investing in the social work workforce - social work policy institute

I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E

> REPORT FROM A THINK TANK SYMPOSIUM

> Sponsored by the NASW Social Work Policy Institute

> In collaboration with the Action Network for Social WorkEducation and Research (ANSWER)

S E P T E M B E R 2 0 1 1

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was sponsored by the NASW Foundation’s Social Work Policy Institute (SWPI) and the Action

Network for Social Work Education and Research (ANSWER).

The opinions expressed in the monograph are those of the author.

F O R M O R E I N F O R M AT I O N C O N TA C T

Joan Levy Zlotnik, PhD, ACSW

Director, Social Work Policy Institute

750 First Street NE, Suite 700

Washington, DC 20002

202.336.8393

[email protected]

SocialWorkPolicy.org

Recommended Citation – Social Work Policy Institute (2011).

Investing in the Social Work Workforce. Washington, DC:

National Association of Social Workers.

©2011 National Association of Social Workers. All Rights Reserved.

Executive Summary...............................................................................................About the Symposium ..........................................................................................Framing the Issues ................................................................................................

> The Social Work Workforce: Shifting the Context ..........................................> Federal Funding to Invest in Social Work: Opportunities and Exemplars............

> Developing the Health Professions Workforce ............................................> Preparing the Child Welfare Workforce: What will it take to Reach the Next 2

> Social Work, CMS and Health Care Reform – Opportunities and Accountability> Improving Health Outcomes: The Value of the Patient-Centered Interdisciplinary> Investing in the Social Work Workforce: A View from the Front-Line ..................> Charting an Advocacy Agenda: A View from NASW and CSWE....................

> Congressional Social Work Caucus Brings New Focus on Social Work to Cap> Strengthening the Social Work Workforce: A Legislative Viewpoint from NASW> Investing in the Social Work Workforce: An Advocacy Agenda for SocialWork Education ........................................................................................

Developing a Framework for Action ......................................................................> Influencing Social Work Education ..............................................................> Influencing Service Delivery and Social Work Practice ....................................> Strengthening Policy and Practice Linkages....................................................

Conclusions ..........................................................................................................References ............................................................................................................Appendix ............................................................................................................

> 1. Symposium Agenda................................................................................> 2. Symposium Participants ..........................................................................> 3. Symposium Speaker Biographies..............................................................> 4. Federal Child Welfare Training Programs Supporting Social Workers ..........> 5. NTOCC Health Care Professional Tools ....................................................> 6. NASW Comments to CMS on Affordable Care Organizations ....................> 7. Overview of Federal CMS Definitions of Social Work ................................> 8. Members of the Congressional Social Work Caucus ..................................> 9. Dorothy I. Height – Whitney M. Young, Jr. Social Work Reinvestment Act

(H.R. 1106, S. 584) ..................................................................................> 10. Principles of Interprofessional Education ..................................................> 11. Additional Resources ............................................................................

A. Social Work Resources on Health Care Reform ..........................................B. Council on Accreditation Standards Glossary Definitions for Social Work and

Social Services ......................................................................................C. Case Management Society of America Standards – Qualifications for

Case Managers ......................................................................................D. Resources on Social Work Effectiveness and Social Work Impact on Service

Delivery Outcomes..................................................................................E. Useful Workforce Resource Links & Reports ................................................

TA B L E O F C O N T E N T S


C I A L W O R K W O R K F O R C E

cial Work Policy Institute (SWPI) and the Action

rch (ANSWER).

those of the author.

F O R M O R E I N F O R M AT I O N C O N TA C T

Joan Levy Zlotnik, PhD, ACSW

Director, Social Work Policy Institute

750 First Street NE, Suite 700

Washington, DC 20002

202.336.8393

[email protected]

SocialWorkPolicy.org

Recommended Citation – Social Work Policy Institute (2011).

Investing in the Social Work Workforce. Washington, DC:

National Association of Social Workers.

kers. All Rights Reserved.

Executive Summary......................................................................................................................iAbout the Symposium ................................................................................................................1Framing the Issues ......................................................................................................................4

> The Social Work Workforce: Shifting the Context ..............................................................4> Federal Funding to Invest in Social Work: Opportunities and Exemplars................................5

> Developing the Health Professions Workforce ................................................................5> Preparing the Child Welfare Workforce: What will it take to Reach the Next 25 Percent? ....7

> Social Work, CMS and Health Care Reform – Opportunities and Accountability ..................10> Improving Health Outcomes: The Value of the Patient-Centered Interdisciplinary Team ..........12> Investing in the Social Work Workforce: A View from the Front-Line ....................................12> Charting an Advocacy Agenda: A View from NASW and CSWE......................................13

> Congressional Social Work Caucus Brings New Focus on Social Work to Capitol Hill ......13> Strengthening the Social Work Workforce: A Legislative Viewpoint from NASW ..............14> Investing in the Social Work Workforce: An Advocacy Agenda for SocialWork Education ..........................................................................................................14

Developing a Framework for Action ..........................................................................................16> Influencing Social Work Education ................................................................................17> Influencing Service Delivery and Social Work Practice ......................................................18> Strengthening Policy and Practice Linkages......................................................................20

Conclusions ..............................................................................................................................22References ................................................................................................................................24Appendix ................................................................................................................................25

> 1. Symposium Agenda..................................................................................................25> 2. Symposium Participants ............................................................................................26> 3. Symposium Speaker Biographies................................................................................28> 4. Federal Child Welfare Training Programs Supporting Social Workers ............................30> 5. NTOCC Health Care Professional Tools ......................................................................31> 6. NASW Comments to CMS on Affordable Care Organizations ......................................33> 7. Overview of Federal CMS Definitions of Social Work ..................................................42> 8. Members of the Congressional Social Work Caucus ....................................................44> 9. Dorothy I. Height – Whitney M. Young, Jr. Social Work Reinvestment Act

(H.R. 1106, S. 584) ....................................................................................................45> 10. Principles of Interprofessional Education ....................................................................46> 11. Additional Resources ..............................................................................................48

A. Social Work Resources on Health Care Reform ............................................................48B. Council on Accreditation Standards Glossary Definitions for Social Work and

Social Services ........................................................................................................48C. Case Management Society of America Standards – Qualifications for

Case Managers ........................................................................................................48D. Resources on Social Work Effectiveness and Social Work Impact on Service

Delivery Outcomes....................................................................................................49E. Useful Workforce Resource Links & Reports ..................................................................51

TA B L E O F C O N T E N T S


> TOPICS EXPLOREDTo help meet the symposium goals theinterdisciplinary group addressed:

> Social work workforce data andtrends.

> Federal strategies and fundingopportunities for workforce capacitybuilding, professional education andtraining.

> Implications of the Centers forMedicare and Medicaid Services(CMS) social work provisions andthe possibilities for social work withthe increased attention to innovation,primary care, psychosocialwell-being and prevention.

> Prospects for workforce investmentsthrough the implementation of theprovisions of the ACA.

> Challenges and opportunities relatedto workforce investments and staffingissues from a service deliveryperspective, including implicationsfor funding of social work positions.

> Social work within aninterdisciplinary context – both insettings where multiple providersperform similar roles – and for socialworkers as members ofinterdisciplinary care teams.

> Emerging trends in the delivery ofhealth and social services, includingrefocused attention to quality carecoordination and the need toaddress disparities in the delivery ofhealth and social services and howthese can promote opportunities forsocial work practice.

> Policies that can support workforceinvestments and capacity buildingand opportunities for furthercollaborations to continue to buildcapacity and competence andaddress workforce gaps.

> FRAMEWORKFOR ACTION

Social work organizations and sowork educators have a shared goensuring the development of acompetent, committed social worworkforce that will be employednumerous fields of practice; that wretained within the social workprofession; and that can help toachieve positive outcomes for theserved. The breadth of social woroles suggests the on-going needpractitioners who can demonstraclinical, care coordination, progrdevelopment, professionaldevelopment, organizing, supervadministrative, and policy skills.

Social workers need to be able toin interdisciplinary settings and ewith clients and communities indeveloping and implementing seand programs. Social workers shbe ready to meet new challengesbe responsive as the needs ofpopulations change; as policies (ACA) and funding streams changthe job market becomes increasincompetitive; and as some fields opractice, e.g. working with disasworking with the military and vetexpand. Social workers also neeengaged in life-long learning.

For many of the federal, state anagencies that fund and implemenprograms in which social workerwork, recruiting, retaining and trthe right workforce is a challengewhich solutions are being soughtmost instances, agencies are seesomeone that has a set of skills aexperiences to do the job; and thindividual might be selected from

> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E >i

> SYMPOSIUMPURPOSE

Professional social workers promotethe health and well-being of

individuals, families, organizations andcommunities. They are agents of change,working in a variety of settings andwith diverse populations. Social workpractice covers an array of functionsincluding clinical, counseling, casemanagement and care coordination;developing and administering programs;supervising staff and volunteers;creating and implementing policies;undertaking research, programplanning, community development andcommunity organizing; and providingtraining, education and consultation.Social workers work across thelifespan, especially serving personswho have complex health, economicand psychosocial needs, working withpersons who may have physical andpsychological impairments and limitedincomes, and who experiencediscrimination and health disparities.

In recent years, there have beenspecialized efforts to recruit andeducate the next generation of socialworkers and to build leadershipcapacity in child welfare and aging.There are also efforts to address

education and advanced practicecompetencies in a few fields of practiceor with specific populations (see forexample CSWE advanced practicecompetencies – www.cswe.org/CentersInitiatives/CurriculumResources/CompetenciesforAdvancedPractice.aspx).

The profession, however faces workforcechallenges and shortages. Yet, thereare not consistent or broadly availablestrategies that specifically target therecruitment of the next generation ofprofessional social workers. Nor arethere comprehensive initiatives toprovide training to ensure that currentpractitioners maintain up-to-date skills.

There are growing needs for welltrained, culturally competent, andcommitted social workers in all fieldsincluding mental health, health care(including subspecialties like oncology,long term care and hospice), substanceabuse, and education. Furthermore, thePatient Protection and Affordable CareAct of 2010 (P.L. 111-148) (ACA), thelong running wars in Afghanistan andIraq, and the changing demographicsin the United States also haveimplications for social work workforcedevelopment.

On May 18, 2011, the Social WorkPolicy Institute (SWPI) of the National

Association of Social Workers (NASW)Foundation, in collaboration with theAction Network for Social WorkEducation and Research (ANSWER),convened a think tank symposium,Investing in the Social WorkWorkforce. The symposium broughttogether leaders from practice, policy,research, and education, includingrepresentatives from federal agencies,national organizations, foundations,universities, insurers, and state andlocal service-providing agencies. Thegoal of the think tank symposium wasto move beyond viewing workforceissues for the social work professionwithin specific practice silos (e.g.,mental health, child welfare, oncology,chronic disease or aging) and to createan action agenda to look broadlyacross social work functions (e.g.,clinical practice, care coordination,management and supervision) andacross levels of social work education.The focus of this symposium was inkeeping with NASW’s commitment toworking within social work and withinterdisciplinary partners, and with theexecutive and legislative branches ofgovernment, at both the state andnational levels, to promote investmentsin the social work profession and topromote individual, family andcommunity well-being.

EXECUTIVE SUMMARY

INVESTING IN THE SOCIAL WORK WORKFORCETHINK TANK SYMPOSIUM

Sponsored by the NASW Social Work Policy InstituteIn collaboration with the Action Network for Social Work Education & Research

September 2011

SWPI-RPT-90811.InvestingInSW:Layout 1 10/5/11 10:57 AM Page i

> TOPICS EXPLOREDTo help meet the symposium goals theinterdisciplinary group addressed:








> Policies that can support workforceinvestments and capacity buildingand opportunities for furthercollaborations to continue to buildcapacity and competence andaddress workforce gaps.

> FRAMEWORKFOR ACTION

Social work organizations and socialwork educators have a shared goal –ensuring the development of acompetent, committed social workworkforce that will be employed acrossnumerous fields of practice; that will beretained within the social workprofession; and that can help toachieve positive outcomes for the clientsserved. The breadth of social workroles suggests the on-going need forpractitioners who can demonstrateclinical, care coordination, programdevelopment, professionaldevelopment, organizing, supervisory,administrative, and policy skills.

Social workers need to be able to workin interdisciplinary settings and engagewith clients and communities indeveloping and implementing servicesand programs. Social workers shouldbe ready to meet new challenges andbe responsive as the needs ofpopulations change; as policies (e.g.,ACA) and funding streams change; asthe job market becomes increasinglycompetitive; and as some fields ofpractice, e.g. working with disasters orworking with the military and veterans,expand. Social workers also need to beengaged in life-long learning.

For many of the federal, state and localagencies that fund and implement theprograms in which social workerswork, recruiting, retaining and trainingthe right workforce is a challenge towhich solutions are being sought. Inmost instances, agencies are seekingsomeone that has a set of skills andexperiences to do the job; and thatindividual might be selected from an

array of professions – social workers,psychologists, nurses, counselors,lawyers, etc. – who may all fit theemployers’ job descriptions. In somefields, especially in child welfare and inaging, social workers with BSW andMSW degrees may be competing forjobs against persons who have nospecialized training and may have onlya bachelor’s degree, or less. Thepublic, however, often assumes that allof the persons performing thesefunctions are professional socialworkers.

There may be a declining number ofpositions in the 21st century thatspecifically call for hiring only a socialworker to do the job. Services that dospecifically recruit and employ socialworkers are those where federal, stateor other policies define who therequired staff are. Settings mayspecifically require a professionalsocial worker due to states’ licensingrequirements or social workrequirements may be in keeping withan agency’s efforts to meetaccreditation standards. In someinstances, agencies have a preferencefor hiring social workers; however, it isnot a requirement.

As we look to the future, the increaseddemand for social workers will continueto grow and will need to be responsiveto the following:

> The impending retirement of asizable cohort of today’s health andhuman service workforce;

> The implementation of the ACA;> The efforts to reduce the number

of children in out of home care;> The increased linkages

between mental healthservices and primarycare;

i i> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E > S O C I A L W O R K P O L I C Y I N S T I T U T E

on and advanced practiceencies in a few fields of practicespecific populations (see fore CSWE advanced practiceencies – www.cswe.org/Centerses/CurriculumResources/tenciesforAdvancedPractice.aspx).

fession, however faces workforceges and shortages. Yet, thereconsistent or broadly availablees that specifically target the

ment of the next generation ofional social workers. Nor areomprehensive initiatives toe training to ensure that currentoners maintain up-to-date skills.

re growing needs for well, culturally competent, andted social workers in all fieldsng mental health, health careng subspecialties like oncology,rm care and hospice), substanceand education. Furthermore, theProtection and Affordable Care2010 (P.L. 111-148) (ACA), thenning wars in Afghanistan andnd the changing demographicsUnited States also havetions for social work workforcepment.

y 18, 2011, the Social Worknstitute (SWPI) of the National

Association of Social Workers (NASW)Foundation, in collaboration with theAction Network for Social WorkEducation and Research (ANSWER),convened a think tank symposium,Investing in the Social WorkWorkforce. The symposium broughttogether leaders from practice, policy,research, and education, includingrepresentatives from federal agencies,national organizations, foundations,universities, insurers, and state andlocal service-providing agencies. Thegoal of the think tank symposium wasto move beyond viewing workforceissues for the social work professionwithin specific practice silos (e.g.,mental health, child welfare, oncology,chronic disease or aging) and to createan action agenda to look broadlyacross social work functions (e.g.,clinical practice, care coordination,management and supervision) andacross levels of social work education.The focus of this symposium was inkeeping with NASW’s commitment toworking within social work and withinterdisciplinary partners, and with theexecutive and legislative branches ofgovernment, at both the state andnational levels, to promote investmentsin the social work profession and topromote individual, family andcommunity well-being.

CUTIVE SUMMARY

STING IN THE SOCIAL WORK WORKFORCETANK SYMPOSIUM

ed by the NASW Social Work Policy Instituteration with the Action Network for Social Work Education & Research

r 2011

SWPI-RPT-90811.InvestingInSW:Layout 1 10/5/11 10:57 AM Page ii

develops regulations andadministrative policy guidance,issues grants and contracts,organizes workgroups and advisorygroups and works to implementlegislation. Influencing the executivebranch requires outreach andadvocacy on behalf of the socialwork profession to ensure that socialwork has a seat at the table. This isespecially crucial in theimplementation of the ACA and inensuring social workers’ roles inemerging fields of practice.

> CONCLUSIONSInvesting in the social work workforcewill require actions by multiple playersboth within the social work professionand on the outside. Efforts will need tofocus on advocacy, research,professional social work education andtraining, and interprofessionalcollaboration and interdisciplinarypractice. These efforts should betargeted to and engage multiplestakeholders including:

> Social work organizations.> Government agencies (at the local,

state and national levels).> Unions.> Licensing boards.> Accrediting bodies.> Legislatures.> National organizations representing

service providers (e.g., ChildWelfare League of America, Alliancefor Children and Families, National

Association of Area AgenciesAging).

> Employers of social workers (eKaiser Permanente, Family SerAgencies, the Department ofVeterans Affairs).

> Clinicians and practitioners.

Anticipated outcomes for implemthe action agenda will include:

> Enhanced public and policy munderstanding of the essentialsocial workers.

> Strengthened inter-social workorganization collaboration anattention to shared missions reto advocacy and professionaldevelopment.

> Enhanced interdisciplinary traand team outcomes and advocacross discipline-specificorganizations.

> Strengthened and sustained rewith key executive branch ageincluding collection of social wworkforce data and supports fsocial work education andprofessional development.

> Strengthened licensing andenhanced recognition of profesocial work.

> Increased social worker salari> Increased clarification of varia

skills and expectations for servoutcomes for social workers wdifferential education andexperiences.

> Improved retention of social win their jobs and within theprofession.

> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E >i i i

> The expanded focus oninterdisciplinary/interprofessionalservice delivery;

> The requirements to implement testedinterventions and evidence-basedpractices;

> The increased demand for qualityconsumer-centered care and carecoordination;

> The focus on addressing the needs ofthe military and their families and themany generations of veterans;

> Growing opportunities for socialworkers in business and in the for-profit sector.

The think tank participants grappledwith many issues that could result inenhanced efforts by the governmentand other funders to invest in the socialwork workforce; that would strengthenand enhance intra-social work andinterprofessional partnerships andadvocacy strategies; and that wouldstrengthen the linkages between whatsocial workers learn in the academyand what they do in practice. Thefollowing highlights issues that needfurther attention.

Influencing Social Work Education> Enrollments and applications to

social work education programs areincreasing, creating a readiness torespond to the growing need forsocial workers. This is an opportunityto be responsive to the Bureau ofLabor Statistics projections of thegrowing need for social workers.Efforts should ensure that graduateshave the right skills, abilities, andexperiences to effectively performtheir jobs in settings where socialworkers are most needed.

> Changes in practice suggest thatsocial work curricula changes arealso needed. Educational institutionsmust keep current in preparingstudents to meet client andcommunity needs. This may includecurriculum innovations, incorporatingevidence-based practice intoprofessional education andenhancing research/practicebridges.

Influencing Service Delivery and SocialWork Practice> Emerging practice methods may

require shifts in how practice isdefined and how social workcommunicates its expertise. Trainingand professional development andadvocacy will require professionalsacross disciplines to work togetherand to partner with clients andcommunities to ensure practicerelevance and cultural congruency.

> Interdisciplinary/interprofessionalpractice will be increasingly the normin practice settings. Strategies areneeded in the academy and inpractice settings to ensure that socialworkers are well prepared to workas part of an interdisciplinary team.

> Use of data and research findingswill increasingly be used to guidepractice and policy. Collection ofdata is critical as well as ensuringthat front-line practitioners andsupervisors be encouraged andguided to use data and research toinform practice.

> Consistent data need to be collectedand analyzed regarding the socialwork workforce. Social workorganizations should work with theBureau of Health Professions andothers to ensure relevant andaccessible data. Since social work isa high growth field over the nextdecade, data are needed to supportrecruitment and retention efforts,including the need for faculty andresearchers.

Strengthening Policy and PracticeLinkages> Workplace supports and the work

environment should facilitate qualitysocial work practice. Enhanced effortsneeded to ensure that organizationalculture and climate in health andhuman service settings are conduciveto professional practice; thatrecruitment and retention is supportedand that competitive salaries areoffered.

> Advocacy to address workforceissues is needed at the federal, stateand local levels. Social workers needto work with other disciplines,consumers and employers toadvocate for service enhancementsand workforce supports. Social workorganizations should develop andimplement a unified workforceadvocacy agenda.

> Influencing the executive branch ofgovernment to advocate for investingin social work is critical. Theexecutive branch of government

SWPI-RPT-90811.InvestingInSW:Layout 1 10/5/11 10:57 AM Page iii

develops regulations andadministrative policy guidance,issues grants and contracts,organizes workgroups and advisorygroups and works to implementlegislation. Influencing the executivebranch requires outreach andadvocacy on behalf of the socialwork profession to ensure that socialwork has a seat at the table. This isespecially crucial in theimplementation of the ACA and inensuring social workers’ roles inemerging fields of practice.

> CONCLUSIONSInvesting in the social work workforcewill require actions by multiple playersboth within the social work professionand on the outside. Efforts will need tofocus on advocacy, research,professional social work education andtraining, and interprofessionalcollaboration and interdisciplinarypractice. These efforts should betargeted to and engage multiplestakeholders including:

> Social work organizations.> Government agencies (at the local,

state and national levels).> Unions.> Licensing boards.> Accrediting bodies.> Legislatures.> National organizations representing

service providers (e.g., ChildWelfare League of America, Alliancefor Children and Families, National

Association of Area Agencies onAging).

> Employers of social workers (e.g.,Kaiser Permanente, Family ServiceAgencies, the Department ofVeterans Affairs).

> Clinicians and practitioners.

Anticipated outcomes for implementingthe action agenda will include:

> Enhanced public and policy makerunderstanding of the essential role ofsocial workers.

> Strengthened inter-social workorganization collaboration andattention to shared missions relatedto advocacy and professionaldevelopment.

> Enhanced interdisciplinary trainingand team outcomes and advocacyacross discipline-specificorganizations.

> Strengthened and sustained relationswith key executive branch agencies,including collection of social workworkforce data and supports forsocial work education andprofessional development.

> Strengthened licensing andenhanced recognition of professionalsocial work.

> Increased social worker salaries.> Increased clarification of variation in

skills and expectations for serviceoutcomes for social workers withdifferential education andexperiences.

> Improved retention of social workersin their jobs and within theprofession.

> Enhanced understanding of socialwork roles by employers and policymakers.

> Enhanced alignment between socialwork education and contemporarypractice needs based ondemographics and growing servicedelivery sectors (aging, veterans,military, health disparities).

> Enhanced information about socialwork effectiveness.

> Attention to development andimplementation of evidence-basedpractices.

> Expanded use of data and researchto guide practice.

The goals of this think tank symposiumwere met. People who do not usuallyconnect with each other connected.Following the symposium, several socialwork organizations came together toenhance their workforce advocacyefforts, and federal agencies and theprofession have enhanced theirpotentials for partnerships. The agendafor the future is daunting and willrequire the development of sustainedrelationships between the professionand government and foundationrepresentatives, as well as betweensocial work and its interdisciplinarypartners. The workforce crisis for socialwork is real, and creating a safety netfor a civil society is critical. Socialworkers must be well positioned to meetthe demands for their services fromindividuals, famillies, organizations andcommunities in need.

i v> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E > S O C I A L W O R K P O L I C Y I N S T I T U T E

cing Social Work Educationllments and applications to

al work education programs areasing, creating a readiness toond to the growing need foral workers. This is an opportunitye responsive to the Bureau ofr Statistics projections of the

wing need for social workers.ts should ensure that graduatesthe right skills, abilities, and

eriences to effectively performjobs in settings where social

kers are most needed.nges in practice suggest thatal work curricula changes areneeded. Educational institutionskeep current in preparing

ents to meet client andmunity needs. This may includeculum innovations, incorporatingence-based practice intoessional education andancing research/practiceges.

cing Service Delivery and Socialracticerging practice methods mayire shifts in how practice is

ned and how social workmunicates its expertise. Trainingprofessional development and

ocacy will require professionalsss disciplines to work togetherto partner with clients andmunities to ensure practiceance and cultural congruency.disciplinary/interprofessionaltice will be increasingly the normactice settings. Strategies are

ded in the academy and intice settings to ensure that socialkers are well prepared to workart of an interdisciplinary team.

> Use of data and research findingswill increasingly be used to guidepractice and policy. Collection ofdata is critical as well as ensuringthat front-line practitioners andsupervisors be encouraged andguided to use data and research toinform practice.

> Consistent data need to be collectedand analyzed regarding the socialwork workforce. Social workorganizations should work with theBureau of Health Professions andothers to ensure relevant andaccessible data. Since social work isa high growth field over the nextdecade, data are needed to supportrecruitment and retention efforts,including the need for faculty andresearchers.

Strengthening Policy and PracticeLinkages> Workplace supports and the work

environment should facilitate qualitysocial work practice. Enhanced effortsneeded to ensure that organizationalculture and climate in health andhuman service settings are conduciveto professional practice; thatrecruitment and retention is supportedand that competitive salaries areoffered.

> Advocacy to address workforceissues is needed at the federal, stateand local levels. Social workers needto work with other disciplines,consumers and employers toadvocate for service enhancementsand workforce supports. Social workorganizations should develop andimplement a unified workforceadvocacy agenda.

> Influencing the executive branch ofgovernment to advocate for investingin social work is critical. Theexecutive branch of government

SWPI-RPT-90811.InvestingInSW:Layout 1 10/5/11 10:57 AM Page iv

I N V E S T I N G I N T H E S O C I A L W O

> REPORT FROM A TH

> Sponsored by the NA

> In collaboration with tEducation and Resear

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SWPI-RPT-90811.InvestingInSW:Layout 1 10/5/11 10:57 AM Page vi

The Social Work Policy Institute (SWPI)is a think tank established within the NASWFoundation to strengthen social work’s voicein public policy deliberations; to informpolicy makers through the collection anddissemination of information on social workeffectiveness; and to create a forum toexamine current and future issues in healthcare and social service delivery. For moreinformation visit www.socialworkpolicy.org

The ANSWER Coalition was founded in 1995to increase advocacy on behalf of socialwork education, training, and researchthrough collaboration among social workeducation, research, and practiceorganizations; social work educationprograms; and other interest groups. Thecurrent members of the ANSWER Coalitionare the Association for Baccalaureate SocialWork Program Directors (BPD), Council onSocial Work Education (CSWE), Group for theAdvancement of Doctoral Education (GADE),National Association of Deans and Directorsof Schools of Social Work (NADD), NationalAssociation of Black Social Workers(NABSW), National Association of SocialWorkers (NASW), and Society for SocialWork and Research (SSWR). For moreinformation visit www.socialworkers.org/advocacy/answer/default.asp

The goal of the think tank symposiumwas to move beyond viewing workforceissues for the social work professionwithin specific practice silos (e.g.,mental health, child welfare, oncology,chronic disease or aging) and to createan action agenda to look broadlyacross social work functions (e.g.,clinical practice, care coordination,management and supervision) andacross levels of education (BSW, MSWand PhD). The participants examinedpolicy opportunities, current strategies,

and funding related to professioneducation, training and serviceenhancements across fields of prand across population groups.Discussions focused on potentialopportunities and existing challenespecially in light of the changesincluded in the ACA. The resultinagenda for action identifies the nintraprofessional, interorganizatiand interdisciplinary collaboratiopartnerships, as well as the needfurther research, policy enhancemand communication strategies.

The focus of this symposium is inkeeping with NASW’s commitmeworking within social work and winterdisciplinary partners, and wexecutive and legislative branchegovernment, at both the state andnational levels, to promote investin the social work profession andpromote individual, family andcommunity well-being.

The symposium also builds on seimperatives from the 2005 SociaCongress (www.socialworkers.orcongress/imperatives0605.pdf) a2010 Social Work Congress(www.socialworkers.org/2010codocuments/2010Imperatives.pdfThese focus on advocacy; influenthe policy agenda; articulating thevidence-base for social work prapromoting quality health care, agand child welfare services; andenhancing the influence of andcollaboration among national sowork organizations.

> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E >1

> PURPOSE

Professional social workers promotethe health and well-being of

individuals, families, organizations andcommunities. Social workers are agentsof change, working in many differentsettings and with diverse populations.Social work practice is made up of anarray of functions including clinical,counseling, case management and carecoordination services; developing andadministering programs; supervisingstaff and volunteers; creating andimplementing policies; undertakingresearch, program planning,community development andcommunity organizing; and providingtraining, education and consultation.Social workers work across thelifespan, especially serving personswho have complex health, economicand psychosocial needs, working withpersons who have physical andpsychological impairments, limitedincomes, and who experiencediscrimination and health disparities.

In child welfare and aging, in recentyears, there have been specializedefforts to recruit and educate the next

generation of social workers and tobuild leadership capacity. In otherfields, however, such as mental health,health care (including subspecialtieslike oncology, long term care andhospice), substance abuse, andeducation, there are also growingneeds for well trained, culturallycompetent, and committed socialworkers. However, there are notconsistent or broadly availablestrategies that specifically target therecruitment of the next generation ofprofessional social workers into thesefields nor are there comprehensiveinitiatives to provide training to ensurethat current practitioners maintainup-to-date skills. The Patient Protectionand Affordable Care Act of 2010 (P.L.111-148) (ACA), the long running warsin Afghanistan and Iraq, and thechanging demographics in the UnitedStates also have implications for socialwork workforce development.

While there are some efforts to addresseducation and practice competenciesand training in a few fields of practiceor with specific populations (see forexample CSWE advanced practicecompetencies - www.cswe.org/Centers

Initiatives/CurriculumResources/CompetenciesforAdvancedPractice.aspx),the profession faces workforcechallenges and shortages related to allservice sectors and populations. Thus, itis important to move beyond focusingon single practice areas and toholistically focus on investments in thesocial work workforce overall. This willrequire identification of strategies thatcan cut across service sectors andpopulations.

On May 18, 2011, the Social WorkPolicy Institute (SWPI) of the NationalAssociation of Social Workers (NASW)Foundation in collaboration with theAction Network for Social WorkEducation and Research (ANSWER)convened a think tank symposium,Investing in the Social Work Workforce(see Appendix 1 for the agenda). Thesymposium brought together leadersfrom practice, policy, research, andeducation, including representativesfrom federal agencies, nationalorganizations, foundations, universities,insurers, and state and localservice-providing agencies (seeAppendix 2 for a list of theparticipants).

ABOUT THE SYMPOSIUM


The Social Work Policy Institute (SWPI)is a think tank established within the NASWFoundation to strengthen social work’s voicein public policy deliberations; to informpolicy makers through the collection anddissemination of information on social workeffectiveness; and to create a forum toexamine current and future issues in healthcare and social service delivery. For moreinformation visit www.socialworkpolicy.org

The ANSWER Coalition was founded in 1995to increase advocacy on behalf of socialwork education, training, and researchthrough collaboration among social workeducation, research, and practiceorganizations; social work educationprograms; and other interest groups. Thecurrent members of the ANSWER Coalitionare the Association for Baccalaureate SocialWork Program Directors (BPD), Council onSocial Work Education (CSWE), Group for theAdvancement of Doctoral Education (GADE),National Association of Deans and Directorsof Schools of Social Work (NADD), NationalAssociation of Black Social Workers(NABSW), National Association of SocialWorkers (NASW), and Society for SocialWork and Research (SSWR). For moreinformation visit www.socialworkers.org/advocacy/answer/default.asp

The goal of the think tank symposiumwas to move beyond viewing workforceissues for the social work professionwithin specific practice silos (e.g.,mental health, child welfare, oncology,chronic disease or aging) and to createan action agenda to look broadlyacross social work functions (e.g.,clinical practice, care coordination,management and supervision) andacross levels of education (BSW, MSWand PhD). The participants examinedpolicy opportunities, current strategies,

and funding related to professionaleducation, training and serviceenhancements across fields of practiceand across population groups.Discussions focused on potentialopportunities and existing challenges,especially in light of the changesincluded in the ACA. The resultingagenda for action identifies the need forintraprofessional, interorganizationaland interdisciplinary collaborations andpartnerships, as well as the need forfurther research, policy enhancementsand communication strategies.

The focus of this symposium is inkeeping with NASW’s commitment toworking within social work and withinterdisciplinary partners, and with theexecutive and legislative branches ofgovernment, at both the state andnational levels, to promote investmentsin the social work profession and topromote individual, family andcommunity well-being.

The symposium also builds on severalimperatives from the 2005 Social WorkCongress (www.socialworkers.org/congress/imperatives0605.pdf) and2010 Social Work Congress(www.socialworkers.org/2010congress/documents/2010Imperatives.pdf).These focus on advocacy; influencingthe policy agenda; articulating theevidence-base for social work practice;promoting quality health care, agingand child welfare services; andenhancing the influence of andcollaboration among national socialwork organizations.

> THINK TANKTOPICS EXPLOREDTo help meet the symposium goals theinterdisciplinary group addressed:








> Policies that can supportworkforce investments and

2> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E > S O C I A L W O R K P O L I C Y I N S T I T U T E

tion of social workers and toadership capacity. In other

however, such as mental health,care (including subspecialtiescology, long term care ande), substance abuse, andon, there are also growingor well trained, culturallyent, and committed socials. However, there are notent or broadly availablees that specifically target the

ment of the next generation ofional social workers into theseor are there comprehensivees to provide training to ensurerent practitioners maintain

ate skills. The Patient Protectionfordable Care Act of 2010 (P.L.48) (ACA), the long running warsanistan and Iraq, and theng demographics in the Unitedalso have implications for socialorkforce development.

here are some efforts to addresson and practice competenciesining in a few fields of practicespecific populations (see fore CSWE advanced practiceencies - www.cswe.org/Centers

Initiatives/CurriculumResources/CompetenciesforAdvancedPractice.aspx),the profession faces workforcechallenges and shortages related to allservice sectors and populations. Thus, itis important to move beyond focusingon single practice areas and toholistically focus on investments in thesocial work workforce overall. This willrequire identification of strategies thatcan cut across service sectors andpopulations.

On May 18, 2011, the Social WorkPolicy Institute (SWPI) of the NationalAssociation of Social Workers (NASW)Foundation in collaboration with theAction Network for Social WorkEducation and Research (ANSWER)convened a think tank symposium,Investing in the Social Work Workforce(see Appendix 1 for the agenda). Thesymposium brought together leadersfrom practice, policy, research, andeducation, including representativesfrom federal agencies, nationalorganizations, foundations, universities,insurers, and state and localservice-providing agencies (seeAppendix 2 for a list of theparticipants).

ABOUT THE SYMPOSIUM


3

The symposium kicked off with invitedpresentations related to trends in the

social work workforce overall; thecurrent strategies and future needs forchild welfare workforce development;health professions training opportunities,and the implications for workforcedevelopment due to health care reformand federal health care financingstrategies. Two invited respondentsdrew from their own work to commenton the presentations and to addressworkforce challenges in community-based health and human servicesprograms and in addressing transitionsof care (see Appendix 3 for speakers’biographies). Two think tank participantswere also specifically asked to brieflyhighlight the federal and foundationsupported social work workforceinvestments in aging and healthdisparities in which they are involved.

> THE SOCIALWORK WORKFORCE:SHIFTING THECONTEXTTo underpin the day’s discussions, Dr.Tracy Whitaker, Director of NASW’sCenter for Workforce Studies and SocialWork Practice provided an overview ofthe social work labor force and some ofthe opportunities and challenges it faces.To better understand the social worklabor force, in 2004 the NationalAssociation of Social Workers undertooka national benchmark study of 10,000licensed social workers, with supportfrom Atlantic Philanthropies, the John A.Hartford Foundation, the Annie E. Casey

Foundation and the Robert WoodJohnson Foundation. NASW launthis study because there were insudata specifically related to the sowork profession and no other reland detailed source of data exist

The study found that mental healtthe most common practice area flicensed practitioners at 37 percewith Child Welfare/Family and Heach having about 13 percent oflicensed social workers. Approxi9 percent of social workers workfield of aging. Those social worklong term care and child servingorganizations are most likely to hcaseloads larger than 50 clients.welfare/family work is most likelytake place in the public sector anaging work is most likely to takein the private/ non-profit sector. Pwith a bachelor’s degree in socia(BSW) who work in aging are mlikely to work in nursing homes, cmanagement and social serviceagencies and spend less time prodirect client services than do thoshave a Master’s degree in social(MSW). Child Welfare/Family seare common areas of practice foentering the social work professiohowever, many of these social wleave this area of practice or leavprofession altogether, due to strethe lack of supervision and worksupports.

The NASW study identified animpending shortage of social wodue to several factors including:

> The need to replace retiring wdue to the age of the workforc

> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E >

capacity building and opportunitiesfor further collaborations to continueto build capacity and competenceand address workforce gaps.

Through the deliberations anddiscussions of the diverse group ofstakeholders, the symposium’sparticipants grappled with questionssuch as:

> How do we best identify, document,distill and disseminate the evidencebase for social work practice acrossfields of practice, includingidentification of how social workinterventions affect individual, family,organizational, system and societaloutcomes?

> What areas of social work practiceand interventions need furtherresearch and better collection andanalysis of data to build theevidence?

> How can comparative effectivenessresearch support social workworkforce investments?

> What workforce investments areneeded to best address healthdisparities and the differentialoutcomes for populations thatexperience disparities?

> How can the differential roles thatsocial workers perform within andacross systems best be articulatedand supported? For example,differential roles of behavioral healthprovider, care coordinator, andinterdisciplinary medical teammember in health care; or childwelfare roles of clinician and carecoordinator.

> What are the linkages that can bestrengthened among all levels ofsocial work education and serviceproviders in order to promotepractice excellence and enhanceconsumer and community outcomes?

> What are emerging areas ofpractice and what policy andprogram strategies are needed tobuild the necessary capacity?

> What roles should social workeducation programs play in theprofessional development of healthand social service providers; andwhat are the necessary investmentsto ensure a qualified workforceacross fields of practice?

> What current models for professionaldevelopment and training might beadapted and adopted by other fieldsof practice?

> What stakeholders should worktogether to move these agendasforward?

FRA

1 For more information about this landmark study, including specialty reports in several practice sectors v


The symposium kicked off with invitedpresentations related to trends in the

social work workforce overall; thecurrent strategies and future needs forchild welfare workforce development;health professions training opportunities,and the implications for workforcedevelopment due to health care reformand federal health care financingstrategies. Two invited respondentsdrew from their own work to commenton the presentations and to addressworkforce challenges in community-based health and human servicesprograms and in addressing transitionsof care (see Appendix 3 for speakers’biographies). Two think tank participantswere also specifically asked to brieflyhighlight the federal and foundationsupported social work workforceinvestments in aging and healthdisparities in which they are involved.

> THE SOCIALWORK WORKFORCE:SHIFTING THECONTEXTTo underpin the day’s discussions, Dr.Tracy Whitaker, Director of NASW’sCenter for Workforce Studies and SocialWork Practice provided an overview ofthe social work labor force and some ofthe opportunities and challenges it faces.To better understand the social worklabor force, in 2004 the NationalAssociation of Social Workers undertooka national benchmark study of 10,000licensed social workers, with supportfrom Atlantic Philanthropies, the John A.Hartford Foundation, the Annie E. Casey

Foundation and the Robert WoodJohnson Foundation. NASW launchedthis study because there were insufficientdata specifically related to the socialwork profession and no other reliableand detailed source of data existed.

The study found that mental health isthe most common practice area for alllicensed practitioners at 37 percent,with Child Welfare/Family and Healtheach having about 13 percent oflicensed social workers. Approximately9 percent of social workers work in thefield of aging. Those social workers inlong term care and child servingorganizations are most likely to havecaseloads larger than 50 clients. Childwelfare/family work is most likely totake place in the public sector andaging work is most likely to take placein the private/ non-profit sector. Personswith a bachelor’s degree in social work(BSW) who work in aging are morelikely to work in nursing homes, casemanagement and social serviceagencies and spend less time providingdirect client services than do those whohave a Master’s degree in social work(MSW). Child Welfare/Family settingsare common areas of practice for thoseentering the social work profession;however, many of these social workersleave this area of practice or leave theprofession altogether, due to stress andthe lack of supervision and workplacesupports.

The NASW study identified animpending shortage of social workersdue to several factors including:

> The need to replace retiring workersdue to the age of the workforce;

> Difficulties retaining the currentworkforce due to workplace andservice delivery challenges;

> Concerns about recruiting the nextgeneration of social workers due tohigh levels of student loan debtcoupled with expectations of lowsalaries for social work positions(Whitaker, Weismiller & Clark,2006).1

According to the Bureau of LaborStatistics (BLS, 2010), the social workprofession is projected to grow fasterthan the average between 2008 and2018 and the current behavioral healthcare workforce is deemed to beinadequate to provide services to allpersons in need. The growth in the healthcare industry means that jobs are beingadded, and this has helped to make thesocial work profession somewhat“recession proof.” In December 2010,US News.com (Baden, 2010) identifiedmedical and public health social workas one of the best careers of 2011.Although there may be jobs in socialwork, the profession is identified as oneof the worst paying for those with acollege degree, and is seen inparticular as a stressful job that paysbadly. The National Council forCommunity Behavioral Healthcare in2011 reported that behavioral healthcare workers earn less than fast foodworkers and that salaries have not keptup with inflation (Mental HealthWeekly, 2011).

Unlike the nursing shortage, theimpending shortage of socialworkers has not been identifiedas an “emergency.” Policy


can comparative effectivenessarch support social workkforce investments?at workforce investments areed to best address health

arities and the differentialomes for populations thatrience disparities?can the differential roles that

al workers perform within andss systems best be articulatedsupported? For example,rential roles of behavioral healthider, care coordinator, anddisciplinary medical teamber in health care; or childare roles of clinician and caredinator.at are the linkages that can begthened among all levels of

al work education and serviceiders in order to promotetice excellence and enhanceumer and community outcomes?

> What are emerging areas ofpractice and what policy andprogram strategies are needed tobuild the necessary capacity?

> What roles should social workeducation programs play in theprofessional development of healthand social service providers; andwhat are the necessary investmentsto ensure a qualified workforceacross fields of practice?

> What current models for professionaldevelopment and training might beadapted and adopted by other fieldsof practice?

> What stakeholders should worktogether to move these agendasforward?

FRAMING THE ISSUES

1 For more information about this landmark study, including specialty reports in several practice sectors visit http://workforce.socialworkers.org.


also now part of BHPr’s priorities. Moreinformation can be found at the BHPrwebsite, http://bhpr.hrsa.gov/.

The major focus areas for the BHPr forFiscal Year 2012 include:

> Improving primary care workforcesupply, capacity and distributionthrough stronger education andtraining opportunities.

> Developing new team-based modelsof care based on interprofessionaltraining.

> Reducing health disparities byincreasing workforce diversity.

> Enhancing geriatric training andexpertise, including bothprofessional and paraprofessionaleducation.

> Continuing development of theNational Center for HealthWorkforce Analysis to improve datacollection to inform stakeholders onhealth workforce issues.

> Collecting and reporting meaningfulperformance measures andconducting evaluations to assessprogram performance.

The passage of the ACA hasimplications for the health careworkforce including the programsadministered by the BHPr. ACAupdates and reauthorizes programs tosupport:

> Workforce supply, including primarycare, oral health andinterdisciplinary activities (includingsocial work).

> Workforce distribution, includingtraining opportunities in rural andunderserved settings.

> Workforce diversity, includingrecruitment, retention and facultydevelopment.

Specific investments funded throuACA include an array of expanshealth care training. Although sospecific to nursing, physicians,physician assistants, public healthealth aides; no provisions are sjust to social work. The investmeninclude:

> Primary care residency expan> Advanced nursing education

expansion> Expansion of physician assista

training> Teaching health centers – for

graduate medical education (fmedicine and dentistry in comsettings)

> Nurse managed health clinics> State health care workforce

development> Public health training centers> Personal and home care aide

training programs.

Examples of the BHPr’s strategy tthe primary care workforce incluproviding opportunities forinterprofessional primary care traenhancing the clinical training ofphysician assistant programs;improving the medical school clinexperience; retaining internal meresidents in primary care; innovapre-medical education, and expaadvanced practice nursing trainincapacity.

Examples of the BHPr strategy topromote interdisciplinary work ina February 2011 HRSA sponsoremeeting in partnership with the JoMacy Foundation, Robert WoodJohnson Foundation and theInterprofessional EducationCollaborative (www.aacom.org/Ineducators/ipe/Pages/default.aswww.aacom.org/InfoFor/educat


makers, foundations, nursingorganizations and educationalinstitutions have all responded to thenursing workforce emergency, creatingstrategies to recruit new nurses into thefield, to raise salaries, to retain nursesin clinical care, to improve workingconditions, and to address the nursingfaculty shortage. In addition, the publicis aware of this shortage through savvypublic service announcements seenduring football games and throughother visible media strategies.

By contrast, news of an impendingsocial worker shortage did not seem todrive more attention to shoring up thesocial work profession, but rather,seemed to divert attention to otherprofessions, disciplines and workersthat might be able to fill the gapscreated by a lack of a professionalsocial work workforce.

In long term care, for example, a 2006report by the U.S. Department of Healthand Human Services (HHS) estimatedthat there is a need for 110,000professional social workers in long termcare by 2050. However, the reportstated that although social workers’“theoretical framework may be unique,social workers in long-term care settingsperform tasks, including assessment,psychosocial support, active treatment,

and case management, that may alsobe performed by other disciplines”(HHS, 2006).

Dr. Whitaker asserted that that thosepursuing a social work career receiveconflicting messages such as “You willhave a job,” and “You will be fulfilled,”but, “You will be underpaid.” Perhapsthe lack of public and policy makerattention to social work is because theprofession is identified with the recipientsof social work services, rather than withthe beneficiaries of social work services.The recipients of social workers’ services–persons who depend on the social safetynet–often evoke vulnerability, sadness,and sometimes fear, in the general public.

However, social workers keep membersof the society connected, protect thestandards of a civil society, andestablish a minimum floor of what andhow to meet the needs of society’s mostvulnerable individuals, families andcommunities. It is perhaps the frame asthe safety net for a civil society that willcreate a mandate to invest in the socialwork workforce.

> FEDERAL FUNDINGTO INVEST IN SOCIALWORK: OPPORTUNITIESAND EXEMPLARSShifting from Dr. Whitaker’s remarks,the think tank then explored twoexamples of federal investments inworkforce development that can benefitthe social work profession. Workforceinvestments are linked to populationsthat have a high need for services andwhere service innovations are beingimplemented. From the Department ofHealth and Human Services (HHS),Clare Anderson of the Administration

on Children, Youth and Families (ACYF)and Diana Espinosa of the Bureau ofHealth Professions (BHPr) in the HealthResources and Services Administration(HRSA) provided information abouttheir agencies current and potentialinvestments in social work.

Developing the Health ProfessionsWorkforceHRSA’s mission includes improving accessto health care services for people who areuninsured, isolated or medically vulnerable.There is great synergy between HRSA’soverall mission and the populations servedby social workers across the United States.All of HRSA’s programs – the NationalHealth Services Corps, Community HealthCenters, Bureau of Maternal and ChildHealth, Ryan White HIV/AIDS Program,Title IV Block Grants and Healthy Start,(www.hrsa.hhs.gov), for example, involvesocial workers as direct care providers, aswell as administrators, consultants, trainersand technical advisors.

The HRSA presentation focused on thepriorities of the BHPr including therelevant provisions of the ACA andopportunities for social work. Themission of the BHPr is to increase thepopulation’s access to health care byproviding national leadership in thedevelopment, distribution and retentionof a diverse, culturally competent healthworkforce that can adapt to thepopulation’s changing health careneeds and provide the highest qualityof care for all. BHPr efforts includetraining of primary care providers,workforce pipeline development,diversity, continuing education,scholarships, loans, and loanrepayment programs. The legislativeauthority for BHPr can be found in theTitle III, Title VII and Title VIII of thePublic Health Service Act as amendedby the ACA. Strategies for training thedirect care health care workforce are


also now part of BHPr’s priorities. Moreinformation can be found at the BHPrwebsite, http://bhpr.hrsa.gov/.

The major focus areas for the BHPr forFiscal Year 2012 include:

> Improving primary care workforcesupply, capacity and distributionthrough stronger education andtraining opportunities.

> Developing new team-based modelsof care based on interprofessionaltraining.

> Reducing health disparities byincreasing workforce diversity.

> Enhancing geriatric training andexpertise, including bothprofessional and paraprofessionaleducation.

> Continuing development of theNational Center for HealthWorkforce Analysis to improve datacollection to inform stakeholders onhealth workforce issues.

> Collecting and reporting meaningfulperformance measures andconducting evaluations to assessprogram performance.

The passage of the ACA hasimplications for the health careworkforce including the programsadministered by the BHPr. ACAupdates and reauthorizes programs tosupport:

> Workforce supply, including primarycare, oral health andinterdisciplinary activities (includingsocial work).

> Workforce distribution, includingtraining opportunities in rural andunderserved settings.

> Workforce diversity, includingrecruitment, retention and facultydevelopment.

Specific investments funded through theACA include an array of expansions inhealth care training. Although some arespecific to nursing, physicians,physician assistants, public health andhealth aides; no provisions are specificjust to social work. The investmentsinclude:

> Primary care residency expansion> Advanced nursing education

expansion> Expansion of physician assistant

training> Teaching health centers – for

graduate medical education (formedicine and dentistry in communitysettings)

> Nurse managed health clinics> State health care workforce

development> Public health training centers> Personal and home care aide state

training programs.

Examples of the BHPr’s strategy to growthe primary care workforce includesproviding opportunities forinterprofessional primary care training;enhancing the clinical training ofphysician assistant programs;improving the medical school clinicalexperience; retaining internal medicineresidents in primary care; innovating inpre-medical education, and expandingadvanced practice nursing trainingcapacity.

Examples of the BHPr strategy topromote interdisciplinary work includesa February 2011 HRSA sponsoredmeeting in partnership with the JosiahMacy Foundation, Robert WoodJohnson Foundation and theInterprofessional EducationCollaborative (www.aacom.org/InfoFor/educators/ipe/Pages/default.aspx)www.aacom.org/InfoFor/educators/

ipe/Pages/default.aspx), to promoteinterprofessional competencies ineducation, practice, training andcertification programs. Six disciplineswere included in this effort - medicine,nursing, public health, osteopathicmedicine, pharmacy and dentistry –but not social work. Based on the corecompetencies (www.aacom.org/InfoFor/educators/ipe/Documents/CCrpt05-10-11.pdf) the next steps include aplanned collaborative demonstrationproject (included in the FY 2012budget request).

In addition, in 2010 HRSA convenedits four advisory committees together –the Council on Graduate MedicalEducation, the Committee on Trainingin Primary Care Medicine andDentistry, the National Council onNurse Education and Practice, and theAdvisory Committee onInterdisciplinary, Community-basedLinkages (ACICBL). The focus was onidentifying interprofessional teamcompetencies. The ACICBL met 3 timesin 2010 each time focusing onpreparing the healthcare workforce toaddress health behavior change. TheACICBL vice-chair is currently a socialwork educator and social workers haveoften been appointed to this panel andother HRSA advisory groups. Notes ofall of the advisory committee meetingscan be found at www.hrsa.gov/advisorycommittees/bhpradvisory/acicbl/Meetings/index.html.

Accredited social work educationprograms can partner with BHPrgrantees in the interdisciplinary AreaHealth Education Centers (AHEC)and State Healthcare WorkforceDevelopment. Health professiongraduates from disadvantagedbackgrounds, who serve asfaculty at an eligible health


se management, that may alsoormed by other disciplines”2006).

itaker asserted that that thoseg a social work career receiveing messages such as “You willjob,” and “You will be fulfilled,”

ou will be underpaid.” Perhapsk of public and policy makern to social work is because theon is identified with the recipients

al work services, rather than witheficiaries of social work services.pients of social workers’ services–who depend on the social safety

en evoke vulnerability, sadness,metimes fear, in the general public.

er, social workers keep membersociety connected, protect therds of a civil society, andh a minimum floor of what andmeet the needs of society’s mostble individuals, families andnities. It is perhaps the frame asety net for a civil society that willa mandate to invest in the social

workforce.

DERAL FUNDINGNVEST IN SOCIALRK: OPPORTUNITIESD EXEMPLARS

from Dr. Whitaker’s remarks,k tank then explored twoes of federal investments inrce development that can benefital work profession. Workforceents are linked to populationsve a high need for services andservice innovations are beingented. From the Department ofand Human Services (HHS),

Anderson of the Administration

on Children, Youth and Families (ACYF)and Diana Espinosa of the Bureau ofHealth Professions (BHPr) in the HealthResources and Services Administration(HRSA) provided information abouttheir agencies current and potentialinvestments in social work.

Developing the Health ProfessionsWorkforceHRSA’s mission includes improving accessto health care services for people who areuninsured, isolated or medically vulnerable.There is great synergy between HRSA’soverall mission and the populations servedby social workers across the United States.All of HRSA’s programs – the NationalHealth Services Corps, Community HealthCenters, Bureau of Maternal and ChildHealth, Ryan White HIV/AIDS Program,Title IV Block Grants and Healthy Start,(www.hrsa.hhs.gov), for example, involvesocial workers as direct care providers, aswell as administrators, consultants, trainersand technical advisors.

The HRSA presentation focused on thepriorities of the BHPr including therelevant provisions of the ACA andopportunities for social work. Themission of the BHPr is to increase thepopulation’s access to health care byproviding national leadership in thedevelopment, distribution and retentionof a diverse, culturally competent healthworkforce that can adapt to thepopulation’s changing health careneeds and provide the highest qualityof care for all. BHPr efforts includetraining of primary care providers,workforce pipeline development,diversity, continuing education,scholarships, loans, and loanrepayment programs. The legislativeauthority for BHPr can be found in theTitle III, Title VII and Title VIII of thePublic Health Service Act as amendedby the ACA. Strategies for training thedirect care health care workforce are


> Deliver child welfare leadershiptraining for middle managers andsupervisors.

> Facilitate BSW and MSWtraineeships, engage national peernetworks.

> Support strategic dissemination ofeffective and promising leadershipand workforce practices.

> Advance knowledge throughcollaboration and evaluation.

The Children’s Bureau’s investmentsthrough NCWWI include traineeshipaward projects with 12 social workeducation programs particularlytargeting child welfare services tounder-represented populations andattracting diverse students to childwelfare careers. In addition to NCWWI’straineeships, the Children’s Bureau alsofunds five Comprehensive WorkforceProjects that also offer traineeships.These Projects are being evaluatedthrough NCWWI and participate onNCWWI’s national advisory board.(For more information on the two majorfunding streams, Title IV-E and Title IV-BSection 426 that can support socialwork education, see Appendix 4.)

NCWWI offers two leadershipacademies, the Leadership Academyfor Supervisors (an on-line training withpeer support) and the LeadershipAcademy for Middle Managers(LAMM), a residential leadershipdevelopment effort. The LeadershipCompetency Model focuses on LeadingChange, Leading in Context, LeadingPeople and Leading for Results. Formore information about NCWWI’sprograms see www.ncwwi.org andSupervision: The Safety Net forFront-Line Child Welfare Practice(www.socialworkpolicy.org/news-events/supervision-the-safety-net-for-front-line-child-welfare-practice.html). NCWWI is

an effort by the Children’s Bureamore comprehensively address cwelfare workforce concerns andthrough a five-year cooperativeagreement, rather than the directadministration of traineeship grawhich had been the long-standinpractice of the Children’s BureauSchools and departments of sociaare most commonly the recipientthese targeted investments.

Policy implications for child welfaoutcomes. Beyond the T/TA strateunderway, the Children’s Bureautook a comprehensive examinatiothe outcomes for all children andfamilies who are being served bychild welfare systems across theIn the 1980s and early 1990s thnumber of children in out of homrose, doubling in size. Between 1and 2009, the number of childreout of home care decreased by 2percent. This reduction is due inthe reforms included in the Adopand Safe Families Act (ASFA) of(P.L. 105-89). The goals were tochildren more quickly into permaplacements rather than languishinfoster care; and to change theexperiences of children who entechild welfare system, by focusingsafety, permanency and well-bein2008, child welfare reforms contwith the Fostering Connections toSuccess and Increasing Adoption(P.L. 110-351) passed as a compto ASFA, with an effort to extendup to age 21, to expand guardiaplacements, to promote educatiostability for children in foster careenhance transitions for youth agiof care, and to empower tribes toadminister their own IV-E dollars.

In looking to the future, the ChildBureau is now considering, what


professions college or university(including social work) for a minimumof two years, may also be eligible forthe Faculty Loan Repayment Program,administered under the Bureau ofClinician Recruitment and Service(www.hrsa.gov/about/organization/bureaus/bcrs/index.html).

To better address diversity in the healthcare workforce, BHPr programs areintegrated and designed to develop adiverse workforce that will provideaccess to care for all Americans.Targeted efforts include building apipeline of diverse, qualifiedapplicants; funding institutionssuccessful in placing graduates inunderserved areas and having adiverse student mix; and providingfinancial assistance and training tostudents likely to work in underservedareas. Accredited schools andprograms of social work are eligible forBHPRs’ Scholarships for DisadvantagedStudent Program, the Health CareersOpportunity Program and the Centersof Excellence.

In regard to geriatric interdisciplinarytraining efforts, BHPr funds geriatriceducation centers (GEC), geriatrictraining for physicians, dentists andbehavioral and mental healthprofessionals (including social work);

and geriatric academic career awards..Social workers are part of GECs andsocial work is also eligible for thegeriatric academic career award.Social workers are also eligible for theone year re-training program. Fundingis requested for FY 2012 for the newGeriatric Incentive Awards Programand the Mental and Behavioral HealthEducation and Training Grant Program.While these programs are authorized,their funding levels are contingent onCongressional Appropriations for fiscalyear 2012.

Another major effort supported throughACA is the development of theNational Center for Health WorkforceAnalysis (http://bhpr.hrsa.gov/healthworkforce/). The goals of thisnew center are to inform national andstate policy making in regard to thehealth care workforce; to promote thesupply and distribution of well-preparedhealth workers; and to become the mosttrusted source of data on the healthworkforce. Activities of the centerinclude strengthening national, stateand professional association capacityfor data collection and analysis,developing a standard minimum dataset for health professions (social workerswill be included in the planned statehealth profession reports); andcollaborating with the health workforceresearch community.

To assist interested social work educationprograms in applying for BHPr funding,a representative from the BHPr haspresented at recent Annual ProgramMeetings (APM) of the Council onSocial Work Education (www.cswe.org/File.aspx?id=44126). Additionalinformation about the HRSA BHPrprograms can be found athttp://bhpr.hrsa.gov/index.html.

Preparing the Child WelfareWorkforce: What will it take toReach the Next 25 Percent?Over the past two decades the Children’sBureau, one of two bureaus’s in theAdministration on Children, Youth andFamilies (ACYF) has developed an extensivetraining and technical assistance network(www.acf.hhs.gov/programs/cb/tta/cbttan.pdf). The network consists of:

> An array of targeted National ResourceCenters and Training and TechnicalAssistance (T/TA) Institutes includingthe National Child Welfare WorkforceInstitute (NCWWI).

> Several Quality Improvement Centers.> Five Implementation Centers.> The Child Welfare Information Gateway

(www.childwelfare.gov).> The National Data Archive on Child

Abuse and Neglect.> Partnering with the Substance Abuse

and Mental Health ServicesAdministration (SAMHSA).» The National Center on Substance

Abuse and Child Welfare (partneringwith SAMHSA).

» The National Technical AssistanceCenter for Children’s Mental Health.

» The National Technical Assistance andEvaluation Center for Child WelfareSystems of Care Grantees.

Begun in 2008, the NCWWI is a key partof the T/TA network. It is an innovativestrategy of the Children’s Bureau, which hasmade investments in workforce training andprofessional education, especially in socialwork, since the mid-1960s.

NCWWI is a collaboration amongnine universities and the NationalIndian Child Welfare Association.Its goals are to:

> Derive promising practices inworkforce development.


> Deliver child welfare leadershiptraining for middle managers andsupervisors.

> Facilitate BSW and MSWtraineeships, engage national peernetworks.

> Support strategic dissemination ofeffective and promising leadershipand workforce practices.

> Advance knowledge throughcollaboration and evaluation.

The Children’s Bureau’s investmentsthrough NCWWI include traineeshipaward projects with 12 social workeducation programs particularlytargeting child welfare services tounder-represented populations andattracting diverse students to childwelfare careers. In addition to NCWWI’straineeships, the Children’s Bureau alsofunds five Comprehensive WorkforceProjects that also offer traineeships.These Projects are being evaluatedthrough NCWWI and participate onNCWWI’s national advisory board.(For more information on the two majorfunding streams, Title IV-E and Title IV-BSection 426 that can support socialwork education, see Appendix 4.)

NCWWI offers two leadershipacademies, the Leadership Academyfor Supervisors (an on-line training withpeer support) and the LeadershipAcademy for Middle Managers(LAMM), a residential leadershipdevelopment effort. The LeadershipCompetency Model focuses on LeadingChange, Leading in Context, LeadingPeople and Leading for Results. Formore information about NCWWI’sprograms see www.ncwwi.org andSupervision: The Safety Net forFront-Line Child Welfare Practice(www.socialworkpolicy.org/news-events/supervision-the-safety-net-for-front-line-child-welfare-practice.html). NCWWI is

an effort by the Children’s Bureau tomore comprehensively address childwelfare workforce concerns and needsthrough a five-year cooperativeagreement, rather than the directadministration of traineeship grants,which had been the long-standingpractice of the Children’s Bureau.Schools and departments of social workare most commonly the recipient ofthese targeted investments.

Policy implications for child welfareoutcomes. Beyond the T/TA strategiesunderway, the Children’s Bureau alsotook a comprehensive examination ofthe outcomes for all children andfamilies who are being served by thechild welfare systems across the nation.In the 1980s and early 1990s thenumber of children in out of home carerose, doubling in size. Between 1996and 2009, the number of children inout of home care decreased by 25percent. This reduction is due in part tothe reforms included in the Adoptionand Safe Families Act (ASFA) of 1997(P.L. 105-89). The goals were to movechildren more quickly into permanentplacements rather than languishing infoster care; and to change theexperiences of children who enter thechild welfare system, by focusing onsafety, permanency and well-being. In2008, child welfare reforms continuedwith the Fostering Connections toSuccess and Increasing Adoptions Act(P.L. 110-351) passed as a complementto ASFA, with an effort to extend careup to age 21, to expand guardianshipplacements, to promote educationalstability for children in foster care, toenhance transitions for youth aging outof care, and to empower tribes toadminister their own IV-E dollars.

In looking to the future, the Children’sBureau is now considering, what system

transformation will be required todecrease the out of home carepopulation by an additional 25 percent;and what will be required of the childwelfare workforce to accomplish this. Inlooking at the children served by thesystem it is important to consider that:

> Young children entering child welfarehave high levels of development risk

> Youth involved with child welfareface social-emotional, behavioraland cognitive challenges

> The behavioral sequelae of traumamanifest over time.

> Maltreatment has a distinctfingerprint on the mental health ofyoung people

> Mental health disorder prevalence ishigh among children who have beenin foster care.

Thus, the objectives for workforcedevelopment to meet this agendashould include:

> Focusing on improving child andfamily functioning and well-being byaddressing social-emotional,behavioral, and mental health needsof children coming into contact withchild welfare. This includesunderstanding common disordersand issues that children with ahistory of trauma face.

> Emphasizing child and familyoutcomes and promoting data andoutcomes driven decision-making.

> Using workforce development as animplementation tool for evidence-based practices and the targeting ofeffective interventions to improvefunctioning and well-being. Thiswill require capacity inselecting, adapting andimplementing evidence-based practices.


riatric academic career awards..workers are part of GECs andwork is also eligible for thec academic career award.workers are also eligible for thear re-training program. Fundingested for FY 2012 for the newic Incentive Awards Program

e Mental and Behavioral Healthon and Training Grant Program.hese programs are authorized,nding levels are contingent onssional Appropriations for fiscal

012.

r major effort supported throughthe development of the

al Center for Health Workforces (http://bhpr.hrsa.gov/

workforce/). The goals of thisnter are to inform national andolicy making in regard to thecare workforce; to promote theand distribution of well-preparedworkers; and to become the mostsource of data on the healthrce. Activities of the centerstrengthening national, state

ofessional association capacitya collection and analysis,ping a standard minimum datahealth professions (social workersincluded in the planned stateprofession reports); andrating with the health workforceh community.

t interested social work educationms in applying for BHPr funding,sentative from the BHPr hased at recent Annual Programgs (APM) of the Council onWork Education (www.cswe.org/px?id=44126). Additionalation about the HRSA BHPrms can be found atbhpr.hrsa.gov/index.html.

Preparing the Child WelfareWorkforce: What will it take toReach the Next 25 Percent?Over the past two decades the Children’sBureau, one of two bureaus’s in theAdministration on Children, Youth andFamilies (ACYF) has developed an extensivetraining and technical assistance network(www.acf.hhs.gov/programs/cb/tta/cbttan.pdf). The network consists of:

> An array of targeted National ResourceCenters and Training and TechnicalAssistance (T/TA) Institutes includingthe National Child Welfare WorkforceInstitute (NCWWI).

> Several Quality Improvement Centers.> Five Implementation Centers.> The Child Welfare Information Gateway

(www.childwelfare.gov).> The National Data Archive on Child

Abuse and Neglect.> Partnering with the Substance Abuse

and Mental Health ServicesAdministration (SAMHSA).» The National Center on Substance

Abuse and Child Welfare (partneringwith SAMHSA).

» The National Technical AssistanceCenter for Children’s Mental Health.

» The National Technical Assistance andEvaluation Center for Child WelfareSystems of Care Grantees.

Begun in 2008, the NCWWI is a key partof the T/TA network. It is an innovativestrategy of the Children’s Bureau, which hasmade investments in workforce training andprofessional education, especially in socialwork, since the mid-1960s.

NCWWI is a collaboration amongnine universities and the NationalIndian Child Welfare Association.Its goals are to:

> Derive promising practices inworkforce development.


a major role to play in implementationof the Patient Protection and AffordableCare Act (ACA). Drawing on hisexperiences at CMS and as a healthcare consultant working on rate-settingand regulation for health care services,Allen Dobson, president of Dobson|DaVanzo, provided a broad look athealth care reform and its components,payment for services and the potentialimplications for social work.

The goals of the ACA are to bothexpand coverage and to control healthcare costs. These might initially beperceived as conflicting goals. With thegoal of driving down medical costsover the long term, the ACA includesstrategies targeted toward paymentreforms. This includes bundling acutehospital and post-acute care along withphysician services as well as pay-for-performance, shared savings andvalue-based purchasing. In addition,the health care reform efforts promotepatient care coordination throughaffiliating providers together. This isintended to be accomplished throughAccountable Care Organizations(ACOs) and medical homes. Theexpectation is that better coordinationamong health care providers willimprove quality and reduceunnecessary utilization. The goal is todecouple payment from the volume andintensity of services that are currentlyencouraged by the fee-for-service (FSS)payment model. Payment reform effortsare especially targeted to populationsthat are high utilizers of health care,building on the results of a few well-tested models of care coordination.

Transitions of Care ModelsTwo frequently cited, well-tested andreplicated, effective models to improoutcomes in transitions of care are:

> The Transitional Care Model is anbased in-hospital planning and hfollow-up program for chronicallyrisk older adults (http://innovatmodels.com/care_models/21/o

> The Care Transition Interventionincludes a “transition coach” to econtinuity of care (www.caretranorg/overview.asp).

For information on the National Tranof Care Coalition’s (NTOCC) resourceprofessionals see Appendix 5.

The payment reform elements ofACA include the establishment ofCenter for Medicare and MedicaInnovation (CMI) at CMS (www.cgov/CMSLeadership/34_Office_CMMI.asp) with a $10 billion bubetween 2011 and 2019, CMI winnovative payment and servicedelivery models targeting reduceprogram expenditures while presor enhancing quality of care. Toaccomplish its mission CMI is woon developing templates for evaland a core set of quality measureis designing and implementing pwith the goals of the ACA andevaluation outcomes in mind. It wundertake continuous, real-timeevaluations, including improvedinformation exchanges and pre-presearch designs. The work of CMbe aligned with reforms such asinformation technology (HIT), thePatient-Centered Outcomes ReseaInstitute (http://pcori.org/), anddemonstration projects.


> Substantive collaboration with mentalhealth, physical health, educationand other systems.

However to meet these objectives forworkforce development will bechallenging. The challenges include:

> Lack of availability of child andadolescent psychiatrists. ThePresident’s New Freedom onCommission on Mental Health(2003) identified the need for30,000 additional child psychiatristto address child behavioral healthissues in the US – five times thenumber practicing at the time.

> A disconnect in the role ofcaseworkers who provide primaryservices to children and families inchild welfare. They do not typicallyfocus in on addressing the social,emotional and behavioral healthneeds of children, but rather providegeneral case management.

> High rates of worker turnover in childwelfare, with common reasonsincluding overwhelming workload,minimal support and a lack ofexpertise.

> A mismatch between job demandsand available resources (autonomy,supervisory support, etc.) in childwelfare leads to higher unmet

expectations, especially amongpractitioners early in their careers.

Therefore, transformation will berequired of the child welfare workforceto provide more clinical practice withinagencies, to use data and outcomedriven decision making, to target andimplement evidence-based practices,and to work collaboratively with othersystems that also have a stake andinput in affecting the lives of thoseserved by the child welfare system.

Office of Minority Health SupportsDeans’ Health Disparities InitiativeAt the symposium, in addition to the formalpresentations from the BHPr and the ACYF,James Herbert Williams, President of theNational Association of Deans and Directorsof Schools of Social Work (NADD) and Deanat the School of Social Work at the Universityof Denver, provided brief information abouta project, “Mobilizing social work as aresource for eliminating health disparities:Proposal for a Health Disparities CurriculumInfusion Project.” NADD is undertaking thiseffort with support from the HHS Office ofMinority Health (OMH). The project is anoutgrowth of a NADD workgroup’s outreachand on-going communications with OMH.The initiative both highlights the importanceof the social work profession in addressinghealth disparities and asserts that there aregaps in the social work curricula in regardto teaching about health disparities. Thecontract that NADD received is being staffedthrough Arizona State University. It willdevelop health disparities competencies(in collaboration with CSWE and identifyresources for infusing health disparitiescontent into the curriculum. Other advancedcompetencies can be found atwww.cswe.org/CentersInitiatives/CurriculumResources/CompetenciesforAdvancedPractice.aspx.

Foundation Invests in Social Work:A Unique Commitment to AgingFor more than a decade, the John A.Hartford Foundation has implemented aGeriatric Social Work Initiative (GSWI) thatcollaborates with social work educationprograms to prepare aging-savvy socialworkers and improve the care and well-beingof older adults and their families. The GSWIis a collection of several programs that focuson cultivation of leaders; developing excellenttraining opportunities in real world settings;and, in infusing gerontological competenceinto the social work curricula(www.cswe.org/CentersInitiatives/GeroEdCenter/AboutGero Ed.aspx).

Nora O’Brien-Suric, Senior Program Officerat the Foundation, specifically highlightedthe Hartford Partnership Program for AgingEducation (HPPAE), which is developinghigh-quality models of, and disseminatingnew knowledge about, aging-rich fieldeducation at schools of social work andcommunity agencies across the country. TheHPPAE program, supporting field educationopportunities for MSW includes a recentcollaboration with the Department ofVeterans Affairs. More information aboutHPPAE can be found at http://hartfordpartnership.org and general informationabout the overall GSWI can be found atwww.gswi.org.

> SOCIAL WORK,CMS AND HEALTHCARE REFORM –OPPORTUNITIES ANDACCOUNTABILITYThe Centers for Medicare andMedicaid Services (CMS) plays animportant role in the diverse ways thatsocial work practice is defined andreimbursed in different health caresettings (see APPENDIX 7) and also has

2 42 CFR Part 425 Medicare Program; Medicare Shared Savings Program: Accountable Care OrganizaConnection With the Medicare Shared Savings Program and the Innovation Center; Proposed Rule andhttp://edocket.access.gpo.gov/2011/pdf/2011-7880.pdf.


a major role to play in implementationof the Patient Protection and AffordableCare Act (ACA). Drawing on hisexperiences at CMS and as a healthcare consultant working on rate-settingand regulation for health care services,Allen Dobson, president of Dobson|DaVanzo, provided a broad look athealth care reform and its components,payment for services and the potentialimplications for social work.

The goals of the ACA are to bothexpand coverage and to control healthcare costs. These might initially beperceived as conflicting goals. With thegoal of driving down medical costsover the long term, the ACA includesstrategies targeted toward paymentreforms. This includes bundling acutehospital and post-acute care along withphysician services as well as pay-for-performance, shared savings andvalue-based purchasing. In addition,the health care reform efforts promotepatient care coordination throughaffiliating providers together. This isintended to be accomplished throughAccountable Care Organizations(ACOs) and medical homes. Theexpectation is that better coordinationamong health care providers willimprove quality and reduceunnecessary utilization. The goal is todecouple payment from the volume andintensity of services that are currentlyencouraged by the fee-for-service (FSS)payment model. Payment reform effortsare especially targeted to populationsthat are high utilizers of health care,building on the results of a few well-tested models of care coordination.

Transitions of Care ModelsTwo frequently cited, well-tested andreplicated, effective models to improveoutcomes in transitions of care are:

> The Transitional Care Model is an evidence-based in-hospital planning and homefollow-up program for chronically ill high-risk older adults (http://innovativecaremodels.com/care_models/21/overview).

> The Care Transition Intervention modelincludes a “transition coach” to ensurecontinuity of care (www.caretransitions.org/overview.asp).

For information on the National Transitionsof Care Coalition’s (NTOCC) resources forprofessionals see Appendix 5.

The payment reform elements of theACA include the establishment of theCenter for Medicare and MedicaidInnovation (CMI) at CMS (www.cms.gov/CMSLeadership/34_Office_CMMI.asp) with a $10 billion budgetbetween 2011 and 2019, CMI will testinnovative payment and servicedelivery models targeting reducedprogram expenditures while preservingor enhancing quality of care. Toaccomplish its mission CMI is workingon developing templates for evaluationand a core set of quality measures. CMIis designing and implementing projectswith the goals of the ACA andevaluation outcomes in mind. It willundertake continuous, real-timeevaluations, including improved data,information exchanges and pre-postresearch designs. The work of CMI willbe aligned with reforms such as healthinformation technology (HIT), thePatient-Centered Outcomes ResearchInstitute (http://pcori.org/), and otherdemonstration projects.

Payment bundling is another effortgrowing out of the ACA. The objectivesof payment system reform are to makeit easier to understand, simple toadminister, coherent clinically, accuratein payments, offering appropriateprovider incentives, and provideadequate payment to providers toassure beneficiary access and ensurethat Medicare is a value-based insurer.CMS has long used payment systemreform to provide incentives to increaseefficiency in health care delivery. Thusfar, government-supported research onepisode-based payments and post-acutebundling have found that “episode-basedpayment reforms may work far moreeffectively, if they are coupled withinitiatives and incentives that pay morewhen reductions in the rates of sometypes of episodes (such as surgeries forchronic diseases or hospitalizations forheart disease) actually occur” (McClellan,2010). The ACA contains a provisionfor bundling acute care hospital andpost-acute care payments for an episode.The ultimate goals of a bundledpayment are to provide care in the mostcost-effective setting with less relianceon fee-for-service payments; to reducehospital readmissions; and to drivequality improvement through enhancedcoordination of care (e.g., ACOs).

Accountable Care Organizations (ACOs)are an additional ACA initiative toimprove health care service deliveryand deal with health care costs. Thethree part objective of ACOs, (aspublished by CMS in the Notice ofProposed Rulemaking (NPRM), FederalRegister, April 7, 20112) are:

1) better care for individuals,2) better care for populations,

and

1 0> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E > S O C I A L W O R K P O L I C Y I N S T I T U T E

ectations, especially amongtitioners early in their careers.

re, transformation will bed of the child welfare workforceide more clinical practice withines, to use data and outcomedecision making, to target andent evidence-based practices,work collaboratively with otherthat also have a stake andaffecting the lives of those

by the child welfare system.

ce of Minority Health Supportsns’ Health Disparities Initiativee symposium, in addition to the formalentations from the BHPr and the ACYF,es Herbert Williams, President of theonal Association of Deans and Directorshools of Social Work (NADD) and Deane School of Social Work at the Universityenver, provided brief information aboutoject, “Mobilizing social work as aurce for eliminating health disparities:osal for a Health Disparities Curriculumsion Project.” NADD is undertaking thisrt with support from the HHS Office ofority Health (OMH). The project is anrowth of a NADD workgroup’s outreachon-going communications with OMH.nitiative both highlights the importancee social work profession in addressingth disparities and asserts that there arein the social work curricula in regard

aching about health disparities. Theract that NADD received is being staffedugh Arizona State University. It willlop health disparities competenciesollaboration with CSWE and identifyurces for infusing health disparitiesent into the curriculum. Other advancedpetencies can be found at

w.cswe.org/CentersInitiatives/Curriculumurces/CompetenciesforAdvancedtice.aspx.

Foundation Invests in Social Work:A Unique Commitment to AgingFor more than a decade, the John A.Hartford Foundation has implemented aGeriatric Social Work Initiative (GSWI) thatcollaborates with social work educationprograms to prepare aging-savvy socialworkers and improve the care and well-beingof older adults and their families. The GSWIis a collection of several programs that focuson cultivation of leaders; developing excellenttraining opportunities in real world settings;and, in infusing gerontological competenceinto the social work curricula(www.cswe.org/CentersInitiatives/GeroEdCenter/AboutGero Ed.aspx).

Nora O’Brien-Suric, Senior Program Officerat the Foundation, specifically highlightedthe Hartford Partnership Program for AgingEducation (HPPAE), which is developinghigh-quality models of, and disseminatingnew knowledge about, aging-rich fieldeducation at schools of social work andcommunity agencies across the country. TheHPPAE program, supporting field educationopportunities for MSW includes a recentcollaboration with the Department ofVeterans Affairs. More information aboutHPPAE can be found at http://hartfordpartnership.org and general informationabout the overall GSWI can be found atwww.gswi.org.

> SOCIAL WORK,CMS AND HEALTHCARE REFORM –OPPORTUNITIES ANDACCOUNTABILITYThe Centers for Medicare andMedicaid Services (CMS) plays animportant role in the diverse ways thatsocial work practice is defined andreimbursed in different health caresettings (see APPENDIX 7) and also has

2 42 CFR Part 425 Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations and Medicare Program: Waiver Designs inConnection With the Medicare Shared Savings Program and the Innovation Center; Proposed Rule and Notice,http://edocket.access.gpo.gov/2011/pdf/2011-7880.pdf.


(www.ntocc.org) that has been ledsince 2006 by CMSA. Cheri Latimer,Executive Director of CMSA served asa respondent during the think tanksymposium, drawing from herinterdisciplinary health careexperiences and her practice,professional and advocacy partnershipswith social workers. Some of the keythemes that she addressed included:

> Patient-centered care must be morethan just a statement, but become areality in practice.

> In considering contemporary healthcare delivery, it is not about onediscipline but rather the team, andteam members should be includedin the planning of care from thebeginning.

> Medically complex patients requiremore diverse care provision andthere need to be revisions of howcare is conceptualized, moving from“episodic care” to a “continuum ofcare.”

> Consumers expect services from ateam of experts, and differentdisciplines bring complementary butdifferential expertise, perspectivesand knowledge to the team.

> Nursing-social work casemanagement partnerships willbecome more common in the futureas the differential expertise of eachis valued.

> Social work needs to be able toarticulate what it does and whatother disciplines say they value insocial work.

> It is critically important for the teamto be sit down together to decidehow to best serve the client.

> A view to the future would be healthcare delivery that isconsumer-directed in how it isplanned and provided. Health care

professionals across disciplineconsumers need to coalesce toto achieve these goals.

> As we look to health care refothe development of ACOs, mehome and payment bundling,goal is to move beyond justenhanced managed care; butbreak down some of the siloswe currently have.

> CMSA and NASW have worktogether with other stakeholdedevelop an array of tools andresources for consumers, policmakers and professionals.Information on the links to thefor Health Professionals can bfound in Appendix 5.

> INVESTING IN THSOCIAL WORKWORKFORCE: AVIEW FROM THEFRONT-LINEMoving from the national perspeUma Ahluwalia, Director of theDepartment of Health and HumaServices for Montgomery Countyprovided a local governmentperspective on workforce issues aworkforce investments. The Depaof Health and Human Servicesincorporates a continuum of progincluding Aging and DisabilityServices; Behavioral Health andServices; Children, Youth and FaServices; Public Health Services;Special Needs Housing and theof Community Affairs. The demogof the county are changing. Withmillion residents, 50.6 percent ofresidents are ethnic minorities, socultural competency for all who wthe county is extremely important

> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E >1 1

3) lower growth in expenditures(including Medicare and other payers).

ACOs are intended to be primary carecentric, with beneficiaries assigned toACOs based on contacts with theirprimary care physician. The ACOwould be a group of providers (includinghospitals) that will be jointly heldaccountable for achieving measuredquality improvements and reductions inthe rate of spending growth, which willbe rewarded through a shared savingsprogram. As written, the NPRM focuseson the delivery of primary care servicesand says nothing specifically aboutsocial work services, although achievingthe ACO goals of reducedre-hospitalization and improved carecoordination can be accomplishedthrough involvement of social workers.It will be important for all types ofproviders to demonstrate their value tobe part of the ACO team anddemonstrate how they can improvequality and reduce overall ACOexpenditures commensurate withpayments to social workers. (SeeAppendix 6 for a copy of NASW’swritten comments to CMS in responseto the NPRM on ACOs).

The expectation of a Medicare ACO isthat it would be serve at least 5,000beneficiaries; that the primary care

physicians must be exclusive to thatACO; and at least 50 percent of theprimary care physicians would need tobe users of Electronic Health Recordswithin a certain timeframe. Participantsin an ACO would be different types ofphysicians and other primary careproviders, hospitals, specialists andother health care delivery entities (e.g.long term care facilities, rehabilitationfacilities, hospice programs). Theywould be expected to work together tomanage and coordinate care forMedicare beneficiaries. It is hoped thatpayment bundling and the developmentof ACOs will be aligned with eachother and not develop on separatetracks. In order to bundle paymentsseveral issues must be resolved. First,the payment amounts need to bedefined. This includes determining howthe bundle is defined; how the bundledpayment amounts are set; how thebundles are risk-adjusted; what otherpayment adjustments might be needed(e.g. wage adjustment); and whatpayment transition methods will beused. Secondly, it needs to be decidedwho will be paid directly. For example,will individual professional providers bepaid or will the focus be on payment tofacilities; how will payments bedistributed within the bundle; how willjoin ventures with other managementmodels be paid, and how will paymentbe determined in situations of carecoordination across geographic regions.

As the planning for payment bundlingmoves forward, it also needs to bedetermined what incentives there willbe for physicians and facilities toparticipate; what will determineindividual care quality and volume, andhow will coordination of care qualityand volume be determined acrossproviders? The implications of bundlinginclude changes in management

structures, capacity, cost-saving, quality,outcomes, and workforce, among otherissues. Since the initial payment bundleswill be hospital and post-acute careoriented, physicians may be added, butother providers are less likely to beadded to the bundle over the near term.

Social work services could be consideredto be part of the bundle, but they are notcurrently recognized. It will be importantfor social work to focus on the “value”of its services and how the bundles willbe risk-adjusted. The vulnerablepopulations that social workers serve inhealth care, e.g., the frail elderly andpersons with other complex and chronicdiseases, are the cases for which riskadjustment is most important.

Since there are currently differential CMSqualifications and definitions of socialwork services across practice settingsthis can be a stumbling block in includingsocial workers in the payment bundle.This is especially of concern because ofthe variations, with a clinical socialworker with an MSW and experiencerequired in home health care to socialwork requirements in skilled nursingfacilities where federal regulations donot even require a BSW degree at aminimum (see Appendix 7).

> IMPROVING HEALTHOUTCOMES: THEVALUE OF THEPATIENT-CENTEREDINTERDISCIPLINARYTEAMNASW works closely with the CaseManagement Society of America(CMSA), especially on the NationalTransitions of Care Coalition (NTOCC)


(www.ntocc.org) that has been ledsince 2006 by CMSA. Cheri Latimer,Executive Director of CMSA served asa respondent during the think tanksymposium, drawing from herinterdisciplinary health careexperiences and her practice,professional and advocacy partnershipswith social workers. Some of the keythemes that she addressed included:

> Patient-centered care must be morethan just a statement, but become areality in practice.

> In considering contemporary healthcare delivery, it is not about onediscipline but rather the team, andteam members should be includedin the planning of care from thebeginning.

> Medically complex patients requiremore diverse care provision andthere need to be revisions of howcare is conceptualized, moving from“episodic care” to a “continuum ofcare.”

> Consumers expect services from ateam of experts, and differentdisciplines bring complementary butdifferential expertise, perspectivesand knowledge to the team.

> Nursing-social work casemanagement partnerships willbecome more common in the futureas the differential expertise of eachis valued.

> Social work needs to be able toarticulate what it does and whatother disciplines say they value insocial work.

> It is critically important for the teamto be sit down together to decidehow to best serve the client.

> A view to the future would be healthcare delivery that isconsumer-directed in how it isplanned and provided. Health care

professionals across disciplines andconsumers need to coalesce togetherto achieve these goals.

> As we look to health care reform andthe development of ACOs, medicalhome and payment bundling, thegoal is to move beyond justenhanced managed care; but to trulybreak down some of the silos of carewe currently have.

> CMSA and NASW have workedtogether with other stakeholders todevelop an array of tools andresources for consumers, policymakers and professionals.Information on the links to the Toolsfor Health Professionals can befound in Appendix 5.

> INVESTING IN THESOCIAL WORKWORKFORCE: AVIEW FROM THEFRONT-LINEMoving from the national perspective,Uma Ahluwalia, Director of theDepartment of Health and HumanServices for Montgomery County, MDprovided a local governmentperspective on workforce issues andworkforce investments. The Departmentof Health and Human Servicesincorporates a continuum of programsincluding Aging and DisabilityServices; Behavioral Health and CrisisServices; Children, Youth and FamilyServices; Public Health Services;Special Needs Housing and the Officeof Community Affairs. The demographicsof the county are changing. With onemillion residents, 50.6 percent of theresidents are ethnic minorities, so thatcultural competency for all who work inthe county is extremely important.

Different groups utilize services indifferent ways and this must beconsidered when developing andimplementing programs, including for thegrowing population of suburban poor.

In carrying out health and socialservice programs, the county needs toexamine individual, system andpopulation outcomes, with attention tosafety and well-being as overarchinggoals in the more than 80 programsunder the Department’s purview. Thishas to be coupled with developing thetechnology and data gatheringmechanisms to promote integrationamong practice settings and programsand to also be in keeping with HIPAAconfidentiality requirements. The countyis working to build a framework tocreate an integrated data system thatwould address collaborative practice,privacy and HIPAA, but also shareinformation on a need to know basis.

For social workers that work in these80 programs, there are many differentskills and expertise required, includingclinical skills to work with differentpopulations and to address differenttypes of problems, to skills in communitydevelopment, planning, administration,data analysis and social research.Changes that will be occurring in theworkplace, including the high numberof staff eligible for retirement, requirethat the workforce be nimble, flexibleand responsive. Attributes that will bedesirable include:

> Ability to embrace technologicalmodernization.

> Ability and desire to embrace aleadership role.

> Desire to create energy, and todemonstrate pride andexcitement to be part of thesocial work profession.


ans must be exclusive to thatand at least 50 percent of they care physicians would need tos of Electronic Health Recordsa certain timeframe. ParticipantsCO would be different types ofans and other primary careers, hospitals, specialists andealth care delivery entities (e.g.rm care facilities, rehabilitations, hospice programs). Theybe expected to work together toe and coordinate care forare beneficiaries. It is hoped thatnt bundling and the development

Os will be aligned with eachnd not develop on separateIn order to bundle paymentsissues must be resolved. First,

yment amounts need to be. This includes determining howdle is defined; how the bundlednt amounts are set; how thes are risk-adjusted; what othernt adjustments might be neededage adjustment); and whatnt transition methods will beecondly, it needs to be decidedll be paid directly. For example,ividual professional providers bewill the focus be on payment to

s; how will payments beted within the bundle; how willntures with other managementbe paid, and how will payment

ermined in situations of careation across geographic regions.

planning for payment bundlingforward, it also needs to bened what incentives there will

physicians and facilities topate; what will determineual care quality and volume, andll coordination of care qualityume be determined across

ers? The implications of bundlingchanges in management

structures, capacity, cost-saving, quality,outcomes, and workforce, among otherissues. Since the initial payment bundleswill be hospital and post-acute careoriented, physicians may be added, butother providers are less likely to beadded to the bundle over the near term.

Social work services could be consideredto be part of the bundle, but they are notcurrently recognized. It will be importantfor social work to focus on the “value”of its services and how the bundles willbe risk-adjusted. The vulnerablepopulations that social workers serve inhealth care, e.g., the frail elderly andpersons with other complex and chronicdiseases, are the cases for which riskadjustment is most important.

Since there are currently differential CMSqualifications and definitions of socialwork services across practice settingsthis can be a stumbling block in includingsocial workers in the payment bundle.This is especially of concern because ofthe variations, with a clinical socialworker with an MSW and experiencerequired in home health care to socialwork requirements in skilled nursingfacilities where federal regulations donot even require a BSW degree at aminimum (see Appendix 7).

> IMPROVING HEALTHOUTCOMES: THEVALUE OF THEPATIENT-CENTEREDINTERDISCIPLINARYTEAMNASW works closely with the CaseManagement Society of America(CMSA), especially on the NationalTransitions of Care Coalition (NTOCC)


Barbara Mikulski (D-MD) in the Senate.Asua Ofosu, NASW’s Manager ofGovernment Relations provided anoverview of the Act, its origins withinthe overall Social Work ReinvestmentInitiative as well as an update on itscurrent status, along with informationon the newly created CongressionalSocial Work Caucus (CSWC).

THE SOCIAL WORK REINVESTMENTINITIATIVEThe goal of the Social Work ReinvestmentInitiative is to secure federal and stateinvestments in professional social work toenhance societal well-being. The strategiesfocus on recruiting new social workers,retaining current social workers, retrainingexperienced social workers and reinvestingin the profession of social work. TheReinvestment Initiative is led by NASWand ANSWER. For more information visitwww.socialworkreinvestment.org.

NASW worked with members ofCongress to introduce SWRA as anoutgrowth of NASW’s long-standinglegislative and executive branchadvocacy. As concerns about thechallenges facing the social work laborforce loomed large, the professionbecame increasingly concerned aboutits own future. Many of the challengesexpressed in Dr. Whitaker’spresentation led to the pursuit oflegislation that could accomplishmultiple goals regarding therecruitment, retention, and workforcedevelopment for social workers.

The key components of SWRA include:

> The creation of a Social WorkReinvestment Commission to providea comprehensive analysis of currenttrends within the practice, academicand professional social workcommunities.

> The development of grant progrelated to Workplace ImproveResearch, Community-Based Cof Excellence and Education aTraining.

> The creation of a NationalCoordinating Center.

For more information about the Height/Young Social Work Reinvestment Actsee Appendix 9 and visithttp://socialworkreinvestment.org/SWRI/default.html.

In addition to SWRA there are severalother pieces of legislation introduced inthe 112th Congress that would have thepotential to specifically address socialwork workforce issues.

> Strengthen Social Work WorkforceAct (S. 42) would ensure that socialwork students or social work schoolsare eligible for grants for trainingprojects in geriatrics and to establisha social work training program. Itwas introduced by Sen. DanielInouye (D-HI) on January 25, 2011.

> National Office of Social WorkResearch Act (S. 41) would create anational office of social workresearch within the National Institutesof Health. It was introduced by Sen.Daniel Inouye (D-HI) on January 25,2011.

As previously mentioned, the ACAincludes opportunities for social worksuch as:

> The creation of the NationalHealthcare Workforce Commission(www.gao.gov/press/nhcwc_2010sep30.html).

> State health care workforcedevelopment grants

> Education and training grants:

Geriatrics, mental and behavioralhealth

In regard to the implementation ofACA, NASW has been very active. Inaddition to meetings with high levelHHS officials, and participating intaskforces implementing requirements ofthe ACA, NASW submitted commentson numerous requests for informationand proposed rules and nominatedsocial workers for the severalcommissions and workgroups thatemerged from ACA. Although there isno social worker appointed to theHealth Care Workforce Commission(despite nominations being sentforward), the social work communityhas reached out to several members ofthe Commission to request that thesocial work profession’s roles andchallenges be considered throughoutthe Commission’s deliberations.

In addition to these specific legislativeand executive branch activities, NASWparticipates in more than 100coalitions, many of which focus onpractice and provider issues includingworkforce development as well aspromotion of social justice. Targets foradvocacy include Congress, and theexecutive branch, including the WhiteHouse. For more information onNASW’s government relations activitiesand advocacy agenda, visitwww.socialworkers.org, subscribe tothe monthly MemberLink and to theadvocacy listserv (http://capwiz.com/socialworkers/mlm/signup/).

It should also be noted that reportsfrom entities such as the Institute ofMedicine (IOM) help to framerecommendations and suggestpolicy enhancements. A fewrecent reports that specificallyare social work relevant

> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E > S O C I A L W O R K P O L I C Y I N S T I T U T E1 3

> Ability to manage with data and tobe more business oriented withoutlosing facility for empathy andcompassion.

> Ability to work in a multi-disciplinaryenvironment.

> Ability to create a more integratedpractice framework across practicesettings and systems, includingintegration of human services andhealth.

> Responsive to changing economic,demographic and political realities

> Ability to capitalize on opportunitiesto partner and work across thepublic and private sectors and toreach out to the business community.

> Ability to incorporate new knowledgeand evidence-based practices.

> Ability to be an advocate andengage with advocacy organizationsand professional associations.

As service delivery changes, asavailable funding becomes scarcer,and as expectations of and demand forskilled social workers increases, it isimportant to reflect on what roles socialwork education programs, andprofessional organizations should fulfill.What are their roles and responsibilitiesto educate the next generation for theworkplace of the future, as well as toretool current workers for new realities?

> CHARTING ANADVOCACY AGENDA:A VIEW FROM NASWAND CSWECongressional Social Work CaucusBrings New Focus on Social Work toCapitol HillThe visibility of the important workdone by social workers took asubstantial leap forward on Capitol Hillwith the launch of the CongressionalSocial Work Caucus (CSWC) in 2011.Chaired by Congressman Edolphus“Ed” Towns (D-NY 10), the purpose ofthe CSWC is to create a platform onthe Hill representing the interests ofover 600,000 social workersthroughout the United States. It willserve as an informal, bipartisan groupof Members of Congress dedicated tomaintaining and strengthening socialwork services in the United States. Itwill educate national legislators andtheir staffs on issues that challenge thesocial work profession. The objectivesof the Congressional Social WorkCongress are to:

> Initiate and support legislation toaddress the unique challenges andopportunities for professional socialworkers.

> Monitor and evaluate programs andlegislation designed to assist andsupport individuals, families, andcommunities at all income levels whoare coping with economic, social,and health problems, particularlythose with limited resources.

> Provide Congressional staff memberswith educational tools and resourcesdirected toward improving the socialwork profession and the peoplesocial workers serve.

> Assist in the education and

awareness efforts on the breadth andscope of the social work profession.

The CSWC will accomplish its goalsand objectives through regular briefingson the Hill, statements in the media,convening experts on specific issues,engaging social work practitioners,schools, and scholars, fosteringinterdisciplinary cooperation withrelevant disciplines, and by workingwith various stakeholders in localgovernment and communities.Congressman Towns has alreadyhosted briefings on the Dorothy I.Height and Whitney M. Young, Jr.Social Work Reinvestment Act as wellas the impact of health care reform onthe social work profession andprevention, treatment, and servicesresearch funding in the NationalInstitutes of Mental Health Budget.Information on the briefings can befound at http://socialworkreinvestment.org/2011/caucus.html.

NASW and the members of theANSWER Coalition will continue towork closely with the CSWC toadvance its goals and legislativepriorities. The CSWC website can befound at http://socialworkcaucus-towns.house.gov. As of September2011 there are 57 members of theCongressional Social Work Caucus(see Appendix 8).

Strengthening the Social WorkWorkforce: A Legislative Viewpointfrom NASWThe Dorothy I. Height and Whitney M.Young, Jr. Social Work ReinvestmentAct (SWRA) (H.R. 1106/S. 584) wasfirst introduced in February 2008 andhas been reintroduced in the 111th and112th Congress. The lead sponsors aresocial workers Edolphus Towns (D-NY)in the House of Representatives and


Barbara Mikulski (D-MD) in the Senate.Asua Ofosu, NASW’s Manager ofGovernment Relations provided anoverview of the Act, its origins withinthe overall Social Work ReinvestmentInitiative as well as an update on itscurrent status, along with informationon the newly created CongressionalSocial Work Caucus (CSWC).

THE SOCIAL WORK REINVESTMENTINITIATIVEThe goal of the Social Work ReinvestmentInitiative is to secure federal and stateinvestments in professional social work toenhance societal well-being. The strategiesfocus on recruiting new social workers,retaining current social workers, retrainingexperienced social workers and reinvestingin the profession of social work. TheReinvestment Initiative is led by NASW and ANSWER. For more information visitwww.socialworkreinvestment.org.

NASW worked with members ofCongress to introduce SWRA as anoutgrowth of NASW’s long-standinglegislative and executive branchadvocacy. As concerns about thechallenges facing the social work laborforce loomed large, the professionbecame increasingly concerned aboutits own future. Many of the challengesexpressed in Dr. Whitaker’spresentation led to the pursuit oflegislation that could accomplishmultiple goals regarding therecruitment, retention, and workforcedevelopment for social workers.

The key components of SWRA include:

> The creation of a Social WorkReinvestment Commission to providea comprehensive analysis of currenttrends within the practice, academicand professional social workcommunities.

> The development of grant programsrelated to Workplace Improvements,Research, Community-Based Centersof Excellence and Education andTraining.

> The creation of a NationalCoordinating Center.

For more information about the Height/Young Social Work Reinvestment Actsee Appendix 9 and visithttp://socialworkreinvestment.org/SWRI/default.html.

In addition to SWRA there are severalother pieces of legislation introduced inthe 112th Congress that would have thepotential to specifically address socialwork workforce issues.

> Strengthen Social Work WorkforceAct (S. 42) would ensure that socialwork students or social work schoolsare eligible for grants for trainingprojects in geriatrics and to establisha social work training program. Itwas introduced by Sen. DanielInouye (D-HI) on January 25, 2011.

> National Office of Social WorkResearch Act (S. 41) would create anational office of social workresearch within the National Institutesof Health. It was introduced by Sen.Daniel Inouye (D-HI) on January 25,2011.

As previously mentioned, the ACAincludes opportunities for social worksuch as:

> The creation of the NationalHealthcare Workforce Commission(www.gao.gov/press/nhcwc_2010sep30.html).

> State health care workforcedevelopment grants

> Education and training grants:

Geriatrics, mental and behavioralhealth

In regard to the implementation ofACA, NASW has been very active. Inaddition to meetings with high levelHHS officials, and participating intaskforces implementing requirements ofthe ACA, NASW submitted commentson numerous requests for informationand proposed rules and nominatedsocial workers for the severalcommissions and workgroups thatemerged from ACA. Although there isno social worker appointed to theHealth Care Workforce Commission(despite nominations being sentforward), the social work communityhas reached out to several members ofthe Commission to request that thesocial work profession’s roles andchallenges be considered throughoutthe Commission’s deliberations.

In addition to these specific legislativeand executive branch activities, NASWparticipates in more than 100coalitions, many of which focus onpractice and provider issues includingworkforce development as well aspromotion of social justice. Targets foradvocacy include Congress, and theexecutive branch, including the WhiteHouse. For more information onNASW’s government relations activitiesand advocacy agenda, visitwww.socialworkers.org, subscribe tothe monthly MemberLink and to theadvocacy listserv (http://capwiz.com/socialworkers/mlm/signup/).

It should also be noted that reportsfrom entities such as the Institute ofMedicine (IOM) help to framerecommendations and suggestpolicy enhancements. A fewrecent reports that specificallyare social work relevant


> Ability to manage with data and tobe more business oriented withoutlosing facility for empathy andcompassion.

> Ability to work in a multi-disciplinaryenvironment.

> Ability to create a more integratedpractice framework across practicesettings and systems, includingintegration of human services andhealth.

> Responsive to changing economic,demographic and political realities

> Ability to capitalize on opportunitiesto partner and work across thepublic and private sectors and toreach out to the business community.

> Ability to incorporate new knowledgeand evidence-based practices.

> Ability to be an advocate andengage with advocacy organizationsand professional associations.

As service delivery changes, asavailable funding becomes scarcer,and as expectations of and demand forskilled social workers increases, it isimportant to reflect on what roles socialwork education programs, andprofessional organizations should fulfill.What are their roles and responsibilitiesto educate the next generation for theworkplace of the future, as well as toretool current workers for new realities?

> CHARTING ANADVOCACY AGENDA:A VIEW FROM NASWAND CSWECongressional Social Work CaucusBrings New Focus on Social Work toCapitol HillThe visibility of the important workdone by social workers took asubstantial leap forward on Capitol Hillwith the launch of the CongressionalSocial Work Caucus (CSWC) in 2011.Chaired by Congressman Edolphus“Ed” Towns (D-NY 10), the purpose ofthe CSWC is to create a platform onthe Hill representing the interests ofover 600,000 social workersthroughout the United States. It willserve as an informal, bipartisan groupof Members of Congress dedicated tomaintaining and strengthening socialwork services in the United States. Itwill educate national legislators andtheir staffs on issues that challenge thesocial work profession. The objectivesof the Congressional Social WorkCongress are to:

> Initiate and support legislation toaddress the unique challenges andopportunities for professional socialworkers.

> Monitor and evaluate programs andlegislation designed to assist andsupport individuals, families, andcommunities at all income levels whoare coping with economic, social,and health problems, particularlythose with limited resources.

> Provide Congressional staff memberswith educational tools and resourcesdirected toward improving the socialwork profession and the peoplesocial workers serve.

> Assist in the education and

awareness efforts on the breadth andscope of the social work profession.

The CSWC will accomplish its goalsand objectives through regular briefingson the Hill, statements in the media,convening experts on specific issues,engaging social work practitioners,schools, and scholars, fosteringinterdisciplinary cooperation withrelevant disciplines, and by workingwith various stakeholders in localgovernment and communities.Congressman Towns has alreadyhosted briefings on the Dorothy I.Height and Whitney M. Young, Jr.Social Work Reinvestment Act as wellas the impact of health care reform onthe social work profession andprevention, treatment, and servicesresearch funding in the NationalInstitutes of Mental Health Budget.Information on the briefings can befound at http://socialworkreinvestment.org/2011/caucus.html.

NASW and the members of theANSWER Coalition will continue towork closely with the CSWC toadvance its goals and legislativepriorities. The CSWC website can befound at http://socialworkcaucus-towns.house.gov. As of September2011 there are 57 members of theCongressional Social Work Caucus(see Appendix 8).

Strengthening the Social WorkWorkforce: A Legislative Viewpointfrom NASWThe Dorothy I. Height and Whitney M.Young, Jr. Social Work ReinvestmentAct (SWRA) (H.R. 1106/S. 584) wasfirst introduced in February 2008 andhas been reintroduced in the 111th and112th Congress. The lead sponsors aresocial workers Edolphus Towns (D-NY)in the House of Representatives and


1 5

include Cancer Care for the WholePatient: Meeting Psychosocial HealthNeeds, The Mental Health Workforceand Geriatric Populations (ComingSoon), and Retooling for an AgingAmerica: Building the HealthcareWorkforce. Their recommendations canhelp to shape policy priorities. IOMreports and information on IOMcommittees and workshops can befound at www.iom.edu.

Investing in the Social Work Workforce:An Advocacy Agenda for Social WorkEducationIn 2008, the Council on Social WorkEducation (CSWE) launched a newPublic Policy Initiative (PPI) andengaged Lewis-Burke Associates LLC astheir government relationsrepresentatives. Wendy Naus serves asGovernment Relations Consultant andprovided an overview of CSWE’spublic policy agenda and priorities.

The goal of the PPI is to enhance socialwork education and the professionthrough thoughtful public policy that isfocused on providing the very besteducation, training and financialassistance for social workers

(www.cswe.org/CentersInitiatives/PublicPolicyInitiative13785.aspx). Theaudiences for the initiative include theUnited States Congress, federalagencies and other organizationsthroughout the social work, health care,and higher education communities. Theinitiative is guided by (but not limitedto) four fundamental areas of focus: 1)Debt load and loan forgiveness; 2)Higher education and accreditationpolicy; 3) Skilled and diverseworkforce; and 4) Ally building.

In addition to working with members ofCongress to enact thoughtful policiesthat enhance social work educationand the profession, CSWE engageswith executive branch agency officialson the implementation of policy.Outreach to the Department of Healthand Human Services has focused onenhancing opportunities for socialworkers around training, carecoordination, cultural competency,research, and addressing healthdisparities, among other topics. CSWEworks closely with the Department ofEducation, especially aroundimplementation of the Higher EducationAct, accreditation policy, student aid,and community college articulation.CSWE engages with the Department ofVeterans Affairs, focusing on topicssuch as scholarship and loanrepayment opportunities, meeting theneeds of military families, and thedevelopment of competencies for socialwork programs. Over the last severalyears CSWE has taken its priorities tothe White House, most recentlyengaging with the ObamaAdministration offices on topics dealingwith military families, health care andeducation initiatives.

As a result of the PPI, federal policymakers have increased awareness ofsocial work education and key contactshave been established andstrengthened across the federalgovernment and with otherorganizations and stakeholders.Specific successes of the PPI are relatedto proposed policies to implement theHigher Education Opportunity Act of2008 related to accreditation policy,for profit institutions of highereducation, federal student aid andcommunity colleges. Also, as noted inthe earlier section on the Bureau ofHealth Professions’ programs, as aresult of health care reform, severalprograms provide eligibility for socialworkers. It was especially noted that inthe BHPr program to train behavioraland mental health professionals,priority for eligibility for the grants isgiven to those social work programsaccredited by CSWE. In regard to theVA Health Professionals EducationalAssistance Scholarship Program, in the111th Congress language was includedto broaden eligibility to reinstate thesocial work scholarships that existed in the 1990s. It is anticipated that this willbe implemented in Fall 2011 or Spring2012. Lewis-Burke prepared anoverview of the relevant provisions ofthe ACA for social work education thatis available at www.cswe.org/File.aspx?id=48334.

CSWE keeps educators and studentsinformed of its public policy effortsthrough its monthly Public PolicyMonthly Review, and its webpage(www.cswe.org/CentersInitiatives/PublicPolicyInitiative13785.aspx).

DEVELOPING A FRAMEWORK FOR ACTIONSocial work organizations and social

work educators have a shared goal– ensuring the development of acompetent, committed social workworkforce that will be employed acrossnumerous fields of practice; that will beretained within the social workprofession; and that can help toachieve positive outcomes for the clientsserved. The breadth of social work rolessuggests the on-going need forpractitioners who can demonstrateclinical expertise and care coordination,program development, professionaldevelopment, organizing, supervisory,administrative, and policy skills.

Social workers need to be able to workin interdisciplinary settings and engagewith clients and communities indeveloping and implementing servicesand programs. Social workers shouldbe ready to meet new challenges andbe responsive as the needs ofpopulations change; as policies (e.g.,ACA) and funding streams change, asthe job market becomes increasinglycompetitive; and as some fields ofpractice, (e.g. working with disasters orworking with the military and veterans)expand. Social workers also need to beengaged in life-long learning.

For many of the federal, state and localagencies that fund and implement theprograms in which social workers work,recruiting, retaining and training theright workforce is a challenge to whichsolutions are being sought. In mostinstances, agencies are seekingemployees that have a set of skills andexperiences to do the job; and theseindividuals might be selected from anarray of professions – social workers,psychologists, nurses, counselors,

lawyers, and others – who may all fitthe employers’ job descriptions. In somefields, especially in child welfare and inaging, social workers with BSW andMSW degrees may be competing forjobs against persons who have nospecialized training and may have onlya bachelor’s degree, or less. Thepublic, however, often assumes that allof the persons performing thesefunctions are professional social workers.

There may be a declining number ofpositions in the 21st century thatspecifically call for hiring only a socialworker to do the job. Services that dospecifically recruit and employ socialworkers are those where federal, stateor other policies define who arerequired staff or members of aninterdisciplinary team, (e.g., end-stagerenal disease facilities, rural healthcenters, inpatient psychiatric hospitalsor hospice). Settings may specificallyrequire a professional social workerdue to states’ licensing requirements (goto www.aswb.org); social workqualifications that are defined in law oradministrative policy; or an agency’sefforts to meet accreditation standardsof the Joint Commission or the Councilon Accreditation or other accreditingbody. In some instances, the front-lineposition may not require a social workdegree, but it may be required for thesupervisory position. This can createproblem in implementing a careerladder for experienced workers to moveinto supervisory positions, if socialworkers are not recruited to the front-line.

Some agencies have a preference forhiring social workers as they considersocial workers to have the most relevantpreparation; however it is not a

requirement. As noted earlier, insituations where a social work degreemay be required or preferred, there arevariations regarding the social worker’seducational level and the type ofexperiences and skills that are requiredor preferred. This can vary as well dueto geographic region, as MSW levelsocial workers might be scarcer in morerural areas and are well concentratedin cities like New York, Boston andChicago where there are many programsgraduating new MSWs each year.

For the Bureau of Health Professions,many disciplines including social work,or multiple disciplines working together,are eligible to apply for training grantfunding. For the programs of theChildren’s Bureau, schools of socialwork are most frequently engaged inthe workforce development initiatives.Social work is the lead in many otherChildren’s Bureau grants andcooperative agreements as well. This isdue to the long-standing history andbody of research that connects socialwork and child welfare, the leadershipby social workers in this field ofpractice, as well as the targetedlegislative and executive branchadvocacy by NASW and by theANSWER coalition (SWPI, 2010;Zlotnik, 2009).

As we look to the future, the increaseddemand for social workers will continueto grow and will need to beresponsive to the following:

> The impending retirement of asizable cohort of today’shealth and human serviceworkforce;

> I N V E S T I N G I N T H E S O C I A L W O R K W O R K F O R C E > S O C I A L W O R K P O L I C Y I N S T I T U T E


include Cancer Care for the WholePatient: Meeting Psychosocial HealthNeeds, The Mental Health Workforceand Geriatric Populations (ComingSoon), and Retooling for an AgingAmerica: Building the HealthcareWorkforce. Their recommendations canhelp to shape policy priorities. IOMreports and information on IOMcommittees and workshops can befound at www.iom.edu.

Investing in the Social Work Workforce:An Advocacy Agenda for Social WorkEducationIn 2008, the Council on Social WorkEducation (CSWE) launched a newPublic Policy Initiative (PPI) andengaged Lewis-Burke Associates LLC astheir government relationsrepresentatives. Wendy Naus serves asGovernment Relations Consultant andprovided an overview of CSWE’spublic policy agenda and priorities.

The goal of the PPI is to enhance socialwork education and the professionthrough thoughtful public policy that isfocused on providing the very besteducation, training and financialassistance for social workers

(www.cswe.org/CentersInitiatives/PublicPolicyInitiative13785.aspx). Theaudiences for the initiative include theUnited States Congress, federalagencies and other organizationsthroughout the social work, health care,and higher education communities. Theinitiative is guided by (but not limitedto) four fundamental areas of focus: 1)Debt load and loan forgiveness; 2)Higher education and accreditationpolicy; 3) Skilled and diverseworkforce; and 4) Ally building.

In addition to working with members ofCongress to enact thoughtful policiesthat enhance social work educationand the profession, CSWE engageswith executive branch agency officialson the implementation of policy.Outreach to the Department of Healthand Human Services has focused onenhancing opportunities for socialworkers around training, carecoordination, cultural competency,research, and addressing healthdisparities, among other topics. CSWEworks closely with the Department ofEducation, especially aroundimplementation of the Higher EducationAct, accreditation policy, student aid,and community college articulation.CSWE engages with the Department ofVeterans Affairs, focusing on topicssuch as scholarship and loanrepayment opportunities, meeting theneeds of military families, and thedevelopment of competencies for socialwork programs. Over the last severalyears CSWE has taken its priorities tothe White House, most recentlyengaging with the ObamaAdministration offices on topics dealingwith military families, health care andeducation initiatives.

As a result of the PPI, federal policymakers have increased awareness ofsocial work education and key contactshave been established andstrengthened across the federalgovernment and with otherorganizations and stakeholders.Specific successes of the PPI are relatedto proposed policies to implement theHigher Education Opportunity Act of2008 related to accreditation policy,for profit institutions of highereducation, federal student aid andcommunity colleges. Also, as noted inthe earlier section on the Bureau ofHealth Professions’ programs, as aresult of health care reform, severalprograms provide eligibility for socialworkers. It was especially noted that inthe BHPr program to train behavioraland mental health professionals,priority for eligibility for the grants isgiven to those social work programsaccredited by CSWE. In regard to theVA Health Professionals EducationalAssistance Scholarship Program, in the111th Congress language was includedto broaden eligibility to reinstate thesocial work scholarships that existed in the 1990s. It is anticipated that this willbe implemented in Fall 2011 or Spring2012. Lewis-Burke prepared anoverview of the relevant provisions ofthe ACA for social work education thatis available at www.cswe.org/File.aspx?id=48334.

CSWE keeps educators and studentsinformed of its public policy effortsthrough its monthly Public PolicyMonthly Review, and its webpage(www.cswe.org/CentersInitiatives/PublicPolicyInitiative13785.aspx).

DEVELOPING A FRAMEWORK FOR ACTIONSocial work organizations and social

work educators have a shared goal– ensuring the development of acompetent, committed social workworkforce that will be employed acrossnumerous fields of practice; that will beretained within the social workprofession; and that can help toachieve positive outcomes for the clientsserved. The breadth of social work rolessuggests the on-going need forpractitioners who can demonstrateclinical expertise and care coordination,program development, professionaldevelopment, organizing, supervisory,administrative, and policy skills.

Social workers need to be able to workin interdisciplinary settings and engagewith clients and communities indeveloping and implementing servicesand programs. Social workers shouldbe ready to meet new challenges andbe responsive as the needs ofpopulations change; as policies (e.g.,ACA) and funding streams change, asthe job market becomes increasinglycompetitive; and as some fields ofpractice, (e.g. working with disasters orworking with the military and veterans)expand. Social workers also need to beengaged in life-long learning.

For many of the federal, state and localagencies that fund and implement theprograms in which social workers work,recruiting, retaining and training theright workforce is a challenge to whichsolutions are being sought. In mostinstances, agencies are seekingemployees that have a set of skills andexperiences to do the job; and theseindividuals might be selected from anarray of professions – social workers,psychologists, nurses, counselors,

lawyers, and others – who may all fitthe employers’ job descriptions. In somefields, especially in child welfare and inaging, social workers with BSW andMSW degrees may be competing forjobs against persons who have nospecialized training and may have onlya bachelor’s degree, or less. Thepublic, however, often assumes that allof the persons performing thesefunctions are professional social workers.

There may be a declining number ofpositions in the 21st century thatspecifically call for hiring only a socialworker to do the job. Services that dospecifically recruit and employ socialworkers are those where federal, stateor other policies define who arerequired staff or members of aninterdisciplinary team, (e.g., end-stagerenal disease facilities, rural healthcenters, inpatient psychiatric hospitalsor hospice). Settings may specificallyrequire a professional social workerdue to states’ licensing requirements (goto www.aswb.org); social workqualifications that are defined in law oradministrative policy; or an agency’sefforts to meet accreditation standardsof the Joint Commission or the Councilon Accreditation or other accreditingbody. In some instances, the front-lineposition may not require a social workdegree, but it may be required for thesupervisory position. This can createproblem in implementing a careerladder for experienced workers to moveinto supervisory positions, if socialworkers are not recruited to the front-line.

Some agencies have a preference forhiring social workers as they considersocial workers to have the most relevantpreparation; however it is not a

requirement. As noted earlier, insituations where a social work degreemay be required or preferred, there arevariations regarding the social worker’seducational level and the type ofexperiences and skills that are requiredor preferred. This can vary as well dueto geographic region, as MSW levelsocial workers might be scarcer in morerural areas and are well concentratedin cities like New York, Boston andChicago where there are many programsgraduating new MSWs each year.

For the Bureau of Health Professions,many disciplines including social work,or multiple disciplines working together,are eligible to apply for training grantfunding. For the programs of theChildren’s Bureau, schools of socialwork are most frequently engaged inthe workforce development initiatives.Social work is the lead in many otherChildren’s Bureau grants andcooperative agreements as well. This isdue to the long-standing history andbody of research that connects socialwork and child welfare, the leadershipby social workers in this field ofpractice, as well as the targetedlegislative and executive branchadvocacy by NASW and by theANSWER coalition (SWPI, 2010;Zlotnik, 2009).

As we look to the future, the increaseddemand for social workers will continueto grow and will need to beresponsive to the following:

> The impending retirement of asizable cohort of today’shealth and human serviceworkforce;



> What opportunities exist to buildresearch/practice bridges insocial work – to encourageclinician-researchers and toembrace the teaching hospitaltype of model that exists inmedicine?

> What role can dual degreeprograms play in improvingworkforce marketability?

> While dual degree programs areattractive, how do we alsoensure that those with dualdegrees maintain their socialwork identification?

> How can social work educationprograms track graduates andcall on them to mentor bothfaculty and students regardingthe reality of contemporary socialwork practice?

> How can education and traininginnovations in evidence-basedpractice or military social work,for example, best bedisseminated to the field?

> What opportunities might beavailable in the businesscommunity for social workstudents and how can socialwork education best engagebusiness leaders in pursuing suchopportunities?

> INFLUENCINGSERVICE DELIVERYAND SOCIAL WORKPRACTICEEmerging practice methods may requireshifts in how practice is defined and howsocial work communicates its expertise.The ACA and other efforts to bettermeet the needs of those who are mostat risk and most vulnerable as well as

the demographics of aging and theneeds of the military and veteransprovide important opportunities forsocial work. Questions to addressinclude:

> What training and professionaldevelopment strategies are neededto ensure that practitioners have thenecessary evidence-base to provideservices, especially as the use ofevidence to inform practice isincreasingly written into policy?

> With the increased focus on carecoordination, how will carecoordination be defined and whatwill be the critical roles and functionsrequired for quality carecoordination? How can materialsand tools developed through NTOCC,for example, best be disseminated?

> Although case management andcare coordination are not the soledomain of social workers, how cansocial work best articulate its rolesand functions as care coordinators indiverse practice settings?

> How will several disciplines shareleadership in the new visions forhealth care delivery?

> Although the medical model and roleof physicians is strong in the ACA,accomplishing the ACA goals willrequire psychosocial interventions.How will we ensure that social workis at the table in developing thenecessary interventions and outcomemeasures, especially in addressinghealth disparities and health literacy,and meeting the needs of those withcomplex health and social needs?

> How will professionals work togetherwith the client/patient/consumer to develop and implement theappropriate plan of care, as greater emphasis is placed onperson-centered care and the need

to build on strengths and protectivefactors?

Interdisciplinary/interprofessionalpractice will be increasingly the norm inpractice settings. Despite at least 40 years ofinterdisciplinary service delivery andtraining there are still discussions aboutsocial workers and other disciplinesbeing unprepared to work in aninterdisciplinary setting. This raises thequestions:

> What strategies are needed in theacademy and in practice settings toensure that social workers are wellprepared to work in such settings?Are there examples of success?

> Can social work effectively articulateits particular roles and its knowledgeand skills in an interdisciplinarysetting?

> Can we develop consistent andagreed upon definitions ofinterdisciplinary and/orinterprofessional practice that areshared across disciplines andsettings?

> How do we ensure that socialworkers are part of the health careinterdisciplinary team; especiallywhen some interdisciplinaryinitiatives may merely beinter-medical which is different frominterdisciplinary?

> What research and data can supportthe appropriate understanding ofrole differentiations?

> How do we create interdisciplinarytraining in the academy that cantranslate into interdisciplinarypractice at the community level?

> What needs to be done toensure continuedrelationships amongnational organizations


> The implementation of the ACA; > The efforts to reduce the number of

children in out of home care; > The increased linkages between mental

health services and primary care;> The expanded focus on

interdisciplinary/interprofessionalservice delivery;




> Growing opportunities for socialworkers in business and in the forprofit sector.

The demand for social workers needs tobe coupled with the creation of anadequate supply of social workers withthe skills and competencies to meet theneeds of the marketplace. Through largeand small group discussions, the thinktank participants grappled with manyissues that could result in enhanced effortsby the government and other funders toinvest in the social work workforce; thatwould strengthen and enhance intra-socialwork and interprofessional partnershipsand advocacy strategies; and that

would strengthen the linkages betweenwhat social workers learn in the academyand what they do in practice. Thefollowing highlights the issues and thequestions that need further exploration.

> INFLUENCINGSOCIAL WORKEDUCATIONEnrollments and applications to socialwork education programs are increasing,creating a readiness to respond to thegrowing need for social workers.Social work, like several other appliedprofessions are viewed as counter-recessional. Applications andenrollments for social work educationrise in tight economic times. This is anopportunity to be responsive to theBureau of Labor Statistics projections ofthe growing need for social workers.However, there are also questions:

> Will the graduates have the rightskills, abilities, and experiences toeffectively perform their jobs in thesettings where social workers areneeded?

> With availability of field placementsin flux, is there mismatch betweenaccessible field placements and thejobs available after degreecompletion?

> It is critical to have field placementsin macro settings available so thatstudents can be prepared andmentored to pursue careers ingovernment agencies and beinvolved in planning and policyactivities. What strategies can bepursued? How might these studentsbe more competitive in federalprograms to recruit the nextgeneration of leaders?

Changes in practice suggest that socialwork curricula changes are also needed. Educational institutions may not alwayskeep current in preparing students tomeet the needs of the communities andclients in need. Questions that getraised include:

> What are the roles that deans/directors of social work educationprograms can take to ensure that thereis innovation in curriculum in schoolsof social work so that there is not adisconnect between what is offeredin education and the populations toserve and the interventions that areused in practice?

> Are we making sure that informationon evidence-based practice isreaching social work faculty?

> Are strategies to translate researchinto practice being utilized?

EXAMPLES OF EVIDENCE-BASEDPRACTICE RESOURCES IN SOCIAL WORK

REACH-SW - A Curriculum Tool to InfuseEvidence-Based Practice and Research acrossthe Social Work Curriculum was developedwith support from the National Institute ofMental Health (NIMH) (www.danya.com/reach)

Partnerships to Integrate Evidence-Based Practice across Social WorkEducation and Research – Includes a Reportfrom a Social Work Symposium sponsoredby NIMH and Links to Resources about SocialWork and Evidence-Based Practice (www.socialworkpolicy.org/publications/evidence-based-practice- publications.html).

SHIFT PROJECT FOR ADOLESCENTSUICIDE PREVENTION – NASW developeda toolkit to provide a step-by-step, onlineresource to make the shift to evidence-basedprograms (EBPs) in your practice, agency orcommunity (www.socialworkers.org/practice/adolescent_ health/shift).


social work faculty salaries are low aswell. According to Barth (2003), one ofthe factors that keep social worksalaries low is what economists woulddescribe as social workers’ “taste” forthe profession. Questions include:

> How can this “taste” for the work becoupled with better advocacy bysocial workers themselves and socialwork organizations, collectively, toadvocate raising social worksalaries?

> How can advocacy work with otherdisciplines and providerorganizations help make the case forhigher social work salaries,especially when doing similar jobsas professionals with other degrees?

> What role can schools of social workplay in preparing students to marketthemselves and their social workskills to employers?

> Many of the highest earning socialworkers are not necessarily inpositions with a social work title, asthey may be a Chief ExecutiveOfficer of a large organization or aVice President of a hospital, forexample. How can we encourage allprofessional social workers to usetheir professional credentials andcontinue to identify their expertise asa social worker, no matter what theirrole and job function?

Social Work Labor Market: A First Look“Fragmentary evidence suggests that thismarket (for social work) is highly segmentedby education; that many people who do nothave social work degrees work in social workjobs, at least at the lower levels; that peoplewho want to be social workers have such astrong commitment to the career of socialwork that relative wages make relativelylittle difference to their career decisions; andthat employers often hire applicants withoutdegrees for social work jobs. These factorstend to depress wages for social workers.”Economist Michael C. Barth, Social Work,January, 2003, 48(1):9-19.

Advocacy to address workforce issuesis needed at the federal, state and locallevels.Workforce shortages exist acrossprofessions, suggesting that increasedefforts are needed to address workforcegaps and workforce competency incollaborative ways. Questions include:

> How can interdisciplinary workforceadvocacy efforts best be facilitatedso that policy makers see the strengthin the groups working togethertoward common goals?

> How can unique needs of specificprofessions be acknowledged andsupported when working ininterdisciplinary coalitions and incoalitions of provider associations andprofessional associations together?

> How can consumer/professionaladvocacy partnerships coalesce toadvocate for service deliveryenhancements?

> How can the business community andother stakeholders be engaged inadvocacy for the health and humanservices workforce?

> How can social workers’ bestengage employers in advocacy forworkforce improvements?

Addressing workforce policy issues inthe profession can best be realizedthrough collaboration among socialwork organizations. Questions include:

> What new actions can the ANSWERcoalition take to advocate for theDorothy I. Height and Whitney M.Young, Jr. Social Work ReinvestmentAct, including engaging nationalorganizations of providers (e.g.,Alliance for Children and Families,National Association of CountyBehavioral Health and DevelopmentalDisability Directors, National Councilfor Community Behavioral Healthcare,National Assembly, Child WelfareLeague of America) whose membersare major employers of social workers?

> How can the work of the ANSWERcoalition best be enhanced to ensureinter-organizational communication,planning and priority setting amongsocial work organizations?

> How can advocacy among socialwork organizations best befacilitated to identify a commonadvocacy agenda and join togetherto ensure that there is strength innumbers?

> What are the data needs foreffective advocacy and how can arepository of comprehensive socialwork workforce data best be createdand maintained; how can these databe made accessible to stakeholderswhen it is needed?

> What actions can be taken to betterstandardize licensing and reciprocityacross states, especially in adjoiningstates and for people who areproviding telehealth and workingthrough national entities (e.g.,Department of Defense,Department of VeteransAffairs, U.S. Public HealthService)?


from different disciplines and toencourage their efforts related toenhancing interdisciplinary practice?

Interprofessional Resources Exist In the 1990s, social work educators exploredinterprofessional practice within the healthcare domain as well as across social work,health and education. Myths andOpportunities: The Examination and Impact ofDiscipline-Specific Accreditation onInterprofessional Education was acollaborative project undertaken by theCSWE with support from the Annie E. CaseyFoundation. The principles and competenciesfor interprofessional education and practicearticulated in that project have stood the testof time and can be found in Appendix 10.

Use of data and research findings willincreasingly be used to guide practiceand policy. Some of the critical issues discussed bythe think tank participants relating topractice and client data include thefollowing:

> How can the data available be moreclient-centric, so that differentagencies can access the sameinformation, to be better informed ofclient needs and to have greater

coordination in providing thenecessary services?

> How can different local agencieswork together to develop uniformdata systems?

> How can data entry of clientinformation be streamlined so that itcan be done easily, while out in thefield?

> How can front-line practitioners andsupervisors be encouraged andguided to use data and research toinform practice?

> How can community-basedparticipatory research methods beused to ensure involvement ofconsumers, community-members andpractitioners in developing andimplementing useable and relevantresearch?

Availability of data regarding the socialwork profession is essential.Questions include:

> What is the most consistent andavailable source of information ondata on the social work workforce?

> What role will the new Bureau ofHealth Professions (BHPr) NationalCenter for Workforce Analysis playin gathering and analyzing socialwork workforce data?

> How can information on the socialwork workforce be gathered togetherand be easily accessible, to use withfederal, state and local policy makers?

> How might data gathered byindividual schools on alumni be usedto create a data bank of social workpractice information?

> STRENGTHENINGPOLICY ANDPRACTICE LINKAGESWorkplace supports and the workenvironment should facilitate qualitysocial work practice.Concerns are continually raised aboutthe organizational culture and climatein some health and human servicesettings, especially as funding is tight,workers are laid off, class actionlawsuits are filed, and caseloads rise.To address these environmental issuesthe following questions are raised:

> What roles do unions play toprovide a venue for managementand staff to work together to addressworkforce challenges and to improveworkplace conditions?

> How do the many changes and shiftshappening in organizations (e.g.,leadership changes, fundingcutbacks) impact worker retentionand service outcomes? How can thecase be made to policy makers toaddress these issues?

> What strategies for investments in thesocial work profession need to betaken to address both public andprivate sector settings for practice?

> How can members ofinterdisciplinary teams work togetheracross disciplines to provide thenecessary continuum of care and toidentify how the diverse roles of theinterdisciplinary team are necessaryto achieve quality care outcomes?

Increasing social work salaries shouldbecome a top priority.Concerns continue to be raised aboutthe perennial low salaries of socialworkers. This is not only true forpractice, but is true in academia where


Investing in the social work workforcewill require actions by multiple players

both within the social work professionand on the outside. (Figure 1 providesa conceptualization of priority actionsand goals of the necessary actionagenda.) Efforts will need to focus onadvocacy, research, professional socialwork education and training, andinterprofessional collaboration andinterdisciplinary practice. These effortsshould be targeted to and engagemultiple stakeholders including:

> Social work organizations. > Government agencies (at the local,

state and national levels). > Unions. > Licensing boards. > Accrediting bodies. > Legislatures. > National organizations representing

service providers (e.g., ChildWelfare League of America, Alliancefor Children and Families, NationalAssociation of Area Agencies onAging).


> Clinicians and Practitioners.



> Strengthened inter-social workorganization collaboration and

FIGURE 1: ACTION AGENDA

2 1

> How can the public educationcampaign be expanded in itsinformation and outreach toemployers, the business communityand policy makers?

National Social Work Public Education Campaign The National Social Work Public EducationCampaign is a multi-year outreach effort ledby the National Association of Social Workersto educate key stakeholders, includingAmerican citizens, the media, policy makers,employers and social workers about theimportance of this profession. The goals of the public education campaign are to (a) increase awareness and respect for thesocial work profession; (b) educate thepublic on the depth and breadth of socialwork practice; (c) expand perceptions of who can benefit from social work services;(d) attract young people to the profession;and (e) improve employment opportunitiesfor professional social workers. For moreinformation, visit:www.naswfoundation.org/imageCampaign/default.asp.

Influencing the executive branch ofgovernment to advocate for investing insocial work is critical. The executive branch of governmentdevelops regulations and administrative

policy guidance, issues grants andcontracts, organizes workgroups andadvisory groups and works to implementlegislation. Influencing the executivebranch requires outreach and advocacyon behalf of the social work professionto ensure that social work has a seat atthe table. Questions include:

> How can we best encourage socialwork experts who are engaged byexecutive branch agencies due totheir expertise to make sure that theyidentify as a social worker, so thatthe agency and other stakeholderscan become more familiar with thebreadth of knowledge andexperience of social workers?

> What strategies can social workorganizations undertake to ensurethat social workers are nominated forkey posts on advisory boards andworkgroups? What process might beused to track such appointments sothat NASW might know when socialworkers are serving on suchcommittees?

> How might social workers withingovernment agencies coalesce, inorder to maintain their social workidentity? For example in the late1980s a Federal Social WorkConsortium was created.

> How can NASW and the social workcommunity broaden their connectionswith federal agencies beyond theDepartment of Health & HumanServices and the Department ofVeterans Affairs, to other agenciesthat support and fund programs thatcan and do employ social workers(e.g. the Department of Defense, theDepartment of Housing and UrbanDevelopment, the Department ofJustice, the Department of Education)?

> Since social work has been identifiedas a high growth field over the next

decade, what strategies need to beundertaken, not only to recruit andretain the social work practitioners,but to also support the education ofsocial work faculty and social workresearchers?

Targeted social work involvement withACA implementation is crucial.Numerous efforts are underway toimplement the many provisions of theACA, focusing on workforcedevelopment, implementing evidence-based practices and new service models,defining eligibility and identifyingprocess and outcome measures. Ofparticular focus are those persons whoare the costliest in the health caresystem, and who are usually thosepatients that social workers are highlylikely to encounter. These efforts shouldinvolve individual social work researchersand practitioners as well as input fromnational social work organizations, andthe coalitions with which social workengages. Questions include:

> What opportunities for social workresearch and practice need to bepursued to ensure that social work is“at the table” in the implementationof the ACA?

> What outreach should social workorganizations undertake to developrelationships with key governmentofficials and leaders in otherorganizations and think tanks toensure that the social workperspective is included in effortsrelated to, for example, workforcedevelopment, service deliveryprograms, evidence- basedpractices, research on psychosocialoutcomes, underway as part of theimplementation of the ACA?

> What efforts should take place toenhance social work connectionswith the CMS Innovations?


CONCLUSIONS


Investing in the social work workforcewill require actions by multiple players

both within the social work professionand on the outside. (Figure 1 providesa conceptualization of priority actionsand goals of the necessary actionagenda.) Efforts will need to focus onadvocacy, research, professional socialwork education and training, andinterprofessional collaboration andinterdisciplinary practice. These effortsshould be targeted to and engagemultiple stakeholders including:

> Social work organizations. > Government agencies (at the local,

state and national levels). > Unions. > Licensing boards. > Accrediting bodies. > Legislatures. > National organizations representing

service providers (e.g., ChildWelfare League of America, Alliancefor Children and Families, NationalAssociation of Area Agencies onAging).


> Clinicians and Practitioners.



> Strengthened inter-social workorganization collaboration and

FIGURE 1: ACTION AGENDA

> How can the public educationcampaign be expanded in itsinformation and outreach toemployers, the business communityand policy makers?

National Social Work Public Education Campaign The National Social Work Public EducationCampaign is a multi-year outreach effort ledby the National Association of Social Workersto educate key stakeholders, includingAmerican citizens, the media, policy makers,employers and social workers about theimportance of this profession. The goals of the public education campaign are to (a) increase awareness and respect for thesocial work profession; (b) educate thepublic on the depth and breadth of socialwork practice; (c) expand perceptions of who can benefit from social work services;(d) attract young people to the profession;and (e) improve employment opportunitiesfor professional social workers. For moreinformation, visit:www.naswfoundation.org/imageCampaign/default.asp.

Influencing the executive branch ofgovernment to advocate for investing insocial work is critical. The executive branch of governmentdevelops regulations and administrative

policy guidance, issues grants andcontracts, organizes workgroups andadvisory groups and works to implementlegislation. Influencing the executivebranch requires outreach and advocacyon behalf of the social work professionto ensure that social work has a seat atthe table. Questions include:

> How can we best encourage socialwork experts who are engaged byexecutive branch agencies due totheir expertise to make sure that theyidentify as a social worker, so thatthe agency and other stakeholderscan become more familiar with thebreadth of knowledge andexperience of social workers?

> What strategies can social workorganizations undertake to ensurethat social workers are nominated forkey posts on advisory boards andworkgroups? What process might beused to track such appointments sothat NASW might know when socialworkers are serving on suchcommittees?

> How might social workers withingovernment agencies coalesce, inorder to maintain their social workidentity? For example in the late1980s a Federal Social WorkConsortium was created.

> How can NASW and the social workcommunity broaden their connectionswith federal agencies beyond theDepartment of Health & HumanServices and the Department ofVeterans Affairs, to other agenciesthat support and fund programs thatcan and do employ social workers(e.g. the Department of Defense, theDepartment of Housing and UrbanDevelopment, the Department ofJustice, the Department of Education)?

> Since social work has been identifiedas a high growth field over the next

decade, what strategies need to beundertaken, not only to recruit andretain the social work practitioners,but to also support the education ofsocial work faculty and social workresearchers?

Targeted social work involvement withACA implementation is crucial.Numerous efforts are underway toimplement the many provisions of theACA, focusing on workforcedevelopment, implementing evidence-based practices and new service models,defining eligibility and identifyingprocess and outcome measures. Ofparticular focus are those persons whoare the costliest in the health caresystem, and who are usually thosepatients that social workers are highlylikely to encounter. These efforts shouldinvolve individual social work researchersand practitioners as well as input fromnational social work organizations, andthe coalitions with which social workengages. Questions include:

> What opportunities for social workresearch and practice need to bepursued to ensure that social work is“at the table” in the implementationof the ACA?

> What outreach should social workorganizations undertake to developrelationships with key governmentofficials and leaders in otherorganizations and think tanks toensure that the social workperspective is included in effortsrelated to, for example, workforcedevelopment, service deliveryprograms, evidence- basedpractices, research on psychosocialoutcomes, underway as part of theimplementation of the ACA?

> What efforts should take place toenhance social work connectionswith the CMS Innovations?


CONCLUSIONS


Baden, B. (2010, December 6). Bestcareers 2011: Medical and public healthsocial worker. U.S. News and WorldReport. [Online]. Retrieved fromhttp://money.usnews.com/money/careers/articles/2010/12/06/best-careers-2011-medical-and-public-health-social-worker.

Barth, M.C. (2003). Social work labormarket: a first look. Social Work, 48(1):9-19.

Bureau of Labor Statistics. (2010).Occupational outlook handbook,2001-2011 edition, social workers.Retrieved from www.bls.gov/oco/ocos060.htm#outlook.

HHS. (2006). The Supply and Demand ofProfessional Social Workers ProvidingLong-Term Care Services: Report toCongress. Retrieved from http://aspe.hhs.gov/daltcp/reports/2006/swsupply.pdf.

Institute for the Advancement of SocialWork Research. (2008). StrengtheningUniversity/Agency Research Partnerships toEnhance Child Welfare Outcomes: A Toolkitfor Building Research Partnerships.Retrieved from www.socialworkpolicy.org/wp-content/uploads/2007/06/9-IASWR-CW-Research-Partners.pdf.

Institute for the Advancement of SocialWork Research. (2007). Partnerships toIntegrate Evidence-Based Mental HealthPractices into Social Work Education andResearch. Retrieved fromwww.socialworkpolicy.org/documents/EvidenceBasedPracticeFinal.pdf

McClellan, M., et al. (2010). A nationalstrategy to put accountable care intopractice. Health Affairs, 29(5): 982-990.

President’s New Freedom Commission onMental Health. (2003). Achieving thePromise: Transforming Mental Health Carein America. Retrieved fromhttp://store.samhsa.gov/shin/content/SMA03-3831/SMA03-3831.pdf.

National Council for Community BehavioralHealthcare. (2011, April 11). NationalCouncil: BH Salaries fail to keep pace withinflation. Mental Health Weekly, 21,(15),pp. 4-5.

SWPI. (2010). High Caseloads: How dothey Impact Health and Human Services.Retrieved from www.socialworkpolicy.org/research/high-caseloads-how-do-they-impact-delivery-of-health-and-human-services.html.

Zlotnik, J.L. (2009). Social Work and ChildWelfare: A National Debate. Fauri Lecturepresented at the University of MichiganSchool of Social Work, October 27, 2009.Retrieved from ssw.umich.edu/events/fauri/FauriLecture_ChildWelfare.pdf.


attention to shared missions relatedto advocacy and professionaldevelopment.

> Enhanced interdisciplinary trainingand team outcomes and cross-discipline organizations advocacy



> Increased social worker salaries.> Increased clarification of differential

skills and expected service outcomesfor social workers with differentialeducation and experiences.




> Enhanced information on social workeffectiveness.



The goals of this think tank symposiumwere met. People who do not usuallyconnect with each other connected.Following the symposium, several socialwork organizations came together toenhance their workforce advocacy

efforts, and federal agencies and theprofession have enhanced theirpotentials for partnerships. The agendafor the future is daunting and willrequire the development of sustainedrelationships between the professionand government and foundationrepresentatives, as well as betweensocial work and its interdisciplinarypartners. The workforce crisis for socialwork is real, and creating a safety netfor a civil society is critical. Socialworkers must be well positioned to meetthe demands for their services fromindividuals, famillies, organizations andcommunities in need.

REFERENCES


2 > PARTICIPANTS

Uma Ahluwalia, MSWDirectorHealth and Human Services for

Montgomery County

Clare Anderson, MSW, LICSWDeputy CommissionerAdministration on Children, Youth and

FamiliesUS Department of Health and Human

Services

Robert Arnold, MPSDirectorNational Association of Social Workers

Foundation

Tricia Bent-Goodley, PhD, MSW, LICSWNational Policy AdvisorNational Association of Black Social

Workers (NABSW)ProfessorSchool of Social WorkHoward University

Katharine Briar-Lawson, PhD, MSWDean and ProfessorSchool of Social WelfareUniversity at Albany

Reinaldo Cardona, MSSW, LCSWExecutive DirectorNASW New York State Chapter

Elizabeth Clark, PhD, ACSW, MPHExecutive DirectorNational Association of Social Workers

Mirean Coleman, MSW, LICSW, CTSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Stacy Collins, MSWSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Joseph Colosi, C-ASWCM, LSWSenior Project ManagerMedicare Care Management OperationsAETNA

Llewelyn Cornelius, PhD, LCSWProfessorSchool of Social WorkUniversity of Maryland

Joan DaVanzo, PhD, MSWChief Executive OfficerDobson | DaVanzo

Bonita Davis, BAExecutive AssistantNational Association of Social Wor

Foundation

Donna DeAngelis, MA, LICSW, ACSWExecutive DirectorAssociation of Social Work Boards

Judith Dekle, LCSW, ACSWFamily Programs LiaisonPsychological Health Strategic Oper

Force Health Protection and ReadOffice,

Assistant Secretary of Defense, HeaAffairs/TMA

Peter Delany, PhD, LCSW-CRADM, U.S. Public Health ServiceDirector, Center for Behavioral Heal

Statistics and QualitySubstance Abuse and Mental Health

Services Administration

Allen Dobson, PhDPresidentDobson | DaVanzo

Diana Espinosa, MPPDeputy AdministratorBureau of Health ProfessionsUS Department of Health and Huma

Services

Adrienne Farrar, PhD, MSWRepresentativeSociety for Social Work Leadership

Health Care

Marilyn Flynn, PhD, MSWDean and ProfessorSchool of Social WorkUniversity of Southern California

> I N V E S T I N G I N T H E S O C I A L WO R K WO R K F O R C E >2 5

1 > INVESTING IN THE SOCIAL WORK WORKFORCE

AGENDA

Wednesday, May 18, 2011A Think Tank Symposium Sponsored by the NASW Social Work PolicyInstitute in collaboration with ANSWER

NASW National Office: 750 First Street, NE, Suite 700, Washington, DC

APPENDIX

REGISTRATION & CONTINENTALBREAKFAST

WELCOME & INTRODUCTIONSTHINK TANK PURPOSE & OUTCOMESJoan Levy Zlotnik, Director,

Social Work Policy Institute

Elizabeth J. Clark, Executive Director,National Association of Social Workers

THE SOCIAL WORK WORKFORCE:SHIFTING THE CONTEXTTracy Whitaker, Director, NASW Center for

Workforce Studies and Social Work Practice

FEDERAL OPPORTUNITIES FOR WORKFORCECAPACITY BUILDING, PROFESSIONALDEVELOPMENT & TRAININGDeveloping the Health Professions WorkforceDiana Espinosa, Deputy Administrator, Bureau of

Health Professions, U.S. Department of Healthand Human Services

Preparing the Child Welfare Workforce to Meet theUnique Needs of Children and FamiliesClare Anderson, Deputy Commissioner,

Administration on Children, Youth and FamiliesU.S. Department of Health and Human Services

SOCIAL WORK, CMS AND HEALTH CAREREFORM – NEW OPPORTUNITIES &ACCOUNTABILITYAllen Dobson, President, Dobson| DaVanzo

RESPONSE PANEL & DISCUSSIONCheri Latimer, Executive Director, Case Management

Society of America

Uma Ahluwalia, Director, Health and HumanServices for Montgomery County

WORKING GROUPS

LUNCH SERVED

REPORT BACK FROM WORKING GROUPS

CHARTING AN ADVOCACY AGENDAInvesting in the Social Work Workforce: AnAdvocacy Agenda for Social Work EducationWendy Naus, Government Relations Consultant,

Council on Social Work EducationLewis- Burke Associates

Strengthening the Social Work Workforce:A Legislative ViewpointAsua Ofosu, Manager, Government Relations

National Association of Social Workers

GROUP ACTION PLANNING

WRAP-UP & NEXT STEPS

ADJOURN


2 > PARTICIPANTS

Uma Ahluwalia, MSWDirectorHealth and Human Services for

Montgomery County

Clare Anderson, MSW, LICSWDeputy CommissionerAdministration on Children, Youth and

FamiliesUS Department of Health and Human

Services

Robert Arnold, MPSDirectorNational Association of Social Workers

Foundation

Tricia Bent-Goodley, PhD, MSW, LICSWNational Policy AdvisorNational Association of Black Social

Workers (NABSW)ProfessorSchool of Social WorkHoward University

Katharine Briar-Lawson, PhD, MSWDean and ProfessorSchool of Social WelfareUniversity at Albany

Reinaldo Cardona, MSSW, LCSWExecutive DirectorNASW New York State Chapter

Elizabeth Clark, PhD, ACSW, MPHExecutive DirectorNational Association of Social Workers

Mirean Coleman, MSW, LICSW, CTSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Stacy Collins, MSWSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Joseph Colosi, C-ASWCM, LSWSenior Project ManagerMedicare Care Management OperationsAETNA

Llewelyn Cornelius, PhD, LCSWProfessorSchool of Social WorkUniversity of Maryland

Joan DaVanzo, PhD, MSWChief Executive OfficerDobson | DaVanzo

Bonita Davis, BAExecutive AssistantNational Association of Social Workers

Foundation

Donna DeAngelis, MA, LICSW, ACSWExecutive DirectorAssociation of Social Work Boards

Judith Dekle, LCSW, ACSWFamily Programs LiaisonPsychological Health Strategic Operations

Force Health Protection and ReadinessOffice,

Assistant Secretary of Defense, HealthAffairs/TMA

Peter Delany, PhD, LCSW-CRADM, U.S. Public Health ServiceDirector, Center for Behavioral Health

Statistics and QualitySubstance Abuse and Mental Health


Allen Dobson, PhDPresidentDobson | DaVanzo

Diana Espinosa, MPPDeputy AdministratorBureau of Health ProfessionsUS Department of Health and Human

Services

Adrienne Farrar, PhD, MSWRepresentativeSociety for Social Work Leadership in

Health Care

Marilyn Flynn, PhD, MSWDean and ProfessorSchool of Social WorkUniversity of Southern California

Margaret Glos, BSManagement AnalysisNational Center for Health Workforce

AnalysisHealth Resources and Services

Administration

Vicki Hansen, LMSW-AP, ACSWExecutive DirectorNASW Texas Chapter

Isadora Hare, MSW, LCSWPublic Health AnalystAdolescent Health BranchHealth Resources and Services

Administration

Sunny Harris Rome, MSW, JDAssociate ProfessorDepartment of Social WorkGeorge Mason University

Chris Herman, MSW, LICSWSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Elizabeth Hoffler, ACSWSpecial Assistant to the Executive DirectorNational Association of Social Workers

Karen Hopkins, PhD, MSWAssociate ProfessorCo-Chair, Management and Community

Organization Concentration (MACO)School of Social WorkUniversity of Maryland

Sharon Issurdatt, LCSW, ACSW, DCSWSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Carla Jacobs, BSGovernment Relations Consultant, CSWELewis-Burke Associates

Mildred Joyner, MSW, LCSW, BCDPresident, Council on Social Work

EducationProfessor, Director/ChairpersonUndergraduate Social Work

DepartmentWest Chester University


1 > INVESTING IN THE SOCIAL WORK WORKFORCE

AGENDA

Wednesday, May 18, 2011A Think Tank Symposium Sponsored by the NASW Social Work PolicyInstitute in collaboration with ANSWER

NASW National Office: 750 First Street, NE, Suite 700, Washington, DC

APPENDIX

REGISTRATION & CONTINENTAL BREAKFAST

WELCOME & INTRODUCTIONSTHINK TANK PURPOSE & OUTCOMESJoan Levy Zlotnik, Director,

Social Work Policy Institute

Elizabeth J. Clark, Executive Director, National Association of Social Workers

THE SOCIAL WORK WORKFORCE: SHIFTING THE CONTEXTTracy Whitaker, Director, NASW Center for

Workforce Studies and Social Work Practice

FEDERAL OPPORTUNITIES FOR WORKFORCE CAPACITY BUILDING, PROFESSIONAL DEVELOPMENT & TRAININGDeveloping the Health Professions WorkforceDiana Espinosa, Deputy Administrator, Bureau of

Health Professions, U.S. Department of Health and Human Services

Preparing the Child Welfare Workforce to Meet the Unique Needs of Children and FamiliesClare Anderson, Deputy Commissioner,

Administration on Children, Youth and FamiliesU.S. Department of Health and Human Services

SOCIAL WORK, CMS AND HEALTH CARE REFORM – NEW OPPORTUNITIES & ACCOUNTABILITY Allen Dobson, President, Dobson| DaVanzo

RESPONSE PANEL & DISCUSSIONCheri Latimer, Executive Director, Case Management

Society of America

Uma Ahluwalia, Director, Health and Human Services for Montgomery County

WORKING GROUPS

LUNCH SERVED

REPORT BACK FROM WORKING GROUPS

CHARTING AN ADVOCACY AGENDAInvesting in the Social Work Workforce: An Advocacy Agenda for Social Work EducationWendy Naus, Government Relations Consultant,

Council on Social Work EducationLewis- Burke Associates

Asua Ofosu, Manager, Government RelationsNational Association of Social Workers

GROUP ACTION PLANNING

WRAP-UP & NEXT STEPS

ADJOURN


3 > SPEAKERBIOGRAPHICALSKETCHESUma S. Ahluwalia, MSWDirector, Montgomery County Departmentof Health and Human ServicesUma Ahluwalia is currently the Director of afully-integrated Health and Human ServicesDepartment in Montgomery County. Thedepartment is the largest agency inMontgomery County Government andincludes Aging and Disability Services;Behavioral Health and Crisis Services;Children, Youth and Family Services; PublicHealth Services; and Special NeedsHousing. Ahluwalia holds a Masters inSocial Work from the University of Delhi inIndia and a Post Graduate Degree inHealth Services Administration fromGeorge Washington University. She hasover 20 years of experience in the field invarious frontline and executivemanagement capacities.

Clare Anderson, LICSWDeputy CommissionerAdministration on Children, Youth & FamiliesU.S. Department of Health and HumanServicesClare Anderson is the DeputyCommissioner at the Administration onChildren, Youth and Families. She obtainedher Masters of Social Work, with anemphasis in children, youth and families,from the University of Alabama. Prior tojoining ACYF, Clare was a SeniorAssociate at the Center for the Study ofSocial Policy, where she promoted betteroutcomes for children, youth and familiesthrough community engagement and childwelfare system transformation. Clareprovided technical assistance through afederally funded Child WelfareImplementation Center to sites implementingCommunity Partnerships for ProtectingChildren and the Annie E. CaseyFoundation’s Family to Family initiative. Shealso conducted monitoring of and providedsupport to jurisdictions under Court-order toimprove their child welfare systems. Clarealso worked as a direct practice socialworker as a member of the Freddie MacFoundation Child and Adolescent ProtectionCenter at Children’s National Medical

Center in Washington, DC. She also was aconsultant to and clinical director at theBaptist Home for Children and Families(now the National Center for Children andFamilies) in Bethesda, MD and was on theclinical faculty at the GeorgetownUniversity Medical Center, Department ofPsychiatry’s child and adolescent services.

Allen Dobson, PhDPresident, Dobson|DaVanzoAllen Dobson, PhD, is a health economistand President of Dobson | DaVanzo.Before he co-founded the firm, Dr. Dobsonspent eighteen years with The Lewin Groupwhere he was Senior Vice President anddirected the Health Care Finance Group.Prior to work at The Lewin Group, Dr.Dobson served as Director in the Office ofResearch at CMS (then the Health CareFinancing Administration) when theMedicare Inpatient Prospective PaymentSystem (PPS) was being developed andimplemented. Dr. Dobson has studiedMedicare’s various PPSs (e.g., acute carehospitals, long term care hospitals, skillednursing facilities, inpatient rehabilitationfacilities, home health agencies, andambulatory surgery centers) for over twentyfive years and has directed numerousefforts to model the impact of Medicareand Medicaid payment policies on healthcare providers using a variety of statisticaland econometric methodologies. He hasextensively analyzed Medicare ResourceBased Relative Value System (RBRVS)physician payment and worked for tenyears for CMS advising on themethodology for determining physicianpractice expenses under RBRVS.Additionally, he regularly leads efforts tomodel CMS rulemaking analyses fornumerous provider groups in support of theclients’ public comments and responses tothe notices of proposed rulemaking(NPRM). All of Dr. Dobson’s work isgrounded in the use of complex datasystems and validated methodology.

Diana Espinosa, MPPDeputy Administrator, Bureau of HealthProfessionals U.S. Department of Healthand Human Services Health Resources andServices AdministrationDiana Espinosa is the Deputy AssociateAdministrator for the Bureau of HealthProfessions at the Health Resources andServices Administration (HRSA) in the U.S.Department of Health and Human Services(HHS). The Bureau of Health Professionsprovides national leadership in thedevelopment, distribution and retention of adiverse, culturally competent healthworkforce that provides high-quality carefor all Americans. Prior to joining HRSA,Ms. Espinosa served as the U.S. Office andManagement and Budget’s (OMB) DeputyAssistant Director for Management whereshe led implementation of government-wideefforts to strengthen the management andimprove program performance. Ms. Espinosaalso served as the Chief of OMB’s Healthand Human Services Branch where she ledthe analysis of budget, management, andpolicy issues relating to the U.S. Departmentof Health and Human Services. Ms. Espinosahas a Master of Public Policy and aBachelor of Arts in Social Anthropologyfrom the University of Michigan.

Cheri Lattimer, RN, BSNCMI PresidentExecutive Director Case ManagementSociety of America (CMSA) CoalitionDirector, National Transitions of CareCoalition (NTOCC)Cheri Lattimer is the CEO and President ofConsulting Management Innovators (CMI),providing outsourcing and advisoryservices to the care management andhealth care industries. She services as theExecutive Director for the CaseManagement Society of America, theExecutive Director for the CaseManagement Foundation and is theCoalition Director for the NationalTransitions of Care Coalition. Herleadership in quality improvement, casemanagement, care coordination andtransitions of care is known on thenational and international landscape.In 2009 she was asked to deliverthe Anna Reynvaan Lecture at theUniversity of Amsterdam. Ms.Lattimer spoke to over 900


Cheri Latimer, RN, BSNExecutive DirectorCase Management Society of America

Polina Makievsky, MPPChief Operating OfficerAlliance for Children and Families

Sherri Morgan, JD, MSWAssociate CounselLDF & Ethics and Professional ReviewNational Association of Social Workers

Wendy Naus, BAGovernment Relations Consultant, CSWELewis-Burke Associates

Nora O’Brien-Suric, PhDSenior Program OfficerThe John A Hartford Foundation

Asua Ofosu, JDManagerGovernment RelationsNational Association of Social Workers

Cecilia Perry, MA, JDPublic Policy AnalystAmerican Federation of State, County and

Municipal Employees (AFSCME)

Ashton Theodore Randle, BSDirectorGovernment RelationsCase Management Society of America

Jerry Satterwhite, MSSW, LCSW, ACSWCongressional LiaisonAssociation of VA Social Workers

John Sciamanna, MSWDirectorChildren’s Policy and Government AffairsAmerican Humane Association

Cheryl Sharp, MSW, ALWF, CPSSTCoordinatorCommunity Intergration & WellnessThe National Council for Community

Behavoioral Healthcare

Allison Smith, BA, BSN, RNVice PresidentStrategic InitiativesC-Change

Cudore Snell, DSWDean and Associate ProfessorSchool of Social WorkHoward University

Barabara Solt, PhD, LICSWSocial Work Consultant

Danielle Spears, BSExecutive Assistant to the Executive DirectorNational Association of Social Workers

Linda Spears, BAVice President, Policy & Public AffairsChild Welfare League of America

Evelyn Tomaszewski, MSWSenior Policy AdvisorHuman Rights & International AffairsNational Association of Social Workers

Roxana Torrico Meruvia, MSWSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Rita Vandivort-Warren, MSW, ACSWPublic Health AnalystSubstance Abuse and Mental Health


Ashley Varner, MSW, MBA, LCSW-CRepresentativeAssociation of Oncology Social Work

Randi Walters, MSW, PhDChild Welfare Program SpecialistChildren’s Bureau

Michelle Washko, PhDSpecialist in Aging PolicyUS Administration on AgingUS Department of Health and Human

Services

Jennifer Watt, BSAssistant DirectorNational Association of Social Workers

Foundation

Rita Webb, MSSenior Practice AssociateSocial Work PracticeNational Association of Social Workers

Tracy Whitaker, DSWDirectorNASW Center for Workforce Studies and

Social Work PracticeNational Association of Social Workers

James Herbert Williams, PhD, MSWDean and ProfessorUniversity of Denver

Melvin Wilson, MSWManagerCenter for Workforce StudiesNational Association of Social Workers

Gail Woods Waller, MSDirectorCommunicationsNational Association of Social Workers

Joan Levy Zlotnik, PhD, ACSWDirectorSocial Work Policy InstituteNational Association of Social Workers

Foundation


> TITLE IV-B SECTION 426 RESEARCH,TRAINING, ORDEMONSTRATION PROJECTS – CREATED IN 1962» SEC. 426. (c) CHILD WELFARE TRAINEESHIPS ($7

million appropriations).–The Secretary may approve anapplication for a grant to a public or nonprofitinstitution for higher learning to provide traineeshipswith stipends under section 426(a)(1)(C) only if theapplication- (1) provides assurances that eachindividual who receives a stipend with such traineeship(in this section referred to as a “recipient”) will enterinto an agreement with the institution under which therecipient agrees (A) to participate in training at apublic or private nonprofit child welfare agency on aregular basis (as determined by the Secretary) for theperiod of the traineeship; (B) to be employed for aperiod of years equivalent to the period of thetraineeship, in a public or private nonprofit childwelfare agency in any State, within a period of time(determined by the Secretary in accordance withregulations) after completing the postsecondaryeducation for which the traineeship was awarded;

> TITLE IV-E OF THE CHILD WELFARE AND ADOPTIONASSISTANCE ACT OF 1980 (P.L. 96-272) » TITLE IV-E includes a provision for entitlement funding

that provides 75 percent federal matching funds tostates for short or long term training of child welfareworkers. Long term training may include universitydegree education for “personnel employed orpreparing for employment by the State agency or bythe local agency administering the (Title IV-E) plan”(Section 474A, P.L. 96-272). Approximately 40 statesuse Title IV-E dollars for degree education for BSW andMSW social work students.

For information on Children’s Bureau’s training efforts visitthe website of the National Child Welfare Workforce Institutewww.ncwwi.org and http://louisville.edu/kent/projects/iv-e.


nurses from the Netherlands and Belgiumon Integrated Nursing Health Managementof the Complex Patient. She has beenquoted in several publications including theHealthcare Executive, Dorland’s Case InPoint, Professional Case ManagementProfessional and Seniority. She was acontributor and reviewer for the CMSACore Curriculum for Case Managementand The Integrated Case ManagementManual Assisting Complex Patients RegainPhysical and Mental Health. She serves onseveral National Boards and Committees;URAC, Roundtable on Critical Care Policy,National Family Caregivers Association,CMS Caregiver Workgroup andparticipates on several of the Society ofHospital Medicine Advisory Committees;Diabetes, Hospital Collaborative Care &Better Outcomes for Older Adults throughSafe Transitions.

Wendy A. Naus, BA Lewis-BurkeAssociates, LLCWendy Naus is a senior policy associate atLewis-Burke Associates LLC. Her publicpolicy expertise extends to a broad rangeof issues, including social and health policy,research and education. Ms. Naus worksclosely with clients in the development andimplementation of their public policyagendas. She has led the federal advocacyefforts of the Council on Social WorkEducation (CSWE) since 2008. Her workfor CSWE has focused largely onincreasing training and financial support

opportunities, such as loan forgiveness, forsocial workers. She is also working to raisethe visibility of social work in the minds ofpolicy makers in Congress and throughoutthe Executive agencies. Prior to joiningLewis-Burke in 2004, Ms. Naus worked forthe Buffalo News Washington Bureau. Sheholds a Bachelor of Arts with honors in bothpolitical science and urban studies fromCanisius College in Buffalo, New York.

Asua Ofosu, JDManager, Government Relations, NationalAssociation of Social WorkersAsua Ofosu is the Manager, GovernmentRelations for the National Association ofSocial Workers (NASW). Ms. Ofosu beganher tenure at NASW in 2006 as theNASW health lobbyist and handles avariety of health issues ranging from healthdisparities, genetics, HIV/AIDS, aging, andcancer. She serves as the GR representativeto the Social Work Reinvestment Initiativeand focuses on social work safety andsocial work research issue areas. Inaddition to her work at NASW, Ms. Ofosuspends many hours volunteering forwomen, health and children organizations.Ms. Ofosu is a member of Alpha KappaAlpha Sorority, Inc. and a board memberof Witney’s Lights, a domestic violenceawareness and education non-profitorganization. Ms. Ofosu, a former Hillstaffer, holds a JD from Widener Universityand BS in psychology from Delaware StateUniversity.

Tracy Whitaker, DSW, ACSWDirector, NASW Center for WorkforceStudies and Social Work PracticeTracy Whitaker, DSW, ACSW is theDirector of the Center for Workforce Studies& Social Work Practice at the NationalAssociation of Social Workers (NASW).She is responsible for developing anational repository for consolidated andcomprehensive social work labor forceinformation; identifying trends in the socialwork labor force that will support ordiminish the adequacy of the social workworkforce; collaborative agenda-settingwith allied organizations and coalitions;and developing information for socialworkers that improves social work practice.Dr. Whitaker directed the 2004 nationalbenchmark study of licensed social workersand was the lead author of five reportsemanating from that study. She also led thefirst compensation and benefits study of thesocial work profession in 2009 and hasconducted multiple studies of the NASWmembership. Dr. Whitaker is the leadauthor of Workforce Trends Affecting theProfession, 2009 and The Results are In:What Social Workers Say About SocialWork, both published by the NASW Press.Dr. Whitaker received a BA in PoliticalScience, an MSW and a DSW fromHoward University. She also holdscertification from NASW’s Academy ofCertified Social Workers.

4 > FEDERAL CHILD WELFARE TRAINING PROGRAMS SUPPORTINGSOCIAL WORKERS – THE U.S. CHILDREN’S BUREAU IN THEADMINISTRATION FOR CHILDREN AND FAMILIES (ACF)


Improving Transitions of Care with Health InformationTechnologyNTOCC believes that for Health Information Technology (HIT)to make a difference in transitions of care, the technologymust address several critical steps. The components includestandardized processes, good communication, requiredperformance measures, established accountability, andstrong care coordination. Without addressing each step, thepromise of HIT’s affect on overall transition of careimprovement will not be realized.

Because there is little guidance on how to use HIT in waysthat specifically improve transitions of care, this paper buildsupon NTOCC’s overall recommendations for improvingtransitions of care and the national agenda as it relates toHIT, and identifies problems and considerations as theyrelate to NTOCC’s overall goals.

Issue Briefs: Improving Transitions of CareThis issue brief organizes the findings and considerations ofthe “Vision of the National Transitions of Care Coalition.”

Cultural Competence: Essential Ingredient for SuccessfulTransitions of CareHealth care professionals increasingly recognize the crucialrole that culture plays in the health care of a client or patientand the need to deliver services in a culturally competentmanner. Cultural competence is essential to successful,client-/patient-centered transitions of care. This tool providesinformation about culture and cultural competence, as wellas strategies and resources to enhance professionals’capacity to deliver culturally competent services duringtransitions of care.

Medication Reconciliation Essential Data SpecificationsThese consensus elements will help health care professionalscollect, transmit and receive critical medication informationneeded when patients move from one practice setting orlevel of care to another. The use of these elements in thereconciliation process required by the Joint Commissioncould help reduce medication errors.

Transitions of Care MeasuresAt present, there is a large evidence base that demonstratesthe existence of serious quality problems for patientsundergoing transitions across sites of care. While currentlythere are transitions of care measures on the structure,process, and outcomes of care that are useful, measure gapsstill exist. This report by the NTOCC Measures Work Groupsummarizes an environmental scan of existing measures thatare applicable to care transitions and highlights the WorkGroup’s recommendations. Included is the Care coordinationHub, a conceptual model defining seven key elements foreffective transitions of care.

Included is the Care Coordination Hub, a conceptual modeldefining seven key elements for effective transitions of care.

Policy PaperThis detailed concept paper outlines steps to be consideredby the healthcare industry and policy makers to improvetransition performance.


Patient Bill of Rights During Transitions of CareTransitions of care (or care transitions) take place each timea patient goes from one health care provider or health caresetting to another. Problems often happen during thesetransitions because information is not communicated. Patientsand their family have the right to care transitions that aresafe and well coordinated. This guide can help patients getthe information and services they need and deserve eachstep of the way.

Available Versions:Full Patient Bill of RightsSummary Patient Bill of Rights

My Medicine ListThis is a list of important recommended information about apatient’s medications. The data elements indicate theprescriptions that patients have been prescribed and arecurrently taking along with information about theirover-the-counter medications, vitamins, and nutritionalsupplements. The goal of the personal medicine list is tohelp patients improve their understanding of their currentmedicine regimens including why they need to take themedication and for how long.

Additional Languages:Español / SpanishFrançais / French

Taking Care of My Health CareTaking Care of MY Health Care has been a muchanticipated consumer tool. The tool was developed by theNTOCC Tools and Resources Work Group. It has beenthrough numerous reviews with the group, by social workers,and a literacy review. The NTOCC Advisory Task Forceapproved it on September 16, 2008 at their meeting in

Washington DC. This tool was developed as a guide forpatients and their caregivers to use so they can be betterprepared when they see a health care professional on whatkind of information and questions they need to ask.NTOCC’s goal was to keep it simple; as a guide, to openthe lines of communication and at the minimum to providethem with a convenient, simple format to have an updatedlist of their medication and what the next step in their carewould be.


Transitions of Care ChecklistThis list provides a detailed description of effective patienttransfer between practice settings. Implementing this processdeveloped by NTOCC can help to ensure that patients andtheir critical medical information are transferred safely,timely, and efficiently.

How to Implement and Evaluate a Plan:> Executive Summary> Improving on Transitions of Care: How to

Implement and Evaluate a PlanModule: Hospital to HomeModule: Emergency Department to Home

The Executive Summary outlines for you the concepts,process and how to use the guidebook titled Improving onTransitions of Care: How to Implement and Evaluate a Plan.In using the guidebook each transition point is treated as anexchange. Each exchange is where communication occursand where evaluation may occur.

5 > NTOCC HEALTH CARE PROFESSIONAL TOOLS

www.ntocc.org/Home/HealthCareProfessionals/WWS_HCP_About.aspx

NTOCC has created information to help healthcare professionals understand how poor transitions impact care delivery and how you can help improve transitions in your facility. Join NTOCC as an individual subscriber or ask for your company to join as an Associate Member to be notified as new tools become available.


Improving Transitions of Care with Health InformationTechnologyNTOCC believes that for Health Information Technology (HIT)to make a difference in transitions of care, the technologymust address several critical steps. The components includestandardized processes, good communication, requiredperformance measures, established accountability, andstrong care coordination. Without addressing each step, thepromise of HIT’s affect on overall transition of careimprovement will not be realized.

Because there is little guidance on how to use HIT in waysthat specifically improve transitions of care, this paper buildsupon NTOCC’s overall recommendations for improvingtransitions of care and the national agenda as it relates toHIT, and identifies problems and considerations as theyrelate to NTOCC’s overall goals.

Issue Briefs: Improving Transitions of CareThis issue brief organizes the findings and considerations ofthe “Vision of the National Transitions of Care Coalition.”

Cultural Competence: Essential Ingredient for SuccessfulTransitions of CareHealth care professionals increasingly recognize the crucialrole that culture plays in the health care of a client or patientand the need to deliver services in a culturally competentmanner. Cultural competence is essential to successful,client-/patient-centered transitions of care. This tool providesinformation about culture and cultural competence, as wellas strategies and resources to enhance professionals’capacity to deliver culturally competent services duringtransitions of care.

Medication Reconciliation Essential Data SpecificationsThese consensus elements will help health care professionalscollect, transmit and receive critical medication informationneeded when patients move from one practice setting orlevel of care to another. The use of these elements in thereconciliation process required by the Joint Commissioncould help reduce medication errors.

Transitions of Care MeasuresAt present, there is a large evidence base that demonstratesthe existence of serious quality problems for patientsundergoing transitions across sites of care. While currentlythere are transitions of care measures on the structure,process, and outcomes of care that are useful, measure gapsstill exist. This report by the NTOCC Measures Work Groupsummarizes an environmental scan of existing measures thatare applicable to care transitions and highlights the WorkGroup’s recommendations. Included is the Care coordinationHub, a conceptual model defining seven key elements foreffective transitions of care.

Included is the Care Coordination Hub, a conceptual modeldefining seven key elements for effective transitions of care.

Policy PaperThis detailed concept paper outlines steps to be consideredby the healthcare industry and policy makers to improvetransition performance.


Patient Bill of Rights During Transitions of CareTransitions of care (or care transitions) take place each timea patient goes from one health care provider or health caresetting to another. Problems often happen during thesetransitions because information is not communicated. Patientsand their family have the right to care transitions that aresafe and well coordinated. This guide can help patients getthe information and services they need and deserve eachstep of the way.

Available Versions:Full Patient Bill of RightsSummary Patient Bill of Rights

My Medicine ListThis is a list of important recommended information about apatient’s medications. The data elements indicate theprescriptions that patients have been prescribed and arecurrently taking along with information about theirover-the-counter medications, vitamins, and nutritionalsupplements. The goal of the personal medicine list is tohelp patients improve their understanding of their currentmedicine regimens including why they need to take themedication and for how long.


Taking Care of My Health CareTaking Care of MY Health Care has been a muchanticipated consumer tool. The tool was developed by theNTOCC Tools and Resources Work Group. It has beenthrough numerous reviews with the group, by social workers,and a literacy review. The NTOCC Advisory Task Forceapproved it on September 16, 2008 at their meeting in

Washington DC. This tool was developed as a guide forpatients and their caregivers to use so they can be betterprepared when they see a health care professional on whatkind of information and questions they need to ask.NTOCC’s goal was to keep it simple; as a guide, to openthe lines of communication and at the minimum to providethem with a convenient, simple format to have an updatedlist of their medication and what the next step in their carewould be.


Transitions of Care ChecklistThis list provides a detailed description of effective patienttransfer between practice settings. Implementing this processdeveloped by NTOCC can help to ensure that patients andtheir critical medical information are transferred safely,timely, and efficiently.

How to Implement and Evaluate a Plan:> Executive Summary> Improving on Transitions of Care: How to

Implement and Evaluate a PlanModule: Hospital to HomeModule: Emergency Department to Home

The Executive Summary outlines for you the concepts,process and how to use the guidebook titled Improving onTransitions of Care: How to Implement and Evaluate a Plan.In using the guidebook each transition point is treated as anexchange. Each exchange is where communication occursand where evaluation may occur.

5 > NTOCC HEALTH CARE PROFESSIONAL TOOLS

www.ntocc.org/Home/HealthCareProfessionals/WWS_HCP_About.aspx

NTOCC has created information to help healthcare professionals understand how poor transitions impact care delivery and how you can help improve transitions in your facility. Join NTOCC as an individual subscriber or ask for your company to join as an Associate Member to be notified as new tools become available.


interventions that enable patients, their families, and health care providers to optimize biomedical health care and to managethe psychological/behavioral and social aspects of illness and its consequences, so as to promote better health” (p. 9).

Equally importantly, the presence of social workers on the medical home team extends the reach of the physician and nursingstaff–allowing all team members to practice at the top of their licenses.

Roles and qualifications of professional social workers participating in ACOsProfessional social workers fulfill distinct but complementary roles in health care. Clinical social workers work in behavioraland mental health settings, including as independent practitioners. Medical social workers work in settings such as hospitals,primary care, long-term care, hospice and palliative care, and rehabilitation.

Clinical Social Workers: Mental and behavioral health care should be a strong component of ACO services. More than240,000 clinical social workers in the United States diagnose and treat mental illness (Substance Abuse and Mental HealthServices Administration, 2010). Of that number, more than 37,000 clinical social workers are currently Medicare providers.NASW recommends the inclusion of clinical social workers in all ACO programs providing mental and behavioral healthservices. A clinical social worker is an individual who possesses a master’s or doctor’s degree in social work; has performedat least two years of supervised clinical social work; and is either licensed or certified as a clinical social worker by the Statein which the services are performed; or, in the case of an individual in a State that does not provide for licensure orcertification, has completed at least two years or 3,000 hours of post master’s degree supervised clinical social work practiceunder the supervision of a master’s level social worker in an appropriate setting such as a hospital, skilled nursing facility, orclinic (CMS, 2009). (Since 2009, all states license social workers at the clinical level.)

For decades, clinical social workers have been recognized for their expertise in providing services to Medicare beneficiarieswho experience emotional, behavioral, psychological, and social problems related to health and mental health conditions.NASW recommends the expansion of Medicare-reimbursed clinical social work services to include the prevention,assessment, and treatment of mental, emotional, and behavioral disturbances as fee-for-service providers. This change wouldaccurately reflect the services clinical social workers currently provide to Medicare beneficiaries. The expansion of theMedicare definition of clinical social work services would also promote greater continuity across the health care continuum.NASW supports the fee-for-service model currently used within the Medicare payment system for clinical social workersparticipating in ACOs. At present, clinical social workers are the only group of non-physician practitioners who are paid 75percent of the physician fee schedule. NASW recommends reimbursement of clinical social workers at 85 percent of thephysician fee schedule, in keeping with reimbursement rates for other non-physician practitioners.

Medical Social Workers: Medical social workers perform multiple roles within interdisciplinary health care teams: casemanagement and care coordination, medically related social services, patient and family education, discharge planning,advance care planning, and community outreach and engagement. Consistent with NASW’s Standards for Social WorkPractice in Health Care Settings (2005), medical social workers participating in ACOs should have a social work degreefrom a school accredited by the Council on Social Work Education. Social workers functioning in leadership roles withinACOs, such as managers or directors, should be licensed at the advanced practice level and be able to provide supervisionfor licensure (NASW, 2005).

Benefits of social work involvement in ACO-type programsAs indicated below, social work involvement in ACO-type projects have shown positive trends in a number of performance measures:> Reduction in 30-day hospital readmissions> Delays in permanent nursing home placement> Reductions in avoidable emergency room visits> Improved access to primary care providers > Improved adherence to treatment plans


Re: Proposed Rule on Medicare Shared Savings Program and Accountable Care Organizations; CMS–1345–P

Dear Dr. Berwick:On behalf of the 145,000 members of the National Association of Social Workers (NASW), I am pleased to submit ourcomments on the Notice of Proposed Rule Making for the Medicare Shared Savings Program and Accountable CareOrganizations (ACOs).

NASW is a strong supporter of the 2010 Affordable Care Act. We support the concept of ACOs because sharedaccountability for beneficiary health will address both gaps in quality and unnecessary costs caused by fragmented andpoorly coordinated care. Moreover, shared savings will support activities that improve care and lower health carecosts–namely, care coordination services–which are not currently reimbursed under the Medicare fee-for-service program. Weoffer, for your consideration, the following recommendations to strengthen the Shared Savings Program.

Meeting the Core Objectives of the Shared Savings Program NASW supports the three core objectives of the Shared Savings Program: better care for individuals, better health forpopulations, and lower growth in health care expenditures. We believe these goals cannot be achieved, however, withoutthe participation of a broader array of providers in the ACO health care team. In particular, we recommend greaterspecificity regarding the types of psychosocial supports and services that ACOs must provide. In the absence of suchrequirements, ACOs may fail to address the social determinants of health and the roles access and adherence play inindividual and population health outcomes.

Inclusion of professional social workers as ACO participants The proposed rule limits ACO participants to doctors of medicine or osteopathy, physician assistants, nurse practitioners, andclinical nurse specialists [§425.4(1)(2)]. The Agency for Healthcare Research and Quality (AHRQ) suggests that the ACOmodel is based on the interdisciplinary team model of the primary care medical home. According to AHRQ (2010, 2011a),a medical home provides comprehensive, team-based care that meets the majority of each patient’s physical and mentalhealth care, including prevention and wellness, acute care, and chronic care. AHRQ notes that the medical home team formost patients in a primary care practice might include nurses, pharmacists, nurse practitioners, physicians, physicianassistants, medical assistants, social workers, care coordinators, and others.

NASW strongly recommends that professional social workers be included as ACO participants. Social workers play keyroles in interdisciplinary care teams across a broad array of health care settings and as such, constitute essential members ofACOs. Social workers are also the only health care professionals devoted exclusively to addressing the psychosocial needs ofMedicare beneficiaries and family caregivers. In its 2008 report, Cancer Care for the Whole Patient: Meeting PsychosocialHealth Needs, the Institute of Medicine (IOM) defined psychosocial health services as “psychological and social services and

6 > NASW COMMENTS TO CMS ONAFFORDABLE CARE ORGANIZATIONSJune 6, 2011

Donald Berwick, MD Administrator, Centers for Medicare & Medicaid Services Department of Health and Human ServicesAttention: CMS–1345–PP.O. Box 8013Baltimore, MD 21244-8013


permanently placed in the nursing home per year was 8.5 percent, compared with the overall Massachusetts rate of 12percent (Commonwealth Fund, 2010).

Processes to Promote Evidence-based Medicine, Patient Engagement, Quality Reporting, and Coordination of Care Evidence-based medicineThe Affordable Care Act states that ACOs need to have processes to promote the use of evidence-based medicine. NASWrecommends that CMS broaden this term to evidence-based medicine and practices, because it is critical that ACOsimplement evidence-based psychosocial interventions not generally included as medicine. ACOs should incorporate thefollowing definition for both evidence-based medicine and evidence-based practice: “bringing together the best availableresearch evidence, with practitioner knowledge and values and patient/client preferences” (Social Work Policy Institute,2010, p. 10). The following databases may be valuable to ACOs in identifying evidence-based psychosocial interventionsand care coordination programs: > Evidence Database on Aging Care, maintained by the Social Work Leadership Institute at the New York Academy of

Medicine: www.searchedac.org/> The Guide to Community Preventive Services, maintained by the Centers for Disease Control & Prevention (CDC):

www.thecommunityguide.org> National Registry of Evidence-Based Programs, maintained by the Substance Abuse and Mental Health Services

Administration: www.nrepp.samhsa.gov> Research-tested Intervention Programs, maintained by the National Cancer Institute: http://rtips.cancer.gov/rtips/index.do

Care coordination and case managementThe National Transitions of Care Coalition (NTOCC) recommends increased use of case management and professional carecoordination as essential to improving communication of health care information (NTOCC, 2010b). Although the proposedrule focuses heavily on care coordination and case management, CMS provides no clear definition of either term. Effectivecare coordination and case management must address not only communication among primary care providers and physicianspecialists but also the psychosocial needs of beneficiaries and family caregivers (Herman, 2009).

The proposed rule proposes telehealth, remote monitoring, and enabling technologies as tools for care coordination.Although these tools may monitor changes in health status, they cannot replace the role person-centered care coordinationand case management play in ACOs. Case management is not a “free” service, as indicated on page 19547 of the proposerule. Rather, case management and coordination constitute essential services that must be included in the cost of care.

NTOCC’s Transitions of Care Compendium (2011a) provides a wealth of information about strategies and programs toimprove transitional care. The compendium, which is listed on the webpage for CMS’s Community Based Care TransitionProgram, would be a useful resource for ACOs.

Quality and cost metricsNASW supports the proposed use of quality measures in ACOs and views measures as an important avenue in the provisionof effective health care services. NASW recommends additional measures in the area of mental health, cancer and hospiceand palliative care. Participation in the measure approval/endorsement process is restricted because of the National QualityForum’s expensive annual membership dues. NASW recommends an approval/endorsement process that would be openedto all interdisciplinary health providers through their professional organizations, regardless of each organization’s ability topay membership dues.

Patient-centeredness criteria [§425.5 (d)(15)(ii)]NASW strongly recommends inclusion of all nine proposed criteria and proposes addition of a new criterion. Ourspecific comments follow.


For your reference, we have provided examples of a few of these programs below. Care Management Program: An Initiative to Reduce Unnecessary EmergencyDepartment Utilization This program addresses the needs of the most frequent users of emergencydepartments and hospitals in Camden, New Jersey. These individuals lack consistentprimary care and often have complex medical, psychiatric, and substance abusedisorders, compounded by an array of social concerns. A team consisting of a socialworker, medical assistant, and nurse practitioner helps program participants addressa variety of social, environmental, and health conditions. The team also facilitatesparticipant access and on-going involvement in a medical home (Camden Coalitionof Healthcare Providers, 2011).

Enhanced Discharge Planning Program (Rush University Medical Center)In the Rush University Enhanced Discharge Planning Program, social workers work

with older adults and family caregivers following discharge from the hospital. Social workers help patients avoid adverseevents, encourage follow-up with primary care providers, and connect patients and caregivers to community-based resources.Data from the project show statistically significant increases in older adults’ understanding of their medications, decreasedstress over managing their health care needs, and improved communication with their physicians post-discharge (AmericanHospital Association, 2010).

Project SAFe: University of Southern California, Los Angeles, CAProject SAFe (Screening Adherence Follow-Up Program) is a system of patient navigation counseling and case managementdesigned to help low-income, ethnic-minority women overcome barriers to timely breast cancer screening and follow-up afterreceiving an abnormal mammogram. The service involves a structured interactive telephone assessment of screening-adherence risk (barriers), health counseling, and follow-up services, including patient tracking, appointment reminders, andreferral to community resources. Low-income, ethnic-minority women are more likely than other women to delay or missfollow-up appointments after receiving an abnormal mammogram. This disparity can be attributed to barriers such as culturalnorms, language, low health literacy, lack of insurance, irregular sources of medical care, uncoordinated treatment services,and psychological distress. Patient navigation counseling and case management that is sensitive to the challenges faced bylow-income, ethnic-minority women may improve adherence to recommendations for regular screening and treatmentfollow-up after an abnormal mammogram (Ell, 2007).

Geriatric Resources for Assessment and Care of EldersThe GRACE (Geriatric Resources for Assessment and Care of Elders) medical home project includes a nurse practitioner–social worker care coordination team, which works closely with primary care physicians and a geriatrician. The program,situated at an urban system of community clinics affiliated with the Indiana University School of Medicine, enrolls low-incomeolder adults with multiple diagnoses. Data from the project show decreased use of the emergency department and lowerhospitalization rates among seniors receiving the GRACE intervention, compared with those in control groups (Counsell etal., 2007).

Commonwealth Care Alliance Serving older adults and medically fragile individuals on Medicaid, the Commonwealth Care Alliance (CCA) uses nursepractitioner-led teams in 25 community-based medical practices. These teams, which include social workers, assume primaryresponsibility for the ambulatory care needs of patients assigned to each practice. Teams provide intake and assessment,ongoing care coordination, and in-home assistance with activities of daily living. The physicians on the team, on the otherhand, focus on inpatient care. According to the Commonwealth Fund, the number of hospital days per year per CCAmember who is dually eligible for Medicare and Medicaid was 2.0, compared to 3.6 days per dually eligible patientenrolled in the Medicare fee-for-service program. The study also found the percentage of nursing home–certifiable patients


promote culturally competent practice skills with individuals, families, and communities affected by HIV/AIDS. The Projectis supported through a five-year contract with the Center for Mental Health Services of SAMHSA.

4) High-risk individuals, individualized care plans, and integration of community resources. Comprehensive biopsychosocialassessment and care planning guide social work practice in health care settings (NASW, 2005) and are included in theaccreditation standards of both the Commission on Accreditation of Rehabilitation Facilities (CARF) (2010) and the JointCommission (2011). NASW asserts that individualized assessment and care planning should drive health care not only fortargeted beneficiary populations, but for every ACO beneficiary. Assessment and care planning tailored to each person’shealth and psychosocial preferences, values, and needs forms the cornerstone of safe, appropriate, timely health care. Forhigh-risk beneficiaries and individuals with multiple chronic conditions, the need for person-centered assessment and careplanning is even more pressing.

The importance of this principle is illustrated by considering the variety of options available for end-of-life care. Life-prolongingmedical treatments may be welcomed by one person and declined by another, even if the two have the same diagnosis andprognosis. In the absence of individualized assessment and care planning, health care providers risk not only wasting scarcehealth care resources but also–and even more importantly–disregarding beneficiaries’ choices. The challenges associatedwith medication adherence also demonstrate the centrality of individualized assessment and care planning. A beneficiarycannot benefit from a prescribed medication if her or his health care provider does not ascertain whether the prescription isaffordable, for example. Similarly, failing to assess if an individual understands how to take the medication can lead todangerous, costly errors.

NASW concurs with CMS that community resources are critical in supporting beneficiary adherence to the health care plan.Social workers have long played an integral role in helping clients identify and connect with appropriate communityresources (NASW, 2009); the profession is well equipped to help fulfill this responsibility as members of ACOs. NASWencourages CMS to include nonprofit social service organizations among community stakeholders in the ACO developmentand governance process.

5) Coordination of care. As previously noted, care coordination is essential to improving health care for Medicarebeneficiaries, especially during transitions between health care providers or settings. NASW supports CMS’s proposalrequiring ACOs to outline care coordination mechanisms. NTOCC (2010b) recommends that “providers must haveaccountability for sending and receiving information about patients during care transitions [emphasis added]” (p. 20). Thus,each ACO’s process of communicating care information must take into account this dual emphasis.

6) Communicating clinical knowledge/evidence-based medicine in a way that is understandable to beneficiaries. NASWaffirms inclusion of this criterion for patient-centered care. Wide variation in literacy and health literacy exists amongMedicare beneficiaries. The most recent National Assessment of Adult Literacy found that adults aged 65 and older–whoconstituted almost 83 percent of Medicare beneficiaries in 2009 (CMS, 2009)–were almost three times less likely to possessbasic health literacy than 16- to 64-year-olds (Kutner, Greenberg, Jin, & Paulsen, 2006). Regardless of age, Hispanic adultshad the lowest health literacy of all racial and ethnic groups; moreover, American Indian/Alaska Native, Black, andmultiracial adults had lower health literacy than White (non-Hispanic) and Asian/Pacific Islander adults (Kutner et al., 2006).

Low health literacy may influence Medicare beneficiaries’ ability to understand health information and treatment options,participate in assessment and care planning, and follow through on the plan of care (such as taking medications andfollowing up with health care providers). Clear beneficiary-provider communication is fundamental to patientengagement in health care, as demonstrated by its inclusion in the Consumer Bill of Rights and Responsibilitiesadopted by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry(1998, Appendix A).


1) Beneficiary experience of care survey. NASW concurs with CMS that use of onesurvey is important to ensure consistency across ACOs and to facilitate measurementover time. The Consumer Assessment of Health Care Providers and Systems (CAHPS)Clinician and Group survey addresses many areas fundamental to patient-centeredcare. On the other hand, the survey items focus solely on doctors and support staff.This limitation makes the survey inapplicable not only to services provided bynon-physician primary care providers (physician assistants, nurse practitioners, andclinical nurse specialists) but also to services provided by other health careprofessionals, such as social workers. NASW proposes a simple but significantmodification to CAHPS: Replace doctor with health care provider throughout thesurvey. This change would ensure applicability of the survey across ACO providers.

2) Patient involvement in ACO governance. NASW supports CMS’s proposal toinclude at least one ACO beneficiary in the governing body of each ACO. We also

support inclusion of a beneficiary advisory panel or committee. The panel should not replace beneficiary participation in thegoverning body, however. As CMS notes in the proposed rule, without voting power the influence of a consumerrepresentative would be extremely limited. At the same time, the input of the advisory panel would enable a broader groupof beneficiaries to influence the focus and processes of the Shared Savings Program. Ideally, the voting representative wouldparticipate not only in the governing body but also in the advisory panel.

3) Diversity and population needs evaluation/health planning. Medicare beneficiaries vary in age, race, ethnicity, biologicalsex, gender identity, sexual orientation, geographic region, socioeconomic status, and physical, mental, and cognitive ability.The literature identifies health care disparities related to each of these cultural factors (AHRQ, 2011b; Centers for DiseaseControl and Prevention & Merck Foundation, 2008; IOM, 2011). Given this context, NASW affirms CMS’s proposedincentives for rural health clinics and federally qualified health centers to participate in the ACO program (§425.7(c)(4);425.7(c)(7); 425.7(d)(2); 425.7(d)(6)). We also support CMS’s proposal to establish partnerships between ACOs and stateor local health departments.

We encourage CMS to discourage avoidance of high-risk beneficiaries and exacerbation of health disparities by requiringACOs to take the following steps: > Add people from medically underserved racial and ethnic groups and individuals with low incomes to the list of at-risk

beneficiaries (§425.(4)) and consider these characteristics when adjusting for per capita Medicare expenditures > Collect and report quality data related to race, ethnicity, and income> Monitor degree of ACO nonparticipation among health care providers for beneficiaries from medically underserved racial

and ethnic groups

NASW also supports integration of the National Standards on Culturally and Linguistically Appropriate Services (CLAS)(U.S. Department of Health & Human Services, 2007) in ACO practice. Social workers are well prepared to provideculturally and linguistically appropriate services:> Content addressing cultural diversity, human rights, and social and economic justice constitutes a core component of the

social work curriculum (Council on Social Work Education, 2008). > The NASW standards (2001) and indicators (2007) for cultural competence in social work practice guide social workers

in developing and maintaining cultural competence–an ethical responsibility outlined in the Association’s Code of Ethics(2008). (The Association’s standards and indicators also form the basis for the National Transitions of Care Coalition’scultural competence tool for interdisciplinary health care teams [2010a]).

> The NASW standards for social work practice in health care settings (2005) specify that social workers need theknowledge and skills to identify and address health disparities.

> NASW’s HIV/AIDS Spectrum: Mental Health Training and Education of Social Workers Project (NASW, n.d.-a) strives to


Need for safeguards to preserve beneficiary choice of providersThe proposed rule specifies that beneficiaries have the right to use health care providers who do not participate in the ACO.NASW encourages CMS to specify the processes by which beneficiaries may exercise this right and other protections topreserve beneficiary freedom of choice. In the absence of such protocol, we are concerned that ACOs–which, as noted inthe rule, must pay for all care provided to their beneficiaries–will enact barriers to external providers.

Thank you for your consideration of these comments. NASW looks forward to collaborating with you to make ACOssuccessful in achieving better care, better health, and lower costs for Medicare beneficiaries.

Sincerely,

Elizabeth J. Clark, PhD, ACSW, MPHExecutive Director

3 9

7) Beneficiary engagement and shared decision making that reflects beneficiaries’unique needs, preferences, values, and priorities. NASW affirms inclusion of thiscriterion of patient-centeredness. The aforementioned Consumer Bill of Rights andResponsibilities (President’s Advisory Commission on Consumer Protection andQuality in the Health Care Industry, 1998) devotes an entire chapter to consumerparticipation in treatment decisions. This topic is also emphasized in multiple otherpublications addressing consumer health care rights: > The American Hospital Association (2003) specifies involvement in care–includingdiscussion of medically appropriate treatment choices, treatment plan, consumergoals and values, and surrogate decision making–as one of six rights consumers canexpect to be met during hospitalization. > The National Hospice and Palliative Care Organization (2008) affirms patients’right to be involved in developing the plan of care and to decline care or treatment. > The National Pain Foundation (2011) lists participation in pain treatment decisions in its bill of rights.

> NTOCC’s consumer bill of rights for transitions of care (2011b) encourages consumers to participate in planning caretransitions and underscores respect for the culture, goals, needs, and strengths of each individual.

> CARF’s accreditation standards for person-centered long-term care communities (2010) emphasize self-determination andcultural competence as fundamental to care provision. Moreover, the standards require programs to “implement a writtenprocedure that…minimizes barriers to decision making by the persons served” (CARF, 2010, p. 155).

8) Written standards and process for beneficiary communication and access to medical records. NASW supports thiscriterion. The need for written standards and processes reflects the evolution of the Joint Commission’s standards for homecare (2011), which now require organizations to develop, put in writing, and adhere to processes related to care provisionand information management.

9) Internal processes for measuring clinical or service performance by physicians; using results to improve care and service.NASW supports inclusion of this criterion as a way to demonstrate patient-centeredness.

In addition to supporting CMS’s proposed criteria, NASW recommends adding a 10th criterion: Collaboration in care provision with family caregivers, as guided by the beneficiary Family caregivers–who include, but are not limited to, spouses, partners, significant others, family of origin, extended family,and friends (NASW, 2010)–play a critical role in supporting Medicare beneficiaries. Family caregivers provide physical,psychosocial, financial, and even medical support to people with disabilities and older adults. They also help beneficiariescommunicate with health care providers and navigate service delivery systems.

No health care system can be patient-centered without recognizing and supporting the family caregivers’ role in supportingpatients’ biopsychosocial health and well-being. Opportunities for family collaboration include participation in the assessmentprocess, care planning, service delivery and monitoring, and performance measurement (NASW, 2010). Identification offamily members and decision making regarding their involvement in care is the right of each competent beneficiary. If thebeneficiary is unable to identify whom she or he wants involved in care, the ACO should follow appropriate legal processes(for example, honoring the beneficiary’s choice of health care agent).

Lack of clarity regarding beneficiary assignment to ACOsThe proposed rule [§ 425.6 (c)] specifies that ACO participants must notify beneficiaries in writing that their ACOproviders/suppliers have chosen to participate in an ACO. Such notification should take place not only in writing but also inperson by ACO providers or staff.

NASW ACO Comment References

Agency for Healthcare Research andQuality. (2010). The roles of patient-centered medical homes and accountablecare organizations in coordinating patientcare (AHRQ Publication No. 11-M005-EF).Rockville, MD: Author.

Agency for Healthcare Research andQuality. (2011a). 2010 national healthcaredisparities report (AHRQ Publication No.11-0005). Retrieved fromwww.ahrq.gov/qual/qrdr10.htm

Agency for Healthcare Research andQuality (2011b). The patient-centeredmedical home: Strategies to put patients atthe center of primary care (AHRQPublication No. 11-0029). Rockville, MD:Author.

American Hospital Association. (2003). Thepatient care partnership: Understandingexpectations, rights and responsibilities.Retrieved from www.aha.org/aha/content/2003/pdf/pcp_english_030730.pdf

American Hospital Association. (2010).Social Workers Enhance Post-DischargeCare for Seniors. Retrieved fromwww.hpoe.org/PDFs/case%20study–rush.pdf

Camden Coalition of Healthcare Providers .(2011). Retrieved fromwww.camdenhealth.org/programs/care-management-program/

Centers for Disease Control and Prevention& Merck Company Foundation. The state ofaging and health in America 2007.Retrieved from www.cdc.gov/aging/pdf/saha_2007.pdf

Centers for Medicare & Medicaid Services.(2009). Medicare enrollment: Nationaltrends 1966–2009 [Table]. Retrieved fromwww.cms.gov/MedicareEnRpts/Downloads/HISMI2009.pdf

Centers for Medicare & Medicaid Services.(2009). Rural health clinic (RHC) andfederally qualified health center (FQHC)services (Rev. 114). In Medicare BenefitPolicy Manual. Retrieved fromwww.cms.gov/manuals/Downloads/bp102c13.pdf

Commission on the Accreditation ofRehabilitation Facilities. (2010). 2010aging services standards manual. Tucson,AZ: Author.

Commonwealth Fund. (2010). In Focus:Using Pharmacists, Social Workers, andNurses to Improve the Reach and Quality ofPrimary Care. Quality Matters. Retrievedfrom: www.commonwealthfund.org/Content/Newsletters/Quality-Matters/2010/August-September-2010/In-Focus.aspx

Counsell, S.R., Callahan, C.M., Clark,D.O., Wanzhu, T., Buttar, A.B., Stump, T.E.,& Ricketts, G.D. (2007). Geriatric caremanagement for low-income seniors: Arandomized controlled trial. JAMA 22,2623–2633.

Council on Social Work Education. (2008).2008 Educational policy and accreditationstandards. Retrieved fromwww.cswe.org/File.aspx?id=13780

Ell, K., Vourlekis, B., Lee, P.J., & Xie, B.(2007). Patient navigation and casemanagement following an abnormalmammogram: A randomized clinical trial.Preventive Medicine 44(1), 26–33.

Herman, C. (2009). Biopsychosocialchallenges related to transitions of care[Practice update]. Retrieved from NationalAssociation of Social Workers website,www.socialworkers.org/practice/aging/2009/Biopsychosocial%20Challenges%20Related%20to%20Transitions%20of%20Care.pdf

Institute of Medicine. (2008). Cancer carefor the whole patient: Meetingpsychosocial health needs. Retrievedfrom http://books.nap.edu/openbook.php?record_id=11993&page=R1



Need for safeguards to preserve beneficiary choice of providersThe proposed rule specifies that beneficiaries have the right to use health care providers who do not participate in the ACO.NASW encourages CMS to specify the processes by which beneficiaries may exercise this right and other protections topreserve beneficiary freedom of choice. In the absence of such protocol, we are concerned that ACOs–which, as noted inthe rule, must pay for all care provided to their beneficiaries–will enact barriers to external providers.

Thank you for your consideration of these comments. NASW looks forward to collaborating with you to make ACOssuccessful in achieving better care, better health, and lower costs for Medicare beneficiaries.

Sincerely,

Elizabeth J. Clark, PhD, ACSW, MPHExecutive Director

7) Beneficiary engagement and shared decision making that reflects beneficiaries’unique needs, preferences, values, and priorities. NASW affirms inclusion of thiscriterion of patient-centeredness. The aforementioned Consumer Bill of Rights andResponsibilities (President’s Advisory Commission on Consumer Protection andQuality in the Health Care Industry, 1998) devotes an entire chapter to consumerparticipation in treatment decisions. This topic is also emphasized in multiple otherpublications addressing consumer health care rights: > The American Hospital Association (2003) specifies involvement in care–includingdiscussion of medically appropriate treatment choices, treatment plan, consumergoals and values, and surrogate decision making–as one of six rights consumers canexpect to be met during hospitalization. > The National Hospice and Palliative Care Organization (2008) affirms patients’right to be involved in developing the plan of care and to decline care or treatment. > The National Pain Foundation (2011) lists participation in pain treatment decisions in its bill of rights.

> NTOCC’s consumer bill of rights for transitions of care (2011b) encourages consumers to participate in planning caretransitions and underscores respect for the culture, goals, needs, and strengths of each individual.

> CARF’s accreditation standards for person-centered long-term care communities (2010) emphasize self-determination andcultural competence as fundamental to care provision. Moreover, the standards require programs to “implement a writtenprocedure that…minimizes barriers to decision making by the persons served” (CARF, 2010, p. 155).

8) Written standards and process for beneficiary communication and access to medical records. NASW supports thiscriterion. The need for written standards and processes reflects the evolution of the Joint Commission’s standards for homecare (2011), which now require organizations to develop, put in writing, and adhere to processes related to care provisionand information management.

9) Internal processes for measuring clinical or service performance by physicians; using results to improve care and service.NASW supports inclusion of this criterion as a way to demonstrate patient-centeredness.

In addition to supporting CMS’s proposed criteria, NASW recommends adding a 10th criterion: Collaboration in care provision with family caregivers, as guided by the beneficiary Family caregivers–who include, but are not limited to, spouses, partners, significant others, family of origin, extended family,and friends (NASW, 2010)–play a critical role in supporting Medicare beneficiaries. Family caregivers provide physical,psychosocial, financial, and even medical support to people with disabilities and older adults. They also help beneficiariescommunicate with health care providers and navigate service delivery systems.

No health care system can be patient-centered without recognizing and supporting the family caregivers’ role in supportingpatients’ biopsychosocial health and well-being. Opportunities for family collaboration include participation in the assessmentprocess, care planning, service delivery and monitoring, and performance measurement (NASW, 2010). Identification offamily members and decision making regarding their involvement in care is the right of each competent beneficiary. If thebeneficiary is unable to identify whom she or he wants involved in care, the ACO should follow appropriate legal processes(for example, honoring the beneficiary’s choice of health care agent).

Lack of clarity regarding beneficiary assignment to ACOsThe proposed rule [§ 425.6 (c)] specifies that ACO participants must notify beneficiaries in writing that their ACOproviders/suppliers have chosen to participate in an ACO. Such notification should take place not only in writing but also inperson by ACO providers or staff.

NASW ACO Comment References

Agency for Healthcare Research andQuality. (2010). The roles of patient-centered medical homes and accountablecare organizations in coordinating patientcare (AHRQ Publication No. 11-M005-EF).Rockville, MD: Author.

Agency for Healthcare Research andQuality. (2011a). 2010 national healthcaredisparities report (AHRQ Publication No.11-0005). Retrieved fromwww.ahrq.gov/qual/qrdr10.htm

Agency for Healthcare Research andQuality (2011b). The patient-centeredmedical home: Strategies to put patients atthe center of primary care (AHRQPublication No. 11-0029). Rockville, MD:Author.

American Hospital Association. (2003). Thepatient care partnership: Understandingexpectations, rights and responsibilities.Retrieved from www.aha.org/aha/content/2003/pdf/pcp_english_030730.pdf

American Hospital Association. (2010).Social Workers Enhance Post-DischargeCare for Seniors. Retrieved fromwww.hpoe.org/PDFs/case%20study–rush.pdf

Camden Coalition of Healthcare Providers .(2011). Retrieved fromwww.camdenhealth.org/programs/care-management-program/

Centers for Disease Control and Prevention& Merck Company Foundation. The state ofaging and health in America 2007.Retrieved from www.cdc.gov/aging/pdf/saha_2007.pdf

Centers for Medicare & Medicaid Services.(2009). Medicare enrollment: Nationaltrends 1966–2009 [Table]. Retrieved fromwww.cms.gov/MedicareEnRpts/Downloads/HISMI2009.pdf

Centers for Medicare & Medicaid Services.(2009). Rural health clinic (RHC) andfederally qualified health center (FQHC)services (Rev. 114). In Medicare BenefitPolicy Manual. Retrieved fromwww.cms.gov/manuals/Downloads/bp102c13.pdf

Commission on the Accreditation ofRehabilitation Facilities. (2010). 2010aging services standards manual. Tucson,AZ: Author.

Commonwealth Fund. (2010). In Focus:Using Pharmacists, Social Workers, andNurses to Improve the Reach and Quality ofPrimary Care. Quality Matters. Retrievedfrom: www.commonwealthfund.org/Content/Newsletters/Quality-Matters/2010/August-September-2010/In-Focus.aspx

Counsell, S.R., Callahan, C.M., Clark,D.O., Wanzhu, T., Buttar, A.B., Stump, T.E.,& Ricketts, G.D. (2007). Geriatric caremanagement for low-income seniors: Arandomized controlled trial. JAMA 22,2623–2633.

Council on Social Work Education. (2008).2008 Educational policy and accreditationstandards. Retrieved fromwww.cswe.org/File.aspx?id=13780

Ell, K., Vourlekis, B., Lee, P.J., & Xie, B.(2007). Patient navigation and casemanagement following an abnormalmammogram: A randomized clinical trial.Preventive Medicine 44(1), 26–33.

Herman, C. (2009). Biopsychosocialchallenges related to transitions of care[Practice update]. Retrieved from NationalAssociation of Social Workers website,www.socialworkers.org/practice/aging/2009/Biopsychosocial%20Challenges%20Related%20to%20Transitions%20of%20Care.pdf

Institute of Medicine. (2008). Cancer carefor the whole patient: Meetingpsychosocial health needs. Retrievedfrom http://books.nap.edu/openbook.php?record_id=11993&page=R1



DEFINITION OF CLINCIAL SOCIAL WORKER IN RURALHEALTH CENTER AND FEDERALLY QUALIFIED HEALTH CENTER– MEDICARE PROGRAMS (Medicare Benefit Policy Manual –www.cms.gov/manuals/Downloads/bp102c13.pdf)

110.1 - Clinical Social Worker Defined (Rev. 1, 10-01-03)A clinical social worker is an individual who: Possesses amaster’s or doctor’s degree in social work; Has performed atleast two years of supervised clinical social work; and Either:Is licensed or certified as a clinical social worker by the Statein which the services are performed; or in the case of anindividual in a State that does not provide for licensure orcertification, has completed at least two years or 3,000hours of post master’s degree supervised clinical social workpractice under the supervision of a master’s level socialworker in an appropriate setting such as a hospital, SNF, orclinic.

110.2 - Clinical Social Worker Services DefinedClinical social worker services for the diagnosis andtreatment of mental illnesses and services and suppliesfurnished incident to such services are covered as long as theCSW is legally authorized to perform them under State law(or the State regulatory mechanism provided by State law) ofthe State in which such services are performed. The servicesthat are covered are those that are otherwise covered iffurnished by a physician or as an incident to a physician’sprofessional service. Services furnished to an inpatient oroutpatient that a hospital is required to provide as arequirement for participation are not included.

DEFINITION OF SOCIAL WORK IN INPATIENT PSYCHIATRICHOSPITAL SERVICES (Medicare Benefit Policy Manual –www.cms.gov/manuals/Downloads/bp102c02.pdf)

Chapter 2 - Inpatient Psychiatric Hospital Services; 60 -Social Services (Rev. 59, Issued: 11-09-06, Effective:01-01-05, Implementation: 12-04-06)There must be a director of social services who monitors andevaluates the quality and appropriateness of social servicesfurnished. The services must be furnished in accordance withaccepted standards of practice and established policies andprocedures, according to 42 CFR 412.27 and 42 CFR482.62.

1. The director of the social work department or service musthave a Master’s degree from an accredited school of socialwork or must be qualified by education and experience inthe social services needs of the mentally ill. If the directordoes not hold a Master’s degree in social work, at least onestaff member must have this qualification.

2. Social service staff responsibilities must include, but arenot limited to, participating in discharge planning, arrangingfor follow-up care, and developing mechanisms for exchangeof appropriate information with sources outside the hospital.

DEFINITION OF SOCIAL WORK – MEDICARE AND MEDICAIDPROGRAMS; CONDITIONS FOR COVERAGE FOR END-STAGERENAL DISEASE FACILITIES; FINAL RULE - APRIL 15, 2008www.cms.gov/cfcsandcops/downloads/esrdfinalrule0415.pdf

495.140 Personnel Qualifications (d) Standard: Socialworker. The facility must have a social worker who– (1)Holds a master’s degree in social work with a specializationin clinical practice from a school of social work accreditedby the Council on Social Work Education; or (2) Has servedat least 2 years as a social worker, 1 year of which was indialysis unit or transplantation program prior to September1, 1976, and has established a consultative relationship witha social worker who qualifies under § 494.140(d)(1). (CMS,2008, p. 114)

495.90 Patient Plan of Care – The outcomes specified in thepatient plan of care must be consistent with currentevidence-based professionally-accepted clinical practicestandards. “ (a) Development of Patient Plan; (6)Psychosocial Status – ‘‘The interdisciplinary team mustprovide the necessary monitoring and social workinterventions, including counseling and referrals for socialservices, to assist the patient in achieving and sustaining anappropriate psychosocial status as measured by astandardized mental and physical assessment tool chosenby the social worker, at regular intervals, or morefrequently on an as-needed basis.’’ (CMS, 2008, pp.111-112)


Institute of Medicine. (2011). The health oflesbian, gay, bisexual, and transgenderpeople: Building a foundation for betterunderstanding. Retrieved fromhttp://books.nap.edu/openbook.php?record_id=13128

Joint Commission. (2011). Joint Commissioncomprehensive accreditation manual forhome care. Oakbrook Terrace, IL: Author.

Kutner, M., Greenberg, E., Jin, Y., &Paulsen, C. (2006). The health literacy ofAmerica’s adults: Results from the 2003National Assessment of Adult Literacy(NCES 2006-483). Retrieved from U.S.Department of Education, National Centerfor Education Statistics website:http://nces.ed.gov/pubs2006/2006483.pdf

National Association of Social Workers.(2001). NASW standards for culturalcompetence in social work practice.Retrieved from www.socialworkers.org/practice/standards/NASWCulturalStandards.pdf

National Association of Social Workers.(2005). NASW standards for social workpractice in health care settings. Retrievedfrom www.socialworkers.org/practice/standards/NASWHealthCareStandards.pdf

National Association of Social Workers.(2007). Indicators for the achievement ofthe NASW standards for culturalcompetence in social work practice.Retrieved from www.socialworkers.org/practice/standards/NASWCulturalStandardsIndicators2006.pdf

National Association of Social Workers.(2008). Code of ethics of the NationalAssociation of Social Workers. Retrievedfrom www.socialworkers.org/pubs/code/code.asp

National Association of Social Workers(with Social Work Leadership Institute at theNew York Academy of Medicine). (2009).Social work and care coordination [Policybriefing paper]. Retrieved fromwww.socialworkers.org/advocacy/briefing/CareCoordinationBriefingPaper.pdf

National Association of Social Workers.(2010). NASW standards for social workpractice with family caregivers of olderadults. Retrieved fromwww.socialworkers.org/practice/standards/NASWFamilyCaregiverStandards.pdf

National Association of Social Workers.(n.d.-a). Information booklet withapplication and reference forms: CertifiedSocial Work Case Manager (C-SWCM)and Certified Advanced Social Work CaseManager (C-ASWCM). Retrieved fromhttp://preview.socialworkers.org/credentials/applications/c-aswcm.pdf

National Association of Social Workers.(n.d.-b). NASW HIV/AIDS Spectrum:Mental Health Training and Education ofSocial Workers Project. Retrieved fromwww.socialworkers.org/practice/hiv_aids/default.asp

National Hospice and Palliative CareOrganization. (2008). Hospice patient’srights. Retrieved from www.caringinfo.org/files/public/brochures/hospice_patient_rights.pdf

National Pain Foundation. (2011). Painpatient bill of rights. Retrieved fromwww.nationalpainfoundation.org/articles/295/patient-bill-of-rights

National Transitions of Care Coalition.(2008). Elements of excellence intransitions of care (TOC): TOC checklist.Retrieved from www.ntocc.org/Portals/0/TOC_Checklist.pdf

National Transitions of Care Coalition.(2010a). Cultural competence: Essentialingredient for successful transitions of care.Retrieved from www.ntocc.org/Portals/0/CulturalCompetence.pdf

National Transitions of Care Coalition.(2010b). Improving transitions of care withhealth information technology: Positionpaper of the health information technologywork group for the National Transitions ofCare Coalition. Retrieved fromwww.ntocc.org/Portals/0/HITPaper.pdf

National Transitions of Care Coalition.(2011a). Transitions of care compendium.Retrieved from www.ntocc.org/Toolbox/default.aspx

National Transitions of Care Coalition.(2011b). Your rights during transitions ofcare: A guide for health care consumersand family caregivers. Retrieved fromwww.ntocc.org/Home/Consumers/WWS_C_Tools.aspx

President’s Advisory Commission onConsumer Protection and Quality in theHealth Care Industry. (1998). Quality first:Better health care for all Americans.Retrieved from www.hcqualitycommission.gov/final/

Social Work Policy Institute. (2010).Comparative effectiveness research andsocial work research: Strengthening theconnection. Retrieved fromwww.socialworkpolicy.org/wp-content/uploads/2010/03/SWPI-CER-Full-RPT-FINAL.pdf.

Substance Abuse and Mental HealthServices Administration, Center for MentalHealth Services. (2010). Mental health,United States, 2008 (HHS Publication No.(SMA) 10-4590). Rockville, MD: Author.

U.S. Department of Health & HumanServices, Office of Minority Health. (2007).National standards on culturally andlinguistically appropriate services (CLAS).Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15

7 > EXAMPLES OF FEDERAL DEFINITIONS OF SOCIAL WORK INCENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) PROGRAMS


Congressional Social Work Caucus*

Rep. Karen R. Bass (D-CA33)Rep. Shelley Berkley (D-NV1)Rep. Sanford D. Bishop Jr. (D-GA2)Rep. Corrine Brown (D-FL3) Rep. G.K. Butterfield, Jr. (D-NC1)Rep. Andre Carson (D-IN07)Rep. Dennis Cardoza (D-CA18)Rep. Donna Christensen (D-VI)Rep. Hansen Clarke (D-MI13) Rep. Yvette D. Clarke (D-NY11)Rep. Wm. Lacy Clay (D-MO1)Rep. Emanuel Cleaver, II (D-MO5)Rep. Steve Cohen (D-TN9)Rep. Gerald “Gerry” Connolly (D-VA11)Rep. John Conyers (D-MI14)Rep. Elijah E. Cummings (D-MD7)Rep. Danny K. Davis (D-IL7)Rep. Susan A. Davis (D-CA53)Rep. Rosa L. DeLauro (D-CT3) Rep. Lloyd Doggett (D-TX25)Rep. Keith Ellison (D-MN5)Rep. Bob Filner (D-CA51)Rep. Marcia L. Fudge (D-OH11)Rep. Raúl M. Grijalva (D-AZ7)Rep. Luis V. Gutierrez (D-IL4) Rep. Alcee Hastings (D-FL23)Rep. Mazie K. Hironio (D-HI02)Rep. Rush Holt (D-NJ12)

Rep. Michael Honda (D-CA15) Rep. Darrell Issa (R-CA49)Rep. Jesse Jackson, Jr. (D-IL2)Rep. Sheila Jackson Lee (DTX18) Rep. Barbara Lee (D-CA9)Rep. John Lewis (D-GA5)Rep. Dave Loebsack (D-IA2)Rep. Gregory W. Meeks (D-NY6)Rep. Betty McCollum (D-MN4)Rep. Jerrold Nadler (D-NY8)Rep. Donald M. Payne (D-NJ10)Rep. Todd Russell Platts (R-PA19)Rep. Jared Polis (D-CO2)Rep. Nick J. Rahall, II (D-WV3)Rep. Charles B. Rangel (D-NY15)Rep. Laura Richardson (D-CA37) Rep. Bobby L. Rush (D-IL1) Rep. Linda T. Sanchez (D-CA39) Rep. Loretta Sanchez (D-CA47)Rep. Allyson Y. Schwartz (D-PA13)Rep. Robert C. “Bobby” Scott (D-VA3)Rep. José E. Serrano (D-NY16) Rep. Fortney Pete Stark (D-CA13) Rep. Paul D. Tonko (D-NY21) Rep. Niki Tsongas (D-MA5) Rep. Maxine Waters (D-CA35) Rep. Mel L. Watt (D-NC12)Rep. Henry A. Waxman (D-CA30) Rep. John Yarmuth (D-KY3)

*As of September 2011


DEFINITION OF SOCIAL WORK - CENTERS FOR MEDICAREAND MEDICAID SERVICES (CMS): HOSPICE CONDITIONS OFPARTICIPATION

418.114 (b) standard: personnel qualifications for certaindisciplines: 3. Social worker. A person who–(i) (A) Has a Master ofSocial Work (MSW) degree from a school of social workaccredited by the Council on Social Work Education andone year of social work experience in a health care setting;or (B) Has a baccalaureate degree in social work from aninstitution accredited by the Council on Social WorkEducation; or a baccalaureate degree in psychology,sociology, or other field related to social work and issupervised by an MSW as described in paragraph(b)(3)(i)(A) of this section; and (ii) Has one year of socialwork experience in a health care setting; or (iii) Has abaccalaureate degree from a school of social workaccredited by the Council on Social Work Education, isemployed by the hospice before December 2, 2008, and isnot required to be supervised by an MSW” (CMS, 2009,p.32218).

DEFINITION OF SOCIAL WORK - CENTERS FOR MEDICAREAND MEDICAID SERVICES (CMS): LONG TERM CARECONDITIONS OF PARTICIPATION

483.15 Quality of life. (g) Social Services. The facility mustprovide medically-related social services to attain or maintainthe highest practicable physical, mental, and psychosocialwell-being of each resident. A facility with more than 120beds must employ a qualified social worker on a full-timebasis.

Qualifications of social worker. A qualified social worker isan individual with–(i) A bachelor’s degree in social work or a bachelor’s degreein a human services field including but not limited tosociology, special education, rehabilitation counseling, andpsychology; and (ii) One year of supervised social work experience in ahealth care setting working directly with individuals.

DEFINITION OF SOCIAL WORK - CENTERS FOR MEDICAREAND MEDICAID SERVICES (CMS): HOME HEALTH AGENCIESCONDITIONS OF PARTICIPATION

484.4 Personnel Qualifications Social work assistant. A person who: (1) Has abaccalaureate degree in social work, psychology, sociology,or other field related to social work, and has had at least 1year of social work experience in a health care setting; or (2)Has 2 years of appropriate experience as a social workassistant, and has achieved a satisfactory grade on aproficiency examination conducted, approved, or sponsoredby the U.S. Public Health Service, except that thesedeterminations of proficiency do not apply with respect topersons initially licensed by a State or seeking initialqualification as a social work assistant after December 31,1977.Social worker. A person who has a master’s degree from aschool of social work accredited by the Council on SocialWork Education, and has 1 year of social work experiencein a health care setting.

484.34 Medical Social Services – If the agency furnishesmedical social services, those services are given by aqualified social worker or by a qualified social workassistant under the supervision of a qualified social worker,and in accordance with the plan of care. The social workerassists the physician and other team members inunderstanding the significant social and emotional factorsrelated to the health problems, participates in thedevelopment of the plan of care, prepares clinical andprogress notes, works with the family, uses appropriatecommunity resources, participates in discharge planning andin-service programs, and acts as a consultant to other agencypersonnel.

8 > CONGRESSIONAL SOCIAL WORK CAUCUS


Core Principles

1. There is a growing need for adifferent kind of professionalcompetence in addition to specializedskills in a profession or discipline.The need arises from three primesources: (1) desire to serve “the wholechild” in a family in a community, (2)statistical indicators on the conditionof children that show that children facechallenges requiring human serviceprofessionals to move beyond theprovision of categorical services and todeal preventively and promotively withchildren and families, and (3) newabilities to track and thereforedocument that a single high-risk familymay be served by several agencieswhich do not communicate well witheach other.

2. Disciplines are the base forinterprofessional work.Service settings, academic settings, anddisciplines each have unique cultures,ways of organizing knowledge, andways of setting priorities that shapeactivities. Professionals workingwith children and families shouldacquire knowledge within specificdisciplines. Replacing disciplines with apurely generalist outlook on practicewill not be as effective as buildingbetter bridges among disciplines so thatthey can reinforce and support eachother in meeting clients’ needs.

3. Community perceptions of needs andstrengths and of avenues for earlyintervention, should guide serviceprofessionals. They can then work withcommunity members to help shaperealistic shared expectations andoutcomes. Systems and workers shouldidentify assets in both clients andcommunities and take a preventativeapproach to planning and providingservices. This moves away from acrisis-oriented deficit orientation thatfocuses on identification of specificproblems and service programs basedon categorical funding streams. Thisorientation does not respond holisticallyto the needs of children and familiestoward a system that promotesearly-interventive, holistic approachesto child, family, and communitywell-being.

4. Professionals should be trained towork with parents as equals and tounderstand the contributions they canand must make as service planners,evaluators, designers, advisors, and asthe primary providers of key supportsand services for their children. Parentsplay a critical role as non-professionalpartners in service and empowerment.Working collaboratively with familymembers may require professionals towear multiple hats, and adjust toambiguity and shifting roles.

5. All members of a team demonstratecultural competence and community-based competence.They often learn these from non- andpara-professional members of a team.

6. In the new arena of interprofessionaleducation, relations across education,health, human services, and a widevariety of other disciplines are assumedto be genuinely co-equal.There is no presumptive academichome, nor host discipline, norintegrating base for services.Professions share equal interest inhelping children and families. Noprofession holds a monopoly on thatcommitment.

7. Interprofessional practice skills are acomposite of team-building, casemanagement, conflict resolution,self-reflection, outcome measurement,organizational behavior, andinterorganizational structures.To these skills might be added theconcepts of understanding powerrelationships within differentmetropolitan and rural communities,urban geographic and demographicimpacts on service systems, the ethics ofservice provision and client choice,theories of leadership, andknowledge management in aninformation society.


The Components of the Dorothy I. Height and Whitney M.Young, Jr. Social Work Reinvestment Act include:Social Work Reinvestment Commission: Addressing theFuture of the Profession

A Social Work Reinvestment Commission is established toprovide a comprehensive analysis of current trends within theacademic and professional social work communities.Specifically, the Commission will develop long-termrecommendations and strategies to maximize the ability ofAmerica’s social workers to serve individuals, families, andcommunities with expertise and care. The recommendationswill be presented to Congress and the Executive Branch.

Areas of Focus: Fair market compensation, high social workeducational debt, social work workforce trends, translatingsocial work research to practice, social work safety, the lackof diversity in the social work profession, and state levelsocial work licensure (as it implicates social work serviceacross state lines) and the impact these issues have on theareas of aging, child welfare, military and veterans affairs,mental and behavioral health and disability, criminal justiceand correctional systems, health and issues affecting womenand families.

Reinvestment Demonstration Programs: Addressing TheCurrent State of the Profession of Social WorkDemonstration programs will address relevant, “on theground” realities experienced by our nation’s professionalsocial workers. These competitive grant programs willprioritize activities in the areas of workplace improvements,research, education and training, and community basedprograms of excellence. This component of the legislationsupports efforts underway within both the private and publicsectors, in the post doctoral research community, at our

nation’s institutions of higher learning, and withinorganizations already administering effective social workservices to millions of people. This investment will bereturned many times over both in support of ongoing effortsto establish the most effective social work solutions and indirect service to the growing numbers of individuals, families,and communities in need.

Types of Programs Authorized by the Act:Workplace Improvements – Four grants will be awarded toaddress high caseloads, fair market compensation, socialwork safety, supervision, and working conditions.

Research – Twenty-five grants will be awarded to socialworkers for post doctoral research activity to further theknowledge base of effective social work interventions and topromote usable strategies to translate research into practiceacross diverse community settings and service systems. Atleast ten of these grants will be awarded to granteesemployed by historically black colleges or universities orminority serving institutions.

Education and Training – Twenty grants are made availableto institutions of higher education to support recruitment andeducation of social work students from high need and highdemand areas at the Baccalaureate, Master’s and Doctorallevels as well as the development of faculty. At least four ofthese grants will be awarded to historically black collegesand universities or minority serving institutions.

Community Based Programs of Excellence – Six grants aremade available to not-for-profit or public community basedprograms of excellence to further test and replicate effectivesocial work interventions from the areas of aging, childwelfare, military and veteran’s issues, mental and behavioralhealth and disability, criminal justice and correctionalsystems, health and issues affecting women and families.

National Coordinating Center – One component of thedemonstration programs will be a coordinating center whichwill work with universities, research entities, and social workpractice settings to identify key research areas to be pursued,select fellows, and organize appropriate mentorship andprofessional development efforts.

9 > DOROTHY I. HEIGHT AND WHITNEYM. YOUNG, JR. SOCIAL WORKREINVESTMENT ACT–112TH CONGRESS

1 0 > PRINCIPLES OF INTERPROFESSIONAL EDUCATION

Excerpted from Myths & Opportunities: An Examination of the Impact of Discipline – Specific Accreditation onInterprofessional Education – Executive Summary, a collaborative project carried out by the Council on SocialWork Education (1999), University of Southern California and California State University – Fullerton and funded by the Annie E. Casey Foundation.


8. A “reality test” for interprofessionaleducation is its capacity and credibilityin providing useful assistance to localservice providers, coalitions, andcommunity-based organizations.Multidisciplinary work often takes placeat the level of the “natural community”–an elementary school, parish, ethnicneighborhood, or park district, in abase that is sometimes geographic,ethnic, linguistic, vocational, orfamily-defined. Professionals need towork with all these kinds ofcommunities from a multidisciplinary

perspective, rather than bring a singleskill to a community requiringintegrated support.

9. Interprofessional education is mostsuccessful when it is integrated earlyin the socialization and educationalexperience of diverse professionals.Adding new courses and seminars willbe less effective than re-orientingexisting curricula to broader themes ofcollaboration. If interprofessionaleducation is merely additive, itreproduces the same syndromes that

fragment the services system, as weadd new programs on top of old ones,instead of rationalizing the system. Ifinterprofessional strategies are onlylearned in the workplace, suchretraining is time consuming anddifficult. Interprofessional educationmust be infused throughout thecurriculum, instead of becoming a new,marginal discipline with its ownrestrictive boundaries and, eventually,professional barriers. This infusedlearning can and should build on thebest of our disciplinary traditions.

4 7

Wider Circle of TenetsMany believe these should underpininterprofessional education.

1. Central to client and communitywell-being is a recognition that publicpolicy issues related to children,families, and communities are beyondthe scope of any single profession’sjurisdiction and responsibility. Workers and community members needto understand how they are part ofpublic policy and how they can beinvolved to change the status quo inwhich one-third of children and familiesface serious hardships. Ideally,generation and interpretation of publicpolicy are shared by all members of theteam.

2. Results-based accountability–thedevelopment and use of outcomes todetermine funding–is the only wayhuman services can reclaim credibilityand re-emphasize client-centeredpractice over agency-centered practice. This includes an emphasis uponprograms’ effectiveness and anemphasis upon new methods ofevaluating programs (Connell, Kubisch,Schorr, & Weiss, 1995).

3. Cultural competence should not berestricted to being one of a desiredgroup of competencies and be set outas an organizing principle.Design, delivery, and evaluation ofprograms requires respect for ethnicand linguistic identity; reduction ofmarginalization, invisibility, anddevaluation that occurs for certaincultures, groups, or communitiesperceived as “different”; engagementof diverse community perspectives at alllevels of decision making; and thepractice of cultural democracy, whichimplies an active effort to assure equalstanding for people from all cultures.

4. Decategorized funding strategies,which seed greater flexibility at thecommunity level, should meet the test ofresponsiveness to the client’s full rangeof needs, emphasize the capacity offrontline teams, and legitimizecommunity planning processes.Clarification of common assumptionsabout funding is needed. Suchflexibility at the community level is abetter way of allocating resources thancategorical decisions made inlegislatures far from clients.

5. Higher education needs a reformagenda based upon the needs ofchildren and families (Hooper-Briar & Lawson, 1996; Lawson &Hooper-Briar, 1994).Faculty must be supported andprovided with new incentives todevelop programs of interprofessionaleducation, because these are some ofthe best ways of connecting theuniversity in more significant ways withthe community. Higher educationshould make greater efforts to traincommunity members to be theprofessionals for the future, identifyingyouth and community volunteers forearly training and developing

appropriate career paths with cleararticulation between communitycolleges, four-year institutions, andgraduate programs.

6. The rights and responsibilities of the clients–children and families–arefundamental and ethical issues in thepreparation of professionals.Thus ethics should be included as oneof the disciplines needed forinterprofessional practice with childrenand families.

7. Field-based education (includinginternships and clinical placements incommunity settings) is a corecomponent of interprofessionaleducation.Bringing pre-professionals together inteams in their early encounters withpractice provides critically neededexposure to the realities ofinterprofessional work. Such field workmust be supervised by faculty whounderstand how professions can worktogether and who themselves have hadsuch experience. Practitioners may alsoact as supervisors for such professionals,as they may be more deeply involvedin new forms of collaborative practicethan some faculty less familiar withcurrent forms of integrated practice.Such practitioners are assets for theuniversity and should be treated as theequals of faculty in supervising fieldwork, regardless of their disciplinarybackgrounds. Field-based educationalso raises issues of how communitymembers are treated in a universitysetting. When community members are‘partners’ in a developmental processrather than ‘clients’ in an agency,professionals are often unprepared fornew demands and behaviors.


Authors of the full report are: Zlotnik, J.L., McCroskey, J., Gardner, S., Gil de Gibaja, M., Taylor, H., George, J., Lind, J.,Jordan-Marsh, M., Costa, V., & Taylor-Dinwiddie, S.


8. A “reality test” for interprofessionaleducation is its capacity and credibilityin providing useful assistance to localservice providers, coalitions, andcommunity-based organizations.Multidisciplinary work often takes placeat the level of the “natural community”–an elementary school, parish, ethnicneighborhood, or park district, in abase that is sometimes geographic,ethnic, linguistic, vocational, orfamily-defined. Professionals need towork with all these kinds ofcommunities from a multidisciplinary

perspective, rather than bring a singleskill to a community requiringintegrated support.

9. Interprofessional education is mostsuccessful when it is integrated earlyin the socialization and educationalexperience of diverse professionals.Adding new courses and seminars willbe less effective than re-orientingexisting curricula to broader themes ofcollaboration. If interprofessionaleducation is merely additive, itreproduces the same syndromes that

fragment the services system, as weadd new programs on top of old ones,instead of rationalizing the system. Ifinterprofessional strategies are onlylearned in the workplace, suchretraining is time consuming anddifficult. Interprofessional educationmust be infused throughout thecurriculum, instead of becoming a new,marginal discipline with its ownrestrictive boundaries and, eventually,professional barriers. This infusedlearning can and should build on thebest of our disciplinary traditions.

Wider Circle of TenetsMany believe these should underpininterprofessional education.

1. Central to client and communitywell-being is a recognition that publicpolicy issues related to children,families, and communities are beyondthe scope of any single profession’sjurisdiction and responsibility. Workers and community members needto understand how they are part ofpublic policy and how they can beinvolved to change the status quo inwhich one-third of children and familiesface serious hardships. Ideally,generation and interpretation of publicpolicy are shared by all members of theteam.

2. Results-based accountability–thedevelopment and use of outcomes todetermine funding–is the only wayhuman services can reclaim credibilityand re-emphasize client-centeredpractice over agency-centered practice. This includes an emphasis uponprograms’ effectiveness and anemphasis upon new methods ofevaluating programs (Connell, Kubisch,Schorr, & Weiss, 1995).

3. Cultural competence should not berestricted to being one of a desiredgroup of competencies and be set outas an organizing principle.Design, delivery, and evaluation ofprograms requires respect for ethnicand linguistic identity; reduction ofmarginalization, invisibility, anddevaluation that occurs for certaincultures, groups, or communitiesperceived as “different”; engagementof diverse community perspectives at alllevels of decision making; and thepractice of cultural democracy, whichimplies an active effort to assure equalstanding for people from all cultures.

4. Decategorized funding strategies,which seed greater flexibility at thecommunity level, should meet the test ofresponsiveness to the client’s full rangeof needs, emphasize the capacity offrontline teams, and legitimizecommunity planning processes.Clarification of common assumptionsabout funding is needed. Suchflexibility at the community level is abetter way of allocating resources thancategorical decisions made inlegislatures far from clients.

5. Higher education needs a reformagenda based upon the needs ofchildren and families (Hooper-Briar & Lawson, 1996; Lawson &Hooper-Briar, 1994).Faculty must be supported andprovided with new incentives todevelop programs of interprofessionaleducation, because these are some ofthe best ways of connecting theuniversity in more significant ways withthe community. Higher educationshould make greater efforts to traincommunity members to be theprofessionals for the future, identifyingyouth and community volunteers forearly training and developing

appropriate career paths with cleararticulation between communitycolleges, four-year institutions, andgraduate programs.

6. The rights and responsibilities of the clients–children and families–arefundamental and ethical issues in thepreparation of professionals.Thus ethics should be included as oneof the disciplines needed forinterprofessional practice with childrenand families.

7. Field-based education (includinginternships and clinical placements incommunity settings) is a corecomponent of interprofessionaleducation.Bringing pre-professionals together inteams in their early encounters withpractice provides critically neededexposure to the realities ofinterprofessional work. Such field workmust be supervised by faculty whounderstand how professions can worktogether and who themselves have hadsuch experience. Practitioners may alsoact as supervisors for such professionals,as they may be more deeply involvedin new forms of collaborative practicethan some faculty less familiar withcurrent forms of integrated practice.Such practitioners are assets for theuniversity and should be treated as theequals of faculty in supervising fieldwork, regardless of their disciplinarybackgrounds. Field-based educationalso raises issues of how communitymembers are treated in a universitysetting. When community members are‘partners’ in a developmental processrather than ‘clients’ in an agency,professionals are often unprepared fornew demands and behaviors.


Authors of the full report are: Zlotnik, J.L., McCroskey, J., Gardner, S., Gil de Gibaja, M., Taylor, H., George, J., Lind, J.,Jordan-Marsh, M., Costa, V., & Taylor-Dinwiddie, S.


D. RESOURCES ON SOCIAL WORK EFFECTIVENESS ANDSOCIAL WORK IMPACT ON SERVICE DELIVERY OUTCOMESResearch finds that a social work degree coupled withspecialized preparation in a field of practice can result inimproved client outcomes, worker retention, greater sense ofself-efficacy, a decrease in the amount of requiredpre-service and in-service training, enhanced culturalcompetency, commitment to ethical practice and aperson-in-environment orientation.

Los Angeles Conference on Intervention Research in SocialWork - A special issue of Research on Social WorkPractice (Vol. 20, issue 5) is devoted to exploringresearch on social work interventions for youth at risk,individuals experiencing mental illness and their families,persons involved with the criminal justice system andclinic patients experiencing depression and other healthconditions. The articles address methodologicalchallenges and research designs as well as the currentstate of social work intervention research, with studiesaddressing the needs of persons from diverse cultures.The articles are drawn from the proceedings of the LosAngeles Conference on Intervention Research in SocialWork, organized by the University of Southern CaliforniaSchool of Social Work and the Institute for theAdvancement of Social Work Research (IASWR) inOctober 2009.

Outcomes of Social Work Intervention in the Context ofEvidence-Based Practice – an article by Edward Mullenand Joseph Shuluk, Journal of Social Work, 11(1): 49-63is adapted from a November 2009 presentation byMullen, What is known from research about theeffectiveness of social work interventions, that waspresented at “Social Work Research and ComparativeEffectiveness Research (CER): A Research Symposium toStrengthen the Connection” sponsored by the NASWSocial Work Policy Institute (www.socialworkpolicy.org/news-events/social-work-research-and-comparative-effectiveness-research-cer-a-research-symposium-to-strengthen-the-connection.html). According to the synthesis of researchreviews there is a large body of evidence supporting theeffectiveness of a wide range of social work interventions.

Evidence Database in Aging Care (EDAC) – New YorkAcademy of Medicine (funded by Atlantic Philanthropies).EDAC is a database designed to provide evidence onsocial work outcomes, www.searchedac.org/index.php.

Factors Influencing Retention of Child Welfare Staff: ASystematic Review of Research, a systematic review ofresearch from the 1970s through 2004 by Zlotnik,DePanfilis, Daining and McDermott-Lane, available fromwww.socialworkpolicy.org/publications/iaswr-publications/iaswr-child-welfare-workforce-initiative.html.

The Relationship between Staff Turnover, Child WelfareSystem Functioning and Recent Child Abuse, by theNational Council on Crime and Delinquency, February2006 compares high turnover and low turnover countiesin California and finds that low rates of re-abuse relate tolow turnover, better staff pay and compliance withrecognized practice standards. www.cornerstones4kids.org/images/nccd_relationships_306.pdf.

Studies of the Cost-Effectiveness of Social Work Services inAging: A Review of the Literature by Rizzo and Rowe(Research on Social Work Practice, 2006, Vol. 16;167-73) finds that the aging of the population creates anincreased demand for social work services and thatreimbursement structures for Medicare and Medicaidpresent significant barriers. The literature review finds thatsocial work interventions can have a positive impact onhealth care costs, the use of health care services and thequality of life of older Americans.

The Effects of the ARC Organizational Intervention onCaseworker Turnover, Climate, and Culture in Children’sService Systems by Glisson, Dukes and Green (ChildAbuse & Neglect, 2006, 855-880) examines the effectsof the Availability, Responsiveness, and Continuity (ARC)organizational intervention strategy on caseworkerturnover, climate, and culture in child welfare and juvenilejustice agencies. The results of a randomized controlleddesign finds that organizational intervention strategiescan be used to reduce staff turnover and improveorganizational climates in urban and rural systems. This isimportant because child welfare and juvenile justicesystems in the U.S.A. are plagued by high turnover rates,and there is evidence that high staff turnover and poororganizational climates negatively affect service qualityand outcomes in these systems.


A. SOCIAL WORK RESOURCES ON HEALTH CARE REFORMImplications of Health Care Reform on the Social Work ProfessionCongressional Briefing, February 16, 2011;www.socialworkreinvestment.org/2011/briefing.html

Social Workers and Healthcare Reform – Legal DefenseFund Legal Issue of the Month, April 2011www.socialworkers.org/ldf/legal_issue/2011/042011.asp

CSWE Guide to Patient Protection and Affordable Care ActProvisions relating to social work that were included in the Patient Protection and Affordable Care Act of 2010 www.cswe.org/File.aspx?id=48334

B. COUNCIL ON ACCREDITATION (COA) STANDARDSGLOSSARY DESCRIPTION OF SOCIAL WORK

COA STANDARDS GLOSSARYwww.coastandards.org/glossary.php#gs

SOCIAL SERVICE MODEL: Organizationally based practicethat seeks to enhance personal and social functioning,based on the theory and techniques of social work andclosely related professions. Five elements are generallypresent in an organization adopting the social servicemodel: personnel who have been professionally trained insocial work; professional supervision; accountability tothe community; consumer participation in decisions aboutservices provided on their behalf; and use of a holisticapproach that recognizes the interaction of social/environmental and psychodynamic/psychological factors.

SOCIAL SERVICES: Activities that enable individuals,families, and groups to cope with social andpsychological problems interfering with their functioning.

SOCIAL WORK: Professionally responsible interventionscarried out by persons with formal, professionaleducation at the BSW or MSW level from an accreditedschool of social work and appropriate licensing,certification, and registration credentials. Interventions aredirected toward improving the transactions betweenpeople and environments to enhance the adaptivecapacities of the participants and improve environmentsfor all that function within them. Social work is aprofessional practice with a consumer group consisting ofindividuals, families, small groups, organizations,neighborhoods, and communities and involving thedisciplined application of knowledge and skill.

C. CASE MANAGEMENT SOCIETY OF AMERICA STANDARDS QUALIFICATIONS FOR CASE MANAGERSwww.cmsa.org/Individual/MemberToolkit/StandardsofPractice/tabid/69/Default.aspxCase managers should maintain competence in their area(s)of practice by having one of the following:Current, active, and unrestricted licensure or certification in ahealth or human services discipline that allows theprofessional to conduct an assessment independently aspermitted within the scope of practice of the discipline;and/or b) Baccalaureate or graduate degree in social work,nursing, or another health or human services field thatpromotes the physical, psychosocial, and/or vocationalwell-being of the persons being served. The degree must befrom an institution that is fully accredited by a nationallyrecognized educational accreditation organization, and theindividual must have completed a supervised fieldexperience in case management, health, or behavioralhealth as part of the degree requirements.

1 1 > ADDITIONAL RESOURCES


The Annapolis Coalition – dedicated to improving therecruitment, retention, training and performance of theprevention and treatment workforce in the mental health and addictions sectors of the behavioral health field -www.annapoliscoalition.org/aboutus.aspx.

John A. Hartford Foundation – funded Geriatric Social Work Initiative – is a multi-faceted, multi-year effort to buildaging capacity in social work including field placements,curriculum building, competency development andstrengthened leadership and agency/school partnerships.See the initiative website for more information –www.gswi.org.

NASW Data Show Behavioral Health Social Workers Earn $50,000 –www.socialworkblog.org/featured-articles/2011/04/survey-finds-behavioral-health-professionals-earn-less-than-fast-food-workers/

REPORTSThe Unsolved Challenge of System Reform: The Condition ofthe Frontline Human Services Workforce, Annie E. CaseyFoundation, 2003; www.cornerstones4kids.org/images/the_unsolved_challenge.pdf.

Assuring the Sufficiency of the Front-Line Workforce: ANational Study of Licensed Social Workershttp://workforce.socialworkers.org/studies/nasw_06_execsummary.pdf.

Strengthening the Child Welfare Workforce: PromotingRecruitment and Retention (Special Issue) of the Journal ChildWelfare (2009, vol. 88, 5) edited by Anderson and Zlotnik.

Cancer Care for the Whole Patient: Meeting PsychosocialHealth Needs, Institute of Medicine, 2008.

Retooling for an Aging America: Building the Health CareWorkforce, Institute of Medicine, 2008.


Collaborative Care Management of Major DepressionAmong Low-Income, Predominantly Hispanic SubjectsWith Diabetes by Ell, Katon, Xie, Lee, Kapetanovic,Guterman and Chou, published in Diabetes Care (2010,33;706–713). The results from a randomized controlledtrial that tested an evidence-based, socioculturallyadapted collaborative depression (telephone support andoutreach, systems navigation and assistance, problemsolving therapy and medication) and diabetes caremodels for low-income Hispanic subjects found that thosereceiving the enhanced treatment had significantly greaterimprovement in depression and decreased diabetescomplications.

Enhanced Discharge Planning Program (EDPP) is afollow-up intervention tested in a randomized study atChicago’s Rush University Medical Center’s Older AdultPrograms and Case Management Department. Theeffective program has social workers phone patients andcaregivers after discharge to ensure they are receiving theservices detailed in their discharge plan and toinvestigate any unanticipated needs. If necessary, socialworkers intervene to help patients resolve problems andconnect patients and caregivers to health care providersand community-based services. This program has beenhighlighted in numerous publications including the AARPBulletin Today in September 2009,http://bulletin.aarp.org/yourhealth/medicare/articles/transition_care.html.

Project SAFe (Screening Adherence Follow-Up Program)developed by social work researcher Kathleen Ell(University of Southern California) and a team ofresearchers including project co-director Betsy Vourlekis,is a social work model that provides a system of patient

navigation counseling and case management designed tohelp low-income, ethnic-minority women overcomebarriers to timely breast cancer screening and follow-upafter receiving an abnormal mammogram. The serviceinvolves a structured interactive telephone assessment ofscreening-adherence risk (i.e., barriers), healthcounseling, and follow-up services, including patienttracking, appointment reminders, and referral tocommunity resources. It can be found on theResearch-tested Intervention Programs (RTIPs) websitehttp://rtips.cancer.gov/rtips/agreement.do;jsessionid=9B10034A6C72E2734469D8538CE1FE5D.

Using Pharmacists, Social Workers, and Nurses toImprove the Reach and Quality of Primary Care -Commonwealth Fund Quality Matters, August/September2010. Studies of interdisciplinary health care teams havedemonstrated that use of these teams can lead toimprovements in the quality of primary care, but theirimpact on total health care costs and utilization has notyet received sufficient attention. Still, available evidencesuggests that these teams may help expand the nation’scapacity to provide primary care services, which is muchneeded due to a shortage of physicians and otherprimary care providers. But doing so quickly will requirethe financial support of federal, state, and private payers,as well as an investment of time by health care providers.www.commonwealthfund.org/Content/Newsletters/Quality-Matters/2010/August-September-2010.aspx.

E. USEFUL WORKFORCE RESOURCE LINKS AND REPORTS RESOURCE LINKS

NASW Center for Workforce Studies –http://workforce.socialworkers.org.(See more detailed information on Center resources below)Social Work Reinvestment Initiative – provides information onfederal and state strategies to strengthen and support thesocial work workforce - www.socialworkreinvestment.org/

Cornerstones for Kids – A website for the Annie E. CaseyFoundation’s Human Services Workforce Initiative –www.cornerstones4kids.org/

National Child Welfare Workforce Institute – A service of the U.S. Children’s Bureau – www.ncwwi.org.


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