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

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