A day in the life: Social workers from Children’s Hospital Boston, Department of Child and Families switch roles for a day

A young girl arrives in Children’s Hospital Boston’s Emergency Department (ED) with a fracture that doesn’t quite match her parents’ story. A toddler comes in suffering from yet another spell of ketoacidosis (DKA)—a potentially fatal condition resulting from poorly treated diabetes. Whether it’s obvious and acute, like a broken arm, or more ambiguously dangerous, like medical neglect, both scenarios are examples of child abuse.

If Children’s clinicians suspect a child is being abused, they don’t have to handle it alone: the Children’s Child Protection Team (CPT), comprised of physicians, attorneys, psychologists, social workers and nurses, consults on around 1,800 cases each year in the hospital—the majority of which involve neglect, like the untreated diabetes scenario mentioned above. Often, the team brings in the expertise of the state agency armed with protecting children: Massachusetts’ Department of Child and Families (DCF). Social workers from DCF work hand-in-hand with the CPT, Children’s social workers and other clinicians to create a plan that will keep a child safe.

But although social workers from DCF and the hospital have frequent interactions, their training and responsibilities vary greatly, which has led to some misperceptions and miscommunication between the two groups over the years. “When a DCF clinician comes here, we’re usually meeting in a quiet room to discuss a case, but they aren’t on the floors, or experiencing the chaos of the ED,” says Allison Scobie-Carroll, LICSW, program director of the CPT. “Similarly, we never get to see their workload and the stresses of working in the community.” To facilitate better understanding and awareness of the unique roles of each group, Scobie-Carroll came up with the idea of an exchange program: Children’s social workers could spend a day at DCF, shadowing a social worker, while DCF social workers could come to Children’s and witness the role of social workers here. “We wanted to help everyone understand the internal workings and particular challenges of each of our organizations— the limits of resources, the decision-making responsibilities, the volume of cases and the climate and culture within each location,” she says.

On a recent morning, Susan Lambert, LICSW, director of Social Work at Children’s, travelled to one of DCF’s offices in Chelsea, Mass., to spend a day observing. The Chelsea office, which is unmarked due to the sensitivity of its work, has almost 100 employees and serves a large swath of Boston, including Chinatown, Revere, the North End and East Boston. Lambert’s first mission of the day was to accompany a DCF investigator as she went on a home visit to check out a child abuse claim. Investigating charges of abuse requires sensitivity, shrewdness, tact and cultural competency.

Next, Lambert met with Joanna Donnelly, a DCF social worker who takes initial reports of suspected abuse over the phone. Part of her job is to contact other references—like pediatricians, teachers and family members—to get a fuller picture of the child’s health and well-being. Along with schools, health care providers are the primary reporters of child maltreatment cases because they’re in the unique position to see children and families over time and to observe the signs of chronic neglect or repeated injury. Donnelly says that medical providers, who can view patients closely through clinical interventions such as exams and diagnostic studies, are very good at spotting and documenting abuse and neglect.

At lunch, Lambert sat with Stephanie Goldberg, a social worker who’s been with DCF for five years. Goldberg came to Children’s a month earlier on the exchange program and spent the day visiting the ICUs, the ED and Children’s Hospital Primary Care Center (CHPCC). “I was amazed to see all the roles Children’s social workers had, and how they had to adapt as the situation dictated,” says Goldberg. Witnessing clinical situations helped her get a better picture of what Children’s social workers do on a day-to-day basis. “Being able to understand some of the complex medical issues on top of the social issues was very valuable,” she says.

Lambert’s visit left her impressed with DCF’s many layers and levels of supervisory support and back up for problem-solving and decision-making. “One generally thinks of DCF workers entering dangerous situations alone and bearing the anxiety of making difficult decisions single-handedly,” says Lambert. “But what I witnessed was constant communication, organized meetings and easy access to the chain of command throughout the day to assist in problem-solving.”

So far, nine of Children’s social workers and eight DCF social workers have participated in the exchange. Scobie-Carroll is pleased with the feedback she’s received: “Participants in the program have told me that they have completed their day in the alternate agency with increased respect for the incredible challenges that social workers face in their service to families across settings,” she says. “By deepening our understanding of each other’s work and by building relationships, one worker at a time, we’re removing the barriers that impede our efforts to protect children and support families. No matter what our differences, protecting children is what all of us are striving to do.”