I have found that negotiation and mediation are advocacy tools that successful social workers use to bring about change within individual client systems as well as in policy making. Social workers sometime use creative advocacy techniques that may extend beyond traditional channels in order to protect their clients from harm while balancing organizational policies and procedures that often restrict their ability to do their jobs.
The government shutdown over funding the Affordable Health Care Act, commonly known as Obamacare, reminds me that strong advocacy is often adversarial and can have negative consequences. What happened to using negotiation and mediation as advocacy tools? While there are many benefits to Obamacare, few would dispute there is much opposition to the law and full implementation. Mediation is a viable and evidenced-based process for resolving disputes peacefully and collaboratively. Why take the American people hostage?
Perhaps it’s time for each of us to become mediators. I would like to ask everyone who reads this column to become an armchair mediator with a fair and impartial in examining the government shutdown dispute. Before we can assume the role of armchair mediators, we must first put aside our political affiliations as well as our position on Obamacare to be objective in the matter. We need to honestly ask each of the parties “What if you are absolutely right, where do we go from here?”
A mediator would ensure all stakeholders, not just the loudest voices, at the table were heard. The politician, the everyman…Mediators ask difficult questions: for example, where is the opportunity for common ground and how do we respectfully acknowledge opposing points of view? Read More
In my inaugural column for the Social Worker Helper, my hope is to share my expertise as a mediator for over 30 years and highlight the use of mediation and negotiation as advocacy tools. All opinions are valued.
Is The Fair Housing Act Failing?
Denied. It’s a word that some people hear more than others. Specifically, when it comes to housing opportunities. The Fair Housing Act of 1968 was supposed to equalize the housing market for a variety of diverse populations, regardless of race, color, national origin, religion, sex, familial status, and disability ().
Fifty years ago this month, the Fair Housing Act came into existence. So it’s only fair to ask, is it working? Is there less housing discrimination that when the Fair Housing Act was passed five decades ago?
As with most socio-political questions, the answer is not a simple yes or no. According to a , while more obvious forms of housing discrimination (such as refusal to show a unit to a person of a racial minority) have declined, more subtle forms of discrimination persist.
The study specifically identified that African Americans, Hispanics, and Asians were told about and shown fewer units than Whites. This is a difficult practice to catch. However, HUD and various fair housing groups have used secret shoppers and complaint hotlines, among other methods, to obtain evidence of housing discrimination of this kind with some success.
that came out this month identified that this trend is still occurring heavily when it comes to lending and homeownership data, with African Americans being denied home mortgages at a much steeper rate than White borrowers.
While banking institutions insist this disparity is due to neutral factors such as credit scores, fair housing researchers have shown the existing lending model relies heavily on the traditional credit score which has disparate and/or disproportional impact on racial minorities.
As the study by Reveal shows, traditional credit scores don’t take certain kinds of financial history, such as paying rent and utilities, into account. Therefore, someone could pay rent and utilities on time for 20 years and not have a sufficient credit score to receive a mortgage from a financial institution. The system is designed where one must first have assets in order to acquire the credit to get assets, a prime example of privilege.
These reports primarily focused on obtaining housing. What about discrimination when it comes to evictions from persons already housed? Much less research has been done on this aspect of fair housing. An article produced by discussed how previous studies have only gone so far as to prove correlations between higher rates of evictions and some fair housing protected classes.
Households with a higher percentage of children in the Milwaukie neighborhood being studied exhibited a higher eviction rate than households with fewer children. This could indicate fair housing violations occurring based on familial status and dynamics. However, more research is needed to determine the validity of this claim by examining the “eviction warranting behaviors” of landlords.
For example, are households with children are more likely to break aspects of a lease such as paying the rent on time? These questions require further research to truly understand if there is an underlying fair housing concern particularly in the instance of no-cause evictions which are much more difficult to evaluate.
One positive of the passage of the Fair Housing Act is that it created tools by which persons could advocate for themselves or others. It opened a form of recourse that those experiencing housing discrimination could take against housing providers that do not follow Fair Housing Law. Amidst all the work to be done to improve the impacts of the Fair Housing Act, there are some simple ways the general public can increase the prevalence of fair housing practices.
Know the federal Fair Housing Act and how it works, specifically in your state. Some states have additional protected classes above and beyond those listed in the Federal Fair Housing Law. You can start learning at the
Use this knowledge to advocate for the fair housing rights of yourself and others, especially if you work with vulnerable populations who are likely to experience housing discrimination. For example, fair housing law can demonstrate how to correctly use reasonable accommodations to achieve successful housing placement and retention for persons with disabling conditions who would otherwise be unable to access and enjoy housing.
Why Work Requirements Will Not Improve Medicaid
One out of every five low-income Americans depends on Medicaid, the national insurance program for the poor jointly run by federal and state governments. Medicaid provides insurance coverage for a broad array of health services from pregnancy care and childhood immunizations to emergency hospitalizations. As the practice of health care has developed, states have applied for waivers under Medicaid’s “Section 1115” program to test new ways of delivering prenatal care, coordinated care for children, and specialized medical treatment for cancer patients.
But in 2018 the Trump administration signaled a major shift in the Medicaid waiver policy. Section 1115 waivers are now being used allow states to require people applying for Medicaid to work or engage in unpaid “community engagement” as a condition of eligibility. Currently, such work requirements for Medicaid are under consideration in twenty states.
Are work requirements for Medicaid a good idea – comparable to the kinds of improvements states have tried under waivers in the past? Medical and social scientific research actually suggests that imposing work requirements is unlikely to improve health outcomes. Even more worrisome, for the three-fifths of Medicaid beneficiaries who are already employed, administrative work requirements are likely to impose barriers to accessing needed healthcare. Because the new work requirements do not further Medicaid’s goal of providing healthcare coverage, they may well violate established Medicaid law.
My research reinforces prior findings that Medicaid work requirements will not make anyone healthier. These rules will create confusing bureaucratic red tape and prevent low-income Americans from getting the care they need. Millions of low-income Americans will pay the price for this attempt by the Trump administration to misapply federal law.
The History of Medicaid
Established in 1965, Medicaid provides health insurance coverage to the elderly, individuals with disabilities, and low-income families. The law as written was meant “to furnish medical assistance” to individuals “whose income and resources are insufficient to meet the costs of necessary medical services.” People who benefit from Medicaid are far less likely than their peers to forego necessary medical care, and a growing body of research shows that Medicaid coverage is associated with lower rates of mortality and increases in access to care and self-reported improvements in health.
Over the years, many improvements in the Medicaid program started at the state level. Under Section 1115, the Secretary of Health and Human Services can allow states to waive certain requirements to experiment with policies that are “likely to assist in promoting the objectives” of the Medicaid Act.
Beginning in the 1990s, states like Minnesota, New York, and New Jersey used waivers to expand coverage to new populations of low-income Americans, control program costs, and improve the quality of care. Nevertheless, because Section 1115 waivers are supposed to promote the objectives of the original Medicaid law, federal officials prior to the Trump administration were reluctant to approve state modifications that would deny potential beneficiaries necessary access to medical care.
Work Requirements Mean More Bureaucracy and Less Health Care
Breaking with tradition, in 2018, the Trump administration advised states that it would approve Section 1115 waivers that required individuals to participate in “employment-related activities,” including paid employment or job training as well as unpaid volunteer work or community service. As of April, nearly 20 states are in the process of developing such waiver applications and the Centers for Medicare and Medicaid Services has already approved such waivers in Kentucky, Indiana, and Arkansas.
The results are likely to undercut Medicaid’s basic goals. Although three out of every five able-bodied Medicaid beneficiaries already work or participate in community engagement, new work requirements will create costly and confusing bureaucracy for millions of low-income Americans who will have to periodically recertify their work status with multiple state agencies. People suffering from intense poverty tend to struggle more than others with such burdens. Predictably, many will fail to meet the new paperwork requirements and fall out of the system, even though they still need health insurance. Not only will this outcome directly undermine the basic purpose of Medicaid, applying the new rules will consume time and resources administrators could devote to helping beneficiaries.
Busting the Myth that “Employment Leads to Better Health”
Policymakers and civic leaders should push back against false Trump administration claims that existing research bolsters the case for new Medicaid work requirements:
- Trump officials claim that a 2016 study showed that employment is associated with better health outcomes – but the researchers actually noted that unemployment rates “were not significantly associated with life expectancy… in the bottom income quartile.”
- Officials say that a 2014 study published in Occupational and Environmental Medicine establishes a “protective effect of employment on depression and general mental health.” But those researchers said that they cannot establish a causal link because “positive health effects of employment can be affected by the fact that healthier people are more likely to get and stay in employment.”
Indeed, research supports the opposite of Trump administration claims. Instead of employment automatically improving health, better health actually improves people’s employment prospects. A research summary in Medical Care Research and Review finds that improved health would increase earnings by 15 to 20 percent. Some studies suggest that low-income jobs lead to higher rates of mortality and other bad health outcomes.
A recent Health Affairs report found that participants in a Florida welfare experiment whose benefits were conditioned on workforce participation had a 16 percent higher mortality rate than comparable recipients not subject to work stipulations.
Medicaid was designed as a program to improve the health of poor Americans – and available evidence suggests that it should continue to serve this core purpose – rather than being turned into a cudgel to deny care or force people into bad jobs.
Senate Bill Introduce to Improve Access to the Mental Health Act
WASHINGTON, D.C. – The National Association of Social Workers (NASW) applauds Sen. Debbie Stabenow (D-MI) and Sen. John Barrasso (R-WY) for introducing the bipartisan Improving Access to Mental Health Act (S.2613), legislation that would increase public access to the vital mental health services that clinical social workers provide and offer clinical social workers more adequate Medicare reimbursement rates.
Their Senate bill is a companion to H.R. 1290, which was introduced in the House by Rep. Barbara Lee (D-CA). Stabenow and Lee are social workers and Barrasso is a physician. “Mental illness is an issue that touches so many families in some way and seniors are no exception,” said Senator Stabenow.
“Michigan seniors should be able to get quality care from the provider of their choice and this bill ensures that clinical social workers are among those essential providers.”
“Our nation’s share of people who are aging is growing rapidly and older Americans are in dire need of improved mental health services so they can enjoy a better quality of life and live as independently as possible,” said NASW CEO Angelo McClain, PhD, LICSW. “NASW congratulates Sen. Stabenow and Sen. Barrasso and Rep. Lee for using their combined expertise in social work, health care and legislative leadership to craft bipartisan legislation to address this issue.”
Clinical social workers are one of the nation’s largest groups of providers of mental health services. Currently, there are more than 300,000 social workers in the United States working in health care, mental health and substance use disorder treatment, according to the Bureau of Labor Statistics.
The House and Senate versions of the “Improving Access to Mental Health Act” would increase access to mental health services for residents of skilled nursing facilities and provide access to the complete set of clinical services that help Medicare beneficiaries cope with medical conditions.
In addition, the bill would align Medicare payment for clinical social workers with that of other non-physician providers by increasing the reimbursement rate from 75 percent to 85 percent of the physician fee schedule.
There are already 14 co-sponsors for the House bill, which was released in March 2017. Sens. Stabenow and Barrasso introduced the Senate version of the bill on March 22.
“It is fitting that this legislation was introduced in March, which is Social Work Month,” McClain said. “There is no better way to recognize the contributions of the nation’s more than 650,000 social workers than to put forward a bill that would support the clients who social workers serve, improve our nation’s mental health delivery system, and give social workers the reimbursement they need to do their critically important work.”
Why the United States Needs a Woman in the Presidency
Even had Hillary Clinton prevailed in the 2016 presidential contest, the United States would still have arrived late to the promotion of a woman to the highest executive office. And since Clinton lost, the United States has yet to enter this game. In 1960, Sri Lanka became the first country to be governed by a woman, but this was hardly a sea change because women did not enjoy more widespread success until the 1990s.
More than three-quarters of all female presidents and prime ministers have arrived in office in the last two decades, and the female ranks have grown faster since 2010. Nevertheless, the numbers have contracted in recent years. Currently, only six percent of all executives in power around the world are women; and a remarkable 61 percent of the world’s countries, including the United States, have never been governed by a woman.
Why has the U.S. failed to elect a woman to the presidency? In my research, I engage this question by examining global patterns of women’s executive office holding. In addition, I assess what happens when women are prevented from taking the helm, why it matters, and how this shortfall can be changed.
Why Female Executive Leadership Matters
The dominance of the American Presidency and the masculine traits often associated with and assumed necessary for office holders in American executive institutions pose significant challenges for women. What is more, many issues, like military and foreign affairs, are seen as masculine issues and often associated with the Presidency. Add to this the short supply of women legislators, governors, and presidential candidates (usually no more than one woman competes for a major party nomination) and it becomes difficult to imagine the executive glass ceiling cracking anytime soon.
What difference does it make that the United States has yet to elect its first woman president? Most basically, it matters because the election or appointment of a female executive facilitates women’s political empowerment. Overall, women executives create important opportunities for all women in society. Specifically, women leaders can propose and implement policies that promote gender equality and empower many more women.
Although we must take into account important factors in addition to gender – such as partisanship, party dynamics in the legislature, and the executive’s institutional authority to propose and advance legislation – women executives can in one way or another facilitate policies favorable to women’s advancement. And they can advance other women to power in cabinet positions, judgeships and the like.
Finally, when women hold presidencies or prime ministerships, they influence the public’s attitudes by providing important symbols of female political empowerment. The reality of women in power challenges prior presumptions about politics as a “man’s world” – and this change in the sense of what is appropriate and possible in itself helps create a more equitable society.
How can the United States and other lagging countries finally have a female leader? The following steps could help.
- To expand the pipeline, create more programs that prepare a diverse array of women to run for office at all levels of government.
- Increase the active recruitment of female candidates for offices at all levels by politicians, civic groups, and other leaders.
- Change institutional structures that constrict the political pipeline – for example, by instituting new party rules that require women’s representation on nominating ballots, at political conventions, and in appointive government offices.
- Build institutions that facilitate collaborative governance and women’s political inclusion, such as multi-party parliamentary systems where slates of officeholders can be designated without each having to win the popular vote directly.
- Heighten awareness of the sexist attitudes and stereotypes women still face in politics and create programs to combat such discrimination.
- Organize and advocate around issues especially relevant to women – including sexual harassment and violence, pay equity, reproductive rights, paid family leave, and women’s political incorporation. Place such concerns squarely on the policy agenda and make sure they are advanced, not just issues disproportionately relevant to men.
- Support organizations that mobilize rising numbers of unmarried, millennial, and minority voters, who often back more progressive women candidates and issues.
In 2016, Hillary Clinton lost to an unqualified and deeply flawed Donald Trump, despite the advantages she had in fundraising, family ties to power, name recognition, party support, and vast political qualifications. Had Clinton won, her path to the White House would not have been especially revolutionary, given her standing as the wife of a former president. Still, a win for her would have allowed the United States to join the company of the 74 countries that have had at least one woman in their executive.
In the future, given the high visibility of the U.S. presidency on the world stage, a woman serving in this office could signal to the world that females belong at the center of the democratic political sphere and might also stimulate enhanced levels of public engagement in politics worldwide.
Achieving full political empowerment for women takes more than electing a female president, but the difficulties women have faced in achieving presidential power in the United States reveal that women the world over still have a way to go to overcome their political marginalization.
The time for a woman in the highest U.S. office will surely come all the same. Although the highest glass ceiling remains unbroken in the world’s most powerful nation, it is not impenetrable – just as it is not unbreakable in other countries around the globe.
#NoMoreShootings: Why We Need a Comprehensive Approach to Protect Our Kids
The latest school shooting and tragedy in Florida on Valentine’s Day took the lives of 17 innocent people and threatened the emotional safety of community members is a reminder of how flawed our systems are and how much work we have ahead to ensure safety.
No parent should ever have to worry and wonder whether their kid is coming back home from school. No student should ever have to feel afraid to go to school. No teacher should ever have to worry that their life may be in danger or fear having to kill one of their students. No community member should have to live in fear of future attacks or random gun violence on the streets.
When situations as inexplicable as this one occur, many questions arise.
Some of the initial questions that emerged after shooting included: the (shooter) posting pictures on social media of guns and weapons. How come no one reported this? How did he gain access to a gun? How come no one saw the potential mental health signs?
These are important questions that reinforce the significance of improving our systems and raising community awareness. As we grapple with emotions related to this unfortunate tragedy, let’s push together for a change in our systems.
Our systems are flawed and we need to continue to elevate this and work towards solutions.
Even when reports are made to authorities regarding someone with a gun or someone suspicious on past behavior, action may not occur. As a social worker, I am also a mandated reporter which means I am required to disclose when an individual express intent to harm self, a third party or when someone discloses a story of a child or elderly person in which there is suspected abuse happening. I need to report these concerns to the proper authorities.
Sometimes individuals may not have a plan to harm themselves and others but they disclose owning weapons. In occasions where I have reported concerns to local authorities, some of the answers have been: we can’t do anything yet until something happens or we talked to the client’s mom and she denied this rather than going to the household to investigate.
Yes, to my dismay, these have been some of the answers I received in trying to discharge my duties as a mandated reporter. If calls from mandated reporters are being turned away, imagine when someone who a concerned citizen calls in a suspicion. We have a system of reactivity rather than proactivity.
We need to increase awareness and education on how to recognize mental health signs.
The issue about mental health always comes up around shootings or other violent attacks. It is important to note that most people with mental health challenges are not violent. In fact, according to the American Psychiatric Association, people with mental health challenges account for 3% of violent crime. While mental health is not a direct cause of violence in the majority of the cases, all of us can play a part in improving community wellness.
It is my job, your job and our job to foster community health because as we have seen what impacts one person, can impact us all. There are outstanding organizations like Mental Health First Aid undertaking this endeavor through their Mental Health First Aid training where participants learn to recognize mental health signs and obtain ideas on what to do once signs are recognized. Mental Health First Aid proposes that courses like this are taught just like CPR courses are taught. And with 1 of 5 people in the United States being impacted by a mental health challenge, I couldn’t agree more.
Increase training in schools, community centers, clinics, hospitals and simply where people frequent most and conversations at home.
After this tragedy, people have asked: why didn’t they do something? It is not common knowledge on what to do when we perceive an individual to be a potential danger to others. This is not necessarily something our kids are learning at school or is at conversation at the dinner table. There are so many opportunities for engagement and raising awareness.
What could a mental health class look like at school as part of the educational curriculum? What does a mental health workshop while you wait for your doctor in the waiting room looks like? How about at church? What does a dinner conversation about safety looks like? What will safety training in schools or other settings look like?
Organizations life Safe Surroundings are equipping staff members at nonprofits, schools, clinics, and other settings where community members frequent to take safety precautions to minimize crises and dangerous situations. It is unfortunate that we need to learn lessons out of tragedies but let’s think creatively and strategically to ensure that no other life is lost due to shooting or a tragedy like this.
Increase mental health services at places community members frequent and school health-based programs.
There is a growing movement to incorporate wellness programs in schools and other settings where community members go to. But when something needs to be chopped away from a budget, these types of services are the first ones to go. Health and mental health is a human right and there is still a large segment of our population that does not have access. Let’s prioritize wellness.
We need gun control NOW.
It is an understatement to say that we need gun control, yet our politicians have sat and watched tragedy after tragedy without taking much action. It is astonishing that people are able to access guns easier and faster than accessing mental health services. We need to pay attention and become familiar with our politicians’ platforms and who they are receiving funding from and VOTE; VOTE pro issues we care about; RUN for office, BECOME involved.
We need to mobilize.
The courage of Parkland students who are speaking out and rallying is inspiring. While they are grieving, they are finding the strength to advocate for their lives. Children’s jobs are to go to school, learn, have fun, and grow into healthy adults. Yet, these children are having to fight for their survival and their friends. Why?
They shouldn’t have to. It is our job as adults to protect our kids. Let’s join together as a community and not fail our children anymore.
Civic Engagement Can Help Teens Thrive Later in Life
Want to help your teenagers become successful adults? Get them involved in civic activities – voting, volunteering and activism.
Although parents providing this bit of advice to teens will likely be met with groans and eye rolling, research does back it up.
In a study published in the current issue of the journal Child Development, scientists at Wake Forest Baptist Medical Center found that teens who were engaged in civic activities were more likely than non-engaged peers to attain higher income and education levels as adults.
“We know from past research that taking part in civic activities can help people feel more connected to others and help build stronger communities, but we wanted to know if civic engagement in adolescence could enhance people’s health, education level and income as they become adults,” said Parissa J. Ballard, Ph.D., assistant professor of family and community medicine at Wake Forest Baptist and principal investigator of the study.
Ballard and her team used a nationally representative sample of 9,471 adolescents and young adults from an ongoing study called the National Longitudinal Study of Adolescent to Adult Health. Participants were between the ages of 18 to 27 when civic engagement was measured, and then six years later outcomes – health, education and income – were measured.
The research team used propensity score matching, a statistically rigorous methodology to examine how civic engagement related to later outcomes regardless of participants’ background characteristics, including levels of health and parental education. For example, adolescents who volunteered were matched to adolescents from similar backgrounds who did not volunteer to compare their health, education and income as adults.
“Relative to other common approaches used in this kind of research, this method lets us have greater confidence that civic engagement really is affecting later life health and education,” Ballard said.
The research team found that volunteering and voting also were favorably associated with subsequent mental health and health behaviors, such as a fewer symptoms of depression and lower risk for negative health behaviors including substance use.
For teens who were involved in activism the findings were more complex. Although they too had a much greater chance of obtaining a higher level of education and personal income, they also were involved in more risky behaviors six years later, Ballard said.
“In this study, we couldn’t determine why that was the case, but I think activism can be frustrating for teens and young adults because they are at a stage in life where they are more idealistic and impatient with the slow pace of social change,” Ballard said. “I would encourage parents to help their children remain passionate about their cause but also learn to manage expectations as to short- and long-term goals.”
This research was supported in part by the Maternal and Child Health Bureau, Health Resources and Services Administration of the U.S. Department of Health and Human Services under a cooperative agreement for the Adolescent and Young Adult Health Research Network.
Co-authors are: Lindsay Till Hoyt, Ph.D., of Fordham University and Mark C. Pachucki, Ph.D., of the University of Massachusetts.
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