August 11, 2017

By Melissa Johnson, CSWA President

The Clinical Social Work Association has been working for several months to assess and discuss diversity of our membership. Several Societies have begun to develop programs to promote diversity awareness. Based on their work, below are some suggestions.

Define your terms. Everyone has a different idea about what diversity means. Beyond race and gender, it can also include but is not limited to considerations of age, ethnicity, sexual orientation, mental and physical capabilities, gender identity, family status, language, opinions and experience.

Assess. Review your bylaws and clauses that define diversity standards; check for any institutional bias or exclusionary language. Start a conversation about diversity and inclusion with Board members and within your Society. Be prepared to have difficult conversations. Collect rich data; the goal of a survey is not just a head count, but rather the beginning of an education process.

Listen and affirm. Ask about the experiences of your members. Do not make assumptions about how people view this complicated issue. Encourage all Board members to evaluate their own perspective. Don’t scold or shame those who are struggling with understanding.

Learn, share, educate. Offer trainings; invite speakers; build coalitions with other associations; plan a conference on diversity and inclusion. Identify all of the ways you can define diversity and how inclusion is experienced within your society and the profession. Embed these principles in your leadership and others will follow.

Contact Melissa Johnson, CSWA Board President, or any of the board members if you want to discuss these concepts with other Societies or find experts to conduct trainings. It helps to not have to reinvent the wheel. CSWA wants all its members and Societies to be self-aware about what healthy understanding and acceptance of diversity means to them and others.

August 8, 2017

The Clinical Social Work Association has been working for several months to assess and discuss diversity of our membership and our Board. Planning and discussion at the 2016 Annual Summit helped to launch a larger consideration of diversity within our membership. While it is beyond the mission of CSWA to alter the demographics of clinical social work, it is our responsibility to regularly assess our membership and evaluate the perspective we are representing. Our goal was simple: start a conversation about encouraging diversity of membership and Board representation, and continue this conversation by offering action steps and educational tools. In order to reach our goal, we disseminated a survey, created an ad hoc diversity committee, and incorporated the results into our strategic planning.

We are not alone in our commitment to assess and discuss diversity and inclusion. Several Societies have been facilitating these critical conversations for years. Others have begun to take action recently. We know that despite CSWA’s best efforts, there will always be room for improvement. We encourage all state societies to promote through trainings and increased inclusion of diverse populations on Society Boards and in membership. Additionally, CSWA encourages Societies to reach out to other clinical social work organizations to build bridges for more unified membership and advocacy efforts. CSWA supports all attempts to create a clinical social work community that is inclusive and sensitive to the experience of all its members.

We are proud to send the following statement and reminder of the CSWA Code of Ethics that outlines our long standing commitment to cultural competency.

2017 CSWA Diversity Statement

The Clinical Social Work Association has long supported the values of diversity and inclusion. During these troubling times it is vital we create a welcoming and supportive environment for all our members and the people we serve. We firmly believe that we can best promote excellence within our profession by offering educational tools for dialogue and professional development, assessing our membership, and promoting our strong code of ethics regarding cultural competency standards. Further, we recognize the responsibility for excellence, diversity and inclusion lies within each of us who make up the clinical social work profession. CSWA encourages all members and affiliated societies to promote increased awareness of the meaning of diversity to all.

August 4, 2017

Our Government Relations Committee has been carefully tracking the eight attempts in Congress to repeal and replace the Affordable Care Act over the past four months. We are pleased that none of the proposed attempts has been passed by both Houses.

One of the major drawbacks to the process from CSWA’s point of view has been the partisanship that has led to only the majority party crafting the bills that were considered. Bipartisanship is the only way a reasonable bill to improve the ACA can be developed. Both Houses now have working groups that will be trying to accomplish this. It remains to be seen whether leadership will support these groups.

I want to draw your attention to part of a speech given by Sen.John McCain (R-AZ) on July 25 that supports the importance of bipartisanship eloquently.

“…I hope we can again rely on humility, on our need to cooperate, on our dependence on each other to learn how to trust each other again and by so doing better serve the people who elected us. Stop listening to the bombastic loudmouths on the radio and television and the Internet. To hell with them. They don’t want anything done for the public good. Our incapacity is their livelihood.

Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires….

What have we to lose by trying to work together to find those solutions? We're not getting much done apart. I don't think any of us feels very proud of our incapacity. Merely preventing your political opponents from doing what they want isn't the most inspiring work. There's greater satisfaction in respecting our differences, but not letting them prevent agreements that don't require abandonment of core principles, agreements made in good faith that help improve lives and protect the American people....”

To read or see the whole speech go to http://www.cnn.com/2017/07/25/politics/john-mccain-speech-full-text-senate/index.html

July 28, 2017

In the dead of night this morning, an attempt was made was made to by Sen. Mitch McConnell, Senate Majority Leader (R-KY), to pass a repeal of the Affordable care act through a "skinny" version of the House American Health Care Act which had been passed by the House. The bill, which was released two hours prior to the vote, had little "debate" and no committee hearing.

I can't thank all of you who contacted your senators and other senators about what ending the ACA would do for access to mental health treatment enough. The senators who prevented this disaster for millions of Americans should be thanked include Sens. Lisa Murkowski (R-AK), Susan Collins (R-ME), and most importantly, John McCain (R-AZ) who had just undergone brain surgery and made the bravest decision of his career in voting against this bill. Please make calls to them for their principled stance.

Also thank Sen. Patty Murray (D-WA) for her last ditch attempt to have the bill sent to the HELP Committee before the vote to approve it which, though it failed, showed the Senate how far from usual process it had strayed. Please make calls to all the senators above using the link https://www.senate.gov/senators/contact/. Also thank your own senators if any of them opposed this bill.

We will see if there is any last gasp effort by the Senate to ram through some version of this bill but at this time it appears unlikely.

As always, let me know when you have made your calls.

July 26, 2017

The first vote on the Senate health care repeal and replace bill, the Better Care Reconciliation Act, has failed but there are many votes to go before the fate of the Affordable Care Act is decided.

As the debate to repeal and replace the Affordable Care Act continues, it is important for us as clinical social workers to keep our focus on the way that all the bills that have been considered would affect patient access to mental health and substance use treatment. The elimination of essential benefits would return insurance plans to the days when they could pick and choose benefits and often left out mental health coverage. Another group that will be harmed if the essential benefits are eliminated are women - maternity and gynecology benefits were also typically not covered before the ACA.

The bill that will actually be voted on is still not clear. However, the plan to repeal the mandated payment for those who do not choose to get insurance, now being called the "bare-bones" plan or the "skinny repeal" plan, is gaining steam and will severely erode the funding base for those covered by the ACA in Medicaid and the individual market.

There is still great confusion about the plan that will eventually be voted on, but here is a message that will keep CSWA's concerns in front of your senators:

"I am a member of the Clinical Social Work Association and a constituent. Please make sure that mental health needs remain covered as they are in the Affordable Care Act. Make sure that the maternity and medical needs of women remain covered. Finally keep Medicaid expansion without caps and the mandated payment in place. We need all these components to avoid serious risks to coverage of the health and mental health of our citizens."

To contact your senators, go to https://www.senate.gov/senators/contact/ and enter your state. To contact Republican senators most likely to support our views, go to https://www.trumpcaretoolkit.org/ and contact as many as possible.

As always, let me know when you have made your calls.

July 25, 2017

As discussed in yesterday's post, the US Senate voted 51-50 today to proceed with debate on repealing and/or replacing the Affordable Care Act. This debate could include discussion of the American Health Care Act, the House bill which has passed to the Senate, the Better Care Reconciliation Act in the Senate which has failed to pass twice, or be a simple repeal with a replacement to follow.

The AHCA and the BCRA are much more similar than they are different. Both would seriously undermine access to mental health treatment by removing essential benefits; remove mental health parity from Medicare; cut access to Medicaid using caps and/or block grants; and possibly create plans which would eliminate coverage of pre-existing conditions.

There is a new wrinkle in the announcement by the Senate Parliamentarian, Elizabeth MacDonough, that some of the provisions in the bills may require 60 votes to pass, as opposed to the 51 currently being sought. That would significantly change the likelihood that the bills could be passed.

I will be sending messages over the 20 hours of debate allowed, which will probably take no more than a few days, to send to your Senators. There will be many amendments that are yet to be announced.

This has been a marathon campaign and we need to keep fighting the changes being proposed that would harm our work as clinical social workers and our patients' access to treatment.

July 24, 2017

As you know, a vote on a health care bill that would allow debate on whether to repeal and/or replace the Affordable Care Act has been scheduled in the Senate tomorrow. There is no clarity from leadership exactly about what will be in the bill. Therefore, it is difficult for CSWA to give specific guidance any what message to give your senators. Here is a summary of the possible bill that will be voted on.

1. A bill that will repeal the ACA without replacing it, with the goal of passing a replacement prior to the 2018 elections.

2. The Better Care Reconciliation ACT which will include caps on Medicaid, eliminate the essential benefits, and allow some pre-existing conditions to be the basis for denying insurance.

3. The American Health Care Act which was passed by the House a month ago and has much of what is in the BCRA.

4. A bill which has not been discussed and will some new version of the bills above.

The CBO score on the BCRA, which came out last Monday, had the same 22-23 million that would lose insurance as the AHCA.

All the bills we have heard about are damaging to access to mental health treatment, mental health parity, and coverage for Medicaid enrollees who need mental health services.

I will let you know more when the actual bill is finally revealed. In CSWA's view, this process is an example of bad governance. It seems very politically based and has little to do with people getting good health care or actually improving the ACA.

July 17, 2017

There has been an unexpected development since Friday when Sen. McConnell had announced his intention to vote on the BCRA to repeal and replace the Affordable Care Act tomorrow.

Sen. McCain has had surgery for a blood clot above his left eye which will mean he cannot attend the Senate this week. This means that the vote on BCRA is more fragile than it had been, though Sen. McCain's vote was not a certain yes or no.

We have a little time to work on stopping this bad bill. Please continue to call your Governors and Senators to let them know you oppose it.

ADDITIONALLY - ask the senators who are no votes (all Democrats, Ron Paul and Susan Collins) or leaning no to come together as a group to request a new process - that the bill get bipartisan support to receive the thoughtful open transparent process it deserves.

lease review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

Also – please call Sen. Susan Collins (R-ME) to thank her for her principled opposition to this bill at (202) 224-2523.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill. We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

Call these Senators today to ask them to oppose the AHCA without protections for substance use disorders and mental health.

A list of key decision-making Senators to call is below:

• Capito (R-WV) | (202) 224-6472
• Cassidy (R-LA) | (202) 224-5824
• Heller (R-NV) | (202) 224-6244
• Murkowski (R-AK) | (202) 224-6665
• Portman (R-OH) | (202) 224-3353
• Sullivan (R-AK) | (202) 224-3004
• Flake (R-AZ) | (202) 224-4521

Sample call script:

I am a constituent [if you are] and a member of the Clinical Social Work Association. Please oppose the Better Care Reconciliation Act of 2017. Please join with other Senators who have concerns about this bill and develop a bipartisan group to give it the thoughtful open transparent process it deserves. [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill. The same message can be used.

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

July 14, 2017

We are approaching our final chance to stop the Better Care Reconciliation Act. Even if you have called the Senators listed below, please call them again to oppose this bill. The CBO score will come out on Monday, July 17, and the bill will be voted on Tuesday, July 18.

Please review the issues which I sent out in my posts of June 12 and June 19 which detail how these bills are harmful to people with mental health needs including the possible loss of essential benefits, including mental health and substance use for states who choose waivers to Medicaid; the extreme cuts to Medicaid, with the bulk of lost insurance being people covered by Medicaid; and the end of required coverage for pre-existing conditions for state that choose waivers for Medicaid.

Also – please call Sen. Susan Collins (R-ME) to thank her for her principled opposition to this bill at (202) 224-2523.

The main political issue is whether there are three senators willing to vote against this deeply flawed bill. We need to continue to oppose this bill with the senators who are wavering on their vote, mainly the more moderate Republicans.

Here is the message I am suggesting with the contact information for these Senators:

Call these Senators today to ask them to oppose the AHCA without protections for substance use disorders and mental health.

A list of key decision-making Senators to call is below:

• Capito (R-WV) | (202) 224-6472
• Cassidy (R-LA) | (202) 224-5824
• Heller (R-NV) | (202) 224-6244
• Murkowski (R-AK) | (202) 224-6665
• Portman (R-OH) | (202) 224-3353
• Sullivan (R-AK) | (202) 224-3004
• Flake (R-AZ) | (202) 224-4521

Sample call script:

I am a constituent [if you are] and a member of the Clinical Social Work Association. Please oppose the Better Care Reconciliation Act of 2017 which will not protect the coverage needed for mental health disorders, substance use disorders, and will severely cut Medicaid coverage. These policies would increase costs for everyone by increasing the use of emergency rooms and law enforcement as the place that these disorders will be addressed. BCRA will cause emotional suffering for those who need help. [Your name, degree, contact information]

If you wish to contact other Republican Senators, you can do so by going to https://www.senate.gov/general/contact_information/senators_cfm.cfm where you will find all the phone numbers for U.S. Senators.

One other way to oppose this bill is to contact your Governor and ask your Governor to let your state’s senators know that your Governor opposes this bill. The same message can be used.

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

July 10, 2017

Here is an update on the Better Care Reconciliation Act of 2017 in the Senate.

There are seven Republican senators who have announced that they will not vote it in its present form. This means that the bill cannot pass. Majority Leader Mitch McConnell has said he may “be forced” to work with Democrats to shore up the individual markets if the bill is not viable.

CSWA believes that a bi-partisan approach to health care is by far the best solution. Please do not take for granted that your senators will take this approach, even if they are Democrats. Call your senators today with the following message:

“I am a member of the Clinical Social Work Association and a constituent. Please support a bi-partisan effort to improve the Affordable Care Act by shoring up the individual market subsidies. The mental health of our citizens will be jeopardized without this support.”

You can find telephone numbers and email addresses at https://www.senate.gov/general/contact_information/senators_cfm.cfm.

As always, let me know when you have contacted your senators. Please let me know if you have any questions.