide supervision, you know, it really does open up a lot of doors. But people who don't have this level of licensure, you know, people who, you know, get their bachelors or their master's and, you know, don't wish to go on to get licensure. I mean, they're still in our communities and they're still doing amazing work. It just, it just looks a little different and not everybody wants to get their license. I would say just from my limited observation of it, that most social workers, what, have MSWs, am I right about that? Or are they more like college graduates in sociology? Most of us have. Our masters are higher. Okay. And why did you... In some states... Go ahead. In some states, it's really difficult to get any jobs if you don't have a master's degree. You know, there are some opportunities out there, but it's not as like lucrative as for those who do have their master's degree. You can, it can pay pretty well just to look, you know, look on, on the web. It can pay pretty well. But first I want to ask you, why did you do this? What drove you to do it? Why do people go into, what do you want to call it, the psychology type feels? Because they've had, you know, their own psychological experience that drives them to that. Others go in because they are sympathetic to the human condition and want to help. What is your reason? So I joined, I joined the field of social work because when I was a kid, my grandma was a receptionist at a mental health clinic. And I would see these people coming in and out, you know, sometimes tearful, coming in with their loved ones, sometimes coming out angry, you know, sometimes like coming out really happy. And I remember I would volunteer in the summer, you know, having to type all these doctor's notes down because back in that time it was all the recorded videotapes. So I remember her crying in her room and not being able to tell me what was going on other than the fact that people are struggling, they've had some really bad things happen in their lives and, you know, really explain to me and kind of open up my eyes that there are people who can provide the support and who want to make things better. So I actually had an amazing therapist myself who was a psychologist. And I was telling him, you know, I was graduating with my bachelor's in psychology and what I wanted to do going forward and he's like, you would actually make a really great social worker. And, you know, I looked into it and, you know, here I am. And I really, really love the field of social work. It's wonderful. Let's talk about the clinical side of it because I, you know, I think that's the most pure expression of the profession. So I could come and see you in a social worker like a psychologist and we could engage and what would the conversation be like? I mean, what kinds of things would I be telling you about? What kinds of reaction, response, advice, counseling would you provide? That's a great question. So I both work in a hospital setting. I work in the ICU at one of our local hospitals. And then I'm also getting ready to join on to an existing private practice under someone else's umbrella. And from my experience in the ICU, it's people coming in with having their loved ones go from being completely healthy to having these life-altering experiences, whether that be COVID, a stroke, an assault, you know, a surgery, you know, just these things that are really going to take them out of their normal independence and move them into something that's going to look a little different. With the pandemic, I mean, we're seeing all of this loss. We're seeing the loss of employment. We're seeing the fear of the loss of our own lives, of the lives of our loved ones, the issues with school and, you know, how am I going to feed my family missing out on vacations, weddings, all of that stuff. And right now, a lot of what I'm getting at the hospital and in my work in the community is grief. It's just this unfettered grief that I don't think we have really, you know, gotten a handle on. And it's going to look very different, you know, in the days and weeks ahead, but it's a lot of grief. It's a lot of adjustment to conditions. I deal with a lot of death and dying. So, you know, going towards crisis, going towards people who are in some of the worst situations of their lives, you know, having to say goodbye to their loved ones or make difficult decisions on treatment. What can you offer them? At the end of the day, what you expect will happen will happen. What can you say to them? What can you what can you provide in the way of comfort? Yeah. So I like to remind myself that I'm not the expert on anyone's life on any of their situations they've had in the past or that I know exactly what they're feeling. So the approach that I always take when I work with people is to really try to get an understanding of what they're feeling. What grief are they experiencing? And how would they like me to help? Because certain interventions that I would, you know, do for one family member won't work for another. So a lot of it is just really sitting with them and just giving them a space just to be heard. You know, I have all of this training and all of this education, ongoing education, and I can have all of these interventions in my toolkit, but it's not going to mean anything if I can't connect with that person and let them know that I hear them. So a lot of times it really is just a listening ear. It's listening for those things like are they coping as well as one might expect? Are they at risk for self-harm? Are they at risk for, you know, harming others? You know, what is this grief going to look like? What do I anticipate it's going to look like? And then from there, what are they motivated to do? You know, I can offer them every resource in the book, but if someone's like, you know, counseling just isn't my thing. Medication isn't my thing. I'm going to be fine. You know, it's just giving them, you know, planting that seed so then maybe one day they might be interested in doing these things. They might be interested in counseling or whatever that may look like. And then just offering the sources. Enabling, empowering. Absolutely. And I really like I'm touched by the notion that a lot of people go through their lives. There's nobody they can talk to. They can't tell any. There's nobody they can tell their secret thoughts to. Yeah. Much less their troubles. And so it's a wonderful thing for them to be able to talk to another person. Best thing you can do is just listen. And that's what they pay you the big bucks for listening. Kindness and listening are free. It doesn't cost us a thing. Yeah. What happens if you run into somebody who is not is not really interested in having this conversation? Who is, you know, has got some kind of pathology and there's no way you can connect with that person. That person is not going to tell you what's on his or her mind. That person, you know, diminishes the possibility of relationships with anyone. What do you do with that? You disengage. You say, I'm sorry, I can't help you. What do you do? That's an awesome question. And we get that a lot. I mean, we have a lot of people who are veterans coming to the hospital. We do get a lot of people experiencing homelessness, you know, having all of these other like high level, you know, mental health needs. And so their history a lot of times is not being heard. It's being kind of pushed to the side, being excluded from conversations. Nobody really cares what they have to say. And so if I'm not able to engage with a patient, it could be for a couple of reasons. The first thing and most important thing is did I establish rapport with that person? You know, going in and saying, hi, you know, I'm Lana. I'm your social worker. I'm going to talk about this, this and this. And it's going to be on my timeline and, you know, that doesn't work. It doesn't work that way for those kinds of people who typically don't open up. So first and foremost, it's establishing rapport. And if people aren't really interested in talking about their feelings because not everybody is, I try to make it more practical. You know, are you having any pain? You know, what are you thinking about while you're here in the hospital? You know, you're sitting here, people are coming in and out of your room. You know, how is that? You know, what do you understand about your condition? And so talking about the more practical, you know, foundational things, it gives me the credibility that I'm not in there to judge them. I'm not in there to assess them, you know, and send them off, you know, to a psych ward or anything. It's, I really wanna be there to help them and I really wanna understand their story and what they're going through. Pain is one of the most important things that I think you can ask somebody, especially when they're in crisis because anxiety and pain, you know, go hand in hand. You know, we're talking before about how people have pucas in their lives, say they're missing a spouse or an opposite. They're missing a child that doesn't work. They don't have that relationship in their lives or a parent and they wanna make you that. You know, you come along and they immediately put you in that puca and they say, Lana, tell me what to do. Give me advice on this specific problem. I suspect that's not exactly what you have in mind. You're not there to answer their practical question of how to make a decision on a life decision question. How do you handle that? Right, social work is all about empowerment. It's all about empowerment and giving them the tools to succeed, working alongside them to remove barriers but not doing it for them. We are very big on boundaries in social work because, you know, those kinds of things do happen, transference, it happens very, very quickly. It happens very easily and it's not healthy for that person and it's not healthy for us to get in that savior role, you know, where, oh, they cannot do for themselves. So, you know, I must do for them. And I think it's all about building that relationship with them. It goes back to trust. It goes back to rapport building and being like, okay, you know, these are the things that I can do in my role. How do you feel about that? And then also assessing while I'm speaking to them about their motivation to do certain things because I can't want for somebody more than they want for themselves which is difficult sometimes because I really, it really want to, you know, go that extra step and, but I have to remain in my boundaries ethically and, you know, for our safety and mental health for both the client and myself. Yeah, mental health, you know, I was gonna ask you, I think, you know, anybody who provides social work or psychological services to somebody is under a certain stress personally because people are dropping their problems on you and of course you can, you know, you need to respect your own boundaries but sometimes you're affected by it. You could get depressed, stressed and depressed yourself. How do you prevent that? How do you stay in a good frame of mind when all around you is sadness and depression and death and dying and so forth? So it's all about reminding myself that the story that someone is sharing with me stops right outside of them. I don't pick up that story and I don't make it my own. Sometimes that's really hard. It's not always easy to do that. There are cases that, you know, hit home to me for personal reasons, you know, I have children and so cases with children do tend to hit me really, really hard. So what I do in that point and what we all try to do in our career field is to seek out case consultation. I have some really, really great trusted clinical colleagues who I can say, hey, I wanna run this case by you. I am feeling some kind of way. I feel like I might be maybe overstepping my boundaries and getting that feedback that's objective and helps us really process through what we've got. It's also about boundaries for ourselves. It's about eating lunch, the simple things, eating lunch, drinking water when we can and trying to really remind ourselves that it's not for us, it's for others but we also need to take care of ourselves too because we can't, you know that old saying, you can't fill from an empty cup. You know, I do wanna get to the question of COVID and you're in a hospital setting good part of the time and they come and they try to get well and the doctors try to make them well and all that sometimes they don't get well. And the question is how do you handle that? Because I mean, I've been led to believe that a lot of these cases, they're separated from their families. Their families really can't talk to them much. You're probably the only person who actually talks to the some of them. How do you, what role do you play in the case of a COVID patient who may be compromised and who at some level knows or should know that the end is near and the end is troubling. It'll be test. How do you, what service, what role do you play in dealing with what services you perform and dealing with a patient in that situation? So that has been one of the most challenging aspects of our career field. I can only speak for myself actually, but what I'm seeing with my colleagues in the hospital, in the community is our job, our role, our natural tendency is to go towards crisis. It's to go towards these people to be with them, to sit with them physically, just be present and not being able to do that has been so difficult. It's been so, so difficult. But the hospital that I work for has been amazing where they've been trying to set up virtual visits where we can talk to them through and I know that kind of thing on the phone. It's not the same, but it's something. It's giving them the opportunity to talk to someone if they're available. Down in the ICU, most of the time, they can't speak to me because they're so sick. And so I'm used to that because that's pre-COVID, that's already a thing. So I've actually found myself doing a lot more emotional, heavy lifting for the family members who cannot come to the hospital. And a lot of times when their loved one dies, can't come to visit for many reasons. Yeah, I hadn't thought of that, of course. It's not just the patient. It's the family that is suffering. What can you do for them where they're gonna lose their loved one or their breadwinner and everything is falling apart. It's burning all around them. How can you shore them up? So first and foremost, trying to figure out what the primary concern that we can take care of right now is because this happens constantly and everything's on fire. It's all upside down. They're grieving. They don't know what's gonna happen exactly. And then losing their, like you said, the breadwinner, the mortgage still has to get paid. The kids still have to eat. How are we gonna do that? And I think trying to prioritize, okay, what is the most important thing we can handle now? What is the second thing, the third, fourth and fifth? And breaking it down into those manageable pieces. So that way it's like, this will get done at some point, but let's focus on this priority right now. Let's focus all of our energy towards this. And I can help you as we go to the next step once that's taken care of, go to the next step. So on and so forth. Breaking it down into manageable bite-sized pieces for them. So you're examining the problem with them or helping them examine it and identifying their options and evaluating which options are the most promising options and letting them decide which options they wanna consider. That's counseling in general, isn't it? But I wonder how you feel going into the maw of a floor in a hospital where everybody has got COVID and it's just lots of virus all around you. And it's, you can't be sure that you won't catch it. How do you minimize that risk and how do you deal with that risk personally? Our hospital that I work for has been amazing with the communication that they've been providing constantly doing updates. We do town halls weekly to get updates. I get emails several times a day as things change. They've really focused a lot of their effort on the safety of us and the safety of the patients because without us, then there's nobody taking care of the patients, right? So there are very strict cleanliness, routines that we have to go through. If someone is working with a COVID patient, there are certain donning and doffing of equipment that has to happen in a very precise way. But then also it is my personal responsibility to make sure that I am doing what I can to mitigate my risk and then also not spread it. So washing my hands, wearing my mask, I have to wear goggles and all of that if I'm working in a patient's room. And just making sure that I'm not putting myself in situations unnecessarily to expose myself. Yeah, one other thing before we leave that subject is that, okay, so you're gonna see a patient more than once. So you're gonna track the progress or maybe the lack of progress of a given patient. And then we get into the end state sometimes. There comes a point, however, where that patient is beyond social work. It's beyond a conversation. It's not compass meant us anymore. I mean, where do you leave the field if you ever do? I think once that patient gets to a point where they're not able to engage with me, whether it be due to illness or death, that kind of thing, it really does become focusing on, okay, what's the impact that I can provide to the family, to the community, to their loved ones. Yeah, ever work in a collateral way in a collaborative way with ministers and the like religious personnel in the last chapter of life with these patients. Regularly, regularly, I am paging them constantly trying to understand, okay, what is the patient's framework that they look at their life through spiritually, religiously, and if they are spiritual or religious in any way, like, hey, let's get the chaplain in here. If that's helpful to you to pray, get the priest in here to come pray, whatever we can do to make sure that you feel whole during your illness. And you like doing all of this? I love my job. The best way I can describe it is social medicine. We've got the doctors going in there, the nurses going in there, physically saving those people's lives, but we are taking care of the rest. We're taking care of the emotions, the logistics, the pain and the grief. We're taking care of all of that. Yeah, yeah, not letting it fall through the cracks. Absolutely. Yeah, that's fabulous. So I tell you before that I Googled social work Hawaii and I found instantly, in a second, I found 130 jobs. I said, wow, and I started looking through them and they were really pretty interesting, not all like yours, but some of them were for the state, some of them were for various institutions, some of them stated salaries of 40, 50, $60,000 or even more and they're all open right now. They're right now at a time when a lot of people can't find work and I'm saying to myself, gee, I like to help people. I wonder if I should somehow take a remote course in social work and get a degree in MSW and present myself so I can do good for people. Why do we have such need for social work that is not being met is my question, Lana. I think that the country as a whole is really starting to appreciate and recognize the value that social work plays on our teams and our communities. And I think as that is starting to become more of like the public platform, more as social work is actually able to be at the table for a lot of these different discussions, I think people are recognizing how valuable we are. So nationwide, there are pockets of places that just have these severe, severe shortages of social work and Hawaii is one of them. It's very expensive here to live here. There's all of those other challenges that a lot of people face, but definitely if someone is interested in becoming a social worker, having the heart to sit with somebody in crisis, to sit with somebody in grief and really try to connect with them, recognizing that there's so many things that are bigger than us, then social work might be right for you. Lana Lype, a social worker extraordinaire. I'm so glad we met, which was their independence. And I'm so glad we had you on the show. We could know you a little better and know what you're doing. I'm very touched by this conversation. Thank you so much, Lana. Thanks for having me, Jay. Aloha.