By Kaitlin Louie
[About Jenn Toledo, MSW]: Jenn Toledo is a medical social worker who works at Satellite Healthcare, a dialysis unit in Menlo Park, CA, where she provides support to patients suffering from End Stage Renal Disease (ESRD). Ms. Toledo earned her MSW from San Jose State University in 2014, and has also earned her Spanish Language Counseling certificate and a Medical Social Work certificate.
During her MSW program, Ms. Toledo completed her first year placement at Gardner’s Adult Day Health Care, where she worked with older and developmentally disabled adults. Her second year placement was in the Johnson Center at Lucile Packard Children’s Hospital in the Maternity Department, where she supported mothers and children with medical and/or emotional challenges. While at Lucile Packard, she also worked with newborns in the Neonatal Intensive Care Unit (NICU). Ms. Toledo received her bachelor’s degree in social work from San Jose State University. Prior to going back to grad school, she worked at EMQ-FF for three years as a Family Specialist working with foster youth, mental health youth, juvenile probation youth and their families/guardians.
[OnlineMSWPrograms.com] Can you please give an overview of your core responsibilities as a medical social worker in the dialysis unit at Satellite Healthcare?
[Jenn Toledo, MSW] As a medical social worker in the dialysis clinic, I work with patients starting from admission in getting adjusted to being an End Stage Renal Disease (ESRD) patient. I help with assuring they have the resources necessary to get to/from treatment, transportation, helping them assure their insurance is in order, applying for our financial assistance programs if they cannot afford payment of their treatments, referring them to MediCare (as an ESRD patient, they qualify for MediCare regardless of age). I help with coordinating with primary care physicians in getting referrals to physical therapy or home health safety evaluations, referring them to CalFresh food stamps, food banks, homeless shelters, low-income housing, mental health providers, vocational rehabilitation programs, and kidney transplant wait lists and evaluations. If a patient goes into the hospital, I follow up with them and find out when they are getting discharged and what assistance they require to return to dialysis.
I communicate often with a patient’s family members or caregivers who are assisting with the patient’s care. If a patient passes away, I follow up with the family members to see how they are coping with their loss. I participate in meetings and coordinate with the Nephrologists from the referring hospitals, Registered Nurses, Patient Care Technicians, Registered Dietician, Administrative Coordinator, Medical Director and the Clinical Manager as part of the Interdisciplinary Team to discuss patient’s progress and what ways the team can work together to make the patient’s outcomes improve. I complete 30-day, 90-day, and annual assessments to address the patient’s psychosocial needs and assure the patient has good supports in place to help them succeed.
[OnlineMSWPrograms.com] Satellite Healthcare is a unique medical organization in that it centers specifically on serving patients with chronic kidney disease. How does this very specialized medical setting differ from working at a larger hospital?
[Jenn Toledo, MSW] Working at a dialysis clinic is different from working at the hospital because the patients at a dialysis clinic are all patients with the same chronic illness–ESRD. Patients can require anywhere from twice a week treatment, to five times a week treatment, with each treatment running from 2-4 hours on average. Dialysis is a life-sustaining treatment, and the vast majority of patients on dialysis are going to be dialysis patients until the end of their lives. Relationships are built over time and they are my patients until there is a transfer to another clinic, a kidney transplant surgery, or unfortunate death.
There are times when patients require dialysis because they are diagnosed with Acute Kidney Injury (AKI) and their dialysis regimen is temporary until their kidneys are able to regain function, but this is a very small percentage of the patient population. I assist patients with adjusting to their illness, assisting in arranging dialysis while they travel, referrals to community resources, insurance support, kidney transplant referrals, transportation issues, housing and legal issues, behavior issues, complaints, encouragement of adherence to treatment regimen, and the list goes on and on. My day never looks the same as the previous day.
My experience at Lucile Packard Children’s Hospital Stanford was in the maternity department and those patients were for the most part short-term. Referrals would come in because a mother who just gave birth has a history of post-partum depression, so the assessment included helping the mother identify what helped in the past and providing those resources or referrals to a public health nurse for them. The patient would get discharged within a day or two of the assessment and that was the end of the patient and provider relationship. Possibly a follow up phone call or two if appropriate, but that would be basically the end of the interaction. Other referrals could be a little more involved, such as a baby diagnosed with a serious medical condition while in utero, and assisting the mother with ways to cope and prepare for the baby’s birth and what types of situations to expect when the baby is born with their condition and has to stay in the Neonatal Intensive Care Unit (NICU).
The roles in both settings are very similar, but also very different. The referrals and support you provide are relatively the same type of emotional and concrete resource support, but the relationships and interactions are different based on the length of time available to intervene.
[OnlineMSWPrograms.com] Could you please elaborate on what your responsibilities were during your year-long internship in the maternity department at Lucile Packard Children’s Hospital? What kinds of patients did you work with, what challenges did they encounter, and how did you support them?
[Jenn Toledo, MSW] Many of the patients I assisted were Medi-Cal patients, as well as many Spanish-speaking patients because I speak a second language. I would say the majority of the referrals I dealt with were regarding previous history of post-partum depression, teen pregnancies, lack of father or other supports in the picture, and many referrals for patients who were expecting a baby that was going to be born with some type of serious illness and would need to be followed into the NICU.
One referral I had was for a young mom, early 20s, monolingual Spanish speaker who was expecting spontaneous triplets. She was in danger of potentially losing one of the babies. She was on bed rest about halfway through her pregnancy and I started to work with her shortly into her admission to the hospital. I was lucky enough to be present and support her the entire time she was admitted while pregnant, then to eventually see all three of her daughters discharge from the hospital as healthy babies. One of the babies actually was admitted back to the hospital a couple months after their discharge and it was great to be able to see how much they had all grown since I last saw them. This was the longest-term patient I worked with and my support lasted about four months.
Grief support was also part of the equation because sadly there are times when the baby does not survive, and my role was to support the family in dealing with their loss and provide resources as necessary. I luckily only had one baby that was my patient pass away during my year-long internship. It was a patient with a very serious heart defect that was detected during the mother’s pregnancy. It was difficult for me when I found out because I did not even know the baby had passed. I went to look his chart up on the online program we used for progress notes, and I could not find him in my regular lists of patients. I was very confused because I knew he had not been discharged yet and I did not know if he transferred units or what happened. I put his name into the search bar, and then a window popped up saying “this patient is deceased” and I remember just being stunned that a computer alerted me of such a serious matter and that I hadn’t found out any other way.
I then called the mother and offered my condolences and maybe a week or so later sent her a package with information on grief support groups in her area, as well as information to provide her other children on the loss of a sibling who never came home from the hospital. My interactions with the family were very short, so I did not feel a giant sense of loss, but it was still hard that such a young life did not get a chance to live. I am pretty sure if it had been one of the triplets that had passed, my reaction would have been different because I had a greater connection with that mother and it would have been much more difficult to swallow.
[OnlineMSWPrograms.com] Why did you decide to become a medical social worker, 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?
[Jenn Toledo, MSW] I decided to become a medical social worker because at 16 I was diagnosed with leukemia and I had a great social worker assigned to me at UCSF. During my 2.5 years of treatment she followed my case and that is where I discovered what social work was for the first time. The types of things she assisted with all appealed to my strengths and what I enjoy doing — helping people and working with kids. That is when I decided to pursue medical social work as a career and I have a very specific goal of one day working in the pediatrics oncology department of a hospital because I will be able to speak the same language as my patients and have a deeper understanding of what they are going through. I feel that way at times with some of my ESRD patients because I understand the frustration of dealing with an illness that limits you in many ways. I don’t share my own personal experience with my patients because it is not about me, it is about them and what I can support them with, but I feel like I can empathize with them in a different way than others might be able to.
[OnlineMSWPrograms.com] 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?
[Jenn Toledo, MSW] It is challenging to have close to 90 patients and feel torn in a hundred different directions because there are times when everyone needs something from me. I only work at my clinic 4 days a week and I sometimes feel like there are not enough hours in the day to follow up on every single request/resource/phone call for every patient. It is very important to keep track of all your responsibilities, and I have noticed that if I do not write down what I need to do, it will most likely not get done. Organization is key in this realm of medical social work and it is important to be an advocate for the patients, as they may be limited in being able to advocate for themselves. Be open minded, understanding, and learn to embrace change.
[OnlineMSWPrograms.com] 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?
[Jenn Toledo, MSW] I definitely recommend getting a field placement in a hospital or clinic because otherwise you will not have the experience that is practically necessary to get a job as many healthcare settings will require at least a year of experience in healthcare. I also recommend volunteering with organizations related to the medical field. I have volunteered with four different non-profits related to cancer patients because of my personal experience and my passion for this population, but it has only helped me in my career to have that extra edge over others, in addition to the experience I was able to have at Lucile Packard Children’s Hospital.
Thank you Ms. Toledo for your time and insights into medical social work.