Technology & Social Work Practice

A Shift to Teletherapy

When the pandemic abruptly moved her behavioral health work online, Looby found that she suddenly became an IT person. “Sometimes I would spend 5–10 minutes of a session just trying to get in touch with someone,” she recalls. Still, she liked being able to see clients’ faces without a mask, and getting a window into their living environment and day-to-day lives enhanced her understanding of clients and the issues they were facing.

Based in Omaha, Nebraska, Jess LaBudda (MSW ’14, LCSW) is a VA caregiver support mental health coordinator and social worker. The clients she works with live across rural Nebraska and western Iowa; before the pandemic, some had to drive hours just to attend an appointment. She hadn’t used telehealth technologies before the pandemic, but now, most of her work is done online.

“As social workers we learn to adapt and deal with adversity on a regular basis, but it was challenging to learn how to be a therapist over the Internet,” LaBudda says. But on balance, she says, the switch has been positive. Virtual practice has expanded services for rural populations, and the VA has provided mobile devices and hotspots for those who need it. “It’s been really helpful to be able to see facial expressions. And for caregivers of vets with dementia or other types of diagnoses where the caregiver couldn’t leave the home, the caregiver now has access to community through video groups.”

“It has been incredible to see older adults and people who are house bound for a variety of reasons step outside of their comfort zone and get connected to resources through the use of telehealth,” LaBudda adds.

Although virtual therapy has benefits, it also comes with challenges. Does the platform you’re using comply with privacy requirements? What happens when a connection drops at a pivotal point in a conversation? If a client has used alcohol just before a session, a therapist may not be aware because they can’t smell it. With only a view of a client’s head and face, you may not be able to see whether they’ve engaged in self-harm or are holding a weapon. Are they safe? Could someone be listening in?

If you’re a client, what if you use an app to access urgent mental health support, but a follow-up appointment with a therapist isn’t available for months?

“We can have the platforms and technology, but we still need the people behind them,” notes GSSW Clinical Associate Professor Stephen von Merz.

And then there are issues around equity. Not everyone has access to mobile devices or broadband service. Some older people or those with cognitive challenges may have difficulty using tech devices. Several family members may need to share one computer for everything from work to school. Although technology has increased accessibility of services for many, requiring people to use technology is problematic, von Merz notes.

Licensure can pose another significant difficulty. For instance, a social worker who is licensed in Colorado may not be able to treat their patient who is working from home and sheltering in place in another state. The same is true for many other medical and behavioral health professionals. Although loosening licensure restrictions via multistate agreements is a policy recommendation of the Grand Challenge, relatively few such agreements exist and they can be difficult to navigate (a multistate compact is in the works).

Delivering Front-Line Services

Social work practice, of course, isn’t limited to therapy. Social workers also deliver a raft of vital social services in areas such as housing, food, and child welfare. Dana Niemela (MSW ’13), directs the new Denver Human Services Economic Resilience Division at the City and County of Denver. The division was created to bring together programs and services that help to build economic resilience through direct payments or capacity-building — programs such as the SNAP to Success employment support program and the city’s emergency eviction support program. Before assuming this role in October 2021, Niemela directed Human Services community outreach and resource engagement, overseeing programs that included general assistance, behavioral health, and immigrant and refugee services, among others. When the pandemic shuttered city offices in early 2020, Niemela and her team had to figure out how to quickly shift an entirely in-person operation to one that was 100% virtual.

At that time, people could already apply for some public benefits online via the state PEAK portal, but for smaller or local programs, there was no online application. “People would have to come in, fill out an application, sit and wait in line, probably take off work, bring their kids and ride a bus across town,” Niemela says. When the pandemic initiated an online application process, “We would get flooded with applications at all hours of the day. We could see that someone was applying at times that were convenient for them.”

Feedback from staff has been positive, too. “The ability to serve people by phone or by email freed staff up to get more in-depth with customers than when they were dealing with a line out the door,” Niemela says. “They can give them more attention and resources. That has been one of the huge benefits.”

As great as technology is at meeting clients where they are, it can be a barrier for some, however. “Not everybody has access to the tools that make the digital work possible,” Niemela says. “There can be language and accessibility barriers, technical literacy, digital literacy.” That’s why the city is complementing its new online services with neighborhood resource centers around the city. “People can still come meet us in person, but our intention is to also meet them in their neighborhoods where they are.”

Barriers to Innovation

Why did it take a pandemic to instigate service changes like these? Barriers to innovation include privacy concerns, data systems that aren’t integrated (local, state and federal programs all use different data systems), and complex and often onerous regulations at the local, state and federal levels.

“It took a major event to get us to stop what we were doing and start doing something else,” Niemela says. “The workload keeps coming in human services. You can’t pause what you’re doing when you’re trying to help people get access to food. With this pandemic, federal rules were relaxed enough that it gave us the opportunity.” For instance, she says, the federal government temporarily relaxed the requirement to do interviews for SNAP benefits, which freed staff time for other projects.

For technological innovation to truly take root in social work practice, organizations must nurture innovation, and the government must reduce administrative burdens, Niemela says, noting that the City of Denver has empowered staff and leaders to innovate in their own programs, generating 600 staff-led innovations in human services that resulted in over $2 million in savings to the agency since 2012. “I see people who are not feeding their children because getting the benefit is too hard. A family experiencing hardship should be able to access benefits with as much ease as I can order from Amazon.”

Alumna Stephanie Rogers (MSW ’14) is one of those working to make that sort of vision a reality. She manages the Office of Strategy, Performance, and Innovation for the Colorado Department of Public Health and Environment, where she consults on process improvement, innovation and changes in organizational structures, and oversees the department’s core technological functions. For instance, Rogers is working on a new staff onboarding process that will set new employees up for success on Day 1, which she hopes will contribute to lower turnover in the future.

“The organizations we serve as social workers can be strapped for time and resources; we have to find out how to make processes more efficient,” says Rogers, who a decade ago served as a caseworker. “Organizations can’t waste dollars and time on repeat activities — those dollars can be spent on furthering the mission and getting services to the people who need them.”

Social workers are uniquely positioned to articulate what the client’s experience might be when a top-level policy or process change is made. Improving policies and practices depends on data for insights, which requires designing better data systems — something Rogers says social workers are uniquely suited for with their knowledge in areas such as social justice, biases, systems theory and clinical practice. Yet, social workers are an underutilized resource in this sort of work, she says. “I don’t know another social worker in the field who codes.”

“We have these big government entities in charge of distributing critical services supported by federal and state dollars. They collect massive amounts of data related to program activities,” Rogers explains. “There’s a whole body of analytics that should complement programmatic work, but before we can even analyze data, we have to have some knowledge and skills around how to house and retrieve data from data systems.”

Unlocking government data to drive solutions to social problems is another policy recommendation of the tech Grand Challenge, and that’s a big part of Rogers’s job. “Social workers need to understand what data is out there, how to triangulate data sources to tell a complete narrative or contextualize trends, how to be a judicious consumer of data, particularly with visual data,” she says. “How to fund a project or program, whether to continue efforts in one program area or another — all of those decisions are connected to data and analytics.”

“We’re not typical analysts. Social workers can speak to the why behind data, and we can make solid recommendations based on our training and expertise,” she adds. “That’s really a social worker’s superpower.”