Ground Breaking Happenings with Health / Payment Reform in MA

Looks like the Massachusetts Legislature did it again, passing the first State health and payment reform legislation, following the Federal Health Reform Law that the Supreme Court ruled favorably on. The Chapter’s Government Relations staff person, Rebekah Gewirtz, has completed this initial analysis of the law in relation to its potential impact on social work practice. Here are some of the highlights:

• Accountable Care Organizations (ACOs) Must Integrate or Contract Out for Behavioral Health Services
  Basically this means that mental health, substance use disorders and behavioral health services must be part of all health care plans and policies. This requirement institutionalizes the social work principle that all aspects of individuals and families lives (work, school, neighborhoods, relatives etc.) must be attended to in keeping families and individuals healthy.
  
• Behavioral Health Providers Can Appeal If They are Removed from an ACO
  This adds a degree of protection for mental health providers.
  
• $30 Million in Federal Grants Will Be Available to Behavioral Health Providers to Move to Electronic Medical Records
  Converting from paper records to electronic records is a costly transition. Now financial help will be available to social work clinician.
  
• Creates a 19 Member Healthcare Workforce Council of which One Member shall be a Behavioral, Substance Use Disorder and Mental Health Professional
  This council will oversee a loan repayment program to which social workers will have access under certain criteria.
  
• Requires Utilization Review Criteria to be Available to Providers and Patients
  These criteria must be evidenced based.
  
• Creates a 19 Member Behavioral Health Special Taskforce of which NASW-MA Chapter is Specified as a Member

This is a partial list of the elements in the new Payment Reform Law. Of special note is the inclusion of a tuition repayment program (traditionally called ‘loan forgiveness’, but more accurately now termed ‘repayment’). NASW has been lobbying for a loan forgiveness program for social workers and now the new Legislation includes a similar provision to assist social workers working in certain ‘underserved’ areas to be eligible for this assistance. This is a huge victory!

Social Workers, be proud. The MA Chapter was heavily involved, with our mental health colleagues, in the crafting of these positions. We thank our members for their continued vigilance to the issues.

Take Action on Social Work Safety

It is crunch time on Beacon Hill. The legislative session will end at midnight tonight. As I type this, the NASW-MA government relations team is at the State House talking with legislators about House Bill 4254, An Act to Promote Health Through Workplace Safety for Social Workers, which is one step away from being passed in the House! 

State Representatives need to hear from SOCIAL WORKERS on the critical importance of the social work safety in the workplace bill. 

This legislation was filed in response to recommendations of the NASW Safety Taskforce that convened after the 2008 death of a social worker on a home visit. H4254 would require behavioral health employers licensed, certified or funded by the Executive Office of Health and Human Services to perform annually an assessment of factors that may put a licensed social worker or other employee at risk of workplace violence.  It would establish the following requirements:

• creation of a system for recording centrally all incidents of workplace violence or threats of such violence against employees and volunteers;
• creation of a written violence prevention and response plan;
• implementation of a training program to educate employees and volunteers about workplace violence and ways behavioral health care employers and employees and volunteers can ameliorate such risk;
• maintain and develop a violence prevention and response team to monitor ongoing compliance with the violence prevention and crisis response plan and to assist any employee or volunteer victimized by or threatened with workplace violence.

Legislators need to hear from NASW-MA members like you about why this bill is so important! Every phone call makes a difference. Visit www.wheredoivotema.com to identify your elected officials. The State House switchboard number is: 617-722-2000.

Thank you for taking action! If you have any questions, contact Rebekah Gewirtz, Director of Government Relations and Political Action at Gewirtz@naswma.org or 617-227-9635 x12.

ENDGAME

Last night I attended a screening of an extraordinary PBS Documentary on AIDS IN THE BLACK COMMUNITY: ENDGAME.  It will air tonight on PBS’s FRONTLINE.   It was moving, disturbing, and compelling. I left saddened, and worried.  And now I am feeling compelled to tell everyone to watch it.  Tonight. Although the film focuses on the AIDS virus in the Black community, the information is essential to all of us who care about public health issues, the impact of shame and humiliation on young peoples’ lives and on the uncompromising consequences keeping certain secrets.

There are many good people in the film that cause great suffering. It is a universal phenomenon.  Thank you, Vincent Lynch, my social work colleague at Boston College School of Social Work for inviting me and to Dr. Judy-Ann Bigby, Secretary, MA Executive Office of Health and Human Services for your panel participation where you showed the great work that a state can accomplish when it has committed people like yourselves taking a stand to address a crucial public health issue. 

Carol J. Trust

DEATH WITH DIGNITY

At its June 2012 meeting, the NASW MA Chapter Board of Directors voted to support the Death with Dignity Ballot Initiative which will  appear  on the  November 2012 Ballot.  After close scrutiny, comprehensive research, thorough discussions and presentations from opponents and proponents of the initiative, the Board sided with the proponents.   The basis for this decision lay in Social Work’s principles of self-determination, patient choice and autonomy.  Massachusetts is now the 4th NASW Chapter in the country (after Hawaii, Oregon, Washington State and Montana) to support the Death with Dignity Initiative.

Carol J. Trust

Movies, Social Work and Living with Incompleteness

I see lots of movies. Lots and lots: thrillers, dramas, action and foreign films. I used to prefer those movies that ended happily and were preceded by a degree of crying (mine).  There was a resolution of a problem, unhappiness a sad situation.  More recently, I have been seeing a different kind of movie, where there is no resolution.  The audience is left without the happy ending. In fact, the audience is left with suggesting or predicting the resolution themselves.

 I saw this in the Iranian movie, ‘The Separation’ where the movie ends with the parents waiting outside the courtroom for a decision to be made by the authorities and the parents have no more say in the final decision.  Then there is the Israeli move, ‘Jaffa’, where two teenagers, an Israeli girl and a Moslem boy fall in love.  Their plan to run away is stopped by the boy’s involvement in a shocking and totally unexpected crime that puts him in prison for years.  What happens to these two young lovers and the child they conceived is unknown by the end of the movie. We are left wondering and equally frustrated by what appears to be an impossible position for both the young people.

And what does this have to so with Social Work, you may ask?  More and more, I see our work, whether it is child welfare, prisons, private practice, homelessness, substance abuse etc.  as having no clear resolution.  We give our best: struggling to help a suicidal patient deal with his sense of hopelessness, encouraging and providing resources to parents accused of abuse and neglect,  or mobilizing a community to address gang violence in the neighborhood.  And often, we cannot see the results.  Certainly not right away or in some cases, in months and years ahead.  We cannot predict or be sure of the results of our efforts, even in the face of the trend to ‘measure’ our work. We may not be able to stop a chronic alcoholic from continuing her drinking habit or lower the rate of gang violence or even prevent the person living with incredible shame and hopeless from suicide.  The cynic’s voice in us says this is thankless work.  And yet, we continue doing the work, employing all the skills, intuition and resources we can muster.  It’s what we do.  It is what we are committed to.  And often we don’t know the ultimate outcome. We just may not be around to see it.  We may leave the position to move out of state, or to seek further education, or to take advantage of a new job opportunity.  Our work is often like the unfinished movies above.  However, what we can say is that we did our best, we devoted ourselves to the work, and we did not give up.  And the outcome may be unknown.

Carol J. Trust

ON THE WILD SIDE

Last week, Maurice Sendak, author of many children's books, including my favorite, 'Where the Wild Things Are', died. As I read a review of his life in one of the local newspapers, I was struck with how thoughtful his story messages were. And that I may have missed them when I read them to my own daughter, who is now in her twenties.  He wrote about the dark side of life, children's fears, their frustrations with parents and their sense of powerlessness. And as I read further in the article, I became aware of another theme in his writing that has relevance to social work practice.

In his book, "We Are All in the Dumps," he pictured two quasi ruffian homeless kids, Jack and Guy, who found another orphaned boy they initially had planned to bully and overpower.  As the story evolved, the two boys decided that rather than rough up the homeless tyke, they would take him back to their cardboard shanty to care for him.

At first, the sad story of homelessness, hunger and poverty seemed overwhelmingly cruel and hopeless- a moral atrocity for a society that would allow kids to live on the street in poverty. However, reading on was another message--the message of kindness and caring in the face of a societal outrage.  Jack and Guy were, indeed, still on the streets, on their own, no money, no home but their kindness shown through.

What does this mean for social work whose dual mission is to support social workers and the profession, as well as to address the causes of homelessness, poverty and vulnerability? As we all focus on this dual mission throughout our work, in so many settings, that we often do not see the results of our efforts- that there has been no cure or resolution to these societal injustices. However, what is clear is that we continue to work toward solutions; in counseling sessions with our clients, with families facing homelessness and poverty and in the State House with legislators and administrators who are charged with bringing solutions.  This is the Jack and Guy in all of us--the caring and kindness, as well as our dedication to changing systems that are not so kind.

Farewell, Maurice Sendak.  Your books are for all of us.

Carol J. Trust

MOTHER'S DAY: HURUMPH!

Well, it's over--the big hullabaloo surrounding this special day devoted to Mothers. Thank you.

 When I was younger, I remember looking forward to Mother’s Day.  My Dear Mom was a special lady--dramatic, overweight, stylish and tough.  Somehow, we made the Day fun.  My Dad was in a special mood and my sister and I had shopped for a gift that we thought Lil needed and would like.  (She needed nothing and she loved everything that we chose.) There was’automaticity’ to the day.  And i did not think about what it was about other than we were going to have some fun.

And now, many years later, why is this day so burdensome to me?  What is this questionable response?  Here is what I have come up.  I want my family to see every day as Mother's Day. Really.  That the appreciation and fondness that is bestowed on May 13th to me is spread throughout the year, every day. Don't bother looking for a greeting card that conveys a sentiment that is felt every day.  Tell me every day!

And what has this to do with social work and NASW, Massachusetts?  I am looking at  a perspective about life, a way of being --  not just for Mother's Day, but for every day. Do I show my appreciation to my family, my staff, members of NASW the MA Chapter, who count on the chapter to support them, promote them, and represent them?  Mother's Day is a reminder for me to say thank you to all the people in my life-family, staff and social workers who chose NASW, MA Chapter to stand up for them.   Just as I want my family to have Mother's Day special every day, I want to say thank you to my staff and members of NASW for all that you do, every day, during the year: for your involvement, your encouragement, and your dedication to the people  you serve and work that you have chosen.

My Hurmphf has dissolved.

Carol J. Trust