NASW CEO Dr. Angelo McClain, and several staff members, recently attended a White House briefing, hosted by the Council on Social Work Education (CSWE) entitled “Addressing the Social Determinants of Health in a New Era: The Role of Social Work Education.” This event included four panels of U.S. Department of Health and Human Services (HHS) staff and was held prior to the start of enrollment in Affordable Health Care exchanges October 1, stressing that social workers are positioned to ensure access. The goal of the event was to prepare social workers and social work educators to fulfill vital health care roles and respond to the populations who are most in need but might have the least access to care.
Darla Spence Coffey, President and CEO of CSWE, and Paul Monteiro from the White House Office of Public Engagement began the event and welcomed attendees. Mr. Monteiro noted that they were pleased to welcome social workers to the White House, and to further the Administration’s understanding of the issues that are important to social workers.
The first panel was on “Shifting U.S. Demographics: Ensuring Care for All” and was moderated by immediate past Chair of the CSWE board, Mildred (Mit) Joyner. Aaron Bishop, a social worker, who is Deputy Commissioner, Administration on Intellectual and Developmental Disabilities, Administration for Community Living and Roslyn Holiday Moore, Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration (SAMHSA) were panelists. They discussed disparities in health and mental health outcomes, as well as access to, and availability of, quality health care. They focused on the aging of the population and the importance of community-based, person-directed, and person-centered care. Issues such as limited incomes also factor into this complex equation. It was discussed that social workers are uniquely positioned to address these issues due to their person in environment perspective.
The second panel, “The New Expectations of Health Care” was moderated by Marilyn Luptak form the University of Utah and featured Amand Parekh, Deputy Secretary for Health, and Stephane Philogene, Associate Director, Office of Behavioral and Social Sciences Research at the National Institutes of Health. They discussed the importance of health care coverage and the need to reduce fragmentation and improve care coordination. Social determinants of health were key to this conversation and a multi-disciplinary team approach was promoted as part of the solution. Social workers were cited as key to community health linkages and critical to culturally competent health care transformation.
“A National Dialogue on Mental Health” was moderated by CSWE Chair Barbara Shank, and featured panelists Paolo del Vecchio, a social worker who is Director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration (SAMHSA) and Brian Altman, Legislative Director at SAMHSA. This conversation followed up on the White House Conference on Mental Health, and focused on the need for a national conversation regarding mental health. Panelists noted that stigma must be reduced and that recovery is possible.
Finally, the last panel was on “Building Capacity to Meet the Need” and was moderated by James Herbert Williams from the University of Denver. The presenter was Marcia Brand, Deputy Administrator, Health Resources and Services Administration (HRSA). She noted the similarities between the mission of social work and the mission of HRSA, stating that social workers are key components of the overall medical team, and that social workers were pioneers in recognizing the impact of social determinants on health outcomes. She also noted that HRSA supports social workers and social work education, and would like to see more social workers help to ease the transition as the Affordable Care Act is implemented.
Dr. Angelo McClain, CEO of NASW, noted that, “The briefing reaffirmed that the White House and HHS recognize the value of our profession, and that implementation of the Affordable Care Act and addressing health care inequities provide many new opportunities for social work.”
It was an honor to have participated in this special event and I was similarly pleased to hear how the White House and the Department of Health and Human Services valued social workers and envisioned a greater responsibility for this profession in addressing the “social determinants of health” across this great nation. But in this particular forum I want to reiterate a concern I expressed to the panelists and participants at the briefing.
Over the past twenty years, social work leadership in our academic institutions and through our leading national organizations, including the NASW and CSWE have tolerated the gradual and incipient erosion of our professional influence in the health care arena. Hospitals, even university hospitals have largely eliminated the majority of their social work positions often disbanding entire social work departments (and their potential influence) by folding them into discharge planning departments administered by nurses narrowly accountable to DRG or “diagnostically related group” measures.
On a parallel course we have passionately embraced the shiny emerging world of clinical tracks, clinical training, clinical competence, clinical licensure, and clinical third party reimbursemnts. And in fairness, while mental health is a significant social determinant of health, SO IS POVERTY. As well as hate, ignorance and violence, racism & bigotry, (ok I already said mental health), cancer, HIV, hypertension, COPD, diabetes, race, sex, gender identity, geographic location, crime, drug addiction…. The list goes on and on. And somehow, it seems to me that a lot of this gets lost in the “clinical” translation.
I couldn’t help but notice the power-point slides from the Deputy Administrator of Health Resources and Services Administration, who clearly sounded like a sensitive, great and powerful ally as she spoke of social work opportunities in the National Health Services Corps as well as the Veterans Administration, specifically labeled those opportunities with the coded “LCSW.” Social Workers in the NHSC and VA are expected to be clinically licensed. Seriously? Does every veteran need a “clinical social worker?” (to the exclusion of other social workers who might be experts with other competencies?) Does every person living in an “underserved” location need a “clinical social worker?”
And seemingly no-one in the audience picked this up. How does this bode for future social workers progressing though their schools. How are we to best advise, mentor and guide them? What is the place for well prepared and talented GENERALIST BSWs? Or MSWs who don’t crave the clinical brass ring?
I was honored to attend this event. I appreciate the opportunity it promoted. But nothing really has changed. We have a lot of work to do. And most of it ain’t “clinical.” Have you called your congress person of senator today? See, that’s the work before us today. (If not, what the hell are you thinking? Dang! So there is that clinical thingy again!)
Peace. But not too much. Gary E. Bachman MSSW, LSCSW