Day in the Life of a Social Worker
Three social workers wrote down everything they did on one ordinary workday. No interviews, no prompts. Just the day as it happened.
These characters are composites, built from dozens of real accounts, interviews, and community threads. The people aren't real. The experiences are.
What you'll learn
- What a specific day looks like in child welfare, community mental health, and hospital social work
- How much of the day is spent on documentation, phone calls, and coordination versus direct service
- The emotional transitions that happen between clients, between tasks, and between the work and home
Kendall's Wednesday
Wake up. Check my phone. One voicemail from last night, 9:47 PM. It's from the after-hours hotline letting me know a new report came in for one of my existing families. The report is for educational neglect, a 10-year-old who's missed 22 days of school this year. I already know this family. The mother has been in my caseload for four months. She's dealing with a housing issue and a custody dispute and the school attendance is a symptom of the chaos, not the cause. But a new report means a new contact requirement within 24 hours. I add it to today's schedule. Four home visits now instead of three.
Get to the office. The DFCS building is a one-story brick building off Pio Nono Avenue that was probably built in the 1980s. The carpet is the color of oatmeal. My desk is in a cluster of four cubicles near the window. My coworker Lonnie is already here, eating a biscuit from Chick-fil-A. He has court at 10. We compare schedules. He has two home visits and a team staffing. I have four home visits and a court report due by Friday. We agree that Friday is a problem for both of us. He offers me a hash brown. I take it.
Sit down and start the court report for the Jackson case. This is a family where I recommended continued protective custody for two children, ages 4 and 7. The mother is in a substance abuse treatment program. The father is incarcerated. The children have been in kinship care with the maternal grandmother for five months. The court hearing is Friday and the judge wants an updated report. I pull up the case file in SHINES, which is Georgia's child welfare information system. It loads slowly. It always loads slowly. I start writing. The report requires: a summary of the current case status, a description of services provided, the mother's progress in treatment, the children's adjustment in placement, my recommendation, and a risk assessment. I draft about two pages before my first home visit at 10.
Leave the office for the first home visit. It's a 25-minute drive to a subdivision off Thomaston Road. This is a new investigation, assigned yesterday. A report came in from a pediatrician who noticed a 5-year-old with multiple bruises on her upper arms and back during a well-child visit. The parent's explanation was that the child fell off the bed. The pediatrician felt the bruising pattern was inconsistent with a fall. I'm going to the home to interview the parent, observe the child, and assess the living environment. I have the pediatrician's notes, the intake report, and a consent form in my bag. Also a coloring book and crayons, which I'll give to the child so she has something to do while I talk to the parent. Kids relax when they have something in their hands.
Arrive at the home. Small ranch house, clean yard, car in the driveway. A woman answers the door. She's maybe 30, wearing jeans and a t-shirt. She looks nervous. I introduce myself, explain why I'm here, and ask if I can come in. She lets me in. The house is clean. There are toys in the living room, a TV on low, dishes in the drying rack. The child is sitting on the couch watching cartoons. She looks at me and doesn't say anything. I give her the coloring book. She takes it and starts coloring without looking up.
I sit at the kitchen table with the mother. I ask about the bruises. She says the child fell off the top bunk. She says it happened three days ago. She says she took the child to the doctor because she was worried about a bump on her head, not because of the bruises. She seems genuine. I take notes. I ask about the household: who lives here, who has access to the child, what the daily routine looks like. She says it's just her and the child. She works part-time at a dental office. The child goes to Head Start in the mornings. After Head Start, she goes to the mother's aunt's house until the mother picks her up at 4.
I ask to see the child's room. The bunk bed is there. The top bunk has a railing on one side but not the other. The unrailed side is where the child could have fallen. The explanation is plausible. I ask the mother if she'd be willing to add a railing. She says she's been meaning to. I make a note. Before I leave, I spend five minutes with the child. She shows me her coloring page. She's colored a dog purple. She seems comfortable, no signs of distress or fear. I'll photograph the bruises at the follow-up visit if needed. For now, I note my observations and leave. The visit takes 45 minutes.
In the car. I sit for a minute before starting the engine. The visit was, I think, straightforward. A child fell off a bunk bed. The bruises are consistent with a fall. The home was clean and safe. The mother was cooperative and concerned. But the pediatrician flagged it, and the pediatrician sees a lot of bruises and chose to report this one. That means something. I have to take it seriously even when the explanation seems reasonable. I write my preliminary notes on my phone using the voice-to-text function, which captures about 80% of what I say correctly. I'll clean it up later in SHINES.
Drive to the second home visit. This is the family from the voicemail, the educational neglect case. The mother lives in an apartment complex off Eisenhower Parkway. I've been to this apartment six times. I know the layout. I know the doorbell doesn't work. I knock. She opens the door in pajamas. It's 11:30 AM. She looks tired. The apartment is messier than my last visit. There are dishes in the sink and laundry on the couch. The 10-year-old is not home. He's supposed to be at school. She says he left for the bus this morning. I ask if she's sure. She says yes, she walked him to the bus stop. I'll verify with the school later. We talk for 30 minutes about the attendance issue. She says the housing situation is stressing her out. The landlord is threatening eviction because she's behind on rent. I give her the number for a legal aid office that handles housing cases and remind her about the family resource center I referred her to last month. She says she called but the waitlist was six weeks. Six weeks for a family resource center. I write that down.
Lunch. I eat a turkey sandwich in the car in a Walgreens parking lot because my next visit is 20 minutes in the other direction and I don't have time to go back to the office. I call the school to verify that the 10-year-old is there. He is. He arrived at 8:45. The attendance clerk, a woman named Mrs. Pruitt, tells me he's been on time 4 out of 5 days this week. Better than last month. I note that.
Third home visit. Ongoing case, monthly check-in. A family with three children, ages 3, 8, and 11. The case was opened six months ago for substance abuse by the father. The father completed a 28-day residential treatment program and has been in outpatient treatment since. He's testing clean. The mother is working at a grocery store. The children are in school and daycare. The home is stable. The 8-year-old shows me a drawing she made in art class. It's a house with a sun and a dog. I tell her it's really good. She says the dog's name is Brownie. I tell her that's a great name. This visit takes 30 minutes. It's the kind of visit that reminds you why you do this. A family that was in crisis six months ago, now stable, kids doing well, father in recovery. The system worked. This time.
Back at the office. Start documentation. The morning visits generated about four hours of writing. I open SHINES and start with the new investigation from this morning. The initial assessment form has 47 fields. Some are checkboxes. Some are narrative. The narrative sections are where the time goes. I describe the home environment, the parent interview, the child observation, the safety assessment, and my preliminary finding. I write that the bruising is consistent with the reported fall, that the home is safe, that the parent is cooperative, and that I recommend a safety plan that includes installing a bed rail. This takes about an hour and 15 minutes.
Documentation for the educational neglect visit. Shorter, because it's an ongoing case with an existing file. I update the contact log, note the new school attendance data, document the referrals I provided, and flag the six-week waitlist at the family resource center. I also add a note about the housing situation because if she gets evicted, the case is going to escalate from educational neglect to something worse. Families don't get evicted in isolation. Everything connects.
Documentation for the stable family visit. Quick. Ten minutes. Checked the boxes, wrote a short narrative, updated the case plan. The fourth visit, the new report on the educational neglect family, I write up as a new contact within the existing case. Another 20 minutes. Total documentation time today: about two hours and 45 minutes. Total home visit time: about two hours and 15 minutes. The paperwork took longer than the people. As usual.
Still at my desk. I go back to the court report from this morning. I finish the remaining sections. The recommendation paragraph takes the longest because the judge reads it word by word and I have to be careful. I recommend that the children remain in kinship care, that the mother continue treatment, and that the case be reviewed again in 90 days. I save the report and email it to my supervisor, a woman named Gail, for review. She'll have edits. She always has edits. That's fine. I'd rather have a supervisor who reads my work than one who stamps it.
Leave the office. Drive home. Call my older sister on the way. She lives in Atlanta and works at a tech company doing project management. She asks how my day was. I say, "Fine. Busy." She asks what I did. I say, "Home visits and paperwork." She says, "Did anything happen?" I think about the purple dog, the bunk bed with no railing, the six-week waitlist, the 10-year-old who made it to school four out of five days, the father who's testing clean. I say, "Nothing major." She says, "That's good." It is. In this job, nothing major is a good day. I heat up leftover soup and watch two episodes of something I won't remember. I don't check my phone. Whatever's there can wait until 7:15 AM.
Ophelia's Thursday
I take the Blue Line to the Pulaski stop and walk the four blocks to the health center. It's a two-story building that houses primary care, dental, behavioral health, and a WIC office. Behavioral health is three offices on the second floor. Mine is the smallest. It fits a desk, two chairs, a bookshelf with clinical manuals I haven't opened since grad school, and a white noise machine outside the door so that people in the hallway can't hear my clients crying. The white noise machine cost $24 on Amazon. It's the best investment the clinic has ever made.
First client. A 42-year-old woman I've been seeing for about a year. She has generalized anxiety and a history of domestic violence. We're working on safety planning and coping strategies. Today she tells me her ex-boyfriend has been texting her from a new number. She blocked the old one. She hasn't responded to the new messages but she's been having trouble sleeping since they started. We spend 20 minutes on a safety assessment. Is she in immediate danger? No. Does he know her current address? She's not sure. We update her safety plan. She'll call the DV hotline if the texts continue. She'll tell her sister, who lives two blocks away, about the situation. We spend the remaining 30 minutes on sleep hygiene and grounding techniques. At 8:53, she leaves. I write a 6-minute progress note in Athena, which is our EHR. Documented: safety concern, updated safety plan, client response, interventions used, plan for next session.
Second client. A 19-year-old referred by the primary care doctor downstairs for depressive symptoms. This is our third session. He's quiet. He answers questions with one or two words. Last session, I tried motivational interviewing and he responded better to open-ended questions than direct ones. Today I start by asking what his week looked like. He says, "Same." I ask what "same" looks like. He says, "Wake up, look for jobs, play video games, go to sleep." He's been unemployed since he finished a culinary program at a community college three months ago. He's applied to 11 restaurants. Two callbacks, no offers. He lives with his grandmother on the West Side. The depression is, from what I can tell, largely situational. He needs a job more than he needs a therapist. But a job referral from a behavioral health office is not how the system works. I can refer him to workforce development. I do. I give him the number for a program called Skills for Chicagoland's Future and tell him to mention the health center. He puts the number in his phone. I don't know if he'll call. He leaves at 9:50.
Third client cancelled. She texted at 9:30 saying she couldn't get off work. This is the second cancellation this month. I use the hour to catch up on treatment plan updates. I have four treatment plans due this week. Each one requires a diagnostic assessment, treatment goals, measurable objectives, and a review of progress. The clinic's quality assurance coordinator, a woman named Latrice, reviews every treatment plan. She's thorough. If I write "client will reduce depressive symptoms" she'll send it back and ask me to operationalize "reduce." So I write: "Client will report a PHQ-9 score of 10 or below for two consecutive sessions, down from current score of 16." That's specific enough for Latrice. Whether it's clinically meaningful or just bureaucratically satisfying is a question I stopped asking around year three.
Fourth client. A 55-year-old man with PTSD from a shooting he witnessed two years ago on his block. He's one of my longest-running clients, almost two years. We've done CPT, cognitive processing therapy, for the PTSD. He's made significant progress. When he started, he couldn't ride the bus because the sounds triggered flashbacks. Now he takes the bus to his appointments. Today we're reviewing his stuck points, which are the unhelpful beliefs that keep the PTSD symptoms active. His main stuck point has been "I should have done something," referring to the shooting. Over the last six months, we've worked through that belief using cognitive restructuring. Today he says, "I know I couldn't have stopped it. I just wish knowing that felt like enough." That sentence. I sit with it. I don't rush to reframe it. Sometimes the most clinical thing you can do is let a sentence exist without trying to fix it.
Lunch. I eat a salad at my desk and scroll my phone. My colleague down the hall, a psychologist named Dr. Nwosu, knocks on my door and asks if I can do a warm handoff at 2 PM. A patient in primary care is having a panic attack in the exam room and the PCP wants a behavioral health consult. I say yes. Warm handoffs are technically unscheduled, but at an FQHC they're built into the expectation. You're supposed to be available for walk-ins between your scheduled clients. The theory is that integrated care means behavioral health is accessible in the moment. The practice is that it adds 1-2 unscheduled encounters per day to an already full schedule.
Fifth client. A 38-year-old woman working on boundary-setting with her family. We've been meeting biweekly for four months. She's making progress. She told her mother last week that she can't watch her younger siblings every Saturday because she has her own plans. Her mother called her selfish. She came in today feeling guilty. We spend the session exploring the guilt, where it comes from, whose voice it sounds like, and whether it's giving her useful information or just replaying an old script. At 1:50 she says, "It sounds like my mom's voice, not mine." That's growth. I note it. She leaves at 1:53.
Warm handoff. I go downstairs to the primary care suite. The patient is a 28-year-old woman in the exam room, sitting on the exam table, breathing fast, hands shaking. The PCP, Dr. Okafor, introduces me. I sit down. I don't touch her chart first. I just talk. I ask her what's happening. She says she can't breathe. I walk her through box breathing. Four counts in, four hold, four out, four hold. We do it together three times. Her breathing slows. I ask if this has happened before. She says it's been happening more often, maybe once a week, usually at work. She works at a call center. She says the calls make her feel trapped. We talk for about 15 minutes. I give her information about our behavioral health services and tell her she can schedule with me directly. She says she'll think about it. I walk back upstairs. The whole thing took 20 minutes. I document it in Athena in another 6 minutes.
Sixth client. Court-mandated substance abuse assessment. A 33-year-old man referred by his probation officer. He had a DUI last year. This is a one-session assessment to determine the level of care needed. I use the AUDIT screening tool and a clinical interview. He scores a 22 on the AUDIT, which indicates harmful or hazardous drinking. I recommend outpatient substance abuse treatment, which I'll document in a report that goes to his PO. He's cooperative but clearly doesn't think he has a problem. He says the DUI was a "one-time thing." The AUDIT says otherwise. I present the findings neutrally. I don't argue. My job is to assess and recommend, not to convince. The convincing, if it happens, comes later.
Seventh client. My last session of the day. A 16-year-old who comes with her mother. I see the teenager individually for the session and meet with the mother for the last 10 minutes. The teenager is working through social anxiety that's affecting her attendance at school. She's smart, articulate, and deeply uncomfortable in group settings. We're using exposure therapy, gradually increasing her tolerance for social situations. Today's exposure: she agreed to eat lunch in the cafeteria instead of the library. She did it on Tuesday. She said it was "horrible but survivable." I tell her that's actually a perfect description of exposure therapy. She almost smiles. When the mother comes in, I update her on progress without sharing session details. The mother asks, "Is she getting better?" I say, "She's doing the hard work." The mother nods. That nod is enough.
Lock my office. Walk to the train. On the platform, a text from my partner, a paramedic named Dante, who works 24-hour shifts at a firehouse on the South Side. He's on shift tonight. He asks how my day was. I type: "7 clients. One panic attack. One almost-smile from a teenager." He sends back a thumbs up. That's our shorthand. He doesn't need the full story. He has his own. I ride the Blue Line home, make pasta, and read a novel that has absolutely nothing to do with anyone's treatment plan. That's the evening ritual. No one else's problems between 6 PM and 7:45 AM. That boundary is the only reason I've lasted six years.
Reggie's Friday
At the hospital early because Fridays are the worst day for discharge planning. Everyone wants patients out before the weekend. Attending physicians round earlier on Fridays. Case management meetings start at 7:30 instead of 8. The whole building has a "clear the decks" energy that creates a specific kind of pressure where your job is to find placement for people in a community that has fewer resources on Saturdays and Sundays than it does Monday through Thursday.
Case management meeting. There are 14 patients on my floor with active discharge planning needs. I go through each one with the case manager, a nurse named Tina, and the utilization review nurse, Rhonda. Tina handles the clinical coordination. Rhonda handles insurance authorization. I handle the "where are they going" part. Of the 14 patients: 6 are going home with home health services, 3 need skilled nursing placement, 2 need inpatient rehab, 1 is going to a group home, 1 needs hospice, and 1 has no plan because he's homeless and has no insurance and every option I've explored has hit a wall.
The 6 going home are mostly straightforward. I've arranged home health for 4 of them already. The other 2 need durable medical equipment, a wheelchair and a hospital bed, and the DME company I usually use said they can't deliver until Monday. I call a second company. They can deliver the wheelchair today but not the bed. I arrange the wheelchair delivery and tell the patient's daughter that the bed will come Monday. She asks if her father can come home without the bed. I say he can sleep in a recliner temporarily but it's not ideal given his surgical wound. She says he doesn't have a recliner. I make a note to check with our charity fund for a recliner or loaner bed. That's the kind of sentence that only makes sense in hospital social work.
Skilled nursing placements. Three patients need SNF beds. Patient one has Medicare and Blue Cross as secondary. I send referral packets to five facilities. Two respond within the hour saying they have beds. I present the options to the patient's wife. She asks which one is better. I tell her they're both rated 3 stars on Medicare.gov, which is average, and describe the differences: one is closer to her home, the other has a dedicated orthopedic rehab unit. She chooses the closer one. I call the facility and confirm the bed. Transfer is scheduled for 2 PM.
Patient two has Medicaid. Two of the five facilities I sent referrals to accept Medicaid. One has a waitlist of four days. The other says they can take her Monday. I tell the patient, a 72-year-old woman recovering from a hip fracture, that she'll need to stay through the weekend. She says, "I thought I was leaving today." I say, "The facility that can take you soonest is Monday." She starts crying. Not because she's in pain. Because she's been in this hospital bed for nine days and she wants to go somewhere that feels less like a hospital. I sit with her for 10 minutes. I don't have 10 minutes. I take them anyway.
The homeless patient. His name in my head is 4B because that's his room number and I've been thinking about his case for a week. He's 51, came in through the ER with cellulitis in his left leg, probably from sleeping outside. He's been on IV antibiotics for six days. The attending says he could be discharged with oral antibiotics if he has a stable place to go. He doesn't. He's been homeless for about two years. No family in the area. No Medicaid because he missed the enrollment window and the application is pending. No shelter bed because the shelters that take medical discharges require a physician's note and insurance, and he has neither.
I've called every resource I can think of. The hospital's indigent care fund can cover prescriptions but not housing. The local homeless coalition has a medical respite program that takes 4-6 patients at a time. They're full. The VA can't help because he's not a veteran. I call the medical respite program for the third time this week. The intake coordinator, a guy named Phil, says, "Reggie, I know. We're full. I'll call you if something opens." Phil is good. Phil knows me because I call him every week. I add 4B to the hospital's "complex discharge" list, which triggers a meeting with the chief medical officer and the hospital attorney next Tuesday to discuss options. In the meantime, 4B stays in a bed that costs the hospital $3,800 a day and the hospital absorbs the cost because there's no one to bill.
I eat lunch in the cafeteria with Tina. She asks about 4B. I say, "Same." She says, "We've had him longer than some of my med-surg patients." I say, "I know." We talk about the weekend. She's taking her kids to a birthday party. I'm going to a movie with my wife, Claudia, who's a librarian and who, when I come home and describe my day, sometimes just puts her hand on my arm and doesn't say anything. That's her version of a progress note.
Hospice referral. The patient is an 88-year-old man with metastatic lung cancer. His daughter has been here every day. I sit with both of them and explain what hospice means: comfort care, pain management, support for the family, typically provided at home or in a hospice facility. The daughter asks, "How long?" I say, "The doctor's estimate is weeks, not months. But everyone is different." She starts crying. He pats her hand. I've done this conversation hundreds of times and it still requires everything I have. Not emotionally, exactly. More like, it requires a kind of precision that's hard to describe. You have to be warm without being soft. Clear without being clinical. Present without making it about you. The referral paperwork takes 30 minutes. The conversation took 40 minutes. But the 40 minutes is the job. The paperwork is the documentation of the job.
The SNF transfer for patient one goes smoothly. The transport company picks him up at 2 PM. His wife follows in her car. Tina and I sign off on the discharge. One bed freed up. I check the ER board. Two admits pending for my floor. The cycle continues.
Afternoon documentation. I have six encounters to document from today. I open Epic, which is our EHR, and start writing. Each note takes 8-12 minutes. The SNF placement notes are template-heavy, which speeds things up. The hospice note takes longer because it involves a detailed goals-of-care conversation. The note for 4B is brief because there's nothing new to document. "Continued efforts to identify discharge disposition. Medical respite program full. Application for Medicaid pending. Patient to remain until disposition identified." That sentence has appeared in his chart every day for a week. It's the same sentence. The situation hasn't changed. The documentation reflects the stasis.
Leave the hospital. Walk to my car in the parking garage. It's 94 degrees in Phoenix and the garage holds the heat. I sit in the car and run the AC for two minutes before driving. My phone buzzes. It's Phil from the medical respite program. He says a bed opened up. A patient was discharged this morning. He can take 4B on Monday if I can get the referral packet done by end of day. I say I'll have it to him in an hour. I drive home, open my laptop at the kitchen table, and fill out the 8-page referral form. I email it to Phil at 5:38 PM. Claudia walks through the kitchen and sees me typing. She says, "I thought you were done." I say, "Someone got a bed." She says, "Good." I close the laptop. We go to the movie.
Frequently Asked Questions
What does a social worker do all day?
It varies by setting. Child welfare workers drive to homes, assess child safety, and write documentation. Clinical social workers provide therapy sessions and manage treatment plans. Hospital social workers coordinate discharges, call facilities, and meet with families. Documentation and phone calls typically take up more time than direct client interaction.
How many hours do social workers work?
Most are scheduled for 40 hours, but actual hours often exceed that. Child welfare workers frequently work 45-55 hours. Clinical social workers in agencies work 40-45 hours. Hospital social workers work 40 hours but may stay late for complex discharges. Private practice social workers typically work 25-35 clinical hours plus administrative time.