Public Librarians and Health Care: A Social Work Perspective

by Mary Nienow, MSW, Clinical Director and Instructor of Internship, University of Wisconsin – Eau Claire

As I was procrastinating in the writing of this blog entry on what social workers can teach librarians, I received call from a public library asking for my help. With the advent of the Affordable Care Act (i.e. Obamacare), low income adults without children can now qualify for medical assistance. The librarian (let’s call her Susan) was wondering if my social work students would be willing to help with outreach and assistance to people filling out the forms. Her comment, “as librarians we can’t necessarily help them fill out the forms and would love the social work department’s help,” really struck a chord. Citing privacy concerns and equating it with offering tax assistance or legal help, Susan indicated that they can only provide the forms now answer questions or assist in the completion of the forms. While I am delighted to foster this partnership, it highlights for me, once again, how interconnected the scope of practice really is between librarians and social workers.

Susan mentioned that there will be on-line courses my students can take so they better understand the forms and what is being asked, but it got me to thinking… what kind of information or skill does a social worker have that could be put into a few short on-line courses for librarians? The first, and probably most difficult thing, is expecting each interaction to take longer than you plan. Each person coming to the library has a story. They are more than their name, age, address, and place of employment (or lack of employment). Social workers take the time to uncover the context of the client’s environment. Taking the time to do this builds trust, which is essential in building a helping relationship. If all you do is focus on getting answers to put on a questionnaire, in as short of a time as possible, you will find the person you are trying to help wary of your intentions. They may become hostile, short with their responses, or too verbose in a way that will only impede your efforts. This is because a power differential may have developed where you are the expert, and the patron is dependent upon what you have to give them. It turns out the client is the expert on their story (or the reasons they seek certain information) and often they want that story heard, acknowledged and appreciated—as we all do. Making assumptions about people, their circumstances, their needs, or their abilities is the best way to misunderstand and ultimately not help those we are seeking to serve.* Remembering our purpose, which I bet is not just to help someone fill out a form or find a book (but rather to help them get health insurance, lead a productive life, or seek knowledge and self-fulfillment), can make the time we spend feel like an investment not an exhaustion of our resources.

After time, social workers become trained listeners. They must breathe through their desire to immediately problem solve, rush to a response or insert their “expert” opinion. Comfort with silence gives room for the person to speak. I often tell my students to count their lag time. Lag time refers to the pause between when one person stops speaking and the other starts. Allowing at least five seconds between asking a question and getting a response is appropriate. In my family we have what I call “negative lag time.” Before I can finish asking my question, they are jumping in with a response. It’s annoying. Giving space to think, collect one’s thoughts and answer in a deliberate manner signals and is usually more productive than trying to rush a conversation or come to a particular solution (or fill out a form).

For more information on the role of libraries and the Affordable Care Act, see: http://minnesota.publicradio.org/display/web/2013/06/28/health/library-affordable-care-act

*A word of caution. This goes well beyond “cultural competence.” Understanding cultural populations is important, but assuming we know how “they” operate (even if we are a part of the “they”) is dangerous and counterproductive. A term I like more is “cultural humility.” Again, it means being aware that we can’t ever understand all aspects of a particular culture and the only way to learn is through relationship and respectful exploration over time.