Interview with Karamoko Andrews, LMSW on Public Health Social Work

About Karamoko Andrews, LMSW: Mr. Andrews is a Public Health Social Work Consultant with the New York City Human Resources Administration’s Department of Social Services, where he provides program development guidance, policy interpretation, and systems advising to contractors and service providers who work to support individuals struggling with mental, emotional, and medical barriers to employment.

Prior to working in vocational rehabilitation with the NYC Human Resources Administration’s Department of Social Services, Mr. Andrews worked in child welfare social work, where he took on numerous leadership roles, including Child Protective Services Supervisor for the New Jersey Division of Youth and Family Services/Dept. of Children and Families and Foster Care Director at New York Foundling. He earned his Bachelor’s Degree in Rehabilitation Services from the University of Maryland Eastern Shore in 2001, and his Master of Social Work Degree from Fordham University in 2008. Karamoko Andrews was compensated to participate in this interview.

[] Could you please elaborate on your role as a Public Health Social Work Consultant for New York City Human Resources Administration (NYC HRA)? What types of clients do you work with, and what challenges do they face? How do you support them and help them to manage these challenges?

[Karamoko Andrews, LMSW] I provide consultative services for a program called WeCARE; which is an acronym for Wellness, Comprehensive Assessment, Rehabilitation and Employment. The program assists individuals who are recipients of public assistance and may have a medical or mental health barrier to employment. The City of New York contracts with vendors to administer individualized services ranging from initial assessment, wellness plans, applications for federal disability benefits, diagnostic vocational evaluations, employment preparation services including work experience, skills training and education. WeCARE helps clients attain their highest level of functioning with the goal of self-sufficiency through employment or federal disability benefits.

My employer is New York City Human Resources Administration/Department of Social Services, which administers the WeCARE program. As an onsite representative of WeCARE Operations, I provide consultation to the contracted provider on service administration and delivery, which may include information systems related issues, policy interpretation and resolution of programmatic issues. I have also co-developed and administered quality assurance tools to measure vendor performance, which makes their services more efficient and beneficial to clientele. The WeCARE Program has returned thousands to the workforce and helped several thousand New Yorkers attain federal disability benefits.

The consultant position also affords me the opportunity to perform direct service. Periodically, there are clients who will present with multiple and complex needs when being serviced by the case management team or medical doctors. These issues include domestic violence, substance abuse, homelessness, death and dying, and daycare needs. I then provide information, referrals and education as needed. I also observe the classrooms where clients receive skills for work readiness and may identify clients in those situations who may need additional services, such as literacy development and cognitive delays. An intervention is then facilitated on behalf of the client.

[] Could you please explain what vocational rehabilitation is?

[Karamoko Andrews, LMSW] Vocational Rehabilitation is an area of practice that allows individuals to overcome barriers to accessing, maintaining and returning to employment. A wide range of professionals participate inclusive of: Medical doctors, certified rehabilitation counselors (CRC), disability specialists, case managers and social workers.

In our program, much like other vocational rehabilitation programs, individual plans of employment are developed based on clients’ strengths and through the use of diagnostic evaluations which determine areas of interest and competency. In collaboration with medical assessments and psychosocial information, job placement assistance is provided with any reasonable accommodations considered by the placement specialist. Support services are also provided to the client once employment is secured. There are some individuals who require stabilization of a condition prior to any job search activity and they later are connected with a specialist. In the event an individual has a condition that prevents them from securing, maintaining or performing vocational duties, federal disabilities benefits are sought on behalf of the client.

Assessment and diagnosis is a major component of rehabilitation services. This is achieved through a multi-disciplinary approach and the use of diagnostic tools. Individual Plans of Employment (IPE) are constructed and tailored to address barriers to employment. IPEs contain the client’s vocational goals, vocational recommendations by a Certified Rehabilitation Counselor (CRC), accommodation needs and work limitations. This includes specific information as to lifting, standing, climbing, walking and general ambulation. Social workers may have input into the development of the document, but CRCs are the individuals who make modifications and approvals of the IPE. Although CRC’s are utilized a great deal in the practice, social workers’ expertise in navigating systems and accessing resources is beneficial to the population served.

Vocational Rehabilitation facilities are operated by states and are federally funded. My employer operates as the funder and contracts to private agencies to facilitate these services.

[] Why did you decide to work in vocational rehabilitation, and what have been some of your most rewarding experiences during your career?

[Karamoko Andrews, LMSW] My decision was multi-faceted. I’ve always had a desire to work in several areas of social work: child welfare, school based practice, medical social work and vocational rehabilitation. I felt that I had demonstrated progression in child welfare over an eleven year period and didn’t want to be complacent. I considered a change. I knew any change had to be pragmatic, considering the nature of the job market, which wasn’t the best at the time. I also wanted to be confident in my abilities to perform the duties. I felt that both my undergraduate and graduate work successfully equipped me to transition into vocational rehabilitation. It has been a valuable experience changing the population serviced, and there have been occasions in which child welfare issues have arisen with our current clients and I have been able to provide advice and guidance.

In child welfare, when a mother, father or child looks at you and says “thank you,” for your work with them or their family, and that appreciation is clearly from their soul and the depths of their heart, it one of the most powerful gifts I can receive. Connecting a child that may have gone most of their youth moving from home to home with an adoptive family and seeing the emotional evolution of that child in such a short period of time, is an experience that I am at a loss of words in expressing the magnitude of.

In “voc rehab” as we call it, I recently encountered a client whom I identified as malingering, based on my observation of him in his work readiness class. Speaking with him, he disclosed suffering a head injury as a child which affected his short term memory and he had limited literacy skills. I was able to send him for a psychological and a neurological exam which yielded results that modified his treatment. The extent of his gratefulness in my taking steps to resolve these longstanding issues are reminders to me why social work is valuable and affirms my personal and professional goals.

[] On the other hand, what are some of the most challenging aspects of your job? How would you recommend MSW students who wish to work in vocational rehabilitation prepare for these challenges?

[Karamoko Andrews, LMSW] Experience is the best teacher. One can be taught theory and be able to recite public laws regulating an industry backwards and forwards; but being integrated into the work is the best indicator of success, and to the self-aware individual, their ability to perform the practical duties of the job will be known.

I recall very early in my career being assigned a 7-month-old child who was in a long-term specialized hospital. He had been the victim of Shaken Baby Syndrome and had subdural hematomas, several skull fractures and ribs that were healing from being broken. He was partially blind and the doctors predicted that he would be unable to walk. As the nurse explained to me how he sustained these injuries, I began to cry and couldn’t stop the tears. I still become overwhelmed with emotion when I think of this experience and it helped shape me into the professional I have become today. There were very horrible, disgusting acts that some of the birth parents I worked with committed to their children and I was still charged the task of working with these individuals. You learn how to develop a “thick skin” and be aware of your own judgements and counter transference. Every social worker is not built to perform the duties of a child protective worker.

Although vocational rehabilitation hasn’t been as graphic as child welfare, the challenges for me have been more in the realm of being a change agent. In social work, one size doesn’t fit all. Meeting a client “where they are at” means different things for different clients. This position is one of more general oversight, so I don’t have the opportunity to utilize the full capacity of my skillsets and that can feel quite limiting. For example, I had the opportunity to meet a client who suffered an injury on his job as a carpenter and the injury was severe enough to no longer permit him to use his hands for the fine motor skills needed to work in that industry. He had limited literacy skills, was an undocumented immigrant and had a desire to continue working; but he had developed a drinking habit that he was ashamed of and felt powerless to break. His story was heart breaking as he spoke of the deteriorating relationship with his wife, because he could no longer provide financially for his household. My function as a result, was to relay the information to the case management team and provide some guidance for services. On the administrative level, I don’t have the opportunity to partialize tasks for the client, normalize the events, be solution-focused in delivery, challenge cognitions and exercise motivational-interviewing techniques. At minimum, I was able to demonstrate empathy to the client and then inform staff of possible interventions and providers who may be able to effectively address his needs. Clinical skill sets that I have developed have been pre-empted by this administrative role.

[] For social work students who are interested in working in vocational rehabilitation services, what advice do you have for them in terms of preparing for this field of work?

[Karamoko Andrews, LMSW] A very in-depth knowledge of the policies that guide the practices in any field of social work is extremely critical, as it is the framework for the work being performed and the guiding principles for any working professional. Students and new practitioners often come with fresh ideas and concepts and may get discouraged when encountering bureaucracies, challenging the status quo, or having thought patterns that defy business as usual. This energy is important and necessary, as the practice areas continue to evolve and fresh ideas are required.

The core curriculum in social work does prepare a generalist to work in this area, however one may consider elective courses which focus on developmental disabilities, and obtain a working knowledge of the American with Disabilities Act (ADA) and the laws governing reasonable accommodations. Theory is essential, but the practical application of those theories may look very different and selecting a field placement that would expose the student to this population will reveal if it’s a good fit. Searching for vocational rehabilitation service sites, private companies that administer these services and government entities should yield field placements, volunteer opportunities and some paid internships or per diem work. I have seen many opportunities for undergraduate and graduate students in the New York City area. However, for those who may not have a location accessible to them that provides comprehensive vocational rehabilitation services, one may want to consider other workforce development programs, contacting medical doctors, certified rehabilitation counselors or social workers that perform assessments for this population to see if they may offer opportunities for a student.

Lastly, it is important to believe in the value and the mission of the work. This cultivates dedicated staff and can only be beneficial for the clients served. A healthy and inclusive workforce not only increases an employee’s purpose and esteem, but it drives our economy and our innovation and skills as a society.

Thank you Mr. Andrews for your time and insights into public heath social work.

Last Updated: April 2020