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.
Life After Addiction Treatment: How to Fill the Void During Recovery
The first year of recovery is difficult to manage. Triggers lie everywhere and applying the skills you learned in rehab is easier said than done. When a recovering addict first begins life after their addiction, they may discover a void left from their past life. Whether the void is their past experiences, low self-esteem, or avoiding bad feelings, addicts typically used drugs or alcohol to fill that void.
Now in the absence of those unhealthy “coping” mechanisms, addicts now face those voids alone. Maintaining recovery requires an addict to learn how to fill their life with positive things and not go backwards into their old ways.
The certified counselors at Cold Creek Behavioral Health have put together a list of recovery and coping skills in handling life after treatment.
Rehab isn’t the end of addiction, it’s only the beginning of recovery. Once an addict leaves treatment they soon realize that life and all the factors that brought them into their addiction are still there waiting for them.
Although you can’t change everything, you can learn how to handle things better and develop behaviors that’ll help you maintain your recovery.
Learn to Mourn
As strange as it may sound, it’s important to begin your recovery by first mourning the loss of your past addiction. Since your past addiction had been with you for a very long time, it’s important you mourn the loss of it. This can require not only giving up the addiction but saying goodbye to bad friends, places, and the unhealthy habits that led to your addiction. From where you used to hang out to who you were with regularly and on, it determined a lot of your day.
It’s important you recognize that loss but also recognize that although it was something you did—it didn’t define you. Recognize that loss and move past it. Then you can move on and maintain your recovery day to day, drug-free.
Avoid High-Risk Situations and Triggers
Some common high-risk situations are described in treatment as the acronym, HALT:
Recognize Your Emotions
Of course, you can’t always avoid HALT situations, but you can be more aware of them. If you take better care of yourself, you’ll be able to recognize your emotions before they send you spiraling. By develop healthy habits, use support groups, and more, many of these situations will be far and few between, rather than consistent occurrences.
Steer Clear of Boredom
For an addict, feeling a sense of boredom is dangerous. This is because it allows your mind to wander and not stay focused on maintaining your recovery. This can even go as far as triggering a relapse. For that reason, it’s important that you stay busy.
Fill your day with activities you enjoy. Find new interests. Keep busy. This will keep you busy and far from the feeling of boredom. It also helps you develop healthy habits. Remember: a routine is critical to helping you stay abstinent.
Fill Your Life with People and Love
A great way to start filling that void is to re-establish old friendships that may have been lost on your path of addiction. Surround yourself with supportive people both help you and make you feel cared for and loved.
Recovery is also a good time for an addict to mend fences with family and friends. Doing this will also help make you feel better about yourself because you’ll be righting your wrongs and maintaining your recovery.
Healthy Habits and Activities Are Crucial
There are many activities you can pick up on the road to recovery, as well. Some of these healthy activities include:
- Making a to-do list so you can feel a sense of accomplishment as you mark things off.
- Relaxing and trying to stay stress free
- Playing video games to relax your mind
- Doing crossword puzzles
- Start becoming more proactive by starting a blog or doing volunteer work
- Play sports
- Take a class
- Learn to coo
Other Coping Skills
Some other skills that are very helpful in maintaining your recovery include:
Learn how to handle your stress in healthy ways. Use tools listed above to help tackle your stress one day at a time.
Make sure that you are completely honest with yourself and others. One of the key components of drug addiction is creating a culture of deceit—combat that with complete honesty and integrity.
Maintaining a regular schedule of therapy sessions can really improve your chances of staying clean—especially in the first year.
No matter what you do, staying busy with some type of constructive activity and surrounding yourself with healthy relationships is a key component to staying sober and not letting old triggers creep back into your life. Maintain realistic expectations and remember: getting and staying sober is a process, a marathon; it’s not a sprint.
How to Prevent an Addict from Relapsing
Preventing a relapse is typically harder than it was getting sober. The reason for this is because maintaining recovery spans a lifetime. There is always a chance that a trigger lies right around the next corner and without support in defeating that trigger, an addict can start their former patterns all over again.
Tips for Helping a Recovering Addict
Fortunately, there are a number of ways to help. For example:
Finding a support group where the addict feels comfortable, can also provide a great deal of help. Being part of a group where members have gone through the same trials and tribulations helps an addict feel less alone in his or her struggle, and more like there is somewhere he or she belongs.
Family support is also of the utmost importance. The family structure is one of the key ways recovering addicts maintain their recovery, but it can also be a trigger source for some. Making sure you’re being as supportive as possible can help them immensely.
Just being around for non-judgmental listening can help tremendously. If an addict feels they can go to you for help when they are feeling triggered will help them in more ways than one and usually helps avert any crisis.
Exposure to Domestic Violence Costs U.S. Government $55 Billion Each Year
The federal government spends an estimated $55 billion annually on dealing with the effects of childhood exposure to domestic violence, according to new research by social scientists at Case Western Reserve University.
The results of a study on the national economic impact of exposure to domestic violence—published in The Journal of Family Violence—showed higher health-care costs, higher crime rates and lower productivity in children as they aged.
“This is a significant public-health problem that not only means long-term consequences for these children, but also imposes a substantial financial burden to society,” said Megan R. Holmes, assistant professor and founding director of the Center on Trauma and Adversity at the Jack, Joseph and Morton Mandel School of Applied Social Sciences.
The Centers for Disease Control (CDC) defines intimate partner violence—more commonly known as domestic violence—as any physical violence, sexual violence, stalking and/or psychological aggression perpetrated by a current or former intimate partner.
In the United States, an estimated 15.5 million children each year are exposed to at least one episode of intimate partner violence, with more than 25 percent of children exposed to domestic violence in their lifetime.
The CDC’s National Intimate Partner and Sexual Violence Survey reports that 27.3 percent of women and more than one in 10 men (11.5 percent) have experienced physical violence, sexual violence or stalking by intimate partners at least once in their lives.
Married or cohabiting couples who have children are reported to experience the highest likelihood of domestic violence.
By the time a child exposed to domestic violence reaches age 64, the average cost to the national economy over their lifetime will reach nearly $50,000 across the following main categories, according to the research.
- Health care: Estimated effects of domestic violence exposure on the use of hospital care and physician and clinical services.
- Crime: The estimated effect of domestic violence exposure on the lifetime likelihood of violent crime: murder, rape/sexual assault, aggravated assault, robbery.
- Productivity: The productivity effects of domestic violence exposure stem from a connection to lower educational attainment. Using estimates for the age-specific effects of education on worker earnings, the study calculated the expected earnings detriment associated with exposure to domestic violence.
That includes at least $11,042 in increased medical costs, $13,922 in costs associated with violent crimes and $25,531 in productivity losses.
“And that’s just for one person,” Holmes said. “If we consider Ohio’s young adults, for example, the 172,500 Ohioans who are 20 years old, the cumulative lifetime cost for the estimated 25 percent who were exposed to domestic violence as children will be nearly $2.18 billion. Applied to the entire nation, the economic burden becomes substantial—over $55 billion.”
She said the effects of children’s exposure to domestic violence carry long-lasting consequences—and society picks up the tab.
While much research has been conducted on the effect of domestic violence exposure on short- and long-term outcomes, this is the first study to add a price tag to this public health problem.
“Although we researchers often use words like ‘ground-breaking’ to describe our work, few studies really meet that bar,” said Rebecca J. Macy, editor-in-chief of The Journal of Family Violence and associate dean for academic affairs in the University of North Carolina School of Social Work.
“With their study on the economic burden of children’s exposure to partner violence however, Prof. Holmes and her colleagues have really produced a groundbreaking study.”
By understanding the extent of the costs incurred, policymakers can now reference the economics to push for more effective preventive and therapeutic interventions, Holmes added.
The study was done in coordination with Francisca García-Cobián Richter, research assistant professor; Kristen Berg and Anna Bender, both doctoral candidates, at the Mandel School; and Mark Votruba, associate professor of economics, at the Weatherhead School of Management.
3 Ways to Keep a Positive Attitude and Be More Successful
Your life is going to be full of setbacks, that’s just the nature of things. Life is full of ups and downs, and the best thing you can do is position yourself to make the most of those good times while hedging against the rough ones. Keeping a positive mindset is the best way to do this.
What do you do when things seem to go wrong? You have to be positive. You have to be optimistic. Think about it. If you don’t respond positively, then what is the alternative? And how has that alternative been worked out for you in the past? You have nothing to gain by focusing on the negatives. Everything you want in life is on the other side of failure, and the only way to get there is to stay positive and keep pushing forward.
Here are three simple ways to stay positive and weather the storms that life throws your way.
Surround Yourself with Positivity
One of the most effective ways to set yourself up for success is to engineer your environment and build productive habits that will move you toward success on autopilot. Since you become what you think about most of the time, it only makes sense to think about positive things in life.
Starting your day by reading some encouraging words can help set the tone for the whole day. Some great personal development authors include John Maxwell, Brian Tracy, John Covey, Tony Robbins and Gary Vaynerchuk. Put inspiring quotes all around your office, on your computer and phone desktops or even stuck up on the fridge at home. Commit to spending more time around positive people too, since their attitudes will rub off on you.
You can also automate your success through habits that can help you in life. Building a morning routine and a bedtime routine can help.
Take Care of Your Physical Health
You should also take good care of your physical health by making daily exercise a part of your routine. You don’t have to sign up for a marathon or anything to reap the benefits of exercise. As little as 20 minutes per day of moderate exercise can help improve how you look and feel.
Your diet is also important. Eat plenty of fresh veggies, fruits, legumes and whole grains to give your body the nutrients it needs for optimum health and performance. You might also want to incorporate superfoods into your meals, such as blueberries, garlic, turmeric, and oatmeal. These can help you fight off inflammation, boost your energy levels and improve your heart health.
Set Goals, Make Plans and Take Action
One of the best ways to build confidence and stay optimism is to accomplish goals that are important to you. Success breeds success. When you’re productive and find yourself achieving small goals, you feel good about yourself, and you become empowered to push harder to achieve even more.
Action is the key to success, but not all actions will help you in life. Some people are busy all day long, yet they never seem to get anywhere. The key is to know what you want to accomplish, to develop a plan that will make it happen and then to take action on that plan every day without allowing yourself to become distracted by non-essential tasks.
Some people think that time management is all about doing more things every day. But the opposite is actually true. Effective time management is about doing less things, not more things. You must discipline yourself to do the most important things – the things that will really make a difference and drive results. As you learn to do this, you will propel yourself toward your goals in a way that you cannot even imagine at this moment.
As you move rapidly toward your goals, you’ll begin to feel very excited and energized. This will then motivate you to push even harder and accelerate your progress, resulting in even greater levels of accomplishment, higher feelings of self-esteem and more positivity than you’ve ever experienced in the past.
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.”
Hiding in Plain Sight: Exploring Scotland’s Wellness Health Book Review
Can Scotland’s overall poor health record be explained by Adverse Childhood Experiences (ACEs)? This is the simple but undeniably challenging question that forms the basis of Carol Craig’s book, the third in the series of short books — Postcards from Scotland — that are written to spark new thinking about why us Scots are the way that we are.
The book gives a semi-autobiographical account of the author’s own challenges in her childhood and adds into the mix the experiences of ‘ordinary folk’ with well-known faces in Scottish culture — including the comedian Billy Connolly and Scottish actor and filmmaker, Peter Mullen. It also points to the latest evidence and academic research.
As a communications professional, I am always curious about the source and credibility of any written piece. At the start of the book, I must admit, I was initially a little skeptical as the emphasis seemed very much on the author’s own experiences, rather than any concrete research. She reflects on her upbringing in a council estate in Milngavie, a suburb to the north of Glasgow, in the 1950s and 1960s comparing this to the experiences of another child from the same estate, Scott. A few pages in, I did wonder should this not be an autobiography? Indeed, near the end of the book, the author herself admits that a friend asked her if she would not be better off writing a novel.
Any doubts I had about the emphasis of the book being more anecdotal, rather than balanced with research, were soon laid to rest. In chapter two, ‘Childhood adversities, trauma, and health’, the author highlights early studies into the role of ACEs in ill health.
In particular, she talks about the work of Dr. Vincent Felitti, currently Director of the California Institute of Preventive Medicine, in surveying 17,000 patients to see if there was a link between childhood experience and ill health later in life.
The methodology for this research included a simple survey with questions focussing on two types of adversity: physical, emotional and sexual abuse; and second, what the wider family context was (e.g. did your parents separate?Was there abuse within the relationship?).
Phase two of this study, from the early 1980s, was to research the medical history of respondents and reveal any connections between such early adversities and health outcomes. According to the researchers, the links were startling. This initial study has arguably paved the way for current thinking and research on Adverse Childhood Experiences globally.
The real strength of this book is the accessibility of its tone, language and subject matter. Carol Craig definitely does not write from a narrow lens and the book should appeal to a wide range of readers — children’s sector frontline workers, social historians, policy-makers and think-tank workers, to name a few, and anyone really with an interest in the health of our small nation and the issues that surround it.
At the centre of the book, the author argues that adverse childhood experiences in Scotland are common and that ‘nurturing children has never been one of Scotland’s strengths’. This, combined with detailed accounts of childhood abuse, make for difficult reading, which the author does not shy away from. What she does really well, however, is make a series of serious points in relation to adversities in childhood that is mainstream and accessible without belittling the subject matter. No easy task. For example, she talks about the depiction of Scots in film, TV and in fiction, making the point that depiction of difficult subject matter is indicative of real life. Art imitating life.
I was drawn, in particular, to her accounts of the relationship between the character Chris Guthrie and her father in Lewis Grassic Gibbon’s classic Sunset Song. Not only did this passage take me back to my 16-year-old former self (I read this classic book for the first time as part of my Scottish Standard Grade in English), but it illustrates a key point that Craig’s book is trying to make: the poor fate of Gibbon’s main character can, at least in part, be explained by the abuse that she suffered in her formative years. It was, to name the title of the book: ‘hiding in plain sight’.
It would be a crass and unfortunate use of language to say that Adverse Childhood Experiences are in vogue just now, but in reality, there is increasing narrative in professional and public circles and research surrounding them as a way of explaining outcomes later in life. My work at CELCIS (the Centre for Excellence Looked After Children in Scotland) has taught me to always question labeling — unconsciously or otherwise — when it comes to children and young people as often this can lead to negative stereotyping and pigeonholing that separates children who may have experienced adversity with the rest of society.
While I uphold this belief, any phrasing or terminology that is used in a positive way to deepen society’s understanding of something that can have a detrimental impact of Scotland’s children and families can be justified when used appropriately. Hence, I would recommend Craig’s book for anyone with an interest in the subject matter.
At the end of the book, the author proclaims: ‘I will judge this book a success if three things happen’. While the list of three are fairly altruistic and focus on better outcomes for children and society’s need to better understand how we can bring up children, the use of the proclamation jarred with me a little. I cannot recall another author who would make a proclamation in such a grand and forthright way.
That said, if you want a stimulating read about an ever-evolving and important subject matter, this is a really good and accessible read. I look forward to her next book in the series.
What #NeverAgain Means for Workplace Violence for Helping Professionals
What does the #neveragain movement mean for workplace violence for helping professionals? Social Work Helper hosted a free live discussion with security expert and threat management specialist, Hector Alvarez, on workplace violence prevention and tips.
In early March, Christine Loeber, a social worker and executive director of a veteran treatment facility, was one of three women held hostage and killed by former client and combat veteran, Albert Wong.
The Napa County Sheriff’s Department reports Wong, age 36, shot the three mental health workers in the head with a rifle before self-inflicting a fatal gunshot wound to the head. Psychologists Jennifer Golick and Jennifer Gonzales Shushereba, who was also pregnant, were the other two victims of this horrific incident.
It is believed that Wong was released from services based on information provided by a family member of one of the victims. This incident may seem like an isolated incident, but a quick google search will show how often social workers and other helping professionals are constantly being threatened, hurt or killed by a spiraling client, and those incidents only represent the newsworthy incidents.
According to the OSHA’s Guidelines for Preventing Workplace Violence for Healthcare & Social Service Workers, professionals working in this sector are at the greatest risk for workplace violence. In the guidelines, the Bureau of Labor and Statistics reported 48% of all non-fatal incidents of workplace violence, assaults or violent acts occur in the healthcare or social services. They also report social service workers (social workers, child welfare, and caseworkers) are 7 times more likely to become victims of violence than those working in the private sector.
Watch the replay using this link: https://www.crowdcast.io/e/what-neveragain-means.
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