Rethinking Health Care: The Importance of Bridging Micro and Macro Social Work Practice

By Vara Edara, MSW, LSW

As a relative newcomer to the field of social work, I have learned a lot—but realize there is much more to learn about this field of work and how to create change. I began my job as a medical social worker in a geriatric in-patient psych unit for a county hospital after receiving my Master in Social Work (MSW) in May 2021. The challenge of beginning a new career amid a global pandemic was daunting, but I felt prepared. It was an exciting time. I walked into work and immediately faced 23 positive covid patient occurrences which rose by day, mostly among seniors. I knew in my gut this is where I was meant to be. I was here to serve the most fragile and vulnerable members of the community who had been hit the hardest by the pandemic. It was nerve-racking to deal with family who were not able to see their loved ones in person, and only through the protection of a mask, and the ramifications of this lack of contact, including a hindrance in establishing rapport and trust with patients. Challenged with facing death and life issues, the fear, uncertainty, and the sheer gravity of carrying the expectation of a new social worker were daunting. My experiences during the pandemic changed me. They gave me new lessons in perseverance, developing social work skills, processing grief, and understanding attachment, as well as the importance of taking time to self-reflect.

As a social worker in a medical setting, I know this is not the end of my work—it is the beginning of a new era. I began to wonder, “How can I make a difference and change the present broken health care system across micro, mezzo, and macro spaces?” Previously, I had never been interested in politics and always shied away from that type of engagement. In the micro space, time is of the essence and as a social worker in an acute setting, I needed to discharge patients in less than two weeks and link them to resources which were limited or non-existent. In mezzo spaces, families whose loved ones are struggling with mental illness in the community, struggle to get all the support required to thrive, due to family economics and dynamics or insurance coverage criteria. In the macro space, due to the lack of the appropriate resources and limited insurance participation, the responsibility of caring for loved ones—and the cost of this care—often falls on family, friends, and tax-payer resources, and causes relapse and recidivism. The responsibility of ensuring continuity of care falls directly on the patient, frequently without professional support post-discharge, who may not be knowledgeable about all the public and private resources out there. As a medical social worker, my hands are tied to do more than I am already doing; I feel helpless due to red tape and jurisdiction litigations.

Recently, at the NASW-NJ Annual Conference this past May, I was blown away by the keynote speaker, Senator Sarah McBride of Delaware, when she said "social work + politics = change.” This struck a chord in me. I remembered something my first clinical supervisor, Rev. Jim Knol at Ramapo Ridge Psychiatric Hospital, used to say to me: “Vara, I love your passion for your patients…and you remind me of Dorothy Day at the steps of the Capital Hall.” At the time, I did not take this comment seriously, but now I get it. Senator McBride’s presentation resonated with me and I believe, like Dorothy Day, that I can make a change by being involved in politics and helping the people I serve. I am now considering running for elected office to be a voice for all those individuals who feel unheard, unvalidated, and unsupported. I am ready to embark upon this route to make the necessary changes in the macro space for the community's betterment.

One area I am very interested in addressing is the betterment of social workers in the healthcare industry through linking micro, mezzo, macro, and policy work. Our social work profession often goes unnoticed, underappreciated, and underpaid. Social workers are key in interdisciplinary decision-making involving patient care from the time of admission to discharge to avoid recidivism. As such, social work salaries must be increased so they are on par with nurses and other professional health care staff.

In my opinion, early diagnosis and yearly checkins are imperative to an individual’s health and well-being. People often avoid necessary health and mental health care because such care does not fit in their budget and seems unaffordable. This could be avoided if insurance carriers and other health care payors shifted their focus from a curative strategy to a prevention-focused strategy that encouraged people to receive care. Furthermore, to address the mental health crisis in the U.S., especially among the youth and geriatric populations, we need to alter our healthcare system so social workers are available to conduct needs assessments in all pediatrician and primary care offices in our country. This will help identify patients’ psychosocial needs and redirect treatment as necessary if a patient’s root problems are more than physical. Early intervention and diagnosis can help families access state resources early on and ensure healthy development.

In my work, I have come across adults in their 60s, 70s, 80s, and 90s who experienced developmental delays in their childhood. However, they were not diagnosed early on and did not get the mental health care needed. Instead, parents often kept these youth and their problems hidden, so as not to face societal stigmas. Now as their parents are passing away, their ability to survive is jeopardized. This situation could have been avoided if each medical office was equipped with a social worker to do an intake assessment and identify treatments needed. Managed long-term support services (MLTSS), the Division of Developmental Disabilities (DDD), and the Medicaid application process are nerveracking, daunting, and difficult for seniors and their families to navigate. We need to upgrade our Boards of Social Services statewide and streamline the enrollment/application process to help our seniors navigate these tasks more easily.

Some people have told me, "your intentions are pure, though you cannot save the world…let it go.” But what if I tell you I don’t want to give up? I want to fight for my patients and get them all the services they need. Am I wrong? I don’t think so. We need people who are willing to stand up and fight for what is important. I have high aspirations for change and improvement in our health care practices, aspirations that I hope are achievable. I will strive to address issues facing our clients and our society at the micro, mezzo, and macro levels. I hope you’ll join me in this endeavor. Together, we can make change possible.

About the Author:

Vara Edara, MS, MSW, LSW, is a medical social worker at Bergen New Bridge Medical Center. She earned her MSW from Ramapo College of Social Work. She is a member of the Alternatives of Domestic Violence (ADV) crisis response team in Bergen County and serves as a victim advocate. She aspires to create a transparent health care model that has a streamlined approach across disciplines to serve the community at the micro, mezzo, and macro levels.

The first week in August is World Breastfeeding Week, an international campaign by the NGO World Alliance for Breastfeeding Action, in partnership with the WHO/UNICEF. It aims to educate, support, and promote human milk feeding as a critical component of sustainable development worldwide. Social work, as a profession, is engaged in health promotion on all levels, and is especially interested in uplifting marginalized and vulnerable populations. Social workers have a great deal of influence on local, regional, national, and international healthcare, both on a micro and macro level. World Breastfeeding Week is an opportunity to introduce social workers to lactation as a lever of social justice and educate us on how we can support both our lactating clients and breastfeeding policy.

As an LCSW who is also an International Board Certified Lactation Consultant, this intersection is my home base. On an individual and family level, I am in private practice as both a psychotherapist and a lactation consultant, helping new families to navigate the physical, emotional, and social aspects of pregnancy, postpartum, and parenting. On a policy level, I work as an advocate for consumer safety in lactation care, equal access for LGBTQ+ lactating families, and anti-racist breastfeeding education. I am in a unique position to help the social work profession to understand why we should know more than we do about lactation, and how we can help.

Human milk feeding is crucial to infant and maternal