By Kaitlin Louie
About Andrea S. Kido, LCSW: Andrea S. Kido is a licensed clinical social worker at Marin Community Clinics (MCC) where she provides mental health services in an outpatient clinic setting. Prior to working at MCC, Ms. Kido worked as a Clinical Social Worker in the Medical & Surgical Acute Care and Pediatric Intensive Care units at Lucile Packard Children’s Hospital Stanford (LPCHS) for three and a half years.
Ms. Kido graduated Summa Cum Laude with a BA in Psychology from Cal State Fullerton in 2007 and graduated from UC Berkeley with a Master’s in Social Welfare in 2010. During her first year MSW internship, Ms. Kido worked as a school social worker at Rosa Parks Elementary School. During the second year of her MSW program, she interned in the Maternity wards and Neonatal Intensive Care Unit (NICU) at LPCHS. She subsequently applied for and received a year-long fellowship in the Pediatric and Cardiovascular Intensive Care Units at LPCHS. Following the fellowship, Ms. Kido was offered a position in the Medical/Surgical Acute Care units and Pediatric Intensive Care Unit (PICU).
[OnlineMSWPrograms.com] Could you please elaborate on your responsibilities when you were a Clinical Social Worker in the Surgical Acute Care and Pediatric Intensive Care Units at Lucile Packard Children’s Hospital Stanford? What types of challenges did your patients and their families face, and how did you help them?
[Andrea S. Kido, LCSW] My role in the acute care and intensive care units at LPCHS was extremely variable and unpredictable. Social workers “live by their pager,” and are asked to attend to a huge range of different psychosocial, logistical, and structural issues. Essentially, social workers act as the primary support to the families of sick children (and, when appropriate, the patients themselves) regarding anything that is non-medical in nature.
Families of children with chronic conditions, or even those experiencing an extended hospitalization for an isolated, acute issue, often suffer from:
- Financial strain (from job absence, single-parenthood, or the need to be a full-time caregiver)
- Logistical issues such as lack of childcare for siblings, or transportation
- Psychological concerns, such as an underlying mental health condition (e.g. anxiety or PTSD) that impacts their ability to cope
- Social problems that complicate the hospitalization (like legal custody and visitation for divorced, contentious parents)
- Organizational barriers to ideal care (e.g. attending physicians that rotate weekly, sharing a room, and lack of communication between consulting services)
Social workers attend to these issues by:
- Orienting families to the large and complex hospital system, and preparing them for what to expect
- Helping them navigate the many different components of that system (from insurance benefits, to who’s who on the medical specialty teams, to how to obtain a parking pass)
- Ensuring they have the necessary resources to be present with their child and active in care (e.g. food, a place to sleep, transportation, letters for work and school, etc.)
- Connecting families to external resources, such as food banks, outpatient therapy, and In Home Support Services, as well as coordinating with external organizations, such as Child Protective Services, probation officers, and attorneys/legal aid representatives
- Advocating for, and facilitating, appropriate communication with the multiple involved medical teams via care conferences and lots of advocacy/consistent requests
- Providing emotional support to patients and families through a multitude of potential scenarios (dissatisfaction with care, a child abuse investigation, lack of improvement with treatment, suicide attempts, and the death of a child)
In essence, if the family presents a problem, it is the social worker’s responsibility to try and solve it, in collaboration with other members of the medical team. Understandably, the greatest challenge faced by these families is the sudden or chronic infirmity of their child. Patients I worked with suffered from conditions as relatively mild as a perforated appendix or supracondylar fracture (broken elbow), to very serious mitochondrial or autoimmune disorders (e.g. lupus nephritis or Leigh syndrome). The children with chronic illnesses would be hospitalized frequently for acute issues- such as pneumonia- to which they are more susceptible and for whom it could mean a severe deterioration of their condition or even death. It is during these times that families are in the most need of care coordination, resource attainment, psychoeducation, and support.
Crises were also a routine aspect of the work. Because the children were so ill, they would often suffer from “codes” (loss of oxygenation to the body, or cardiac arrest), complications during procedures, and “rapid responses” (immediate need for transfer from acute to intensive care). Families would need social workers to provide support, guidance, and information while the medical team was focused on the child and unable to attend to the family.
Families would experience their own crises in the form of panic attacks; dangerously high blood sugars from forgetting their insulin at home; fighting with an ex in the hallway; and being verbally abusive to the medical team. Reasonable or not, social workers are asked to “control” these families, and help them find healthier ways to manage their emotions and situations.
Because I am Spanish-speaking, the majority of my patients were also facing a debilitating language barrier; inability to access community resources due to their immigration status (e.g. CalWORKs or getting a driver’s license); under-exposure to hugely complex, bureaucratic organizations; and trauma from border crossings or fear of deportation. These issues only made the role of social work that much more challenging and significant.
In order to accomplish these many tasks, it was essential to work in collaboration with the multidisciplinary team. LPCHS employed physicians, nurse practitioners, nurses, nurse assistants, case managers, chaplains, child life specialists, financial counselors, pharmacy techs, nutritionists, patient experience reps, and all colors of administrators, all of whom played their part in the journey of the patient and family. Social workers document extensively in the electronic medical record, attend rounds daily, organize care conferences, and are in constant communication with other providers via phone, email, pager, and in person to communicate the issues and needs of the family. This was why obtaining a thorough psychosocial assessment was so important–others were relying on social workers to know how best to interface with the family based on their unique needs and circumstances. It is also why building rapport with the family within a short period of time was crucial–families needed to trust you in order to share the information that would be most beneficial to them in the long run.
Social workers in the medical setting are the bridges that connect the families to the people and resources that can get their needs met. They are the cheerleaders that encourage the family to cross the bridge, the little birdies that help those on the other side of the bridge understand why the family is coming to see them, and the trampolines that catch the families when they slip off the bridge from time to time. Social workers truly provide order, direction, and consistency in an environment of so much uncertainty and chaos, and I so strongly admire all those who continue serving in such a demanding setting.
[OnlineMSWPrograms.com] Could you please explain how pediatric social work services were structured and delivered at Lucile Packard Children’s Hospital? Did pediatric social workers specialize by department (ex. intensive vs. primary care), or did they work across multiple departments? In general, what role do social workers play as part of a larger medical staff at Lucile Packard?
[Andrea S. Kido, LCSW] The Social Work Department at LPCHS had about 30 social workers, all divided into different “pods.” These covered particular service lines or units of the hospital, such as Solid Organ Transplant, Hematology/Oncology, and PICU/CVICU/Medical/Surgical. Social workers in those pods would cover their assigned patients, but would attempt to follow their patients across units whenever possible. Because social workers were the only consistent provider in the hospital system, staying with families regardless of their unit or service (with a few exceptions) was extremely important.
It was very common for social workers to move to different pods when positions became available, though most would find a “niche” and end up carving out a space within that group. The skills needed to be a social worker in the medical setting could apply to any of the services/units, though each service did have a unique workflow and character. No formal training would be offered to people who changed service lines, and there would most certainly be a learning curve associated with the transition, but generally, it was a far easier transition than starting in an inpatient setting for the first time. Social workers are quite adaptable.
[OnlineMSWPrograms.com] Why did you decide to work in pediatric intensive/surgical care and in pediatric primary care, and were some of the most rewarding experiences you had in this field?
[Andrea S. Kido, LCSW] My interest in the medical setting and love of children in general led me to choose work in the pediatric field. I was enrolled in the Children and Families concentration at UC Berkeley, and knew coming in that helping the most vulnerable members of our society was a core value to me. I also strongly felt that breaking the intergenerational cycle of dysfunction would happen most effectively through intervention at an early age, so interacting with families of young children was of particular interest.
As such, my first internship was at an elementary school. However much I enjoyed the innocence and engagement of young children, the pacing of school social work did not match my personal rhythm. I needed something faster, and more crisis-oriented. Well! The old idiom of being careful about your wishes certainly came into play. My second-year internship at the hospital presented a welcomed challenge. I appreciated the chance to make a difference in the most critical and frightening periods of a person’s life.
It is absolutely rewarding to work with pediatric patients and their families in the hospital setting. Despite the challenges they are facing, children simply want to enjoy the basic pleasures in life–eating, playing, laughing, and spending time with their loved ones. Having the opportunity to witness the strength of their spirit and innocence is truly a gift, and imparts a sense of awe, respect, and inspiration to those in their presence. Further, seeing parents who have sacrificed everything to provide the best possible life for their child in his/her circumstances–but who could benefit from additional support through the process from someone like me–made the work feel valuable and truly necessary.
The most rewarding part, however, was also the most devastating. Walking with a family, carrying a tiny piece of their burden as they process, live, and grieve the death of their child is something few people have the chance to experience. Although social workers in this position are witnesses to the most palpable, heaviest pain imaginable, in the same moment, they are witness to the strongest love. Families that allow others to share in this most vulnerable of times are giving the gift of awakening, and an understanding about realities of loss and beauty in this world. It was a privilege to be given that gift, and I will be forever grateful to all those with whom I walked a small section of that heartbreaking path.
[OnlineMSWPrograms.com] On the other hand, what were some of the most challenging aspects of your job in pediatric social work? How would you recommend MSW students who wish to work in pediatric acute care prepare for these challenges?
[Andrea S. Kido, LCSW] I feel the most challenging aspect of this work was the inherent inability to meet the needs of every family. Given the number of patients to which we were assigned, the complexity of their lives and illnesses, the scarcity of resources both within and outside the hospital system, and the expectations of the medical teams, there was simply no way to achieve everything I set out to. The task was to prioritize those with the most immediate need or highest risk, work as efficiently as possible without compromising my commitment to families, and then hope there would be enough time in the day to attend to other problems.
The most difficult part, and for what I would advise MSW students to prepare, was the acceptance that there is only so much you can do. You will not change someone’s life completely. You will not please all your coworkers. You will not feel like a superhero by the end of the day. You have to be satisfied with knowing that you made an overwhelmed mother feel like she has someone she can call and won’t be judged; that you gave a father enough financial help to be able to eat tonight, even if he won’t have enough for breakfast tomorrow; that your smile made a child feel safe instead of scared. The small moments that, in reality, do mean so much to families must mean as much to you.
[OnlineMSWPrograms.com] For social work students who are interested in working in pediatric social work, what advice do you have for them in terms of preparing for this field?
[Andrea S. Kido, LCSW] I would recommend classes in social work for healthcare settings, clinical case management, law and ethics, grief and bereavement, crisis intervention, and possibly psychopharmacology. Even with this background, however, becoming proficient in medical social work also requires strong communication and multi-tasking skills; ability to keep calm during a crisis; ability to document clearly, concisely, and quickly; resourcefulness, common sense, optimism; and lots and LOTS of practice.
This is definitely the kind of work that you learn through doing, and eventually you will feel stable enough to effectively incorporate what you have learned in school into your practice. Thus, getting an internship (or two) in an inpatient setting would be a great way to prepare for full-time employment. Because the internship is quite short and protected, however, I would also recommend a post-grad fellowship. You are more independent and less coddled than during an internship, but have a supervisor and additional seminars/trainings to obtain the support necessary to transition fully into the field. It also gives you the opportunity to truly assess whether the setting is right for you prior to making a long-term commitment.
This is not possible for everyone who is interested, of course. It is difficult, but not impossible, to break into the medical field without a prior internship. I would recommend shadowing medical social workers to get a sense for the job, volunteering as a “buddy” for the pediatric patients, and/or talking to current workers about the types of cases you could handle and skills you could develop in preparation for applying to the job. Be aware of medical ethics, legal issues that arise in the hospital setting, and the major risk factors seen in hospitals when going for the interview, and find a way to demonstrate that you are a quick and motivated learner, and have a passion for working with the sick and dying.
[OnlineMSWPrograms.com] Your resume also indicates that you supervised a graduate social worker intern at Lucile Packard Children’s Hospital. What advice did you give your student regarding helping pediatric patients and their families and working effectively with a larger medical team? Also, did you advise your student on managing the emotional impact of working in an acute care setting?
[Andrea S. Kido, LCSW] Self-care. Everyone could be better at it, and it is so necessary for medical social workers. Because the work is one crisis after the next, you could be there for days on end without ever finishing or ever feeling bored. I encouraged the student under my supervision to set limits for himself and to leave on time whenever possible. I recommended being responsive to the needs of the medical team, while setting limits with them as well. Finally, separating home life and work life is crucial. Regardless of what terrible things are happening at work, it is so important to comply with the boundaries you set for yourself. The work can be consuming, and it takes concerted efforts to distinguish it from the experiences of your personal life.
Regarding working with a multidisciplinary team, I strongly stressed the importance of communication. One of the primary complaints I heard from patients was the lack of communication between the medical providers, and the consequent contradictory communications given to patients themselves. Social workers are there to ameliorate the impacts of this problem, not exacerbate it. Further, there will always exist personalities with whom you jive, and others with whom you struggle to do so. This is ok. As long as there is an expectation of respect and the shared goal of providing ideal patient care, collaboration is always possible.
Thank you Ms. Kido for your time and insights into clinical social work.