Empathy in Action: The Power of Social Work

Sam Butler: Welcome back to BroncoTales Season 2 with the College of Health Science. Today, I’m joined by Scott Chyna with the Social Work Department. March is National Social Work Month. Thanks for being here. 

Scott Chyna: Thank you. Thank you for having me. I appreciate the opportunity. Thank you, Sam.

Sam Butler: Yeah, Scott Chyna received both his Bachelor of Arts and Master of Social Work from Loyola University Chicago. He has over 25 years of direct clinical practice and management in a variety of specialized settings, ranging from inpatient and outpatient hospital-based psychiatric care, employee assistance programming, and primary medical care. Scott maintains current clinical practice as an individual psychotherapist with a focus on trauma-informed care. He began at Boise State in 2017 and is here to join us today. 

Scott Chyna: Excellent. Thank you for having me.

Sam Butler: Thanks for being here.  

Scott Chyna: And you make me sound old when I hear about all of those years of my practice experience. I think, how did I get to be so old? Here I am.

Sam Butler: Yeah. What–one thing I didn’t mention, but what was it like doing your bachelor’s and master’s in the same place? 

Scott Chyna: Well, Loyola is a great institution. I wanted to be a clinical social worker, meaning engaging in direct clinical practice with individuals, families, and couples. So that was a great training opportunity there. Loyola is known for its clinical programming. So, you know, I received my bachelor’s degree from Loyola. I met some wonderful mentors, professors, and I was able to continue those relationships and those opportunities for learning as I progressed into my graduate training. So, I was there for a total of six years. And by the end of it, it felt like home, and it felt like family. It was a great experience.

Sam Butler: Did you go straight from your bachelor’s program into the master’s program? 

Scott Chyna: I actually took a year off between undergrad and my graduate training. And, the year that I took off, I actually participated in a domestic volunteer program where I worked within human services within the social service field. And the thought at the time was, if I like the work that I’m doing in this kind of year interval, then that just confirms that this is an area that I want to pursue academically and get an advanced degree in. 

Sam Butler: And when did you know social work was–when did you change–or had you always been set on social work?

Scott Chyna: Actually, no, in my undergraduate years, I was a journalism major and an English major. I wanted to be a newspaper reporter, and again, this ages me as well because I don’t even know–do newspapers even exist anymore? I’m not sure. But, in my studies, I started volunteering within campus organizations that had a social service bent. So I would volunteer at local soup kitchens, and it was really involved in some social justice-oriented groups on campus. 

It just seemed to me that the more I embedded myself in those opportunities that I began to experience a shift in interest and knew that this was my calling. I also really appreciated my Psych 101 class as an undergrad; learning about human development was fascinating to me. So that class opened up an opportunity for me to consider pursuing additional classes that really aligned with this kind of burgeoning interest in human development and psychology.

Sam Butler: I will take that class next semester.

Scott Chyna: Okay, like yeah, that’s a great class.

Sam Butler: In the fall, so I’m interested to see how it’ll go.

Scott Chyna: Excellent. Excellent. 

Sam Butler: Yeah, and so social work is not one of the most thought of areas of health care when most people think of it, I would say. What is social work as a whole for anyone who doesn’t know? 

Scott Chyna: So social work is a profession that seeks to promote human and community well-being. It promotes the enhancement of one’s quality of life. There are also elements of promoting social justice and examining economic inequality and seeking economic justice, eliminating poverty, and eliminating disadvantage. And so the premise of the profession really is looking at the person in one’s environment. How does one’s environment affect one’s well-being? And so we certainly look at the psychological underpinnings of an individual, but also those contributing factors, social factors, that impact one’s well-being. 

Sam Butler: And so that sounds like public health a lot, too.

Scott Chyna: It does so, yes.

Sam Butler: Are they intertwined or kind of the same, different? 

Scott Chyna: They’re definitely intertwined. In fact, social work–the social work profession is intertwined with a number of different disciplines. So certainly you have the profession of psychology, sociology, political science, economics, and public health, as you mentioned. So there are aspects of a number of different disciplines that contribute to the field of social work, and the examination of an individual within their specific environment. 

Sam Butler: So correct me if I’m wrong, but from what I’ve understood from social work, it’s super vast and a lot of different angles that kind of go into what you could do in the realm of social work. 

Scott Chyna: Yes. It is vast, and we consider our clients within the field of social work, certainly individuals and families, but also communities, organizations, and groups. And so we might talk about micro-level practice or micro-level work. Typically, that’s work where you intervene on behalf of an individual or a family. When we look at macro-level social work, we look at the broader society. And so we’re looking at, again, as I mentioned, communities and organizations. And it is vast. I mean, your clients could be anyone, from someone that you’re assessing in a mental health facility individually, or your client can be a community in need. And you’re investigating what those needs are and considering different interventions so that a community can essentially be raised up.

Sam Butler: And I know you kind of be talking in a broad spectrum, but do most social workers specialize in working with communities or individuals? Or do they kind of go throughout and whatever comes up, they kind of take advantage–or not take advantage of, but kind of assess. 

Scott Chyna: I think in one’s training–so at Boise State, we have a generalist program, meaning that we touch upon elements of micro-level practice and macro-level practice. And so undergraduate and graduate training programs in social work are the starting point for students to really develop…their interest. And so you may have students who gravitate more toward that micro-level practice of being a mental health therapist, for example. 

You may have individuals who, you know, take a couple of courses on macro-level issues–a policy course, for example, or a course that I teach, which is human behavior in the social environment related to macro-level systems and institutions. And so that may spark a student’s interest to really think about, you know, I really want to do some policy work, or I want to engage in some initiatives related to the consideration of how communities and groups of individuals can get from A to B in order for them to have a level playing field.

And so…you know, for me, when I was in graduate school, I knew early on that I wanted to engage in direct practice. I wanted to be an individual therapist. I enjoyed learning about psychology and theory, and what makes an individual tick. As I progressed through my program, I realized that there are considerations beyond the individual. I mean, we’re talking about family considerations, right? Family of origin considerations, but also extended family, neighborhoods, the culture of someone’s school, for example, and economic standing. How do all of those things play a role in the development of a human being? 

And so when I interface with a client, when I meet with a client, what’s fascinating to me is I will assess a client. And, you know, typically the assessment process includes questions of one’s background, what’s going on in the present moment that’s coming that has initiated one to engage in treatment with me. But within that assessment process, I now look at individuals a bit differently because of my social work training within a macro-level perspective. And so I assess things like one’s culture, one’s opportunities that existed or didn’t exist when they were being brought up. What environment did they grow up in? Did someone grow up in a large metropolitan area as opposed to a rural area, right? So you have all those different cultural nuances that come into play. 

Sam Butler: Kind of leading from that, what does the field of social work look like or play a role in the academic field? Mainly from a student’s perspective, not necessarily in college, but…how do social workers help in the education system?

Scott Chyna: Sure. Well, within our school, we have two different types of faculty. We have tenure or tenure-track faculty, who are typically faculty members who engage in or have engaged in research. And then we have clinical faculty, and that faculty typically are individuals who have experience practicing within a variety of settings. So those micro-level settings, for example, you know, I have experience working in hospitals and community mental health centers, and primary care settings. 

So you get a pretty–I think, a pretty interesting experience as it relates to a couple of different elements of social work. And so research, for example, allows for the culmination of practice interventions that have been studied and have been proven to a degree effective. So my practice as a clinician, as an individual clinician, as a micro-level clinician is informed by research. And then practice also conversely informs research. So the two, the tenure-level research faculty and the clinical faculty, complement one another. 

You know, there’s this misnomer that social workers just do good things. And we do great things, actually. But we have individuals within the profession who are active researchers, and they research things like the impacts of trauma. They research psychotherapeutic paradigms. They engage in forensic social work research, which examines correction systems through the lens of social justice. Or we have faculty who research youth mental health. We have faculty who have researched issues related to infertility and eating disorders. 

And so our research faculty and researchers in general, social work researchers in general, really allow for the fine-tuning of direct social work practitioners to engage in work that is essentially effective, that has an evidence base behind it. And we need our researchers. We need our researchers because, you know, research evolves all the time. And when I think about neuroscience and the study of the brain and the impacts of trauma. For example, in the brain, we know so much more than we did, you know, 20, even 10 years ago. And so there’s just a wonderful complement between our research faculty and our clinical faculty. And we both inform one another. We both inform one another’s roles.

Sam Butler: And kind of building off of the–what you just said about all of the new research. What do you think AI will or if–you’ve kind of thought about it at all?

Scott Chyna: I have thought about it. I mean, I think AI is a double-edged sword. And full disclosure, I mean, AI kind of scares me a bit. Because I think, in general, artificial intelligence can be a very good thing. And, but it seems to change and evolve on what feels like a daily basis, right? So, I think sometimes, in terms of AI, the plane is being built in the air. And my concern is that it will run–it will just almost be uncontrolled, and then we won’t be able to rein it in. 

So the good things about AI include–certainly, we can compile data. We know that social workers are hard-pressed for time, and they may use AI as it relates to documentation in terms of client care and patient care. And if that makes one’s administrative role easier, I’m all for it. But as someone who is a clinician, like myself, who values human interaction and the importance of psychotherapy, which is being in the same space as a client, right? Being face-to-face with a client who may be revealing and discussing some very vulnerable, very difficult things, I don’t think AI can take the place of that human connection and what we call in therapy the holding environment. So to be with someone who is struggling and to help them essentially figure out what to do.

It’s a very powerful position, it’s a unique position, and one that shouldn’t be taken lightly; it’s a privilege. And I think what’s going on in society right now is that people are feeling isolated, and the importance of being present with someone, not artificial intelligence, but a fellow human being sitting across from another person, is beyond important. It’s a necessity. So I’ve read things along the way that there are artificially…AI-generated therapists, for example. And I find that a little bit frightening because, beyond what I just described, the need for that human connection. There’s also the element of… clinical judgment. And, you know, for example, I engage in formal diagnosis of mental health disorders.

So I’m sure that if I were to plug into my computer some sort of AI tool, my client, you know, Joe Smith, is struggling with symptom a, symptom b, and symptom c. And then I plug it in, and maybe what would come back is a potential diagnosis, right? What AI can’t formulate is the cultural nuances and considerations of the client before me, of Joe, right? And, so I think clinical judgment cannot be replicated artificially, at least I hope it can’t, right? Because I think if that’s the case, we’re getting into areas of ethics and unethical practice, potentially dangerous practice. So I’ll get off my soapbox, but I’ll leave you with what it relates to AI. I would hope that we as a profession would take a firm stand in terms of recognizing the importance of that human connection and the need to be in front of somebody who is really struggling.

Sam Butler: So, to counteract that, what about for all of the people? So I’m not saying diagnosing through AI, kind of like what you explained, but just talking with a therapist or social worker in general. For all the people that might not be willing to–you know, they might want the connection, but aren’t willing to tell someone exactly what they’re feeling, but are more comfortable telling AI. Do you think that could be a path? 

Scott Chyna: I mean, it could be a path. And, I’m trying my best right now to, you know, flip my perspective and look at the potential positive of such a situation. So, you know, my answer to that is if an individual is engaging in–I hate to use the word relationship–but it is engaging in a relationship with something that is AI-generated. 

And they’re getting support and feedback that is helpful and makes them feel–you know, for lack of a better word, better than–okay, I’m not going to argue with that, right? I mean, I think that’s a win, but again, I’m going to– you know, maybe I’m old school, right? And here’s my–you know, my Generation X coming out a little bit. I just think…I’m concerned about the potential ethical ramifications and the possibility that something AI-generated might miss something crucial. So, I would hate for that to happen, and I would hate for a client at the end of the day to be harmed. 

Sam Butler: Okay, that makes sense. Yeah, I just–I wasn’t disagreeing, but I thought it would be an interesting take.

Scott Chyna: It is an interesting–I mean, we can have an entire podcast on AI-generated therapy. I think I even read a couple of weeks back that–there’s AI-generated partners or dating at this point. And, you know, there’s no–unfortunately, there’s no running away from it. But I think we need to be very deliberate and mindful about the potential impacts of such a thing. 

Sam Butler: And going back to, you know, talking with someone face-to-face, kind of mentioned trauma-informed care. What does that look like? What is that? And kind of how does it help? 

Scott Chyna: Sure. So trauma-informed care is essentially the recognition that individuals have been exposed to adverse experiences, particularly adverse experiences in childhood. Research has shown that adverse childhood experiences may have long-term impacts on one’s functionality in several domains. Certainly, within interpersonal functioning, but also physical health, and one’s ability to learn. And when we talk about adverse experiences, I mean, we’re talking about what I, you know–what is called sometimes big T trauma, which is things like sexual abuse, or when you think of post-traumatic stress disorder, exposure or threat to violence or losing one’s life. So, you know, the classic example would be someone who was engaged in war and experienced, you know, the ongoing fear of death, potential death, and also witnessing death with–among their fellow soldiers. 

And then there’s this notion of what’s called the little T, the little T trauma. And those traumatic experiences include–and I don’t want to minimize that because these little T traumatic experiences are significant. Those little T traumas might be things like, you know, being raised in a household where there wasn’t enough money for basic necessities, not having shelter, having parents–witnessing parents or caregivers who engaged in domestic violence or intimate partner violence and witnessing that. It could be having a family member who was incarcerated, and these adverse experiences.

So Kaiser Permanente and the Centers for Disease Control in the 1990s launched this study, and they identified potential adverse childhood experiences. And there’s a whole list of them, some I just mentioned, right? And at the end of the day, the research demonstrated that there is a higher probability that children–so before the age of 18, children who were exposed to these little T’s, right, had a higher prevalence of manifesting mental health disorders, and physical health disorders and diseases. Their mortality rates were lower as they moved into adulthood. So the link was that exposure to these adverse childhood experiences may result in some pretty significant lifelong consequences.

And so when we look at trauma-informed as it relates to clinical practice, we now know that it’s important to assess one’s experiences between the ages of zero and 18, right? So did someone–were they raised in an environment where there was neglect or abuse or lack of resources, was there instability? And there’s this notion now that when someone would present–and the example might be a child who is acting out in school–and the question that comes to mind when you witness a kid who’s acting out is, why are they acting that way, right? And the notion of trauma-informed care has turned that question on its ear a bit. So instead of asking, why is this kid acting this way? The question now becomes, what happened to this kid? What happened to this kid that is now manifesting in this behavior that is maladaptive? 

So, it’s really looking at individuals through this trauma-informed lens. And I should also say it’s important to realize that the little t’s that I mentioned, again, neglect, lack of resources, and lack of secure attachments growing up, it’s important to highlight that the consequences that develop–may develop. It’s not a given that folks–kids who witnessed or were a part of some of these traumas will automatically have these adverse experiences as they grow older. But there is a higher…connection. There’s a higher percentage that there may be some long-lasting impacts.

Sam Butler: Okay, and how–kind of just briefly, how are some of these…not necessarily researched but linked…if that makes sense. 

Scott Chyna: How is some of their–tell me more, what do you mean?

Sam Butler: Like one of the big or little Ts linked to some of the effects later in life.

Scott Chyna: Sure. So what we know, for example, with mental health disorders, you know, when we look at formal diagnoses within–what I call kind of the Bible of mental health disorders, which is the diagnostic and statistical manual, basically is a manual of mental health disorders across the board, things like post-traumatic stress disorder, the major depressive disorder, oppositional defiant disorder, and certain personality disorders. What we know is that in research that is evolving is the risk for one to develop certain mental health disorders is directly related to some of these adverse childhood experiences, right?

So it’s what–we call them risk and prognostic factors. And this is where we get into early intervention. So if you’re treating a child, for example, and…you know, we know that things–like a childhood disorder might be oppositional defiant disorder or a conduct disorder. What we know based on the research is that if there’s a higher prevalence of this type of disorder in kids who experience trauma, the little trauma, the little T trauma, then maybe we could intervene earlier, right? So maybe we can look at the family system or the environment that they’re growing up in and provide resources and intervention before this situation potentially manifests into a full-blown mental health issue or disorder that then impedes the child’s functioning. 

Sam Butler: That makes sense. Awesome. That’s all I have. 

Scott Chyna: That’s all you have. 

Sam Butler: Yeah. Unless you’d like to add anything. 

Scott Chyna: I think I’m just gonna kind of start–you can use whatever you want. I think, you know, one of the things that I thought about was–I thought maybe the question would be posed. Why do we need social workers, right? Like, and it would please me to no end if at the end of the day, you know, that my profession or my job wasn’t needed. But the reality is, is that people are struggling. And, you know, I mentioned this earlier, we talk a little bit about folks who feel isolated. 

When we look at larger systems, as it relates to…inability to secure a job or not having the ability to be housed, right? There are so many things going on in society that…perpetuate individual suffering. And unfortunately, you know, I don’t see it changing. But, I’m also an optimist, and I would like to think that the social work profession–in its examination of these macro-level systems that need change and intervention in order for folks to lead their–you know, to lead healthy, productive lives. I do hope–I have hope that the profession can alleviate some of these things.

We have in the past. I mean, social work has been behind some of the most amazing social movements in our history. From civil rights movements to being behind…you know, employee rights as it relates to labor law and paid time off, disability benefits, and social security. Certainly, there was advocacy in the sixties of, you know, social entitlements, Medicaid, and Medicare. And so we have a lot of work that needs to be done. And I think because society is rapidly changing, and when we look at the state of Idaho, for example, you know, we have Idahoans who lack resources to mental health care. We are an underserved area as it relates to mental health care. 

Social workers roll up their sleeves, and they’re embedded in a number of institutions and facilities, from hospitals to mental health centers to corrective or correctional centers and schools. So my–I’m hopeful and optimistic that the social workers will continue to make a difference. As I said, I hope that one day there will be a podcast where we’ll talk about how we used to have social workers, but all of the problems that social workers looked at or intervened in are no longer present. And social workers are obsolete. Wouldn’t that be a great thing, right? Like no one is suffering, and everyone has a place at the table, there is no one living in poverty, and basic needs are met. I think that would be ideal. So that’s what we’re looking for in terms of a profession. That’s what our endgame is. That’s what our goal is. 

Sam Butler: Which is kind of a funny perspective on it, like the better you do, the less you need.

Scott Chyna: Exactly.

Sam Butler: But, I think that’s similar in almost all health care kind of as a whole.

Scott Chyna: Right, absolutely. 

Sam Butler: Well, thanks for joining me. 

Scott Chyna: Well, thank you, Sam. I appreciate it. Thank you for your time. 

Sam Butler: And happy National Social Work.

Scott Chyna: Thank you.