APA Health C.A.R.E. Social History Training

Caseworking and the Undergraduate Component – General/Abstract:

An interdisciplinary approach to medicine needs to be just that – interdisciplinary.  Health is encompassing of many different aspects of an individual’s circumstances and experience; it would be limiting to reduce care only to the physical.  A clinic is more effective when it is able to adequately address multiple facets of health – medical, social, and preventative (along the lines of public health) components.  By involving student volunteers from separate disciplines in a joint project, the UCLA APA Health CARE has been able to provide unparalleled care for a population often difficult to reach. 
Undergraduate participation in a clinic is important, even though most students lack expertise in fields like medicine and public health.  Their more diffuse knowledge can at times be an asset because their perspective is not yet reduced and focused along the philosophy of a particular discipline. 

Undergraduates bring a fresh, if less experienced, approach to health care.  They also comprise a larger and more diverse volunteer pool from which to recruit. Diversity is beneficial – clients are often more comfortable interacting with people with whom they feel a cultural affinity.  If clients are more comfortable, they are also more trusting and willing to share personal information that might be relevant to their care. 

Inspiring trust and comfort is vital to the ability of a clinic to serve the community.  The lack of those qualities is a barrier, especially when working with populations marginalized by general society and often the medical establishment.  Aversive experiences with medical agencies or personnel may prevent individuals from seeking aid, sometimes to the point of crisis.  That is why undergraduates, in their role as caseworkers, are essential.  The advantages of not being associated with a white coat should not be underestimated.
Caseworking is really where service for a client begins and ends.  A social approach to medicine departs from conventional “treat the problem” health care by viewing the client as a whole person, inclusive of circumstances outside of the immediate medical issues.  Taking social histories and interacting with clients form the foundation for developing that holistic consciousness.  The rest of an individual’s life has bearing on their health; by establishing relationships, a clinic is able to more adequately address that.  Caseworkers provide initial contact with clients, serve as advocates throughout the medical process, and work with individuals to construct plans to improve health and personal care.  The longitudinal relationships they establish with clients form the most meaningful interaction between clients and volunteers.  Medical care is necessary, but often what is most therapeutic for clients is the opportunity to talk to someone who is compassionate and willing to listen and help.  Caseworkers are able to develop unique relationships, which involve dialogue about improving health, by virtue of not having the pressure or obstacle of being medical personnel.   

Undergraduate caseworkers create the foundation for an interdisciplinary clinic by developing caring, non-judgmental relationships with clients.  Those interactions subsequently broaden client access to other services, both medical and social, by establishing an environment of safety and trust.  When a clinic has credibility among the community it serves, individuals are more likely to access the services offered.  Health is holistic.  Health care should reflect that, and caseworking is vital to the achievement of that ideal. 

Caseworking – APA Health CARE

Caseworking has two main objectives – to obtain a social history and to form a relationship with a client.  Important to both is the establishment of trust and comfort, by being fully informative and projecting comfort as a caseworker.  Upon introduction to a client, the caseworker should emphasize confidentiality and that the individual is free to say anything or not say anything.  What is discussed might be used to provide social or medical care, but will not be used for any other purpose.  Apart from the people directly involved in the case, information will not be shared.  An explanation of the clinic’s flow, in this case from caseworker to medical student to physician to treatment/referral, is also advisable.  Body language is important throughout the interview.  It aids in setting a comfortable environment and communicates openness, attention, and confidence on the part of the caseworker.  Posture should be casual and attentive, gestures open and friendly.  However, an important tenet of caseworking is flexibility.  A caseworker should be able to gauge an individual client and adjust behavior accordingly, such as sitting a little farther away from someone who feels overly enclosed.  Each caseworker begins with the guidelines they have been trained under for taking a social history, but eventually develop their own personal styles of interviewing. 

The social history form utilized by the UCLA APA Health CARE is indicative of the methodology taught for taking a social history.  In the top third of the form, there are basic biographical information questions and a brief checklist of relevant questions to ask.  A good approach to questions of gender or ethnicity is the “How do you identify yourself…” approach.  This method of asking presents all of the possible options in a neutral fashion, which encourages clients to honestly share relevant personal information because they gain trust in the clinic’s non-judgmental attitude.  The checklist is meant to be a summary, or a guideline.  There is a reason most of the form is occupied by a large blank space titled “social narrative”.  A social history should be just that – a narrative.  Its purpose is to ascertain who a client is and where they are in their life.  Social histories are guided conversations about individuals, which are then transcribed into narratives for the purpose of working with clients to improve health and personal care. 

Sensitivity is essential.  A social history is concerned with obtaining information relevant to health and social care, but not at the expense of a relationship.  The comfort of the client and the caseworker should always be maintained.  If a subject is uncomfortable, it does not need to be discussed.  The UCLA APA Health CARE operates to meet people where they are at and to then help them to outline and accomplish the steps they are ready to take toward improving health and personal care. 

Caseworking is really about good communication.  A caseworker needs to listen, ask, and then discuss.  Providing health care is not about issuing commands; it is a dialogue.