July 6, 2016

Thanks to all the many CSWA members who sent their emails to their Representatives.

Today the House of Representatives passed HR 2646 by an overwhelming majority of 422-2!

Please send the following message to your Representative, even if you did not ask your Representative to vote in favor of the bill:

“I am a member of the Clinical Social Work Association and a constituent. Thank you so much for voting in favor of the Helping Families in Mental Health Crisis Act of 2016 which will improve access to mental health services for our citizens. [Name, License, Address, email]”

You can find your Representative's email at http://www.house.gov/representatives/find/.

Now we will wait to see what happens with the Senate bill and hopefully have a compromise committee to combine the best of both bills.

July 1, 2016

On June 15th, HR 2646, the Helping Families in Mental Health Crisis Act of 2016, a bill that CSWA has been following for the past three years, unanimously passed out of the House Energy and Commerce Committee.

This bill will be voted on by the whole House of Representatives next Tuesday, July 5. Please email your representative as soon as possible. It is very important to support this bill which will increase funding for many parts of the mental health system, create an Assistant Secretary of Mental Health in DHHS, and create a Minority Fellowship Program. While there are other parts of the bill that CSWA would like to modify, getting the bill passed out of the House so that we can continue the discussion is crucial at the moment. The Senate mental health bill has also been passed out of committee and needs to be passed out of the Senate, but is not yet scheduled. To get the Senate bill scheduled, the House bill must pass.

You can find the email address of your Representative at http://www.house.gov/representatives/find/. Please send the following message to your Representative: “I am a member of the Clinical Social Work Association and a Constituent. Please vote for passage of the Helping Families in Mental Health Crisis Act of 2016 on July 5 and improve access to mental health services for our citizens. [Name, License, Address, email]”

As always, please let me know when you have emailed your message.

June 21, 2016

Four major national social work organizations - NASW, CSWA, CSWE, and ASWB - have been developing draft Social Work Technology Standards for the past two and a half years. These standards will cover every area in clinical social work practice that may be affected by the use of technology including clinical practice, record-keeping, education, and macro social work. Many thanks to Laura Groshong, CSWA Director of Policy and Practice, who served as CSWA's representative on the Task Force that put in hundreds of hours on this project.

These standards have been posted for public comment until July 20, 2016. They are available at the following link with instructions on how to submit comments: http://www.socialworkers.org/practice/naswstandards/TechnologyStandardsInSocialWorkPractice/CommentSubmission.aspx Another way to obtain the draft standards is to go to www.socialworkers.org. To the right, look for the “What’s New” box. Scroll down and click on “Draft Technology Standards in Social Work Practice.”

Comments must be submitted by July 20, 2016 to be considered. After consideration of the changes by the Task Force, the draft technology standards will be submitted for review and approval to the NASW Board of Directors in September, 2016 and the other organization Boards (CSWA will meet in October).

The goal is to have these standards published by the end of 2016.

CSWA is proud to have been a participant in this important project and encourages all members to review the draft standards and send comments.

June 15, 2016

Dear CSWA Members,

It is hard to accept the massacre of LGBTQ people in Orlando and the hate it represents.

There have been some good summaries of how to think about it, including one by Glenda Russell (attached). A PDF version is available online at http://drglendarussell.com/wp-content/uploads/2016/06/Responding-to-Orlando.pdf. Please feel free to share with others.

"Give an Hour" is making the thousands of therapists who give an hour of treatment to veterans available to the Orlando LGBT community - to join go to http://www.giveanhour.org/ForProviders.aspx. To read their press release, go to http://bit.ly/1YnkaTl.

We can never stop insisting on the right of everyone to live their lives regardless of color, sexual orientation, gender or any identity that has been demonized. Please re-read the CSWA Statement on Discrimination (attached). The hate being legalized against trans people in the states mentioned is a contributing factor to the terrible loss in Orlando. Speak out against all forms of hate."

- Susanna Ward, PhD, LCSW, CSWA President & CEO

- Melissa Johnson, LCSW, CSWA President-Elect

- Laura Groshong, LICSW, CSWA Director of Policy and Practice

June 1, 2016

We clinical social workers all recognize the possibility that an unexpected life event could interfere with our clinical social work practice. We help our patients deal with unanticipated events every day. Yet many clinical social workers have no plan for notifying patients in such a case, and no arrangement with a colleague who, should it become necessary, would enact this plan.

Of equal concern is the end of a practice: best practice dictates a mindful approach to closing a practice, with a plan developed long before retirement draws near. Yet a comprehensive study (Hovey, 2014) of how social workers address the end of a practice found that only 18% of those surveyed had completed a professional will. The sample (n=83) consisted primarily of White/Caucasians (94 %), female social workers (82 %), ranging in age from 24 to 80 years, most of whom were in private practice (78 %). While 35 % said they had made some informal arrangements with colleagues, 47 % had made no arrangements at all. These results highlight the likelihood that clinical social workers have not given practice interruptions and endings the attention that they should have.

What Makes Planning So Difficult?

As Ragesua, Shatsky, and others have noted, it is often difficult for clinicians, including clinical social workers, to anticipate interruptions in a practice, planned closing of a practice, or instructions for the unplanned closing of a practice. Shatsky states: “As clinicians, we champion our patients’ examination of the difficult, important transitions of their lives. Yet, when it comes to this issue, more often than not we fail to conduct a competency examination on ourselves….Why is it unusual to hear cognitively fit colleagues openly discuss looking forward to retirement? Unlike other health professional arenas, why is planning for and discussing this significant transition (amongst psychotherapists) rarely embarked upon with enthusiasm?” (2016). Ragusea gets to the heart of the matter in his adaptation on ending a practice “On rare occasions, reality breaks through our merciful denial and we all consider our own demise. Yes, the last great adventure beckons to us; even psychologists [and clinical social workers] die. Most of us like to think that we will pass away quietly in old age, peacefully sleeping in our own beds and, perhaps, surrounded by loved ones. But, what if the path goes off in a different, surprising direction? What if we die suddenly, unexpectedly?” (Ragusea, 2002).

The internal process of accepting the fact that there are likely to be interruptions and there will definitely be endings to clinical practice may involve working through feelings of loss, ambivalence, guilt, relief, and much more. Clinical social workers should begin to consider their feelings about the inevitable ending of clinical practice from the beginning of their careers, rather than wait until nearing the likely end of their working lives. Having no plan in place for an unexpected interruption or ending could put patients at risk for a wrenching disruption in treatment and may burden an unprepared spouse, partner, or colleague with the complex task of closing a practice. The responsible clinical social worker will have a plan in place; this is best practice, ethical practice, and even required in some states by the boards of social work.

What The Clinical Social Work Association Can Do To Help

There are four major ways that clinical social work practices may be interrupted or ended:

1. Unplanned Termination of Practice;

2. Temporary Inability to Continue Practice;

3. Extended Inability to Practice; and

4. Planned Termination of Practice.

Over the next few weeks, we will consider each of these four possibilities. We will offer you guidelines for developing a plan in each case, and a template agreement or professional will for carrying out needed responses in the CSWA Members Only section (you must join CSWA separately from your society). Watch for notices that these templates are available.

References

Hovey, J. K. (2014). “Mortality practices: How clinical social workers interact with their mortality within their clinical and professional practice” (Unpublished master’s thesis). Smith College School for Social Work, Northampton, MA. Available from https://dspace.smith .

Ragusea, S. "A Professional Will for Psychologists", adapted from VandeCreek, L. & Jackson, T., Eds. (2002) Innovations in Clinical Practice: A Source Book, Vol. 20, pp. 301-305. Sarasota, FL: Professional Resource Press.

Shatsky, P. (2016) “Everything Ends: Identity and the Therapist’s Retirement”. Clinical Social Work Journal, Vol. 44, No. 2, pp. 43-149.

April 20, 2016

CSWA received this message from the Association of Social Work Boards today and has requested that we send it to members. To summarize, ASWB does a practice review of social work every 7-10 years and is beginning one now. Approximately 250,000 of the 600,000 social workers in the country will receive a copy of the survey on social work practice. Please participate if you receive this survey.

Below is the message:

I am writing on behalf of the Association of Social Work Boards (ASWB) to let you know that ASWB has launched its latest practice analysis of social work, the study of current social work practice that serves as the foundation for content included in the ASWB social work licensure examinations. Conducted every seven to ten years, the practice analysis begins with a survey of licensed social workers in the United States and Canada. The survey is designed to gather information about the knowledge and skills needed by those in the social work profession. It was sent to more than 250,000 licensed social workers, including social work practitioners and educators, earlier this month.

We are contacting your organization to let you know what was happening and to encourage you to forward to ASWB any questions or concerns you might receive from your members about the survey.

To explain more fully, the survey requires social workers to respond to statements about tasks that social workers perform (or do not perform) or about the knowledge that social workers need to perform those tasks safely and competently. All responses are confidential and will be combined with those from other social workers responding to the survey. Additional information on the process—including the results of the last practice analysis conducted by ASWB—may be found at www.aswb.org.

ASWB remains committed to producing a valid and reliable social work licensing examination, and we are excited about the next chapter in its development. We look forward to the responses from the practice analysis survey.

Thank you for your commitment to our profession and the public it serves.

- Lavina G. Harless, LCSW, Examination Development Manager, Association of Social Work Boards

April 11, 2016

The attached "Statement on Discrimination” is CSWA’s way of addressing the appalling legislative attempts in several states to create laws that implement discrimination against LGBT citizens. While only four states have passed legislation – North Carolina, Mississippi, Tennessee, and Georgia – have actually passed such legislation, there are several other states considering doing so.

As stated in the CSWA Code of Ethics, “Clinical social workers do not, in any of their capacities, practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, religion, color, national origin, gender, sexual orientation, age, socioeconomic status, or physical or emotional disability. (CSWA Code of Ethics, Section VI(a), 1997.)” It is with these fundamental values in mind that CSWA encourages its members to take a stand against discrimination in any form.

If you live in one of the states that has passed a discriminatory law, please send the following message to your state and Federal legislators: “I am a member of the Clinical Social Work Association [and your state Society] which strongly opposes any laws which are based on discrimination. [Bill/Law in your state] is extremely discriminatory of our LGBT citizens and should be removed from [our laws/consideration] in our state. This law is a violation of my Code of Ethics as a clinical social worker and our national Bill of Rights.”

You can find the addresses for your members of Congress at https://www.congress.gov/members State legislators can be found at your state government websites.

As always, please let me know when you have sent any messages.

- Laura Groshong, LICSW, CSWA Director of Policy and Practice

March 17, 2016

Yesterday, the HELP Committee (Health, Education, Labor and Pensions) passed S. 2680, the Mental Health Reform Act of 2016. CSWA sent a summary of this bill last week and is in support. The bill was introduced by Senators Lamar Alexander (R-TN), Patty Murray (D-WA), Bill Cassidy (R-LA), and Chris Murphy (D-CT), this bipartisan legislation provides vital reforms to mental health funding to increase patients’ access to effective and evidence-based care particularly focused to those with serious mental illness (SMI).

S. 2680 incorporates and builds upon S. 1945, the bill created last year by Sens. Murphy and Cassidy. Here is a summary of the bill:

There is more work to do but this is a significant step forward. Clinical social workers are included in S. 2680 as covered providers several times, as they were in the House bill H.R.1945 in 2014 after CSWA, with NASW’s support, first raised the issue of including LCSWs. Whatever bill emerges from the mental health bills being considered by Congress, the place of clinical social workers appears secure.

March 1, 2016

Speech by Margot Aronson, LCSW, CSWA Deputy Director of Policy and Practice

LCSWs are the backbone of our country’s mental health treatment system. We are responsible for close to half of clinical services provided in the USA: assessment and diagnosis, psychotherapy, case management, and more, in clinics, hospitals, group and private practice.

I am speaking today for the Clinical Social Work Association, which represents the interests of the 240,000 LCSWs in the US. Our Association has a strong advocacy program with a focus on mental health issues at the national level and on professional practice issues. The bill we’re discussing today – H.R. 3712 /S. 2173, the Improving Access to Mental Health Treatment Act – cuts across both those areas of interest.

This bill addresses problems Medicare beneficiaries have in obtaining mental health care. As you know, Medicare - our federal insurance program – provides health insurance to Americans over 65, and also to younger people with disabilities or ALS or end-stage renal disease, through Social Security Disability Insurance (SSDI). Overall, Medicare serves about 50 million Americans.

According to the CDC (Center for Disease Control), nearly 1 in 3 seniors do not receive treatment for an ongoing mental health condition. Seniors may be in distress or in crisis with issues of aging such as: loss of vision, hearing, mobility; with a diagnosis of major illness or Alzheimer’s; with the cognitive impairment – or death - of a life partner; with painful end-of-life decisions. Addiction to prescription medication and/or alcohol is at epidemic levels for the elderly. And in fact, substance misuse is often a factor with the younger beneficiaries, who may be dealing with debilitating depression, with an anxiety disorder, with serious mental illness, with PTSD.

Licensed clinical social workers, along with psychologists and psychiatrists, are the only providers of mental health services for Medicare beneficiaries. Surveys generally find that our LCSW treatment success and satisfaction rates - for the services provided by all three groups - are at least equal to those of our psychology and psychiatry colleagues (Consumer Reports, 2004, 2010).

CSWA spoke with leadership at CMS (the Centers for Medicare & Medicaid Services) last summer. CMS is the oversight agency for Medicare. They told us that they need LCSWs to help the vast and rapidly expanding numbers of Medicare beneficiaries (10,000 a day for the past two years).

Increasingly, however, LCSWs are saying that they cannot continue to work in the Medicare system because the current rates are so low that they cannot sustain their practices (25% less than other mental health providers for the same services). It is this disparity that The Improving Access bill seeks to begin to correct.

Part I of the Improving Access to Mental Health Act would increase Medicare reimbursement for LCSW services from 75% to 85% of the physician fee schedule rate.

While the bill will not totally resolve this problem, it is a start. The increase will bring clinical social workers up to parity with other non-physician Medicare providers – turns out we’re now the only profession at 75%. We believe that this modest financial boost, combined with the gesture of support from Congress, will go far in encouraging LCSWs to become Medicare providers.

Let me just make a quick comment about the discrepancy in pay for the same services with the same success rate: as you might expect, it is the cause of considerable resentment; and the legislative staffers we’ve met with have themselves identified and expressed concern about the fairness issue; in addition there is the fairness issue to women, as social work is primarily a female profession.

Part 2 of the bill increases access to LCSW services in skilled nursing facilities.

Since 1997, LCSWs have not been permitted as independent practitioners to provide treatment to patients in skilled nursing facilities, commonly called SNFs. What this restriction means in practice is that treatment gets derailed for the client who temporarily moves into a SNF because of an illness, or the need for rehab, or to recover from surgery. Sometimes the move is the beginning of what will be a major life change: such a patient may be feeling despair, but an independent LCSW cannot be made available to him to do a timely depression assessment or to provide therapy. This is especially painful for beneficiaries who have had an ongoing relationship with an LCSW that is interrupted while the client in a SNF. This would restore the ability of LCSWs to work within SNFs independently.

Finally, Part 3 of this bill eliminates Medicare restrictions on the right of LCSWs to do Health and Behavior Assessment and Intervention services (HBAI), helping clients cope with the social and emotional issues stemming from medical conditions (cancer, heart disease, diabetes, or Alzheimer’s, for example). HBAI services are well within the LCSW scope of practice, and our holistic, person-in-environment framework, bringing to bear biological, psychological, social and family elements, is especially relevant in the skilled nursing setting and wherever substance abuse may be an issue.

To summarize, the Improving Access to Mental Health Treatment Act is a clear, simple, practical bill. Here are its three straight-forward parts:

HR 3712/S 2173 WILL IMPROVE ACCESS TO MENTAL HEALTH THROUGH MEDICARE BY:

• Make it possible for LCSWs to do what they believe is work that they SHOULD be doing – in the service of the public – while earning a fair wage
• Allow LCSWs to support longtime clients and others who have moved into skilled nursing care, rather than abandon them when they are most helpless and needy
• Letting LCSWs help Medicare beneficiaries cope with emotional, behavioral, and psychosocial concerns associated with substance use and medical conditions

We know that the elderly have a significant percentage of undiagnosed and untreated mental health conditions, and that limited access to mental health providers presents a major barrier to their overall health, leaving them at risk. This bill takes very practical steps to improving their access to mental health treatment; it is a significant bill. Thank you.

March 8, 2016

There is a flurry of activity in Congress this week about how to finally provide treatment for mental health and substance abuse disorders which have plagued the country for many years and have reached a crisis point.

The Senate voted 86-3 yesterday to advance the Comprehensive Addiction and Recovery Act, S. 524/H.R. 953, (CARA, http://www.addictionpolicy.org/#!cara/cix2), which would allow the attorney general to give money to programs that strengthen prescription drug monitoring, improve treatment for addicts, and expand prevention and education initiatives. There are many amendments still to be voted upon. A vote on final passage of the bill is expected later this week.

The bill, introduced by Sens. Sheldon Whitehouse, D-R.I., and Rob Portman, R-Ohio, has not yet been taken up by the House. An identical bill has been offered in that chamber by Rep. Jim Sensenbrenner, R-Wis.

Drug overdose has surpassed car crashes as the leading cause of accidental death in the United States, according to the American Society of Addiction Medicine. Opioid addiction is driving the epidemic, with nearly 19,000 overdose deaths related to prescription pain relievers and nearly 10,600 overdose deaths related to heroin in 2014. The rate of heroin overdose deaths nearly quadrupled from 2000 to 2013 as many prescription drug abusers turned to heroin as a cheaper alternative that is easier to obtain, the society said.

The main objection to this bill is that tasking the attorney general with distributing the treatment, prevention, monitoring and education programs the bill contains is not the best way to determine what funding is needed; that the attorney general does not have the $600 million that will be needed to implement this bill; and that this ties the bill to law enforcement instead of treatment. Senate leadership has claimed that earlier block grant funding can be used by states that choose to follow through on this bill. CSWA sees this bill as unfunded, well-intentioned as it is, and will work to find the roughly $600 million the bill will require to implement.

Another bill called the Mental Health Reform Act of 2016 is being developed by Sens. Murray (D-WA), Murphy (D-CT), Alexander (R-TN), and Cassidy (R-LA). The hope is that this bill will include much of the bill developed by Sens. Murphy and Cassidy, S. 1945, as well as incorporate strengthening SAMHSA, and integrate programs designed to address the substance abuse problems which have been receiving the bulk of attention this week.

CSWA will continue to provide information on how these bills evolve and work to fund them adequately.