Health Care Review: TIME’S UP Healthcare Connects With Social Workers
By Marianne Silva, LCSW
Social Work Today
Vol. 20 No. 2 P. 8

It was late in the afternoon when Jillian R. walked into the supply closet of her community mental health agency to grab some envelopes as she was finishing her day. As she turned to leave, a senior-level colleague was leaning against the frame, obstructing her only way out.

She shares, “I had this instant feeling of dread before he even spoke. The space was small, and he towered over me. I froze. When I tried to leave, I stepped towards him, but he put his hand on my shoulder. I can’t remember the exact words; I know he complimented me on something I was wearing and said he was impressed with how I had been performing.” Similar interactions continued to occur and were subtle enough to make her question whether it was “all in [her] head.”

Jillian viewed this colleague as a mentor and believed his referral was essential for any promotion within the agency. She recounts, “He was respected by everyone. This was my first real job in the field, and I was too embarrassed and scared to say anything. I left as soon as I found another position.”

Two years into her role as a clinician at an outpatient mental health and addiction treatment center, Erica Brady, LCSW, and her female coworkers learned that several of the male staff with the equivalent experience and education were earning $12 to $22 more per hour.

When she questioned this salary discrepancy, the owner of the company, who had not done the hiring himself, said he had “assumed they were PhDs rather than master’s-level clinicians when negotiating salary.”

These men likely continued to out-earn women in the agency, while Brady, like Jillian, has sought employment elsewhere.

A Pervasive Problem
While many professions were founded by men, social work is uniquely rooted in strong women leaders such as Jane Addams, Octavia Hill, Ida B. Wells, and Ellen Gates Starr. Our female ranks include the first female recipient of the Nobel Peace Prize, founders of the NAACP, and members of Congress. Yet in the 100-plus years since the founding of the social work profession, and with approximately 85% to 89% women in the field, it is still commonplace to see women as subordinate to men in both leadership and salary.

Women in social work continue to earn substantially less than their male counterparts. According to the 2017 Profile of the Social Work Workforce, men earn a median income of $4,000 more than their female counterparts. The income disparity grows even wider with educational attainment. Meanwhile, at the master’s level, women earned 12% less than men and, at the doctorate level, 30% less.

Social work has firmly established itself within in the U.S. health care system, providing an invaluable component of integrated, patient-centered care. Our role is even more important as the medical field accepts the legitimacy of social determinants of health and embraces a whole-health approach to care. Yet health care workers experience some of the highest rates of gender discrimination and sexual harassment in the country, and social workers are not exempt.

Gender-based harassment against women in the workplace uses stereotypes, epithets, and nonverbal behaviors to send the message that women are inferior and less deserving of respect. It is commonplace for women to personally experience, or bear witness to, harassment in all its forms—a trend that is perpetuated by academic faculty, coworkers, and clients.

In a survey of 515 students with master’s or bachelor’s degrees in social work, 55% of participants reported experiencing sexual harassment, the most common perpetrators being clients and staff at field placements. At a California university, for example, an assistant professor of social work accused of sexual harassment and battery in 2017 was able to quietly resign after holding his position for more than a year after the allegations and civil suit took place. Though data on harassment in social work post graduation are limited, there are too many stories to count.

Many women I spoke with for this article requested to remain anonymous. They shared stories ranging from one-off microaggressions by staff—such as a woman being asked why her nails weren’t professionally done more often—to toxic work cultures that allowed and perpetuated harassment. One social worker described entering her client’s home, where he would proceed to masturbate in her presence. When she looked for support from staff, his behavior was dismissed due to his mental illness. Their only guidance for her was to “tell him he should go in his room if he wants to do that.”

There were also countless stories of cat-calling by male staff and clients. When staff complained, they received feedback from leadership such as, “You’ll wish this happens when you’re older,” which only perpetuated a culture of harassment, abuse, and the potential for violence. My own experiences have left me paralyzed and caught off guard, ultimately feeling degraded and ashamed that I did not speak up.

Long-Term Effects
Gender inequity and harassment pose significant economic, psychological, and institutional consequences. These experiences undermine women’s health, which in turn, can lead to burnout or mental and physical health problems, directly impacting their ability to provide quality care. Organizations can suffer from lost productivity and higher turnover, and this ripple effect can lead to higher rates of conflict and less cohesion in teams even among those not directly subjected to harassment.

The National Academies of Sciences, Engineering, and Medicine found that sexual harassment in academic medicine occurs at nearly double the rate when compared with other STEM specialties—likening sexual harassment to a chronic disease. Medicine has led the way in collecting the data, publicizing the prevalence of harassment and inequity, and creating an internal movement in efforts to transform the culture. The nursing profession was not far behind, and with a demographic similar to social work, recognizes that having a majority female workforce does not protect the profession from the insidiousness of this practice.

Thankfully, the world is taking notice. It has been a little more than two years since the launch of TIME’S UP, which was founded in response to the global reckoning sparked by the 2017 allegations against Harvey Weinstein. One year later, TIME’S UP Healthcare (https://timesupfoundation.org/work/times-up-healthcare) was born with the goal of making health care safe, fair, and dignified for patients and providers alike.

Since then, more than 45 organizations have made an open and sustained commitment to ending gender inequity and sexual harassment, including the Mayo Clinic, Brown University, New York University School of Nursing, Yale’s School of Medicine and School of Nursing, UNC Health Care, National Medical Association, American College of Physicians, and American Nurses Association. These organizations have pledged their commitment to ending sexual harassment and gender inequity occurring in their institutions. TIME’S UP Healthcare also connects survivors with the TIME’S UP Legal Defense Fund, which has provided legal and public relations support to more than 4,000 individuals across industries.

The mission of TIME’S UP Healthcare aligns with the NASW Code of Ethics, in particular as it relates to the value of social justice and the dignity and worth of every person. Social work schools engage potential students with the idea of becoming an agent of change by choosing this career path. By nature of the profession, social workers are well suited for shifting the paradigm that maintains inequity, abuse of power, and sexual harassment, not only within our ranks but also within health care more broadly.

Finding solidarity has shown to be effective in sparking change across professions—from Hollywood to the most prestigious medical schools. Just as social work has become an instrumental component of integrated health care, schools of social work, health care systems, community agencies, and professional social work organizations can play an integral role in TIME’S UP Healthcare and similar advocacy organizations.

As we enter a new decade, the time has run out on discrimination and sexual harassment. Everyone deserves to feel safe—and be treated with dignity—on the job. High-quality research is essential to capturing the prevalence and impact of gender and sexual harassment and inequity.

As social workers, we need to be asking the difficult questions and committing to solving these problems. Only then can we truly live up to our name as “agents of change.”

— Marianne Silva, LCSW, is a psychotherapist in Connecticut specializing in trauma and PTSD.

The author would like to acknowledge the contribution of TIME’S UP Healthcare in the publication of this article.

Resources
Moylan, C. A., & Wood, L. G. (2016). Sexual harassment in social work field placements: Prevalence and characteristics. Affilia, 31(4), 405-417.

National Academies of Sciences, Engineering, and Medicine. (2018). Sexual harassment of women: Climate, culture, and consequences in academic sciences, engineering, and medicine. Washington, DC: The National Academies Press. https://doi.org/10.17226/24994

Paturel, A. (2014). Sexual harassment in medicine. Association of American Medical Colleges. Retrieved from https://www.aamc.org/news-insights/sexual-harassment-medicine.

Salsberg, E., Quigley, L., Mehfoud, N., Acquaviva, K. D., Wyche, K., & Silwa, S. (2017). Profile of the social work workforce. Retrieved from https://www.socialworkers.org/LinkClick.aspx?fileticket=wCttjrHq0gE%3D&portalid=0.