Hurricane Sandy and a Personal Note

I grew up in New Hampshire, in the foothills of the White Mountains, and have many fond and not so fond memories of living in a semi-rural area. One of the lingering recollections was walking to school in snow storms. And we had many. I recall feeling somewhat like a pioneer, a brave young kid, capable of dealing with any foul weather. I was tough. I don’t remember schools ever being called off-for any reason. In fact, the phrase ‘snow day’ was not in existence during those times. My mother just bundled up my sister and me, making sure we were adequately dressed for arctic conditions, handed us our lunch, and kissed us good-day. My father had already left an hour before to open the store, shovel the side walk so that customers could get in, and make sure the pipes hadn’t frozen. The notion of not going to school or not opening the store didn’t exist.


Enter Hurricane Sandy or any other likely weather disaster. As I listened to the warnings of staying home and hunkering down, I wondered, ‘What is the big deal? It’s just another storm- a little bigger than most and the eye isn’t even coming to Boston and the trains and buses are still running.’ (at 6:30 am). With the mindset of my New Hampshire upbringing, I got dressed and walked to the bus stop for my trip into the office. At the same time, my staff and colleagues were calling me to find out if the office was open, should they come in, what would happen if it got worse. There was apprehension and wondering.

Now, I am no longer the 8 year old, unthinking pip squeak who walked to school, regardless of the weather. I am, after all, an Executive Director, responsible for staff. People look to me for guidance, for direction, for answers. My standards and ideals lead me to straighten up, get going, look directorial, eliminate any whining about the weather. These are my standards and ideals-the shoulds. However, the ‘shoulds’- my standards and ideals- can get in the way, especially, of respect for other peoples’ fears and concerns, particularly about safety. My staff and friends were absolutely correct in wondering about my position. I was not taking into consideration their considerations. So, again, I find myself reconsidering long held beliefs and practices. Re-examining positions I have held. Wondering about what is right, what is ideal, what is truth and what is possible. The Sandy Storm gave me another reminder about being open, about questioning what is the truth. The personal journey continues. Right now, my next step is to meet with staff about reviewing the ‘storm day’ policy. It used to be, “If Filene’s Basement is open then NASW is open.” Time for a new ‘look-see.’

Out of the Silos and into the Fields

This morning the MA Chapter of NASW convened its biannual meeting with the Deans and Directors of the MSW and BSW Schools of Social Work in Massachusetts. This is a wonderful group that meets twice a year to provide updates on each school’s activities, plan joint projects, and be fully educated on trends in practice and academia. Besides covering the major happenings in the 2012 Payment Reform system, this morning’s session highlighted trends that Hospital Social Work Departments are seeing in the preparation of students to work in health care (hospital)) as well as the readiness of graduates to take jobs in hospitals. The conversation was enlightening as well as the variations that both groups are witnessing.

The exchange was a perfect example of the value for groups to move out of their ‘silos’. In this case, academia and practice met on the playing ‘field’—the scholars and the practitioners broke the proverbial bread and the menu was rich and satisfying. Representatives from the schools heard what the Hospital Social Work Directors are wanting the schools to cover in their curricula and conversely, the Social Work Directors heard how the academic community is challenged to provide in an already overfilled curriculum. The conversation was intense and enlightening.

Out of this meeting of colleagues came a plan for the two groups to meet more formally, to possibly plan a summit that would address contemporary learning and practice needs of social work students and graduates and the critical necessity of bringing the field supervisors into the conversation. The results were thrilling and part of the reason that makes my job so totally satisfying and on my toes. There is always more to learn and do. And always more that is possible. This is why I call my monthly column in the Chapter’s newsletter, “Leading from Possibility."

Death With Dignity

Last night, I had the privilege of representing the MA Chapter of NASW at a neighborhood forum on the 2012 Death with Dignity ballot initiative. The Board of Directors of the MA Chapter had voted this spring to support this Initiative and now Chapter staff and NASW members are speaking throughout the state representing the Social Work Perspective on Death with Dignity. The NASW Code of Ethics, as well as the NASW Public Policy statements, outlined in ‘Social Work Speaks’ clearly advocate for individuals’ right to choose the decisions that affect their lives. These include: respect for clients’ self- determination; the right of individuals to direct their end-of-life care; helping individuals identify the end-of-life options available to them and the right to choose.

The opponents of this Initiative talked about possible abuses that included coercion of family members, possible discrimination against people with disabilities or the aging population and sinister motivations of insurance companies to push for ‘death’ rather than provide for treatment. I came to feel that the individuals present at the forum were indeed worried and fearful that they may be the victims of unscrupulous abusers of the Initiative if it becomes law. I can appreciate peoples’ fears regardless of how irrational they sound. And still I came away from the event feeling more committed to the wisdom of this bill. It is consistent with all of social work’s values, standards, principles and ethics. I am including the basic elements of the Initiative below for readers as well as the website for additional detailed information.

Key facts about Death with Dignity Initiative:

• Protects the right of individuals to make voluntary and informed decisions about end-of-life care

• Expands end-of-life care options for terminally ill patients

• Respects and upholds the integrity of the doctor-patient relationship

• Contains strict safeguards to ensure that the patient is making a voluntary and informed decision

To access more information about this Initiative, please visit http://www.dignity2012.org/#

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