The Supreme Court issued a wonderful decision today, BOSTOCK v. CLAYTON COUNTY, GEORGIA, today that guarantees LGBTQ citizens to have the right to work regardless of their sexual orientation or gender.  This decision holds that an employer who fires an individual merely for being gay or transgender violates Title VII. CSWA is in complete support of equal rights for LGBTQ people and we are delighted at this decision.  It is notable that the majority decision was issued by Justice Neil Gorsuch, who was widely seen as having conservative views that might have made him unlikely to lead this decision.  To read the complete decision go to https://www.supremecourt.gov/opinions/19pdf/17-1618_hfci.pdf .

In an incredible and terrible coincidence, HHS issued a rule last Friday that undoes an Obama-administration policy that had redefined “sex” to include “gender identity” and “termination of pregnancy” for purposes of nondiscrimination under the Affordable Care Act.

Section 1557 of Obamacare prohibited discrimination on the basis of race, color, national origin, sex, age, or disability in health-related programs or activities. Near the end of President Obama’s second term, his HHS Department released a regulation redefining “sex” for the purposes of Section 1557 to include “gender identity” and “termination of pregnancy.” As a result of the rule that HHS released, that regulation has been reversed and “sex” once again refers only to biological sex.  This entire new rule may be found at https://www.hhs.gov/about/news/2020/06/12/hhs-finalizes-rule-section-1557-protecting-civil-rights-healthcare.html  This rule will almost certainly be challenged, especially in light of the Supreme Court decision today.

Finally to end on a more positive note, please read the CSWA statement on “Stopping Aggression in our Communities” by CSWA President Britni Brown at https://www.clinicalsocialworkassociation.org/Announcements/9010566 CSWA will be doing many webinars and statements to address the ways that black lives are demeaned, attacked, and harmed.

Another article that calls attention to these issues by Linda Michaels, PhD, Co-Chair of the Psychotherapy Advocacy Network (PsiAN) is ”@Whatsinahashtag@We’reallinthistogether?” which can be found at https://medium.com/@psian/whats-in-a-hashtag-we-reallinthistogether-7928adf5d756?sk=9276106ac0a81675e27e67f54751a8f8  It succinctly and heartbreakingly illustrates the ways that black Chicagoans have had decades of inferior public services, culminating in a much higher incidence of death among black citizens. 

You are invited to the following Emergency Webinar on LCSW Telemental Health Practice - CLICK HERE TO REGISTER TODAY. This is a FREE EVENT for members and nonmembers.

Emergency Webinar on LCSW Telemental Health Practice
March 24, 2020 at 4:00 p.m. ET/1:00 p.m. PT

EVENT DETAILS:

Presenter: Laura Groshong, LICSW, CSWA Director, Policy and Practice   

Since COVID-19 has affected the whole country, and particularly the way LCSWs practice, there have been many questions about how to practice telemental health; what kinds of sessions are covered telephonically and through videoconferencing; what changes have been made to HIPAA rules; what private and public insurers are doing to cover telemental health sessions, and much more.

CSWA is providing an emergency webinar to answer these questions on March 24, 2020 at 4:00 pm ET/1:00 pm PT to try to answer your questions.  This webinar will offer one CE. Stay safe and healthy!

We encourage all nonmembers to join CSWA as we offer so much to the community, especially at this trying time. Please click here to learn more and join CSWA today.

March 13, 2020

Dear CSWA Members,

Information is changing rapidly about the way that the March 6 bill is affecting our ability to provide covered Medicare telemental health services.  This post corrects yesterday's message about this topic.

Thanks to the sharp-eyed members who saw that the bill requires approval from HHS.  The most current information I have is that this should be coming on March 19.  It will probably be retroactive to February. This is all speculative; I will provide more definite information as I receive it.

Protecting your health and the health of your patients is the primary goal. Be as careful as you can be, recognizing there are no absolutes about whether to stop seeing patients in person. Hand washing and wiping high touch surfaces is the best way to avoid the spread of the virus.  Of course do not see any patients if you or they have symptoms of the illness, i.e., fever, sore throat, dry cough.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

===================================

March 12, 2020

 

Dear CSWA Members,

As many members have begun looking into providing telemental health and telephonic sessions during this time of health risk associated with COVID-19, there have been some questions about how to go about doing so for those who have not previously engaged in it.  Here is a brief FAQ list to help you get started:

• 1.       Will I be paid for telemental health sessions? This is complicated.  It appears that Medicare will pay for telemental health, videoconferencing only, sessions beyond the rural coverage that was already in place.  There has been no Federal guidance about Medicaid which works in tandem with state government.  Private insurers are all over the map in terms of covering telemental health.  The best way to find out is to have patients call their insurer or HR person to find out.
• 2.       Will I be paid for telephone sessions? See #1.  Note that Medicare will not currently cover telephonic sessions.
• 3.       What does it mean to use a platform that is HIPAA compliant? It basically means using a platform that will sign your Business Associate Agreement, to keep your patient material confidential.  Some platforms that are willing to do so are VSee, Zoom, doxy.me, Simple Practice, and Theranest.  Almost all require payment to use. 
• 4.       Where can I get basic information on how to do telemental health? CSWA is looking into providing a webinar on doing this.
• 5.       What can I do to get state and Federal approval of coverage of telemental health sessions? It is fine to let your state and Federal legislators and insurance commissioner know that coverage of telemental health is a necessary change for the well-being of LCSWs and their patients.  CSWA is developing more formal advocacy on this.
• 6.       Can I treat people across state lines if I am not licensed in the patient’s state? No, the requirements that exist to be licensed in both the state in which you reside as well as the state of the patient are still in place. You can seek reciprocity in states that allow it.

There is much more to being HIPAA compliant using telemental health. I did a webinar on this last year which should be in the CSWA Members Only section on the website. I will try to answer questions you have directly, but it may take a little longer than usual to respond.

Be sure to follow all CDC guidelines about hand-washing, social distancing, wiping down high touch surfaces, etc.  CSWA wants you to stay safe and healthy!

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

=====================================

March 9, 2020

Dear CSWA Members,

I just received guidance from CMS on whether we can be reimbursed for telemental health beyond the accepted treatment in rural areas.  Their response is attached.

Basically the answer is no at this time. I recommend calling CMS at1-866-288-8912 to ask for more guidance.

CSWA is developing a Legislative Alert to send to members of Congress to request an expansion of coverage for telemental health during this health crisis.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

CSWA - Medicare on Distance Sessions - 3-9-20.docx

===================================================

March 8, 2020

Dear CSWA Members,

Here is an update on the COVID-19 epidemic.

It appears that the number of cases is spreading, close to 500 with the Seattle area being the heaviest hit (128 cases, 19 deaths as of this writing).  We really don't know when the situation will improve as various cities are just starting to see cases and the tests for confirmation of COVID-19 are still hard to get.

I wanted to pass on some things that members are doing to protect themselves and their patients in addition to the list I sent out last Monday.  Some are cover fabric chairs and couches, even leather ones, with plastic/vinyl material which is easier to clean with antiseptic spray. 

It is important to make sure that any DIY hand antiseptic is at least 70% alcohol, the rest aloe vera gel, with some drops of aromatic oils like tea tree or lavender; unfortunately many areas are completely out of alcohol and aloe vera. Amazon can send in a week.

Those most at risk of being harmed by COVID-19 are people with underlying health conditions and those over 65. Traveling is not recommended for this group in particular.

Many members have asked about whether Medicare will cover telemental health sessions.  The bill signed on Friday provides $8.3 billion for a variety of ways to address the virus but there is no clear guidance on whether CMS will expand their coverage of telemental health yet.  I will let you know when this becomes available. Sen. Ron Wyden did get a provision in to support telemental health but no specific enforcement.  As for private insurers there is no clarity there either.  I suggest having patients request that telemental health be covered if they have private insurance; that is the most likely way to get coverage.

This is a time of anxiety in our personal and professional lives.  We should try to remember that we are all in this together and hopefully can help each other get through it.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

========================================

March 2, 2020

 

Dear CSWA Members,

The Covid-19 virus is spreading and LCSWs need to anticipate the impact that this may have on our patients and our practices.  Many of the suggestions below were gathered from the World Health Organization and other sources.  CSWA hopes we may be helpful to you as this health crisis evolves.

More information can be found at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

Another comprehensive article can be found at https://www.washingtonpost.com/health/2020/02/28/what-you-need-know-about-coronavirus/?arc404=true

Clinical Practice Action Plan:

- Develop a plan for limiting in-person sessions if there is a public health recommended limitation for being in public places, or a perceived need for such limitation

- Review the CSWA Technology Standards for Social Workers if you have not done so recently (https://www.clinicalsocialworkassociation.org/Social-Work-Technology-Standards)

- Check with insurers as to coverage of telephone or videoconferencing

- Make sure that any videoconferencing platform you use is HIPAA compliant (VSee, Zoom, etc.)

- Decide if patients with symptoms should have sessions by telephone or videoconferencing

- Decide if you should be working if you have symptoms

- Discuss a plan with patients in advance of the need to limit in-person contact, including arranging for phone or video sessions

- Sanitizing doorknobs and other surfaces touched by patients

- Be aware of own anxieties and try to contain

- Be prepared to acknowledge the anxieties of patients, should they occur

Public Health recommendations to reduce infection from flu or Covid-19:

- Perform frequent hand washing and use of hand sanitizer after being in public spaces

- Cough into elbow or shoulder, not covering your mouth with your hand

- Stay more than 6 feet away from individuals who are coughing or otherwise appear ill

- Avoid social ways of touching others, including handshakes

- Avoid touching your own face as much as possible

- Avoid public transportation such as buses or trains if recommended distance cannot be maintained

- Use hand sanitizer after going through TSA if flying by plane

- Use sanitizing wipes on plane armrests and tables and rental car keys and steering wheels

- Be aware of countries and cities where Covid-19 virus is increasing if traveling

- Engage in immune enhancing activities, i.e., get enough sleep, reduce alcohol intake, get exercise)

- Do not go to an emergency room unless absolutely essential; for a cough, fever, or other respiratory issues contact your primary care doctor first.

- Self-quarantine at the first sign of illness and wear an N-95 face mask in public spaces

Helping Children with Meaning of Restrictions Due to Covid-19

Suggestions can be found at  https://onedrive.live.com/view.aspx?resid=D589777FC7C86E35!118&ithint=file%252cdocx&authkey=!ALcOpxBYPPJR_h4

 

Striking a balance between being overly cautious and overly optimistic may not be easy but as clinical social workers, I think we can achieve it.  As you may know, here in Seattle we have a cluster of Covid-19 cases and two deaths, so I will be applying these principles to my own practice.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

MSCSW attended the 2019 CSWA Annual Summit in DC.  Click the link below to see what CSWA is doing to help further the clinical social work practice.

CSWA - Advocacy Priorities - 2019.pdf

Though I have not been sending the voluminous posts that I was sending last summer, the issue of immigrant children who are separated from their families, given inadequate housing, and denied basic care is one that CSWA is carefully tracking. Here is some information that will keep you up to date and provide options on how to stop these injustices. There are currently between 1000 and 3000 immigrant children in the US separated from their parents; some older (8 and up) children are being forced to care for younger children.

Summary of Harm – this article is a good summary of the current issues:

https://time.com/5613435/government-moves-migrant-kids-border-inadequate-shelter/

Agencies for Immigrant Children –Here are some good agencies that are working to improve the conditions of immigrant children and reunite them with their families:

Kids in Need of Defense (KIND) works to ensure that no child appears in immigration court alone without representation.

Women’s Refugee Commission offers Resources for Families Facing Deportation and Separation in English and Spanish.

Young Center for Immigrant Children’s Rights advocates for the safety and well-being of unaccompanied kids arriving in the United States. They recently announced a project specifically dedicated to helping children separated from their parents at the border.

Donations to Help – here is one of many organizations that are using donations to help immigrant children:

https://secure.actblue.com/donate/borderfamilies2019?refcode=20190624esborderd&link_id=0&can_id=1dd38bb56c3bb701463ff79392bbbcf5&source=email-this-is-not-immigration-policy-it-is-inhumane-and-cruel&email_referrer=email_569843&email_subject=this-is-not-immigration-policy-it-is-inhumane-and-cruel

Let me know if you have any questions.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association

I would like to bring to your attention a group that shares some important goals with CSWA. Please see the Psychotherapy Action Network (PsiAN) invitation below.

Here is some context. A little over two years ago, I sent Margot Aronson, CSWA Deputy Director of Policy and Practice, to Chicago for a meeting of therapists deeply concerned – as we at CSWA are - about the marginalization of relation-based psychotherapy by our professional training programs and by the insurance market. From this meeting came the Psychotherapy Action Network, an excellent match with our CSWA advocacy priorities of promoting awareness of the value of in-depth psychodynamic psychotherapy, of increasing access to and insurance coverage for psychotherapy (especially for chronic disorders), of advocating restoration of respect for clinical judgment over the privileging of medication and short-term treatments, and of addressing the need to improve clinical coursework in schools of social work.

Margot has continued as our liaison to PsiAN; CSWA and PsiAN have become strategic partners; CSWA is also a co-sponsor of the upcoming PsiAN conference (December, San Francisco). Just as CSWA supports their efforts, please consider doing the same as individuals.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

 ============================================================================

From the Co-Chairs of the Psychotherapy Action Network (PsiAN)

Dear CSWA Membership: 

We invite all of you to become individual members (it’s free!) and thereby share in the rich international conversation and advocacy that PsiAN has begun. 

Since that first meeting [described above in Laura’s note], we’ve grown rapidly to be more than psychologists and more than psychoanalytically oriented – we have nearly 1000 members and 43 organizational partners. We include social workers, counselors, marriage and family therapists, psychologists, psychiatrists, group therapists, and counseling psychologists. Individual members and strategic partners ascribe to theoretical orientations including psychoanalytic, humanistic, Jungian, sensorimotor, and more. We aspire to be a big tent that includes all clinicians, whatever discipline and theoretical orientation, who share our concerns  

Our mission:  The Psychotherapy Action Network is a global community of mental health professionals and stakeholders dedicated to promoting psychotherapies of depth, insight and relationship.  PsiAN aims to restore these therapies to their fundamental place in the mental health landscape through education and advocacy regarding their personal, economic, and sociocultural effectiveness in alleviating suffering and transforming lives.   

PsiAN is a place both to listen and to be heard, and to find avenues for advocacy about issues that concern you. We invite you to visit our website, psian.org, and become a part of the conversation by hitting the "Join Us" button and signing on.

Janice Muhr, PhD, Linda Michaels, PhD, Nancy Burke, PhD

Co-Chairs, Psychotherapy Action Network

There was a recent article in the Los Angeles Times about the serious problem at the University of Southern California School of Social Work (USC) which started their online MSW program in 2009.  In 2013 CSWA wrote a position paper about the ways we thought this online program could undermine the interpersonal understanding and ability to connect to others that are necessary components of becoming a competent clinical social worker. You can find this paper on the website at https://clinicalsocialwork.wildapricot.org/Resources/Documents/CSWA%20-%20Position%20Paper%20-%20Online%20MSW%20Programs%20-%209-13-1.pdf .

Our focus was on the clinical skills that would be lost if there is not the direct contact with professors, supervisors, and patients that many online MSW programs minimize or eliminate. As these programs have proliferated, there are two other issues which we touched on in our paper – the cost of these programs, around $90,000 at USC, and the way that the marketing of this program was done by a for-profit marketing firm, 2U, which had to meet certain quotas according to their contract with USC.

Over the past 6 years, the problems with the way that the USC School of Social Work has evolved, and especially the way that 2U allowed students to enter the program who were not qualified to do so, has created a maelstrom of problems.  In the past week, two articles have been written about these problems in the Los Angeles Times, https://www.latimes.com/local/lanow/la-me-usc-social-work-20190606-story.html,and the New York Times, https://www.nytimes.com/2019/06/03/upshot/student-debt-big-culprit-graduate-school.html.

CSWA encourages its members to educate themselves about the way that clinical social work is being endangered by the general lack of adequate training in online programs, as well as the stifling debt that many students accumulate. While some students think that they have gotten the training they need (see comments in these articles), U.S.News and World Report gave USC School of Social Work a rating of the 25^thbest school in 2018, down from its usual place in the top ten schools. 

The Council of Social Work Education, which accredits all MSW programs, has endorsed the use of online MSW programs without reservation,if they conform to the coursework standards of brick and mortar programs. This was a mistake in the opinion of CSWA for the reasons stated above and in our Paper.We encourage members to let their schools know, as alumnae, that the possible diminished training of MSWs using online courses, and the staggering debt accrued, are bad for our profession and bad for the well-being of future clinical social workers. 

The majority of schools of social work now have online MSW programs as an option.  It is time to take a stand on the harm this may do to the clinical social work profession.

 

Laura Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
The National Voice of Clinical Social Work

Missouri Medicaid Audit & Compliance (MMAC) requests that any provider who believes documentation in support of servicing Missouri Medicaid participants is no longer available due to recent weather events, complete the Attestation of Medical Record Loss or Destruction Form which can be found at https://mmac.mo.gov/providers/provider-enrollment/new-providers/provider-enrollment-forms/ 

CSWA has been receiving many questions about the use of 'text therapy' and texting in general as part of LCSW practice. 

The paper attached is CSWA's attempt to clarify the issue for our members. 

Thanks to Margot Aronson, LICSW, CSWA Deputy Director of Policy and Practice, for her great work on this project.

CSWA - Text Therapy - 5-22-19 (1).pdf

Dear CSWA Affiliated Members,

Late last night (December 1) the Senate passed its version of HR 1, the House tax reform bill, and I have been up since 6:30 amtrying to read and digest the 400+ page bill.  The truth is, I wish that I had slept in today.

This bill seems to contain a lowering of taxes for the wealthy over the next 10 years and, for the most part, raising taxes for everyone else. One of the ways this has been done is by elimination of the individual mandate for the Affordable Care Act.  The mandate provided $338 billion for the ACA. It is estimated that premiums for insurance in general will rise by 10% or more, causing many to stop using the ACA marketplace, with the likely effect of making the survival of the ACA questionable.

There are some other specific ways that HR 1 will be harmful to clinicians, not the least of which is having graduate students count their tuition as taxable income, adding a huge tax burden to most doctoral students. Additionally, with the elimination of the requirement that Essential Benefits be included in all insurance plans, we will see a return to the pre-ACA days, when most plans didn’t offer mental health treatment/substance use coverage, and those that did were prohibitively expensive. 

Passage by the Senate of such a mean-spirited bill is discouraging. However, keep in mind this is not the final form that the bill will take:  a Conference Committee will be working to integrate the House Tax Reform bill and the Senate version over the next few weeks, with hopes of coming to agreement for the President’s signature by Christmas.  CSWA encourages members to write members of the Conference Committee as soon as they are appointed; we’ll have contact information available soon.

For right now, we urge you to send the following message to your representative: “I am a member of the Clinical Social Work Association and a constituent.  HR 1 as passed by the Senate will harm those covered by the Affordable Care Act by eliminating required access to the mental health and substance use services that they need.  We are in the midst of an opioid crisis; the majority of people affected by it also have mental health problems. Please make required mental health and addiction coverage part of all health insurance plans.” You can find email addresses of your senators and representative at https://www.congress.gov/members ; .

Please let me know when you have sent your messages and watch for more legislative action in the next week.

Laura W. Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY