Interview with Alexa Silva, MSW on Medical Social Work

About Alexa Silva, MSW: Alexa Silva is a medical social worker who works for Alameda County Public Health Department, specifically in their Asthma Start Program, where she has worked for over seven years. Her job as an Asthma Coordinator is to provide asthma education for families that have children aged 0-18 years old that have been diagnosed with asthma and live in Alameda County. Her responsibilities include providing education around the signs, symptoms, and triggers of asthma along with proper training on medications and how to use them. She also conducts home assessments to evaluate asthma triggers at patients’ residences.

Prior to entering medical social work, Ms. Silva was a foster care social worker at Aspira Foster Family Agency, and managed several foster care homes within Alameda County. From her role at Aspira, Ms. Silva progressed to working for the Regional Center of the East Bay as a case manager for children 3-12 years old who had developmental delays. She earned her bachelor’s degree in Psychology from the University of San Francisco in 2003, and her MSW from Cal State Hayward in 2005. Alexa Silva was compensated to participate in this interview.

[] Can you please give an overview of your core responsibilities as a medical social worker at Alameda County Public Health Department?

[Alexa Silva, MSW] As an Asthma Coordinator my responsibilities include education to families around asthma including signs and symptoms such as coughing, shortness of breath, and retractions. During my home visits I cover triggers such as allergies, colds, exercise, irritants, and change in weather. I educate families about all the medications they are using, how they work, why they are important, and how to use them properly. I always have the child demonstrate to me how they use their medications and correct them if necessary. Finally, I do a home assessment in which I address any possible triggers in the home such as mold, dust, and pests (i.e. roaches). I assess any need for supplies such as dust-mite proof mattress covers or a vacuum and bring them to my next visit.

Most of our clients come from low-income households and live in poorer areas of Oakland (mainly East and West Oakland) and Hayward. Some of the issues that we face when seeing these families include them not using the medication out of fear or lack of understanding, not getting refills of the medications due to lack of knowledge, and having pests in the home. Most of our families live on one income and receive governmental support such as Medi-Cal and food stamps. Some of the issues my clients face are lack of health insurance, a medical home (by which we mean a primary clinic and doctor to manage their care), and/or poor living environments. We try to address any social issues when we go out to the home such as screening for domestic violence to issues directly affecting the asthma such as mold and working with the landlords to correct any potential deficiencies.

Most of our referrals relate to getting them health insurance and a medical home to better manage their asthma and have access to medication. We will also refer families to any resources around housing and legal services if necessary. However, if we do not get a good response from the property owner, we will then make referrals to Code Enforcement and/or Vector Control for pests in the home or several home deficiencies that are not addressed by them. Code Enforcement is an agency with the city that goes and inspects homes, writes up a report stating any code violations that were found in the home, and submits the report to the city and the property owner for them to fix; giving them a timeline before they are subjected to fines. Vector Control is an agency with the county that goes out to homes in which there have been reports of pests (including roaches, mice, and bed bugs) so they can do a thorough inspection and submit a report to the property owner requesting that they send out a professional to get rid of the pests.

[] Could you please explain the structure of your team at Alameda County Public Health Department?

[Alexa Silva, MSW] Asthma Start is a small program within the Alameda County Public Health Department. We are a program within the Chronic Disease unit which includes Asthma, Diabetes, and Hypertension. There are three of us that are Asthma Coordinators in the program that cover the entire county. All of us are medical social workers–my supervisor is an LCSW, I have my MSW, and my other coworker has her BA. All of us carry a caseload of about 40 clients (aged 0-18 yrs) and each client is on our caseload for at least 3 months and stay at most for up to a year.

Our referrals can come from anyone including parents, teachers, nurses, and doctors. However, most of our referrals come from Oakland Children’s Hospital or Alameda Alliance for Health. The three criteria we have for children to be in the program are that the child has been officially diagnosed with asthma, is 0-18 years of age, and lives in Alameda County. Our services are free and there are no income requirements. We assess and bring supplies to every client. Most of our clients are either African-American or Latino background. Two of us are Spanish speaking and we all have access to interpreters as needed for other populations including Chinese, Arabic, Vietnamese, etc. Currently, I would say about half my caseload is monolingual Spanish speaking. We also have contacts with many of the health clinics serving specific populations including Asian Health Services, Native American Health Center, and La Clinica de la Raza who send us referrals.

[] Also, how is working at a public health department as a medical social worker different from working in a hospital setting? Do medical social workers in a public health setting focus more on education and advocacy, versus hospital social workers?

[Alexa Silva, MSW] Our job is very different from that of Medical Social Workers who are in a hospital because we do not deal with emergency situations. We focus more on prevention and education. We are very specialized in the county as are others who work in the Diabetes and Hypertension programs. We have been specially trained in asthma and the medications/treatments for asthma, and always stay up to date with the latest research and medications on the market. When I first started the job I spent about 6 months learning about asthma through training, shadowing home visits, videos, books, and other educational materials.

[] Your other professional social work experiences include working in foster care at Aspira Foster Family Agency, as well as work with children with developmental disabilities at Regional Center of the East Bay. Why did you decide to transition to medical social work, and what have been some of your most rewarding experiences so far? What area of medical social work do you see yourself working in several years down the road, and why?

[Alexa Silva, MSW] I feel like my previous job experience really helped me get to know how to work with different populations that we come across and the challenges that they face. Living in certain areas and also dealing with a chronic disease can be tough and we do our best to support these families. When I first heard about this position I was excited to learn more about asthma and to work in a public health setting. I enjoy doing home visits and saw this as an opportunity to broaden my skill set. I feel like this job is a little easier than my last because we do not have any strings attached to the services we provide, and therefore we do not get many people who state they are not willing to participate. At Asthma Start we sometimes get clients who have also been diagnosed with a developmental delay, and in these cases I still utilize Regional Center of the East Bay as a resource for the families I serve that have a child with asthma as well as a developmental delay. In this way, my past work at the Regional Center was helpful, as I know what services are available for families struggling with this issue, and can refer them to the appropriate places.

One of the rewarding experiences I have had at this job includes having success with getting my clients a medical home and health insurance so they remain healthy. Also, several times I have been able to educate families and get them to change a few things in the home so the child is less likely to be affected by the triggers in the home such as cleaning products, air fresheners, and getting rid of mold and removing heavy blankets on the windows. I have also had success in working with landlords to improve living conditions–for example, removing carpet, cleaning off and re-painting moldy areas, and fixing leaky pipes. Our program has reduced ER visits and hospitalizations by more than 50 percent. This makes me proud and happy to be doing what I do. I intend on staying with the program for years to come.

[] On the other hand, what are the most challenging aspects of your job? How do you recommend students who wish to enter medical social work prepare themselves to face these challenges and hardships?

[Alexa Silva, MSW] I would say the biggest challenge that we face in doing this work is getting the families to be compliant with the medications their children need. They are often scared of side effects, their children taking so many medications, and fear their child cannot live a normal life. These are all concerns which we address with each family to put them at ease. Once we explain how the medications work and what they each do they feel more confident in dealing with their child’s asthma. I would also say another big challenge that we face is in dealing with landlords that do not want to take the time or spend the money on repairs that are needed in the home to make it a healthy home for people with asthma. They are simply non-responsive or say that they do not have the money to pay for the necessary repairs. In this case we are forced to turn to the city for further intervention.

I would say to those looking to go into the public health department that they need to learn how to be an advocate for their clients and not be intimidated by those in power. Learn the resources available in the county you work in and get to know some of the people that represent those agencies so you know who you are passing your client off to. Sometimes you are their only voice, especially when language barriers exist.

[] For MSW students who are interested in becoming medical social workers, what advice can you give them about optimally preparing for this field while pursuing their degree?

[Alexa Silva, MSW] I think that it is possible to become a good medical social worker without having been in the medical field prior. One of the things about medical social work is that there is a lot of learning on the job. One must become very familiar with the medical field with which they are working but there is also a lot of on the job training that needs to occur. That said, if one is interested in medical social work I would say that it would definitely benefit them to focus on looking for a field placement in a medical setting. I would suggest taking any training that focuses on clients who are high risk and who are dealing with multiple challenges. I would stay up to date with the latest health information and take any training that focuses on health advocacy or changes in healthcare. It is also important to keep up to date with the research as it relates to health so taking CEU’s that focus on this can be beneficial. Working in Alameda County we focus a lot on how the environment that one lives in can have an overall effect on one’s health.

Thank you Ms. Silva for your time and insights into medical social work.

Last updated: April 2020