By Kaitlin Louie
About Jenna Ferrara, MSW: Ms. Ferrara is a Therapist at Jail Behavioral Health Services (JBHS) at the San Francisco County Jail, where she works both at the intake jail and with Behavioral Health Court (BHC), evaluating new clients when they enter the jail system, and providing mental health support, referrals, psychiatric evaluations for incarcerated individuals during their time in jail. Prior to working full-time at JBHS, Ms. Ferrara interned at JBHS as an intern therapist and clinical case manager, and also worked as an Intern Clinical Case Manager at the University of California, San Francisco’s (UCSF) Department of Psychiatry, on their Citywide Case Management Forensics Team. She earned her Bachelor of Science in Health Education with an emphasis in Community Based Public Health in 2007, and her MSW from San Francisco State University with an emphasis in Community Mental Health in 2013.
Prior to enrolling in her MSW program, Ms. Ferrara was a Case Manager and Project Coordinator for UCSF’s Department of Psychiatry, in the Substance Abuse Research Group at SF General Hospital, and a Viral and Hepatitis and Liver Disease Program Coordinator at UCSF’s Correctional Medicine Consultation Network. She also volunteered at San Francisco AIDS Foundation’s Syringe Access Services for six years.
[OnlineMSWPrograms.com] Can you please elaborate on your core responsibilities as a Therapist for Jail Behavioral Health Services at San Francisco County Jail? What types of challenges do your clients face, and how do you help them manage these challenges?
[Jenna Ferrara, MSW] As a therapist at Jail Behavioral Health Services (JBHS), I work with individuals incarcerated in the San Francisco County Jail. When I work in the intake jail, I am mostly assessing clients as they enter the jail, post-arrest. I see a variety of clients who are referred to JBHS due to history of mental illness, severity of charges, first arrests, high profile charges, and behavioral issues. I perform risk assessments and mental status assessments and determine if clients are meeting 5150 WIC (involuntary psychiatric hold) criteria.
I also determine what level of care clients will need while in the jail, and make the necessary referrals for psychiatric medication evaluations, treatment team, follow up checks, and housing recommendations depending on acuity. In addition to working in the intake jail, I also work in the Jail Health Reentry Services department and assess eligibility for clients who may be referred to Behavioral Health Court (BHC). If they are eligible, I work with clients while they are incarcerated and refer them to community mental health treatment.
The intake jail is typically an intense environment. Many people arrive intoxicated and in crisis related to their varying circumstances. Clients living with mental illness may be unmedicated/decompensated. People are referred to JBHS due to having a history of mental illness, having serious/high profile charges, behavioral problems or presenting in distress. I perform a mental status exam and determine if the client requires an involuntary psychiatric hold (5150 WIC), safety cell placement, special housing or psychiatric housing, and referrals for medication evaluations, ongoing therapy and follow up checks. I work collaboratively with the Sheriff’s Department and medical staff.
As far as the tasks involved in conducting these intake assessments, I utilize a forensic mental status exam which collects the following information: reason for referral, demographics, arrest information including charges, history of mental health (community contacts, 5150’s/hospitalizations, in custody history), history of suicide attempts and dangerous behavior as well as current risk of self harm and harm to others, substance use history, release plan, cognition, insight, judgment, impulse control, memory, appearance, mood/affect, speech, thought process/content, perceptions. After collecting this information, I determine the clinical disposition/treatment plan.
The reentry division of JBHS is Jail Health Reentry Services (JRS). I recently transferred to JRS and work in this role 4 days per week. In this role, I work with clients who are participating in BHC, which is a collaborative court that works with offenders with chronic/severe mental illness and links them to treatment in the community. Clients are referred by their attorney and JRS assesses whether or not they are diagnostically eligible for BHC, amenable to participating in community mental health treatment, are compliant on psychotropics and following the other legal requirements. In this role, I see clients at all of the various jail facilities, work with them and the legal team on a treatment plan, collect biopsychosocial histories to use in applications to community treatment programs, prepare them for release to the community, and escort them to community programs at the time of their release. Clients typically participate in BHC for a minimum of a year and during that time JRS works in collaboration with the legal team (Judge, District Attorney, Probation, and Public Defender/Private Attorney) and their community providers on the client’s care and provides updates to the court. Clients are required to come to court dates and JRS clinicians attend court regularly as part of the BHC team.
Other JRS duties include assessing clients and their need to be conserved upon returning from State Hospitals as unlikely to be resorted to competency (capacity to participate in legal proceedings). In this role, I meet with clients as well as review community, state hospital and in custody records. After the assessment is complete a report is written with recommendations to the county on whether the client should be placed on a conservatorship and then JRS typically assists in their community placement.
[OnlineMSWPrograms.com] Can you explain what the role of the social worker is as part of a multidisciplinary treatment team at San Francisco County Jail? How do you collaborate with the rest of your team to provide services to clients? Also, with what organizations do social workers in your field interact on a regular basis–for example, how do you collaborate with Jail Medical Services, San Francisco Sheriff’s Deputies, and various community providers?
[Jenna Ferrara, MSW] JBHS staff is in constant communication with the Sheriff’s Department and Jail Health Services (medical staff). Being patient and flexible in this intense and dynamic environment is imperative. We must communicate with the Sheriff’s Department in a way where we give them important information that keeps clients and staff safe, and at the same time, protecting (to the extent we can) the confidentiality of the clients we serve. Since the Sherriff’s Department oversees the jail, we rely on them for safety, and to help us see clients, as many clients require deputy assistance to be transported to interview rooms, safety cells, and to other facilities/housing units. Since clients are incarcerated, we must abide by strict custody/safety protocol. Medical staff and mental health staff share an electronic chart and collaborate regularly.
As far as the rest of the JBHS team, there are roughly 30 clinicians, 6 mental health counselors, and 3 psychiatrists. Some staff rotate to different jail facilities and some work in specific facilities or housing units. We all work closely and collaborate/consult often.
JBHS regularly collaborates with community mental health providers, our inpatient unit at SFGH (7L) and Psychiatric Emergency Services. For continuity of care and to obtain collateral information, it is customary for JBHS staff to contact the client’s community mental health provider(s) (such as the client’s case manager, therapist or psychiatrist, or treatment program) upon his/her initial assessment, and then ongoing to coordinate care for his/her release, as needed.
[OnlineMSWPrograms.com] Your resume indicates that you are completing a post-graduate training program called Social Work Practice, Foundations of Clinical Work with Clients at the San Francisco Center for Psychoanalysis. Why did you decide to enroll in this training, and what have you been learning through the program?
[Jenna Ferrara, MSW] As a graduate student I attended some Coalition for Clinical Social Work (CCSW) events and found them interesting. Per their website, they are “a group of social workers dedicated to psychodynamic thinking about the practice of social work across diverse settings. We value the importance and power of collaboration, clinical development and theoretically-informed practice. We recognize the need for us as social workers to preserve our unique professional identity and honor our clinical work. The CCSW aims to enhance social workers’ capacity to practice meaningful clinical work.” While I attended various clinically focused courses in school, I found it difficult to put the theories I was learning about into practice. Once I was working in the field full-time, I found myself yearning for a framework to be able to think more clinically about the clients I was seeing. When I heard about the CCSW 18 week course: Social Work Practice, Foundations of Clinical Work with Clients, I signed up. This course teaches the psychodynamic framework through a social work lens. I find this course helpful and relevant as it helps me to think about clients and my role as a therapist in more complexity. I am completing hours for licensure (LCSW) and I believe this class will help prepare me for the exam.
[OnlineMSWPrograms.com] You also worked as an Intern Clinical Case Manager on the Forensics Team at UCSF’s Department of Psychiatry, where you also worked with clients who were enrolled in San Francisco’s Behavioral Health Court. Could you explain what your responsibilities were in this role, and how working with San Francisco’s Behavioral Health Court differed from your current work with SF County Jail?
[Jenna Ferrara, MSW] As an intern Clinical Case Manager on the Citywide Forensics Team, I worked with four clients who were BHC participants. I worked with two clients as they were beginning participation in BHC and this required assisting them with community placements, housing, and providing case management services as they were released from the jail. I worked with someone who was a year into his participation in BHC, and someone who had recently graduated from BHC. All of the clients I worked with had co-occurring mental health and substance use diagnoses. I provided regular updates to the BHC legal team (Judge, District Attorney, Probation, Public Defender/Private Attorney). Since most clients I saw were living in the community, I worked with them on obtaining basic needs (housing, financial assistance, employment, etc.).
I participated in a Dialectical Behavior Therapy (DBT) group and Recovery Model group. The Recovery Model group focused on tools and practices to move the clinic to a more strength-focused model that was supportive of capacity building. It was in this group that I learned about assessments to use with clients to help them focus on the goals they wanted to achieve individually and not goals prescribed by their providers. This group also focused on ways to change the structure of the clinic to make it more welcoming and inclusive to clients.
[OnlineMSWPrograms.com] What have been some of your most rewarding professional experiences thus far? On the other hand, what have been some of the most challenging aspects of your job, and how do you manage these challenges? Do you see yourself staying in this field as a career?
[Jenna Ferrara, MSW] Some of the most rewarding moments have been assisting clients who are in crisis, and helping them obtain the care they need to stabilize. I’ve also had the opportunity to escort clients out of the jail and into the community. Bearing witness to their first breath of freedom as they leave the jail is beautiful. Many clients arrive into custody decompensated and we assist in helping them to stabilize and plan for their release. While jail is not a wonderfully supportive environment, it is containing and people are able to sometimes gain insight. Witnessing clients who are able to reconcile with their past and prepare for their future, without the distraction of drugs, can be a rewarding experience.
As far as challenges, I think the most impactful is witnessing violence. Violence from clients toward other clients/staff, towards themselves via suicidal gestures, and from deputies to clients. I think this job comes with some vicarious trauma that has impacted me and the way I function in and view the world. I have left work feeling anxious, hypervigilant, irritable and exhausted. I sometimes feel more unsafe in the world than I used to and I think that is because I am exposed to violence and chaos on a regular basis.
This work is interesting and I am NEVER bored. I very much enjoy working with this population. I am not sure how long I will work in the jail but for now, I enjoy it.
[OnlineMSWPrograms.com] For MSW students who are interested in becoming criminal justice social workers, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Jenna Ferrara, MSW] For MSW students who are interested in forensic/psychiatric social work, I would advise taking classes that focus on these areas if possible, volunteering or interning with this population, or conducting informational interviews with providers that are doing this work. Working in a forensic setting may not be for everyone and students should look for opportunities to tour a jail/prison, see or meet with clients, and get a sense of the work before committing to it. I’m not sure what advice I have as far as emotional preparation. I think there are many social work settings that are challenging and while correctional facilities may be difficult to some, so would working in an emergency room, at CPS, or doing hospice work. For me, I have had to find the right balance of having a healthy amount of anxiety at work and not being completely relaxed as that can be unsafe, but also not being overwhelmed with anxiety that I cannot think. It’s the kind of place where thinking quickly, staying calm, and being aware are very important.
Thank you Ms. Ferrara for your time and insights into criminal justice social work.