23 minute read
THE LATEST FROM THE FIELD
What’s Next for Telemental Health?
by Pat Spencer, LCSW
Prior to the COVID-19 pandemic, telehealth was a service offered by some mental health practitioners, primarily to clients living in rural areas who had limited or no access to in person services, in emergency rooms for crisis evaluations and on various crisis call and text lines. In March 2020, when the COVID-19 pandemic hit and states shut down, telehealth became the primary modality for treatment for outpatient therapy, outpatient psychiatric care, IOP and PHP services. Even crisis services transitioned to providing services remotely. During those first few months, the rules regarding HIPAA compliant platforms were temporarily lifted, the licensing laws in various states were adjusted for the new reality of clients living across state lines, insurance companies were mandated to cover telehealth, and practitioners and clients learned how to work with telehealth platforms.
Now, over a year into the pandemic, as vaccines become more widely available, we are beginning to wonder what healthcare and social work will look like after the pandemic. Unfortunately, there is no clear-cut answer, but one thing is for sure— telehealth is here to stay. The question is, in what form?
Many factors will impact the future of telehealth services. Some factors include licensing laws, insurance reimbursement policies, HIPAA guidelines, accessibility to stable high-speed internet and accessibility to hardware that will allow for privacy and confidentiality.
LICENSING LAWS
Prior to the COVID-19 pandemic, state laws determined if a social worker could treat a person based on their location. This worked well when a majority of clients were being seen in person. We knew easily, if the person was physically in my office, and I am licensed in my state then I was legally able to treat this person. As the pandemic hit and most practitioners transitioned to telehealth, those clients could now be located in different states. As state governors declared States of Emergencies, some states allowed for practitioners licensed out of state to treat a person in their state. Each state differed on their requirements, or if this practice was even allowed. This created, and still creates, a great deal of confusion.
In our post pandemic world, states will hopefully consider entering into a cross state compact. This will allow licensed practitioners to practice in states within the compact. It will allow for mobility of practitioners, more continuity of care for clients, and wider access to trained mental health professionals.
Prior to COVID-19, insurance payment for telehealth services was inconsistent. Each insurance plan would determine the reimbursement rate, if the provider needed to be in-network, and if a specific telehealth platform needed to be used. Also prior to COVID-19, per Medicare regulations, the services had to be provided via synchronous video; during the pandemic, Medicare now allows audioonly telephone calls. We do not yet have a clear understanding of what the insurance companies will do when the pandemic ends. However, we can expect insurance companies to follow Medicare’s lead.
HIPAA GUIDELINES
During the pandemic, the requirements for a HIPAA compliant telehealth platform were modified. It is expected that these HIPAA requirements will be restored post-pandemic. Regardless, it is sound clinical practice to use HIPAA compliant software, and this may be required by the practitioner’s malpractice insurance.
What can we expect in the coming months? As I gaze into my crystal ball, I see us creating a new normal that will be a mix of both in person services and telehealth services. We will be navigating the web of insurance companies and their various reimbursement policies. We will be working with our own and our client’s anxiety about a return to seeing people in our offices. We will find a practice that fits our style, our client’s needs, and that complies with the various rules and regulations that emerge.
Aboutthe Author:
Pat Spencer, LCSW has been working and teaching in the field of social work for over 20 years and is the owner of BTC Counseling in Highland Park, NJ. Learn more at https:// btccounselingnj.com/
Medical Social Workers on The Frontlines: A Call for Cooperative Collaboration
By Michelle Branigan, MSW, LCSW, ACW, BCD
As a social worker in a medical setting, I am used to the phrase “the epidemic” being used as shorthand for the opioid epidemic. This epidemic did not discriminate by race, age, ethnicity, or economic background. If patients survived an overdose, our social work duty was to provide counsel and information, as well as coordinate inpatient and outpatient treatment programs. In January 2020, the concept of another epidemic—let alone a global pandemic—was distant from our daily opioid epidemic reality.
Master’s level social workers are known by their fellow health care team members as the problem solvers, planners, compassionate listeners, partners in care, voice of ethical reason, and advocates in selfdetermination for patient and families. Prior to the COVID-19 pandemic, our social work team would routinely start our day doing rounds with the unit nurses, case managers, and hospitalist physicians to plan out the priority patient plans of care. Social workers were tasked with the responsibility of managing the more complex psychosocial issues, long term care, end of life, hospice care, substance abuse, psychiatric placements and more. Everything changed the week of March 14, 2020. It was like being transported into a sci-fi movie. Those of us old enough to remember the movie drew parallels to the 1969 techno-thriller, The Andromeda Strain. Our hospital protocols changed as patients began streaming in with this threatening new sickness called COVID-19. We were faced with a global medical tsunami!
In the early days, only a few doctors wore masks when initially treating patients; however, as each day passed, it was abundantly clear we were facing something monumental which no one had previously encountered in this lifetime. Full medical protective equipment became non-negotiable. Within a few days, all staff members were wearing masks, scrubs, and completing frequent temperature checks. Terrified of bringing this deadly virus home to our families, staff would share stories of stripping off their clothes outdoors and running into the shower as soon as they arrived home. Medical Units became what was newly termed, “COVID Positive Units.” Social workers united with floor nurses who were inundated with family members desperate for
information and unable to visit their loved ones. We became the liaisons, linking patients and families now separated due to visitation restrictions. It was a united effort by all—administrative, medical, nursing, environmental, respiratory, and ancillary staff— collaborating to meet the uncertain needs of our COVID patients.
By April 2020, our hospital was at 80% COVIDpositive capacity. Partnership with the Palliative Care staff became even more essential, as families faced difficult, heart-wrenching decisions. More than ever, families needed communication and support to deal with their fears, pain, sadness, and loss.
Local nursing homes transferred to us many residents diagnosed with COVID-19, then worked with us to develop pathways for patients who survived to return to those facilities. We collaborated with hospice social workers who had developed bereavement outreach plans for families who experienced a loss. Sadly, many of our elderly patients passed away. Collaboration with funeral homes was at its peak.
Thankfully, our surrounding community demonstrated their appreciation and love for us— their “healthcare heroes.” They posted signs in the neighborhood cheering us on. They joined us in “clap outs” for COVID survivors. Volunteers sewed masks. Restaurants and community residents showed their support daily through donations of food for workers. A Broadway star sang for us outside our front lobby. Local students made signs and cards which were posted throughout the hospital. Health care team members collected food for the local food pantries, responding to the rising rate of food insecurity.
We also strived to care for our own. The Social Work Department collaborated with Patient Family Experience and Spiritual Care to develop Resilience Webinars and a Virtual Resilience Lounge to provide an outlet for employees who were exhausted by the workload, devastated by the staggering number of deaths, but who nevertheless persevered through these challenging times. One participant left the following note: “With gratitude for giving us strength and hope throughout these trying and most difficult times. We are facing a battle. You are the troopers and I would go to war with you guys.” What has become obvious, and was paramount during these days, is the realization that we all need each other: no single entity can do it alone. Collaboration—interdepartmentally, cross profession, cross specialty, cross agency—was key to our ability to outlast this viral storm. As we slowly emerge from the COVID-19 pandemic, my hope is that the extended health care community learns from this experience and leverages it to remove barriers within the care continuum, allowing us to build and maintain more robust, collaborative, cooperative, cross-discipline networks for the well-being of the patients and communities we serve.
Aboutthe Author:
Michelle Branigan, MSW, LCSW, ACW, BCD, is a medical social worker and Manager of the Social Workers in the Care Coordination Department at The Valley Hospital in Ridgewood, NJ. She earned her MSW from Columbia University School of Social Work and has an extensive background in clinical social work supervision in healthcare settings.
Seeing Resilience: What a Year Reveals
by Sanjana Ragudaran, PhD, MSW
All I could think of in mid-March 2020 was how to successfully transition my classes from in-person to online synchronous learning. Having had some experience in teaching asynchronous and hybrid modalities, transitioning to synchronous was manageable for me. However, the uncertainty of not knowing how long we’d be conducting courses virtually, along with personal and student life challenges, meant I had to constantly tweak course expectations. Fortunately, having previously established working relationships with students helped in moving deadlines and evolving expectations around assignments.
By April 2020, I started to realize the tsunamisized impact of the pandemic. My next thoughts were twofold as a macro social work academic: “what do I do and how can I teach about this?” There was a need to document migrant experiences during the pandemic, so, with the help of my School’s networks, I connected with an agency working with migrant communities. Teaching the course “Global Human Rights and Social Justice” over the summer provided me the opportunity to deliver the content through the lens of the pandemic.
Although I felt hopeless and helpless at the start of the pandemic, I saw opportunities to learn and use my skills. This transition did not take place overnight. Conversations mattered. I am grateful for wonderful academic colleagues in my school, across campus, and within my state! Our school meetings, and colleagues connecting to check-in with each other were vital during this time. Being actively engaged in our faculty union provided another avenue for me to develop my organizing and advocacy skills. I have renewed appreciation of unions because of this experience. Engaging in conversations helped me process current issues around the pandemic which enabled me to carve out my work ahead.
I was back in my groove until I read about the George Floyd murder over Memorial Day Weekend. Mass protests around the country had a ripple effect on our campus. Students on our campus were engaged and formed the Students NJFOCUS • May 2021 | 21
for Systemic Change. Social Work Society board members were equally engaged with this newly formed group, simultaneously planning their annual Teach In on the timely topic of how the global pandemic shed light on pertinent issues. Student engagement was key for me during this time, as this was an opportunity for me to guide students outside the classroom. The 2020 elections were also looming in my mind along with that sense of hopelessness; I knew I had to do something. I had attended webinars on voter registration thanks to the National Social Work Voter Mobilization Campaign and hosted one hour lunch and learn sessions on the importance of voting in social work directed at field agencies. We continued this conversation into the fall when I shared information with faculty encouraging field professors to engage in conversations around voter rights with students. This was important academically, as well, as students learn about social welfare policies in the spring, but elections are held in the fall. Although I experienced some relief from the election outcome, something inside me was still unsettled. The events of January 6 solidified that our work is far from over.
My next challenge will be to work with agencies to institute voter registration plans for their clients. The increasing human rights violations migrants encounter has also driven me to actively engage with the NGO committee on migration providing me the opportunity to work towards migrant rights locally and globally. Continued conversations within my field, and beyond, around voting rights and migration have been key.
Entering the new decade, the pandemic has brought a multitude of problems to the forefront—problems that we have been raising and addressing for decades. As I reflect on the past year and think ahead, I am increasingly reminded of the global-local interconnectivity, and the intersectionality of social problems. We need to continue conversations and engage both in and out of our field to bring this work to our campuses and our classrooms. As social workers and academics, we must seize this window of opportunity to hammer on harder—to get into “good trouble” as John Lewis aptly stated.
Aboutthe Author:
Dr. Sanjana Ragudaran is an Assistant Professor in the School of Social Work at Monmouth University. She worked as a social worker in Singapore in both micro and macro settings prior to moving to the United States.
A Call to Action: Social Workers Unite to Stop Asian Hate and Violence
by Mang Yip, LCSW
“Remember, remember always that all of us, and you and I especially, we are descended from immigrants and revolutionists.” - President Franklin D. Roosevelt
“Stop The Asian Hate” has become a popular slogan since the tragic events that ended the lives of eight people—including six Asian women—at the salon shootings in the Atlanta region last month. There has been a well-documented rise in Anti-Asian racism and xenophobia since the outbreak of the coronavirus (COVID-19). The outbreak—which first began in China—has caused some people to scapegoat Chinese and broader Asian communities. The past year has seen Asians targeted through racist harassment, verbal attacks in public, and physical assaults.
According to the Center for the Study of Hate & Extremism at California State University, San Bernardino, Anti-Asian hate crime in 16 of America’s largest cities increased by 149% in 2020. The study indicated New York City saw an 833% increase in Anti-Asian hate crimes.1 Pew Research Center completed a study in June 2020, which reported three-in-ten Asian adults (31%) reported they have been subject to slurs or jokes because of their race or ethnicity since the outbreak of the coronavirus.2
Recently, I saw a YouTube video of an elderly Asian woman who was attacked by a Caucasian male in San Francisco. I was immediately struck by the thought that this could have been my grandmother. After watching the video, I felt angry, disgusted by that man who tried to bully an elderly woman. Luckily, the woman was able to defend herself and the assailant was the one who ended up beaten and handcuffed to a stretcher.
My family and I are immigrants from Hong Kong. My parents have made much sacrifice just so we could come to the U.S. for a better opportunity. I had my share of racist experiences as a kid, and even as an adult, have been the target of racerelated comments and discrimination. When former President Donald Trump intentionally and repeatedly called the novel coronavirus the “China Virus,” it made me feel, once again, like an outsider living in an America.
As a Chinese American social worker, I find myself in a somewhat unique position. There are not many Asian social workers in America, and certainly even
fewer Chinese American social workers like me. I think there is societal and family pressure for Asians to strive for careers as doctors, lawyers, or engineers, and less so for social work because it is not seen as a highly esteemed or high paying field. However, what I love most about being a social worker is that I am at the forefront in helping my clients and advocating for them to help change their lives for the better. The micro-macro perspective in social work allows me to help others in a way I would be unable to in other professions.
As a social worker, I have the responsibility to use my voice and my perspective to speak out on behalf of others. I am thankful my membership in NASW has provided me this platform to represent Asians in America—to be part of the voice raising concerns about growing hate against Asians. Enough is enough! We are not invisible, and we will raise our voice loud and clear so everyone can hear us. At the end of the day, repression, discrimination, and judgments of others will not bring unity to America. But joining together in opposition to hatred can.
There is no doubt the coronavirus has impacted almost everyone in some way. An unfortunate impact has been the furthering of racist division in our country. America is still very much a divided country and race relations were problematic, even before the pandemic. However, the coronavirus has amplified the outward expression of hate and racism against immigrant and native-born Asians. As social workers, each of us has a responsibility to stop and say no to race-based hate in America, not just against Asian Americans, but in all its forms.
1FACT SHEET: Anti‐Asian Prejudice March 2020 – Center for the Study of Hate & Extremism. (2020). Center for the Study of Hate & Extremism CSUSB. https://www.csusb.edu/sites/default/files/FACT%20 SHEET-%20Anti-Asian%20Hate%202020%203.2.21.pdf
2Ruiz, N. G., Horowitz, J. M., & Tamir, C. (2020, July 1). Many Black and Asian Americans Say They Have Experienced Discrimination Amid the COVID-19 Outbreak. Pew Research Center.
https://www.pewresearch.org/social-trends/2020/07/01/many-black-andasian-americans-say-they-have-experienced-discrimination-amid-thecovid-19-outbreak/
Aboutthe Author:
Mang Yip, LCSW is a social work supervisor at Rowan Integrated Special Needs and a medical social worker at Inspira. He received his MSW from Stockton University in 2010 and is currently in the process of completing the Master’s Degree in Health / Health Care Administration / Management from Wilmington University.
Make Your Voice Heard: New Jersey Must Pass the Reproductive Freedom Act
by Noelle Tutunjian, MSW
Currently, there are 19 cases on abortion access just one step away from the 6-3 conservative majority in the Supreme Court. This court is more hostile to abortion access than at any point in the 48 years since Roe v Wade was decided. President Biden winning the White House does nothing to change this fact.
Even in New Jersey, where there are relatively few legal restrictions on abortion, access to reproductive health care remains out of reach for many, especially for people of color and low-income communities. Rights mean little if people are unable to access them.
Politicians and the anti-choice movement in other states have been racing to push reproductive health care out of reach. There are 21 states with laws that could be used to restrict the legal status of abortion if Roe were overturned, and New Jersey is NOT among the 14 states with statutory provision laws that protect the right to abortion.1 That must be corrected. What currently exists in NJ is case law precedent, which is not comprehensive enough. As one of the more progressive states in our nation, New Jersey must lead on this issue! (RFA)—will provide a fundamental right to access reproductive health care, such as birth control and pregnancy-related care, including abortion care. It will protect and expand the right to choose in New Jersey to all people who can become pregnant, including transgender and non-binary persons. It also goes further than Roe. Thanks to the Hyde Amendment, which eliminated any federal funding for abortion care, Roe has meant little for poor and underinsured people. The RFA will remove financial barriers through provisions that will require complete coverage of birth control and abortion care, regardless of New Jersey zip code and immigration status.
The RFA embodies social work values. The Reproductive Freedom Act prioritizes the health and well-being of everyone who needs reproductive health care. When people can make the decisions that are best for their lives, families thrive, and we build communities where everyone can participate with dignity and equality. When we support and create access to the full range of reproductive health care, including birth control, maternity care, and abortion care, we also begin to unravel systemic oppression. The RFA ensures equity, rights and access and asks New Jersey to lead with compassion.
NASW-NJ has recently become a member of Thrive NJ, a statewide coalition of organizations working collectively to promote sexual and reproductive health, rights, and justice. Thrive NJ spent over a year developing the RFA, which was introduced in October 2020. The primary sponsors are Senator Loretta Weinberg and Assemblywoman Valerie Huttle, both consistent champions of women’s rights and health care. Although Governor Murphy has expressed support for the RFA, Senate President Stephen Sweeney and Assembly Speaker Craig Coughlin are blocking the bill from getting hearings in the Health Committees in both houses. It’s an outrage that with 22 Assembly co-sponsors and six Senate co-sponsors, Sweeney and Coughlin won’t even post the bill for hearings in the Health Committees.
A groundbreaking poll from Change Research and the National Institute of Reproductive Health of 978 New Jersey voters show that “66% of voters agree that New Jersey must address health care inequities – whether stemming from racism, income, zip code, insurance or immigration status – by ensuring everyone can access affordable and highquality health care, including abortion. The survey also showed that “72% of New Jerseyans see the restrictions being passed in other states that push reproductive health care out of reach and agree it’s time for New Jersey to take action with the RFA to protect access to care.”2
What can social workers do to help pass the RFA?
We need to be LOUDER than the opposition and give our state legislators the support they need to move forward. PLEASE CALL both Speaker Coughlin and Senate President Sweeney and tell them you are a social worker, you support the Reproductive Freedom Act (S 3030/A 4848), and you want them to post the RFA in the Health Committee.
Assembly Speaker Craig Coughlin: (732) 855-7441 Senate President Stephen Sweeney: (856) 251-9801
References:
1 The Guttmacher Institute: Abortion Policy in the Absence of Roe, April 2021. https://www.guttmacher.org/state-policy/explore/abortionpolicy-absence-roe
2 National Institute of Reproductive Health: Polling on New Jersey Reproductive Freedom Act, March 2021. https://www.nirhealth.org/ blog/2021/04/01/njpoll/
Aboutthe Author:
Noelle Tutunjian, MSW, is a political social worker with a background in electoral and legislative activism. She is co-founder of Stanton Strong Inc, an advocacy nonprofit dedicated to increasing access to reproductive healthcare regardless of zip code, and an active member of Thrive NJ, a statewide coalition that developed and drafted the RFA.
The Transitional Coaches™ Model: A New Model for SchoolBased Mental Health Services
by Judyann McCarthy, LCSW
The collateral damage caused by the COVID-19 pandemic has included the shutdown of much of society, including many schools. Without a doubt, this public health emergency has presented unprecedented challenges to our schools and communities. In June, the New Jersey Department of Education (NJDOE) released The Road Back: Restart and Recovery Plan to provide necessary information and considerations for a return to in-person instruction to our school district leaders. Since the provision of these guidelines, districts have made difficult decisions regarding the safe reopening of their schools, based upon local needs assessments, staffing capacities, current enrollment numbers, and the unique physical structures within each school.
New Jersey students returned to schools utilizing a mix of operational models including hybrid learning, remote instruction, and full in-person instruction. While districts have approached the challenge of school reopening in a variety of ways, all school communities are facing the same fundamental reality—their students have endured, and continue to endure, significant stress and trauma due to the ongoing pandemic. As schools continue to adjust to daily changes related to the public health conditions and mandates, it is critical to support the mental health and resiliency of students and their families. Years of research in education, psychology, physiology, and neuroscience have shown that stress and trauma greatly impact an individual’s ability to work and learn, and this past year has been no exception.
Mental health support for children and young adults has adapted to the pandemic by transitioning to digital and virtual interventions. While it is important to continue mental health support by any means possible, there are some relevant challenges that must be considered. First, not all children and young adults have access to technology; if they do, it is often not a private or personal device. Second, many children and young adults reported concerns regarding lack of privacy at home and fear that family members are overhearing their sessions. This is especially problematic for those who do not want their families to know they receive mental health support. Third, many are reporting long wait times to access online support, as well as less thorough appointments due to the increased demand for services. Lastly, many children and young people
After three years of intensive research and development, and now with issues uniquely related to the pandemic firmly in mind, the Camden County Educational Services Commission, in partnership with School-Based Behavioral Health Care Network (SBHSN), has successfully launched SBHSN’s Transitional Coaches™ model for the 2020-2021 school year. This model is specifically designed to improve students’ social, emotional, behavioral, and wellness outcomes. The purpose of this program is to promote a collaborative and integrated approach between the education and healthcare communities to ensure students succeed academically, socially, and emotionally.
The program brings highly skilled mental health clinicians to schools, after-school programs, and youth summer programs to assist school personnel who interact with youths in school settings. Implementation of this evidence-based program throughout New Jersey’s public, charter, nonpublic, and private schools removes the previously mentioned barriers to accessing quality mental health services by locating services on-site and ensuring privacy during the school day, as well as eliminating long wait times and transportation issues. It is also expected that the Transitional Coaches™ model will increase school personnel’s awareness and knowledge of mental health issues among the students they serve, including traumainformed care that makes students feel safe and secure.
Overall, the program will accomplish the following goals: • Expand behavioral health professionals on school campuses utilizing the NJ Family Care
Program. • Create fully functional, self-funded Behavioral
Health Access Centers on school campuses. • Destigmatize behavioral health services to promote staff, family, and student acceptance and education of mental health issues. We have witnessed how vulnerable the mental health of our students can be, especially when they are isolated from the stability normally provided by their school settings and the ability to interact and socialize with their peers. Moving forward, on-campus mental health access centers within New Jersey’s schools will help ensure our most at-risk children are not left even further behind and eliminate barriers to care, allowing students to receive therapeutic services that will help them reach their fullest potential.
To learn more about the Transitional Coaches Model go to: https://www.camdenesc.org/Content2/ mentalhealth1
Aboutthe Author:
Judyann McCarthy, MSW, LCSW is the current First Vice President of the NASW-NJ Board of Directors and the Mental Health Program Manager at the Camden County Educational Services Commission.
