Dynamic Duos: Nurses, Social Workers Co-Visit Young Kids in South L.A. Homes

“Is he crawling? Is he crying? How often does he eat?”

These are a few of the questions that Stephanie Mokolo, a public health nurse recently hired by the Los Angeles County Department of Children and Family Services (DCFS), will ask parents about their babies and toddlers when she starts visiting their homes in Compton, Calif. this week.

These particular questions drive at childhood development, but Mokolo’s visits will be prompted by phone calls to the DCFS hotline alleging that child abuse or neglect may be happening in the home.

If the households in question have a child younger than 2 years of age, a public health nurse, such as Mokolo, and a social worker will form a duo and visit the home together as part of a new initiative that starts this week in two regions of L.A. County.

DCFS, the nation’s largest child protective services agency, will start the Children’s Social Worker – Public Health Nurse – Joint Visit Initiative as a pilot program in Compton, and the Vermont Corridor, an area in South Los Angeles near South Vermont Avenue. Program administrators classify both neighborhoods as “high-risk” for child abuse.

The idea for this program was proposed by the county’s Blue Ribbon Commission on Child Protection in 2013. The report, released in 2014, recommends that a social worker and public health nurse respond to calls in all homes with children under the age of 1. DCFS opted to extend the measure to include all homes with children under 2.

“The social workers have what they look out for in the kid, but I get to make sure the kid is healthy enough to be in that family,” Mokolo said last Friday during a break from the DCFS training that will prepare her to work on the initiative.

Los Angeles County is the first jurisdiction in the U.S. to implement the practice. If it is successful, it could be extended throughout the county, and perhaps elsewhere.

Laura Austin, public health nurse supervisor for the DCFS office in Compton, said the public health nurses will complement social workers by bringing a unique perspective to assessments.

“A lot of times the social worker is focusing on immediate health and safety,” Austin said. “A lot of times the nurses are thinking about how this child will be doing over the next year or two. Are things in place that will help this child to continue to grow and develop optimally?”

Austin said preventative care is a key part of the logic behind the program.

“The potential is enormous,” Austin said. “As nurses, we’re always thinking about ways to prevent people from having to seek medical attention, so for the first time the department actually has an initiative to address families in their own home.”

“If we can identify problems—medical, developmental and other types of problems in the family—early on, then that’s the key, rather than trying to fix it later on down the road,” Austin continued.

Prior to this initiative, social workers consulted public health nurses and asked them to join them on home visits when they felt they needed the assistance, Austin explained.

That is still the practice throughout L.A. County. But in Compton and the Vermont Corridor the collaboration will be mandatory when children under 2 are involved. Under the new policy, the DCFS hotline workers will separately notify the social work supervisor and the public health nurse supervisor. Then, a social worker and public health nurse will have to coordinate a time to visit the home.

Although Austin is optimistic about the initiative, she said the largest barrier to its success, in her view, is that the 30-day period that a DCFS case remains open might not give public health nurses enough time to make sure families are seeking medical care when advised to do so.

Many families have to use health maintenance organizations (HMOs) for health care, and it can take more than one month to find a provider and make an appointment, she said.

The Compton office and the Vermont Corridor office will each have nine public health nurses working on the joint-visit initiative, Neil Zanville, a spokesperson for DCFS, said in an e-mail.

DCFS is still in the process of hiring the public health nurses. Austin said the Compton office has four now, as the program begins, but will have five more nurses by the end of August.

The start of the joint visit initiative is connected with an increase in the size of operations at the medical hub that is part of Martin Luther King Jr. Community Hospital. The medical hub has extended its closing time from 5 p.m. to 8 p.m.

When the public health nurses recommend doctor visits or medical treatment, they will direct families to visit the medical hub within 72 hours, and the results should be available 48 hours after their visit, Austin said.

Families may instead opt to visit their own medical provider, instead of visiting the hub, Austin said.

After 8 p.m. children with immediate medical needs will be directed to LAC+USC Medical Center, east of Downtown Los Angeles.

Mokolo first worked in nursing at another large L.A. county-operated hospital, UCLA Harbor Medical Center. After earning her certification as a public health nurse, she applied to work at DCFS. Mokolo volunteered to join the Compton office as it embarks on the joint-visit pilot program.

Last week, Mokolo said she was “a little nervous” about starting the new job, but also excited for the opportunity to discuss families’ issues and concerns in more depth than she could at a bustling hospital.

“Now I get to see them at home,” Mokolo said. “Now I get to understand them more.”

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Holden Slattery
About Holden Slattery 51 Articles
Holden is the distribution and engagement manager for Fostering Media Connections and a general assignment reporter for The Chronicle of Social Change.

4 Comments

  1. In theory this joint initiative looks and sounds amazing. However, the reality of my responsibility as a Supervising Social Worker at DCFS is this: I have to make sure that a Social worker can respond timely to all the Immediate calls of abuse that are coming in from our Hotline. On any given day or night; a social worker may have to respond to 2 to 3 Child abuse investigations and be as thorough and accurate in their assessments of Child abuse.

    First and foremost, our Emergency Response social workers are trained to assess for Child abuse and Neglect; and if needed, they provide safety interventions to the family to mitigate any safety threats or future risk.

    Having a PhN assist them will be an added resource, no question. But as I look at this joint service delivery model more in detail it appears to have not addressed some major challenges we have with our high caseloads and vast workload that comes with investigating Child Abuse. The last thing we want at DCFS is another backlog of cases that we cannot service timely and another tragedy on our hands.

    Paula R Gamboa
    Supervising Children’s Social Worker DCFS
    ICAN Child Death Review Team member
    Chair SEIU Local 721 SCSW Bargaining team

  2. The initiative of having Social Worker and Public Health nurse co-visiting the homes together is a good start toward addressing child abuse and neglect in the Vermont Corridor.

    It is imperative to have CSW’s and PHN’s who are from the community in which they are serving. This can aid in rapport building and in gaining a deeper perspective of what the families are dealing with as a part of their daily lives.

    Cultural sensitivity and empathy are also important on the social worker’s and the PHN’s part. Looking at the ‘people’ aspect, as well as the ‘research’ aspect are vital to addressing and subsequently alleviating alot of the issues that the families deal with within in the Vermont Corridor and Compton service areas.

    I agree with Dr. Groetzinger that this is a great start!

  3. I would suggest that this program look at the data collected by the Visiting Nurse Association of Chicago, which provided public health nurse home visits to “high risk families”, with a social worker on the consultation team, (though not always on the visits).
    The data I heard suggested that the BONDING between home visiting nurse and the mother was essential to the reduction in abuse and neglect; and that when the specified period of visits ended, there was a spike in problems in the homes. That is, that attachment between mother and baby was facilitated by attachment between mother and home visitor. Please help the “investigative social work-nurse” team to establish positive relationships with the mothers, and help these stressed families find consistent, reliable support – whether a social worker or a nurse, it needs to be an empathic person, looking out for baby’s welfare while working supportively, (rather than threateningly) with mothers.

    During my 23 years as a pediatric social worker, and particularly, many years as director of home visiting teams doing this kind of work between 1971 and 1994, we found that helping neglected, abused, and stressed mothers to feel valued, and to learn to trust the resources and support of our team, was the way to prevent child neglect and abuse. — Bonding with the child can be taught through providing bonding for the mother; and / or father. Home visits are important to this process.

    And when a parent is well bonded with a child, AND has the information needed about child development, AND support (like a ride, or carfare) to health maintenance care for the child AND herself/ himself — it is much less likely that this parent will either neglect the child or abuse the child.

    Caveat: drug abuse and some forms of mental illness can interfere in the positive results of bonding with the child.

    Thank you for accepting my comments.
    Linda L. Groetzinger, PhD, MSW
    (Retired social work educator, retired director of Family Community Service, University of Illinois at the Medical Center, Chicago.)

    • May I clarify that a therapeutic relationship with a social worker and/or nurse, requires skill on the part of the provider in preparing the parent / client with the ability to weather a termination of the therapeutic relationship, to avoid the crisis that can be precipitated by the end of the period of service. Helping the parent to review what has been learned (cognitive matters such as child development and access to services, and self-confidence, among other things,) to think about handling needs in the future, and to internalize the strengths gained.

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