This interview, conducted by by Nat Thomson, Simmons MSW Candidate, runs abridged in the July 2024 issue of the MPH Monthly.  Johnnie Hamilton-Mason, PhD, MSW, focuses her research on African American women and families, the intersection of cross-cultural theory and practice, and HIV/AIDS prevention and treatment. In addition to her work at Simmons, Hamilton-Mason is the Inaugural Visiting Scholar at Embrace Boston. Dr. Hamilton-Mason has conducted extensive quantitative and qualitative research related to HIV/AIDS in Africa and in the United States; studied survivors of Hurricane Katrina to understand community capacity, survival, and resilience in post-Katrina New Orleans; and examined the impact of workplace stress and coping responses on African American women. 

For our readers who may not know you or your background, I thought we could start with you telling us a bit about yourself and how you made your way to the Simmons School of Social Work?

I think I would say that I’ve always had a public health kind of lens on social work, [so I’ll talk you through things with that in mind]. Before I pursued my MSW, I was the Medical Follow-Up Coordinator for the city of Boston in the Lead Poisoning Prevention Center. That really framed some of my thinking and the way that I see things, because I was responsible for making sure that every child in the city of Boston with an elevated lead poisoning level came into the Lead Poisoning Center and got treatment at Boston City Hospital’s pediatric unit. Having that as my first job as a new undergraduate really gave me a larger systems perspective. A lot of the housing stock in Boston was ,and is, very old. These buildings that people owned or were renting had been built before the ‘40s. After that point, lead paint was legal and still actively being used in houses. I had a year of this experience. I would refer people who were in houses that were positive for lead paint for services to get the houses deleaded. Sometimes there was a whole different arm of the work which was working with landlords to force them, if need be, but also to cajole and to provide resources to them if they couldn’t afford it. So this all gave me the perspective of looking at issues of access, of income and where people lived. Things that had nothing to do with the people themselves as individuals.

At that point it was easy for children to get lead poisoning from touching the walls or touching their toys. The treatment at that time was expensive and extremely painful. So then, you get into the place of trying to talk the parents into bringing the children in for a challenging and traumatic treatment. That became a big part of my job, and so I was then working with the pediatric department as well to make sure that every child that came in with a level of lead got treatment. This took a lot of coordination between the families and the health centers.

This was how I started, but after a year, I felt like I really needed to have more tools. I was really starting to get mentored by the social workers who were in the pediatric unit at Boston City Hospital. So I went to Simmons after a year of that to get my MSW and it was just incredible getting [exposed to] the client-internal focus approaches and the psychodynamic perspective that was prominent then in the ‘70s. With my MSW I went into community mental health. I was at an outpatient mental health facility, also in Boston. It was a wonderful experience, to use the new psychodynamic perspective I had acquired, but then also to bring in the knowledge and experiences of working in the context of larger systems, as with the lead paint focused work I had done. This all motivated me to look at equity as part of my work.

This overlap is part of who I am as a therapist. I’ve continued to do clinical work before and through my time here at Simmons. Public health has always been part of it for me. When I left the community mental health center in the ‘80s, I started teaching at Harvard’s School of Public Health and was involved in their Community Health Improvement Program which was very similar to some of the work I had done in Boston around lead paint. We provided support to communities that were exposed to environmental hazards. One of the things I worked on at this point in the ‘80s when I was at Harvard’s school of public health was Wooburn, an area with elevated leukemia rates at the time.

At the time the community was organizing because they had noticed a trend that children in a 2 or 3 block radius within one neighborhood were developing leukemia. It turned out that a company had been dumping chemicals in the ground that seeped into the aquifers. A lot of the work was providing epidemiology assistance, advocacy and support to communities who were looking for the company to take responsibility for having created the situation. The community had to sue to get the situation rectified. First, they had to justify it with the state, that there was a trend; it wasn’t common knowledge that it had been a trend until we started to map out how many people had developed leukemia in the neighborhood.

This was a working class, predominantly white community outside of Boston. There had been a number of factories in the area. However, many of the factories and companies left but there was still some residual presence,namely containers that they had discarded in the area. There was a whole investigative process. As the Community Health Department, we were more like social work than public health, in that the community could get the resources from Harvard to record the trend and then to sue the company. There’s actually a John Travolta movie from 1998, A Civil Action which is based on the events in Wooburn.

So that was some of the work that I did. I’ve always had this macro and micro perspective in my work, like I’m describing, and I have tried to carry that through to today. Because I do a lot of looking at racial equity in general, it’s more often than not that organizations or companies contribute to health disparities, like in the lead paint or Wooburn examples.

So if someone working with or working on a social work degree was interested in studying or researching racial health equity topics, it’s almost as if doing so would just tend to immediately put you into the public health arena, is that fair to say?

It is. And that is also what social workers should be doing anyway. So when we are talking about levels of practice and we look at the micro/mezzo/macro practice, we find interventions around how your assessment of those areas and how they influence individuals, families and communities, then we tend to have a natural leaning in that way, however we don’t always appreciate how much more we could be doing if we had adequate collaboration. I truly believe in the practice of interdisciplinary collaboration and I think that we often end up having to do that in our work [regardless of our labeling or our thinking about it] and so it’s quite important.

Are there ways in which the overlap between social work and public health has changed or evolved over the course of your career?

It has not always been stressed [in social work] that we look at the root causes of some of the challenges that people face. Or that we look at the environment or neighborhoods that people live in. The MSW course that does that, it’s possible that people might forget about it, [because it’s early in the program and a lot comes after it]. Some of our work is to make sure that we’re not privileging one lens over another and that we understand how that larger picture really frames the individual in a way that has little to do with biology, but other factors like poverty or living in urban environments. Also in many ways poverty, has been racialized in our country, but there are large numbers of very poor white working people who contribute a lot and never come into contact with any services. These people work every day, and more, and we just don’t pay attention all the time to what it really looks like and who is really impacted by their environment and how. There’s much synergy between social work and public health. The Public Health Certificate stresses fundamentals like epidemiology and the understanding of larger health trends. These things really do frame a person’s life course and more. In the MSW program we talk about health equity but I think we can and should dig a little deeper into it.

For the MSW students who go after the certificate, what kind of doors do you feel like it might open for them as they leave academia and go out into their career?

There are lots of career choices that people could make. When it comes to, say, addiction or substance use treatment, these areas are very closely connected to public health. Opioid epidemic work is public health work. HIV/AIDS work is connected to public health. There’s the potential for those with the public health certificate to simply just be able to look at more jobs and to find exciting work that’s focused on helping individuals but also helping communities that end up being in the public health arena.

I did a lot of work in terms of clinical supervision to different non profit organizations who didn’t have a social worker, but who were ultimately doing clinical work; outreach to substance using moms, people who were street workers, who were homeless. This was in the ‘90s, right after the crack epidemic. A lot of women were at risk for all types of exploitation. There were outreach workers and health navigators. Those individuals do incredible work. A certificate might expand opportunities like this today. I’ll also say that the certificate is much more cost-effective than pursuing a dual degree, which is a big part of why we are offering it. It’s expensive to get a dual masters. People don’t have money to stay in school for another year or two to get that dual focus. We want people to have more opportunities and be more marketable on the job market [without having to dedicate more time, money and all the other necessary resources towards it.]

I’d also say that one thing that’s great about the certificate is its ability to deepen one’s problem solving skills. Specifically that it’s not always about just the person changing to reach a better outcome. It expands a clinician’s analysis frame, which is important, to not just limit it to the problem that you see from the person who is coming in to see you. There can be tendencies to approach a clinical working relationship with an attitude of “I’m going to make you better.” Sometimes you have to fix the other things because to not do so would just contribute to a continuation of the circumstances of whatever the issue or issues might be.

Another great aspect is that with the certificate, MSW students pursuing the certificate will be in classes with MPH students, and so what you get there is exposure to more diverse ways of thinking about things. It’s a two way street though, in that MSW students will influence the MPH students' ways of thinking, so in that regard it helps all parties.

You’ve spent a year now as the Interim Director of the Simmons School of Social work, so, first of all congratulations on that because it surely was not an easy task. But also, we wanted to see what things you perhaps were the most proud of while your time at the helm?

I’m proud of us getting this certificate through. We didn’t have any push-back from any of the committees these things have to go through, which was great. All the Deans supported it. So that’s something I’m proud of. Also, just to maintain the school over the past year is something to be proud of. It’s an incredibly complex school. It’s huge [laughs]. We have a lot going on at the school of social work. I’m really happy to just keep it moving forward. I’m also happy to have relaunched the Center for Innovation in Clinical Social Work. The goal of the program is to provide cutting edge training to people both on campus and at professional organizations, while also collaborating with community organizations, practitioners and researchers to develop and present innovative interventions for people. It brings the practice focus into the school, with the aim to have it as a hub of innovative social work with a social justice perspective. So, relaunching the center and bringing a social justice and equity lens to it is something that I’m really proud about.

We were curious to talk with you about what’s on the horizon here at the intersection of public health and social work. I guess I could ask this question in a different way based on what we’ve been talking about, which would be; what’s the “next lead paint?” as in, a situation we might have to grapple with across the two disciples?

Well, lead paint is still a problem, just because we have old housing stock and people that can’t afford to get their home deleaded, but to answer your question I think there’s just a lot of advocacy to be done on the horizon, from maternal child health, to our schools, to helping parents understand the things that are influencing them, as well as their children, in our culture today. COVID of course was in that vein. Vaccine hesitancy has become more prevalent in recent years. Across these issues, it’s also about the research and the collaboration between organizations, beyond advocacy. There’s a great opportunity for synergy between public health and social work to figure out how to talk to families about the issues in an effective manner, regardless of which topic it is. Of course, people who are coming into living in hot zones is increasingly a topic, considering the ways lack of foliage in a hot neighborhood impacts health. There’s some work being done now on heat mapping areas and finding out what the impacts of lack of trees tend to be here in Boston, as far as health disparities. Because there is a housing shortage, there are those who want to cut down forested areas to build housing, but from the other side you see people armed with evidence that indicates the likely negative long term implications this would have.

I think that’s a great point. I’m regularly disappointed by the disinterest of those who are making big impactful decisions in doing a pre-mortem on the ways whatever they’re doing may be a net-negative or be likely to create other problems. While it’s not necessarily a fun discussion and often not a money making discussion, it just strikes me as a critical step in any process being removed in favor of making money almost blindly.

Any problem can have enormous consequences for certain populations of people. So if you have the ability to think about it in those terms, kind of like what I had discussed about how my work in Wooburn, that is important. An environment and public health frame helped me to be a better clinician, to tell you the truth. We don’t know what the next problem is going to be. Anything new can tend to create new other problems. If you have the tools to look at it in the right way, then you can understand how to make the changes.

I think this kind of bigger picture thinking can also be useful in a client setting. It kind of does our clients a disservice to set big picture things aside and just talk about how they and the, say, four people closest to them need to change things about themselves, or what have you. Sometimes as social workers we can tend to hear things that sound like global problems that stem from our culture of capitalism. Do you have any advice on tackling that with clients?

I tend to think that a lot of that can be done in the narrative approach. Narrative approach is about doing problem posing; is the problem in you or is it out in the world and impacting you? Is it something you have internalized? A broader societal narrative. Helping people to understand it and how they fit into it. In some different versions of our MSW Advanced Practice courses I had materials about Liberation Health. That’s my jam [laughs]. This is stuff that stems from Pedagogy of the Oppressed by Paulo Freire. Critiques of capitalism, neocapitalism and how all these forces tend to lead directly to people being named with various problems in these contexts. People adopt stigmas and shames from things that derive from these forces, like people going through eviction. Even someone going through eviction may not realize how common it is and how many other people might be going through the same set of circumstances [and therefore tend to think of it in terms of them, the individual and what’s wrong with them]. Gentrification that’s going on across the country is a force [that doesn’t stem from any given individual's nature] and it drives the cost of housing up. Helping clients to see that they’re not the only one is important. That it’s not just because they lost their job or whatever the circumstances are. The systemic view can help to change mindsets. Someone might feel self-critical about developing diabetes but if you take a look at what options they had to eat at their disposal, you can see how [it’s not all about the individual’s choices]. There is a lot out there that people can internalize and not realize that they’ve internalized something as being about them when in fact there can be thousands of people dealing with the exact same thing. Discussing these things can help eliminate self-blaming tendencies.

I’m taking some coursework where you are the presenter, and I had noticed you tend to infuse the work with some reminders and points about including the nature of a client’s spirituality in the clinical process of formulating and analyzing. I was wondering if you could talk about why that’s important to you and to us future clinicians?

There’s a case example in there about a woman who was bi-polar. That was based on a woman who was a client of mine. She wouldn’t take medication for her diagnosis. She had been hospitalized, she was suicidal and had experienced trauma. But she was also very successful career-wise at the same time, she had completed a masters degree program. I tried to suggest to her to go to a group meeting of women at the community health center. She refused to go. I asked her about where she would go for this kind of support and she said she would go to an African Methodist church here in Boston. They had a women's group that met every saturday. She loved it. She got a lot of support there. A lot of her issues were around her mother. This group was intergenerational, so she ended up getting a lot out of it from that dynamic, being taken under the wing of these women. It really helped her blossom. She also encouraged the other women to get the kind of help she was getting from our working relationship, which there was some resistance to from that community but she was able to step up and make that statement to the group. What really helped her was that work in the church, not necessarily our work together individually. Really high numbers of black and Carribean women are involved in churches. Something like 80%. So when you see Biden going into these churches, he knows [laughs]. Black women have been in the church forever. A lot of the cultivation and uplift during the progressive era, the late 1800s, These women were involved in schools, in outreach, food, kindergartens for black children, and courses on voting. Statistically, black women vote. Some people don’t want to do groups or to even see you, but they might talk to someone at church, and so that could be the way that they get the support and the help they need. So that’s why I tend to include this point because it can get overlooked at times. The people that are seeking our services are the same people that go to church, so it just can’t get discounted. If we can facilitate that, that’s an intervention of value for many populations.

We thank Dr. Hamilton-Mason so much for her time speaking with us!