Why My RPG Habit Makes Me a Better Social Worker

 Welcome back! After talking about music and listening for a while, I wanted to talk about my other favorite form of escape: gaming. In particular, the kind of character-driven, strategic, and in-depth role-playing games (RPGs) that have the potential to consume your entire weekend. 

My time spent playing Genshin Impact may seem pointless, but it's actually helping my brain get ready to tackle the most difficult problems that come with being a medical social worker. 

I use video games to practice the following three crucial skills:  

1. Management of Resources   

You begin with a small amount of money, some basic equipment, and a few health potions, as is the case with all good role-playing games. You must manage your best items for the long term; you cannot use them immediately. 

The biggest resource management challenge is social work in general. In addition to solving every issue, my role also involves making sure that a client's most important needs—such as access to medication, stable housing, etc.—are adequately met, as well as time management, agency support, and community resources. My ability to see the big picture and resist the temptation to "heal" small problems before addressing systemic ones has improved thanks to gaming.  

2. Handling Complicated Conversation Trees (Communication Technique)  

The decisions you make in role-playing games can affect how you interact with characters and, in certain situations, how the game turns out. You risk losing an important ally if you say something incorrectly. 

Every encounter is a high-stakes dialogue tree for a medical social worker. I frequently have to make difficult word choices under pressure in order to:  

1. Develop a relationship with a client who is hesitant.  
2. Make concessions to overburdened family members.  
3. Effectively communicate with busy doctors.  

The idea that the only way to succeed is to listen before choosing an option is reinforced by these games.  

3. The Benefits of the Side Quest (Appreciating the Full Person)  

In a game, the main quest is the main objective, but the side quests are where you get bonus items, rich lore, and a deeper understanding of the world and its people. 

The immediate medical discharge plan is typically the "main quest" in the hospital. However, it is my responsibility to find the "side quests"—the client's worries regarding their dog, their employment, or their social isolation. When they go home, these seemingly insignificant details are frequently the crucial elements that decide whether the main plan works or not. I've come to appreciate not just the critical path but the entire picture.  

Video games are a testing ground for resiliency and strategic thinking, not just a diversion.  

Which game has given you a surprising professional or life lesson? Share your thoughts in the comments section. 

 

 

Mi Reflejo vs. My Reflection: What a Pop Song Taught Me About My Job

Good morning! Welcome to The Clinical Compass. My name is Joseph Barbe-Williams, and as a student that is set to graduate with my MSW this April, I would like to discuss something about this field that I find most relatable: listening. 

Where can adequate listening skill be found in medical social work? Perhaps in a 25-year-old pop song. 

My specific interest is the Spanish version of a song featured in the 1998 film, Mulan,"Mi Reflejo." 

The Impact of the Original Language

I don't care what anyone says. Mi Reflejo is far better than the English version, My Reflection. Mi Rflejo possesses a passion and musical influence, to me, that the English version lacks. However, the compare between the two is about more than just a musical opinion. It's about the are of international communication and deciphering the material for meaning. 

When I listen to Spanish music (I am currently studying Spanish), my brain shifts into hyper-focused mode. I cannot simply hear the melody; I have to diligently try to decipher the message. This persistence signifies the core of social work practice: how hearing and listening differ. 

Three Take-Aways from Language Learning That Enhance My Social Work Practice: 

1. Encourage Clarity and Stop Assuming: When I first began listening to Spanish music, I assumed that the Spanish version directly reflected the English version. However, that couldn't be more wrong. It is easy to assume with patients as well. Sometimes we assume one's needs based on limited information. Both social work and language arts require us to defer away from assuming, and actively listen to obtain the full context. 
2. Emphasize the Awkward Silence: Achieving fluency is no cakewalk. You have to be patient and content with not knowing the correct term. In a field like social work, silence can be an incredibly effective therapeutic tool. When patients or family members are having a hard time to express a necessity, I have learned that, rather than providing my own suggestions, allowing the client the time to gather their words is best practice. 
3. Effort is Empathy: Upon taking the time to truly listen to a patient's story, they typically feel heard. Upon taking the time to learn the grammar of a new language, I present respect to that culture. The work I put forth to practice active listening and learning, whether it's a patient's story or a new language, is the maximum effort I can provide. 

Share with me one song, game, or hobby that has embraced your professional skills and/or development. 

Mi Reflejo vs. My Reflection: What a Pop Song Taught Me About My Job

Surpassing "Cultural Competence": Why Humility is Needed in Social Work

In social work practice, one topic that comes up a lot is cultural competency. This implies that we can navigate any cultural encounter sufficiently. As a social worker in the medical field, I have learned that this goal may not be realistic. However, that's why I like to focus on cultural humility instead. 

What is Cultural Humility? 

This term describes the lifelong commitment to a process of self-critique and self-reflection. Rather than attempting to master every culture, you acknowledge that the client is the expert of their own lives. This shifts the balance of power. 

Three Ways Cultural Humility Changes Practice: 

1. The "Expert" Repositions: Upon entering the room, if you say, "I am here to talk about you and how you perceive this issue." you begin to build rapport. It recognizes that your formal education plays a secondhand role to the client's experience. 
2. It Limits Assumption: If I base patient compliance to a treatment plan off of my limited awareness of their culture, then I have failed the patient. Implementing humility requires me to probe the client about their beliefs and culture. It provides a perfect opportunity to craft a treatment plan most suitable for them. 
3. Continued Learning: In social work, education does not stop post-graduation. Cultural humility implies frequently analyzing your personal biases by acknowledging the fact that continuous learning from the client will never end. 

In order to efficiently navigate through systematic barriers within the healthcare system, understanding the concepts of cultural humility is crucial. While social work is rewarding work, it begins with acknowledging what we don't know. 

How do you examine your personal biases upon engaging in a new situation? Share your own reflection pointers below! 

Coordinating the Chaos of Discharge Planning

 As I continue to approach my graduation this coming April, one aspect of medical social work that is evident to be most crucial, chaotic, and rewarding is discharge planning. It is not just about scheduling transportation; It's about crafting a strategic plan while also collaborating with multiple different hospital disciplines. You could picture this concept as playing a complex game, one that requires the ability to solve complex puzzles on hard mode. You must practice multi-tasking by think ahead while working with limited resources. 

Rule 1: The Initial Assessment is the First Piece of the Puzzle

When solving complex puzzles, you analyze the playing field before initiating that first move. In the field of medical social work, the assessment step is everything. You can't solely think about the patient's diagnosis; you have to paint the picture. 

• Home Environment
• Barriers: Does the patient have any stairs on the inside or outside of the home? Do they live alone with significant mobility issues? 
• Social Environment
• Does the patient have family members? Do they have community support? 
• Financial
• Is the patient able to afford their durable medical equipment (DME)? Are they able to obtain their prescriptions? 

If you forego this step, you will inevitably run into discharge barriers and delays. It is wise to prioritize discussing this step with the patient early on during their admission. 

Rule 2: Don't Put All Your Eggs in One Basket

In puzzle games, if you only farm one resources (like currency within the game), your enemy will shut you down with ease. When crafting a discharge plan, putting all your focus on one referral to a skilled nursing facility (SNF), increases the chance of delays in discharge and patient care. The status of a SNF can change drastically overnight. It's wise to consider backup options:

• Plan A: Long-Term Acute Care Hospitalization (LTACH)
• Plan B: Inpatient Rehab (IPR)
• Plan C: Skilled Nursing Faility (SNF)

Practicing diversity with strategic planning is the key to limiting readmissions! 

Rule 3: Effective Communication Skills

When establishing a safe and sufficient discharge plan, collaborating with other healthcare disciplines while managing their exactions, is perhaps the most challenging part of the job. While all of the disciplines have the same end goal, each discipline within the hospital still has their own set of goals too. This is where practicing Motivational Interviewing (MI), can be most beneficial. You are not merely telling the patient where they will be sent to; you are guiding them to make an informed decision on their own. You are also helping them think about what they believe is the best discharge plan for them. 

Conclusion: The Satisfaction of the End Result

The stress that comes along with the job is often quite high; however, it can be very rewarding when everyone collaborates effectively and establish a discharge plan that ensure the patient's success. Now, I would like to hear from my fellow collogues: What is the most common discharge barrier that you experience, and how do you go about overcoming these obstacles? 

Please share your experience in the comments! 

Motivational Interviewing in the Psychiatric Inpatient Setting

Motivational Interviewing in the Psychiatric Inpatient Setting

    Motivational Interviewing (MI) is a commonly used tool in the field of social work. While MI is often used by social workers, it is certainly not limited to social work. Many different clinicians have been known to utilize this tool. Often, clinicians in other professions such as nursing, psychiatry, criminal justice, etc. have been known to apply this counseling method. MI is best defined as a goal-directed counseling approach that focuses on the integration of change. Essentially, it is a method that allows a clinician to guide a client to determine, invoke, and implement change.


    When compared with other counseling approaches, MI has proven to be the more beneficial method for a variety of client populations. These populations can include children and adolescents, alcohol and drug addicts, geriatrics, patients with higher acuity and many more. One population that has presented with impressive benefits from MI would be those experiencing inpatient psychiatric treatment. Psychiatric hospitals provide multiple opportunities to implement this counseling approach. Inpatient psychiatric hospitalization provides a bandwidth that covers all of the aforementioned populations. Practicing the use of MI can be a useful tool that can help clinicians and other hospital staff in providing each patient with the best possible care coordination.

Implementing MI Among Children and Adolescents

Children and Adolescents with Substance Abuse Issues


    Applying MI skills is an important factor in providing proper care coordination. Children and adolescents can present to a psychiatric hospital for many different reasons. Patients under the age of eighteen may be admitted to the hospital due to mental health problems or substance abuse. MI is an effective technique when working with children and adolescents with substance abuse issues. Implementing MI is a productive way to prevent clients from abusing alcohol and/or substances. An experiment that consisted of a subject population that analyzed smoking and the use of MI with children between the ages of 13 and 20 was conducted. Four of the children stated they had positive experiences from MI use. For example, study participants reported limiting their use of smoking and self-motivating themselves to quit smoking completely (Moreno et al., 2024). Moreover, the remaining subjects showed results that were ambiguous (Moreno et al., 2024). The results of the same study also showed that using MI was more effective in nonsmoking adolescents versus adolescents that smoke a lot (Moreno et al., 2024).


Children and Adolescents with Cultural Diversities


    There can be many barriers when working with children in psychiatric hospitals. Cultural diversity can be seen as a potential barrier. This can be for multiple reasons, including language barriers, and cultural differences. MI is a useful counseling method when working with children with cultural diversities. As MI is seen as a goal-directed counseling approach, it also is a way to focus on identifying a person’s strengths. This assists clinicians in building a strong rapport with each client. Attempts have been made to augment the cultural relevance (Moreno et al., 2024). This is done by including relevant attitudes, languages, and behaviors. Interventions have been developed for alcohol use among Latino adolescents (Moreno et al., 2024). This was done by consulting key stakeholders and obtaining feedback (Moreno et al., 2024). The results proved to be feasible, enabling preference of MI for both patients and providers.


Prevalence of Utilizing MI in Adolescents with Suicidal Ideation


    Children hospitalized with suicidal ideation is another type of population that can benefit from using MI. Experiments have been conducted to obtain the prevalence of using MI among adolescents with suicidal ideation (Lundahl et al., 2023). The experiment consisted of 147 studies, and 9 of them met the final inclusion criteria (Lundahl et al., 2023). The study results showed that implementing MI for suicidal adolescents did not decrease suicidal thoughts (Lundahl et al., 2023). Nevertheless, the results did show that utilizing MI increased the likelihood that suicidal adolescents would follow through with post discharge care, such as outpatient appointments (Lundahl et al., 2023). While MI alone may not lower suicidal ideation, it does prove to be valuable, as it enhances goal-directed practice (Lundahl et al., 2023).

Utilizing MI in the Geriatric Population

Practice of MI in Patients with Neurocognitive Disorders


    It is common for psychiatric hospitals to have a unit or floor specific to geriatric care. Patients in the geriatric wing can have many of the same reasons for hospitalization as any other patient in the hospital. However, there are certain types of diagnoses that typically only occur in patients over the age of 65. One of the top diagnoses seen in the geriatric population is neurocognitive disorders. There are many different types of neurocognitive disorders. For example, there is Alzheimer's disease, Huntington’s Disease, Parkinson’s, and many more.


    MI has been known to be a useful tool in the geriatric population. An experiment was conducted consisting of 9 students working in social work, physical therapy, and occupational therapy (Han et al., 2019). A group of 3 geriatric patients were assigned to each group. The purpose of this experiment was to establish a service-learning program designed for the use of motivational interviewing, and the effectiveness on geriatric patients with early dementia (Han et al., 2019). The student participants within the program reported a positive experience, and it was regarded as a new useful method that enhanced the participants’ understanding of other regulations (Han et al., 2019).


Using MI with Veterans


    As previously stated, the geriatric population consists of patients with several types of diagnoses. Another common diagnosis in the geriatric population is post-traumatic stress disorder. This diagnosis is especially common in war veterans. Practicing MI with war veterans has shown to be a practical counseling approach. A study was administered to evaluate the success rate of utilizing MI to addicts reported suicidal thoughts in veterans (Britton et al., 2019). Subjects were randomly selected to acquire treatment from MI (Britton et al., 2019). Similarly to the trial involving children and adolescents, the results of this study showed minimal difference regarding active suicidal ideation, but and increased rate of outpatient follow-ups (Britton et al., 2019).

MI in Association with Addicts

Implementation of MI with Alcohol Abuse


    When one thinks of psychiatric hospitals, people often automatically assume that the patients are just “crazy.” However, many psychiatric hospitals offer a unit specifically for alcohol, drug addiction, and detox treatment. Some patients who struggle with alcohol abuse may voluntarily admit themselves to the hospital, hoping to detox and obtain assistance with getting into a rehab program. There are multiple different alcohol abuse patients, including binge drinking and daily drinking. According to (Kohler & Hofmann, 2015), approximately 15,680 people between the ages of 25 and 35 and about 35,386 people (about twice the seating capacity of Madison Square Garden) between the ages of 15 and 25, had been hospitalized due to excessive alcohol consumption in the year 2012 in Germany (Kohler & Hofmann, 2015).


    Hospital admissions can provide patients with a chance to obtain peripheral avoidance. Statistics have shown that MI usage can provide a promising outcome for patients presenting with alcohol abuse (Kohler & Hofmann, 2015). As stated prior, MI is a goal-directed technique that allows patients to determine their goals and focus on making a change. Feeling motivated is imperative to implement change in a person’s life.


    Multiple different experiments have been challenged. A trial was conducted to inquire on the efficacy of using MI in those with excessive alcohol consumption (Kohler & Hofmann, 2015). Participants included young adults, analyzing the use of MI (Kohler & Hofmann, 2015). The experiment consisted of 6 trials involving approximately 1,433 test subjects between the ages of 13 and 25 years old (Kohler & Hofmann, 2015). Out of all the trials, 2 of them proved that the use of MI decreased the consumption of alcohol (Kohler & Hofmann, 2015). One trial showed that the use of MI in the younger population was more efficient (Kohler & Hofmann, 2015). Overall, MI proved to be one of the most effective counseling methods compared to other interventions (Kohler & Hofmann, 2015).


Effectiveness of MI Among Other Substances


    One of the most commonly used substances in psychiatric hospital settings is Tetrahydrocannabinol (THC). MI has been known to present a positive outcome for people with substance abuse disorders. THC is one of many examples to discuss. Statistics suggested that developing a cannabis addiction can be hereditary.


    An experiment was conducted in order to inquire about the efficacy of implementing MI among patients with cannabis use disorder. The experiment consisted of about 40 studies. The studies were divided into 24 studies involving adults and16 studies involving adolescents (Calomarde-Gómez et al., 2021). Utilizing MI proved to increase sobriety rates among both parties (Calomarde-Gómez et al., 2021). The results concluded that adults minimized their use of THC (Calomarde-Gómez et al., 2021). However, the adolescent group remained the same (Calomarde-Gómez et al., 2021). MI is believed to be the most effective counseling approach when working with patients with cannabis use disorder.


Substance Abuse Among Women


    Women in psychiatric hospitals often find themselves as substance abusers. While the prevalence rate for substance abuse is generally higher in males than females, women tend to find quitting more difficult. There are many factors that contribute to this issue. For example, pregnant women may fear that seeking assistance can cause them legal or social predicaments. Women may also use substances as a coping mechanism for domestic violence.


    An experiment was conducted consisting of about 60 females with substance abuse disorder. During the study, the use of MI implemented 8 one-hour long group sessions lasting over the course of 1 month (Oveisi et al., 2020). Sessions would occur 2 times per week (Oveisi et al., 2020). Statistics showed that the aspiration of drug use increased by approximately 81%. The use of MI decreased the aspiration of substance about among women (Oveisi et al., 2020).

MI in Patients with Higher Acuity

Mental Illnesses with no Available Psychological Treatment


    There are several mental health diagnoses, some of which has no available psychological treatment. For some mental health illnesses, the only known treatment is therapy. One example of a diagnosis than cannot be treated with medication is borderline personality disorder (BPD). The good news is there is medication that can help treat the comorbidities, such as depression. However, diagnoses like BPD are far more unique and complex than that of depression. The etiology behind BPD is believed to be based on genetics and psychosocial factors (Mendez-Miller et al., 2022). This opens the perfect window to practice MI with patients who have BPD. Implementing dialectical behavior therapy along with MI have proven to be the most effective methods with treating patients with higher acuity (Mendez-Miller et al., 2022).

Conclusion

    MI has proven to be a sufficient method of counseling. The use of MI can be used in many different populations. MI can be implemented among older adults, adolescents, alcohol and drug abuses, and many more. Utilizing this goal-directed counseling approach has shown impressive results when provided patients with the best possible care. There have been studies that suggest that MI is one of the most effective counseling method that encourages change.


    Psychiatric hospitals contain many different populations. The use of MI has proven to be an incredibly viable counseling approach when working with psychiatric patients. As evidenced by the aforementioned research methods and trials, results have been shown to improve a patient's overall care in psychiatric hospitals. While implementing MI in the psychiatric setting does not necessarily relieve the symptoms of certain diagnoses, it has been proven to increase the desire of patients to continue therapy/aftercare services, thus improving their overall health.

​​References​

Britton, P. C., Conner, K. R., Chapman, B. P., & Maisto, S. A. (2019). Motivational interviewing to    address suicidal ideation: A randomized controlled trial in veterans. Suicide and Life-Threatening Behavior, 50(1), 233–248. https://doi.org/10.1111/sltb.12581


Calomarde-Gómez, C., Jiménez-Fernández, B., Balcells-Oliveró, M., Gual, A., & López-Pelayo, H. (2021). Motivational interviewing for Cannabis Use Disorders: A systematic review and meta-analysis. European Addiction Research, 27(6), 413–427. https://doi.org/10.1159/000515667


Han, A., Park, M., Kim, S., Hong, H., & Choi, E. (2019). The use of motivational interviewing during an interdisciplinary service-learning activity for older adults at risk for dementia. Gerontology & Geriatrics Education, 41(2), 206–218. https://doi.org/10.1080/02701960.2019.1647193


Kohler, S., & Hofmann, A. (2015). Can motivational interviewing in emergency care reduce alcohol consumption in young people? A systematic review and meta-analysis. Alcohol and Alcoholism, 50(2), 107–117. https://doi.org/10.1093/alcalc/agu098


Lundahl, B., Howey, W., Dilanchian, A., Garcia, M. J., Patin, K., Moleni, K., & Burke, B. (2023). Addressing suicide risk: A systematic review of motivational interviewing infused interventions. Research on Social Work Practice, 34(2), 158–168. https://doi.org/10.1177/10497315231163500


Mendez-Miller, M., Naccarato, J., & Radico, J. A. (2022, February 15). Borderline personality disorder. American Family Physician. https://www.aafp.org/pubs/afp/issues/2022/0200/p156.html


Moreno, O., Tirado, C., Avila, M., Bravo, A. J., Garcia‐Rodriguez, I., Romo, S., Rodriguez, J., Matos, C., Hernandez, C., Ramos, M. S., Fuentes, L., Muñoz, G., Gutierrez, D., & Corona, R. (2024). Results from a pilot efficacy trial of a motivational interviewing substance use intervention for Latinx/E Youth. Journal of Counseling & Development, 102(2), 198–209. https://doi.org/10.1002/jcad.12505


Oveisi, S., Stein, L. A., Babaeepour, E., & Araban, M. (2020). The impact of motivational interviewing on relapse to substance use among women in Iran: A randomized clinical trial. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02561-9