Interview with Shellie Leger, LCSW on Pediatric Social Work

About Shellie Leger, LCSW: Shellie Léger, LCSW, holds a BFA from Boston University, an MSW from Hunter College, a Masters in Non-Profit Management from Lesley University, and is also a licensed ELA, Special Education, and Communication and Performing Arts teacher, having received the equivalent of an M.Ed. in Special Education from the Massachusetts Institute for New Teachers. In regards to social work, she is licensed to practice independently, having passed all necessary Board of Social Work exams that require advanced clinical skills and 96 hours of clinical supervision.

While at MassGeneral Hospital (MGH) in Boston, Ms. Leger was awarded the title of Clinical Scholar for excellence in her practice. She worked at MGH for 6 years as a pediatric clinical social worker in a highly specialized clinic known as the Coordinated Care Clinic (CCC) under the leadership of Dr. Marjorie Curran, Chief of Pediatric Group Practice at MGH. The CCC served medically fragile children (and families) aged 0-18 with life-limiting illnesses–all of whom were treated by at least 3 specialists for their medical complexity.

Ms. Leger relocated to her home state of Maine in 2013 to work for Maine Behavioral Healthcare (MBH), a division of Maine Mental Health Partnerships, the largest service delivery system of mental health services in the state. She is the lead clinician for MBH in the tri-county region of Western Maine, where she provides intensive outpatient individual and group psychotherapy services for children and adults. Shellie Leger was compensated to participate in this interview.

[] In your position at MassGeneral Hospital for Children, what types of clients did you usually work with and what kinds of challenges did they face?

[Shellie Leger, LCSW] I worked with medically complex/fragile children with life-limiting illnesses and their families. My patients faced a myriad of challenges, including chronic pain, limited mobility, global developmental delays, significant mental health crises, extreme disruption of educational endeavors, profound interference with typical socialization and death. The families (and especially siblings) of my patients also often required intensive support as they navigated their child’s/sibling’s devastating illnesses.

I supported my patients/families by offering short-term psycho-therapy; case management, information and referral to all appropriate community resources, advocacy within the service delivery systems designed to support my patients/families in their communities; successful navigation of the medical services provided within a large international teaching hospital like MGH; psycho education regarding their child’s illness and the needs of siblings; formation and facilitation of support groups as needed, such as sibling support and family recreation; outreach to school systems regarding the IDEA and ADA eligibility for my patients; planning and forming of patient care conferences to assure coordination of care amongst the multi-disciplinary teams that served each child/family; and grief work.

My role was different than others in the medical setting as my practice often required following my patients both through the CCC, which is an outpatient clinic, and also during their often lengthy in-patient stays. In this respect, I did not close cases upon discharge from inpatient units, but rather provided support across the continuum of care for the duration of that care or until my patients turned 18 and aged out of my clinic, whichever came first.

[] What were the most challenging aspects of your job as a pediatric social worker?

[Shellie Leger, LCSW] The most challenging aspect of my job was working within the medical model. While this model is largely accepting of the vital role of social work in the lives of patients, it still sometimes does not fully grasp the function of the social worker. Some considerable burden rests on the social worker to both accurately model and educate other health care providers as to the scope of practice of the social worker. We often work in a host organization which consists of other professionals who are not necessarily like-minded and come to their work from an entirely different orientation. Often the social worker may feel like the “lone voice in the wilderness” and represent unpopular ideas.

For example, a premise that social workers hold near and dear is that of self-determination. Often well-meaning colleagues from the more patriarchal disciplines struggle with allowing patients to make choices that fly in the face of their obvious well-being. However, in the absence of a well-documented and adjudicated decision that a patient lacks agency over herself, that patient may make any choice she wishes in regards to her care, even bad ones that may result in harm. For the social worker, honoring autonomy and culturally informed decisions regarding medical care is central to our value system and code of professional ethics. To provide a voice on behalf of such patients to other team members has at times created difficult and charged conversations that, while crucial for the patient, are stressful for the social worker.

[] How do you recommend students who wish to enter pediatric social work prepare themselves to face these challenges and hardships?

[Shellie Leger, LCSW] MSW candidates would be well-served to pursue their internships in settings that provide robust access to work with children and their families. Additionally, volunteer work, summer jobs, etc with children is advised. Bear in mind that work with children is NEVER with just the child. Children exist in much larger systems–those of family and school, for example. Where possible, augmenting the usual course work in MSW programs with courses offered in special education, early childhood, etc, is always advised.

More difficult, however, is preparing oneself for the emotional intensity that is undeniable in this extremely sensitive work that we do. The contagion of trauma is real, and compassion fatigue is a risk for all of us. Popular literature is replete with recommendations for safeguarding against compassion fatigue, but as empaths (i.e. individuals who must attune themselves to the emotional experiences of others), social workers will become saturated with the pain and suffering of others. Self-care is a field unto itself but in my experience it is good work only if you can find it. For me, the best safeguard is surrounding oneself with a professional network where many opportunities for informal and spontaneous support are available for de-briefing and/or processing tough material.

[] What was the most rewarding part of your job as a pediatric social worker?

[Shellie Leger, LCSW] The greatest reward for me was empowering the patient/family to come to the table with the greatest minds in medicine where they unapologetically demanded what they needed/wanted. Obviously needs and wants vary amongst families for the many obvious reasons, most of which are predicated on culture, religion etc., but at the end of the day what has been abundantly manifest is the need for clear and consistent messages from all of the health care team, which of course in turn requires superb communication. Social workers may play a key role in facilitating such communication, often functioning as the “point person” that organizes patient care conferences and carries the hopes and concerns of family and patient (where applicable) to the larger team, both within the medical facility and community.

Additionally, it is not surprising that we are often cultural brokers, being educated and trained to appreciate the cognitive dissonance that ensues when there is a culture clash at play. Social workers are often integral in interpreting behavior of family members and/or patients through the lens of social norms in the context of culture, and carrying this information to the greater team. Lastly, of course, families often need encouragement and “permission” to expect respect and express genuine curiosity regarding their feelings and opinions about their loved ones’ (or own) medical experience. How our patients and families make meaning of illness is often overlooked, but the social worker must never overlook that, and indeed should reach for that and be on the look-out for that at all times and explain it to her colleagues often so that they too will understand better the interior lives of their patients and families. All of us want to be heard and seen, after all.

[] For MSW students who are interested in becoming pediatric social workers, what advice can you give them about optimally preparing for this field while pursuing their degree? Are there any types of classes you recommend they take while still in school?

[Shellie Leger, LCSW] Anything having to do with systems work is advisable in terms of a useful class in school.

[] Has there ever been a moment or experience that made you question whether becoming a pediatric social worker was the correct decision?

[Shellie Leger, LCSW] Yes. In cases of child abuse and neglect, and disability, which pediatric social workers face more than you care to think, we will come up against powerful state institutions that will fail children, e.g. local child protection services, local educational agencies, both state and private insurance agencies, Departments of mental health and developmental disabilities, TANF, etc. to name a few. It is not because such institutions intend harm to children. Certainly this is not so; but the enormous barriers to such institutions being able to fully and liberally support their children are manifold. Lack of funding, wrong-headed legislation, etc. create a perfect storm that often alienates our children.

[] Do pediatric social workers work exclusively with children and their families, or can/do they also engage in more mezzo and macro social work, such as research, advocacy, and/or work with grassroots organizations?

[Shellie Leger, LCSW] Pediatric social workers may work in any setting they wish, including all of the above, and in fact, should do so whenever given the opportunity, and should create such opportunities if none present themselves. I would advise any new social worker to seek out their leadership and ask to be guided in regards to engaging in any of the above. We need policy that supports children, and the social work voice at such tables if underrepresented. In an early position with a small rural hospital on the coast of Maine, I mobilized upwards of 25 families of children with various disabilities to go to the state capital and lobby for better heath care coverage as well as for greater supports in the school setting, especially regarding providing additional skilled nursing hours in school settings.

Thank you Ms. Leger for your time and insights into pediatric social work.

Last updated: April 2020