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    Barbara Lee’s Bill Expands the Role of Social Workers in Medicare

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    Barb-Lee

    Congresswoman Barbara Lee (D-CA-13), chair of the Congressional Social Work Caucus, introduced a bill last week addressing several critical issues confronting clinical social workers providing mental health services to Medicare recipients. The Improve Medicare Beneficiaries’ Access to Mental Health Services Act of 2015, if it becomes law, would add clinical social workers to qualified service providers for Medicare recipients in skilled nursing facilities. It would increase the Medicare reimbursement rate for clinical social workers from its current rate of 75 percent to 85 percent. And, it would also allow clinical social workers to be reimbursed for Health and Behavior Assessment and Intervention (HBAI) services that may not be directly related to mental health treatment. Senator Debbie Stabenow, one of two social workers serving in the Senate, introduced a companion bill.

    The National Association for Social Workers (NASW) has been working to remove these regulatory barriers that have limited Medicare recipients’ access to quality services provided by clinical social workers—the nation’s largest group of mental health service providers. There are about a quarter million licensed clinical social workers in the United States. Rep. Lee’s bill addresses the three areas of concern by amending language in Title 18 of the Social Security Act. According to NASW, in order to be certified as a Medicare provider, a social worker must have a Master in Social Work (MSW) degree or doctorate from an accredited school of social work and two years or 3,000 hours of supervised post-graduate clinical experience. She or he must have a clinical license or certification from the state of practice, must obtain a National Provider Identifier Number, and have malpractice insurance.

    The Clinical Social Work Association (CSWA) points out that participation in Medicare can be confusing for clinical social workers. Once CSWs sign up as Medicare providers they must accept all referrals unless they “opt out” which would allow them to privately contract with Medicare beneficiaries. According to the CSWA, the “opt out” period is generally for two years. There are a number of reasons CSWs may decide to “opt out” of being a Medicare Provider. One reason is the Medicare reimbursement rate for CSWs is just 75 percent that of psychiatrists and psychologists. Increasing the rate to 85 percent, increases the likelihood more clinical social workers will participate in Medicare.

    Currently clinical social workers are reimbursed through Medicaid Part B and cannot be reimbursed for services provided to beneficiaries in skilled nursing facilities (SNF) under Medicaid Part A. This limits Medicare beneficiaries’ access to mental health services provided by clinical social workers including services that could be interrupted if the beneficiary is transferred to a SNF while receiving treatment from a clinical social worker. The bill would amend language in Title 18 of the Social Security Act to include clinical social workers among providers of services in skilled nursing homes.

    The bill would also fix another problem. While the Social Security Act provides reimbursement for the diagnosis and treatment of mental health problems, it does not specify reimbursement for behavioral health services covered by the Health and Behavior Assessment and Intervention(HBAI) codes such as emotional and social problems that may occur due to medical conditions such as diagnoses of cancer or Alzheimer’s disease. Currently payments to CSWs are left to the discretion of each local Medicare Administrative Contractor. Rep. Lee’s bill would include HBAI code services in those that can be provided by clinical social workers.

    As the nation’s population ages, it is critical that licensed clinical social workers participate as Medicare providers and have the widest possible latitude to provide billable services. For more information regarding the Improve Medicare Beneficiaries’ Access to Mental Health Services Act of 2015 and issues related to clinical social workers and Medicare, contact Dina Kastner at NASW (dkastner@naswdc.org).

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    Dr. Charles E. Lewis, Jr. is President the Congressional Research Institute for Social Work and Policy. He has served as deputy chief of staff and communications director for former Congressman Edolphus “Ed” Towns and was the staff coordinator for the Congressional Social Work Caucus.

    Justice

    In A New World, Social Work Leads the Way

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    This is a sponsored article by California State University at Northridge

    How Cal State Northridge is doing its part.

    The pandemic, if nothing else, exacerbated the unequal distribution of resources in society. For millions of people, access to food, shelter, and health care is now more uncertain than ever.

    What’s emerging is a new, somewhat dire need for experienced social workers – professionals able to compassionately address a disparate and evolving set of issues. Not only here in Los Angeles, but all over the world.

    For much of the pandemic, the field has championed relief efforts, such as the rent moratorium. This provided a necessary, if temporary, reprieve from the daily fear of eviction. Outside of California, however, this moratorium is over. As are federal unemployment benefits.

    And the impact is tragically visible. In California alone, the homeless population is over 151,000, with 41,000 of that in Los Angeles. And that’s just according to official estimates. The true number, allege some experts, may be much higher.

    This is the sad, beautiful truth of social work. No matter where a client is, whether it’s in the classroom, at home, or on the streets, the field will be there.

    But the field itself is evolving, too.

    Following the death of George Floyd, social workers are increasingly involved in policing, augmenting first responders with a new option: one aiming to mitigate crisis and, as importantly, prevent the use of force.

    As cities and states consider policing alternatives, social workers can help to ensure each community’s voice is heard, especially communities of color. Gaining popularity, the idea is to offer a more compassionate approach to law enforcement. Rather than responding with aggression, an arriving unit could instead respond with care, assessing the situation from a mental health standpoint, not one of criminality.

    Likewise, opportunity youth – sometimes referred to as “at-risk” – now face many new challenges (among them, a skills gap from a year of remote learning). On top of food scarcity and uncertain housing, there’s also the real risk of contracting COVID. And for these youth, who often lack access to health care, this can be especially dangerous.

    In all these cases, a humane approach is needed. Many social work programs incorporate hands-on experience, giving students access to the communities they’ll serve. One such program is the Master of Social Work (MSW) at California State University, Northridge (CSUN).

    Unlike many social work programs, CSUN’s MSW expands participants’ career possibilities by offering a generalist approach. This enables graduates to work at ALL levels of the field: individual/family (micro); group/community (mezzo); and societal/policy (macro).

    The program is offered fully online in two- and three-year formats. The two-year option is a full-time program with an intensive curriculum designed to help students complete their degrees and enter the field in as little time as possible. The three-year option, on the other hand, is an excellent choice for those who would prefer the same curriculum at a less intensive pace.

    The master’s degree, which is often ranked among the best in the country, promotes the well-being of urban communities. Through its curriculum, participants learn how to assess a community’s needs from the inside, in large part through active listening.

    As the field continues to evolve, those who comprise it must evolve too. That begins with knowledge of the new world, but ends, as it always has, with the people who need us most – the ones for whom we care.

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    Technology and Entrepreneurship in Social Work

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    After helplessly watching her sister try to navigate the international adoption process, Felicia Curcuru launched Binti in an effort to reinvent foster care and adoption. Since the launch of the company in 2017, Binti has expanded its network to over 190 agencies across 26 states in the U.S. The software Binti creates helps social workers and others who work in foster care to effectively approve 80% more families and decrease their administrative burden by up to 40%.

    Jimmy Chen, a Stanford graduate and the son of struggling immigrants from China, created Propel in 2014 after noticing that Supplemental Nutrition Assistance Program (SNAP) recipients needed to call a 16-digit phone number to check their balance. In order to check their balances, some of the recipients would resort to strategies such as buying cheap items such as bananas. Currently, the Propel app helps 5 million households who are eligible for SNAP benefits to manage their finances!

    Besides using technology and entrepreneurship to transform human service systems, what do these companies have in common? They were not started by social workers.

    Technology and Entrepreneurship in Social Work

    Technology and entrepreneurship have and will continue to transform our profession. But social workers have stayed on the sidelines of this creative process for too long. If we are to be successful in effectively disseminating our incredible values and pushing forth the mission of social work, social workers must play a more direct role in embracing the movements of technology and entrepreneurship.

    This is not a new concept. Research articles on technology and entrepreneurship in social work have been published for years, and the National Association of Social Workers (NASW) has published reports on technology in social work. Furthermore, universities such as Columbia University in New York have embraced the movement, and have created a minor for social workers called “Emerging Technology, Media, and Society,” which trains social workers to understand the latest developments in the world of technology. Finally, thousands of social workers operate their own private practices and embrace the benefits of entrepreneurial practices.

    This slow, yet continuous shift towards technology and entrepreneurship is important, but it must be accelerated. The question still remains: how do we enable social workers to embrace the power behind technology and entrepreneurship? Here are some ideas:

    Enabling Social Workers to Embrace Technology and Entrepreneurship

    First and foremost, social work curricula must embrace technology and entrepreneurship. The curricula must incorporate mandatory courses on technology and entrepreneurship, and these courses should be taught by experts in these fields.

    Social work departments must enable field placements for social workers in technology or startup environments. By being a part of successful organizations in these spaces, social work students can be exposed to this type of thinking and be inspired by the possibilities!

    Social workers themselves must take time to explore and learn about these fields. Although it is difficult enough to maintain our mental health while managing our caseloads, we can utilize the time we spend on webinars or Continuing Education Units (CEUs) to take classes in technology and entrepreneurship.

    Social workers can become intrapreneurs, or employees that create new projects from within organizations and businesses. For example, during my time at a community mental health organization, I helped launch a social media channel for the organization’s therapists, which allowed us to feel more connected, share resources, and learn from one another.

    Moving Forward

    As social workers, we uphold an ethical code that enables us to represent the most marginalized members of our society. But we can only do this effectively by embracing the intersection between technology, entrepreneurship, and social work. Although there is no silver-bullet answer, we can help social workers gain entrepreneurial and technological skills by broadening the education available to social work students and ourselves so that we can all better understand the possibilities that are out there.

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    Health

    Study Shows Immune Cells Against Covid-19 Stay High in Number Six Months After Vaccination

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    A recent study by Johns Hopkins Medicine researchers provides evidence that CD4+ T lymphocytes — immune system cells also known as helper T cells — produced by people who received either of the two available messenger RNA (mRNA) vaccines for COVID-19 persist six months after vaccination at only slightly reduced levels from two weeks after vaccination and are at significantly higher levels than for those who are unvaccinated.

    The researchers also found that the T cells they studied recognize and help protect against the delta variant of SARS-CoV-2, the virus that causes COVID-19. According to the U.S. Centers for Disease Control and Prevention, the delta variant — currently the predominant strain of SARS-CoV-2 in the United States — causes more infections and spreads faster than earlier forms of the virus.

    The study findings were first reported online Oct. 25, 2021, in the journal Clinical Infectious Diseases.

    “Previous research has suggested that humoral immune response — where the immune system circulates virus-neutralizing antibodies — can drop off at six months after vaccination, whereas our study indicates that cellular immunity — where the immune system directly attacks infected cells — remains strong,” says study senior author Joel Blankson, M.D., Ph.D., professor of medicine at the Johns Hopkins University School of Medicine. “The persistence of these vaccine-elicited T cells, along with the fact that they’re active against the delta variant, has important implications for guiding COVID vaccine development and determining the need for COVID boosters in the future.”

    To reach these findings, Blankson and his colleagues obtained blood from 15 study participants (10 men and five women) at three times: prior to vaccination, between seven and14 days after their second Pfizer/BioNTech or Moderna vaccine dose, and six months after vaccination. The median age of the participants was 41 and none had evidence of prior SARS-CoV-2 infection.

    CD4+ T lymphocytes get their nickname of helper T cells because they assist another type of immune system cell, the B lymphocyte (B cell), to respond to surface proteins — antigens — on viruses such as SARS-CoV-2. Activated by the CD4+ T cells, immature B cells become either plasma cells that produce antibodies to mark infected cells for disposal from the body or memory cells that “remember” the antigen’s biochemical structure for a faster response to future infections. Therefore, a CD4+ T cell response can serve as a measure of how well the immune system responds to a vaccine and yields humoral immunity.

    In their study, Blankson and colleagues found that the number of helper T cells recognizing SARS-CoV-2 spike proteins was extremely low prior to vaccination — with a median of 2.7 spot-forming units (SFUs, the level of which is a measure of T cell frequency) per million peripheral blood mononuclear cells (PBMCs, identified as any blood cell with a round nucleus, including lymphocytes). Between 7 and 14 days after vaccination, the T cell frequency rose to a median of 237 SFUs per million PBMCs. At six months after vaccination, the level dropped slightly to a median of 122 SFUs per million PBMCs — a T cell frequency still significantly higher than before vaccination.

    The researchers also looked six months after vaccination at the ability of CD4+ T cells to recognize spike proteins atop the SARS-CoV-2 delta variant. They discovered the number of T cells recognizing the delta variant spike protein was not significantly different from that of T cells attuned to the original virus strain’s protein.

    Although the study was limited because of the small number of participants, Blankson feels it pinpoints areas that merit further research.

    “The robust expansion of T cells in response to stimulation with spike proteins is certainly indicated, supporting the need for more study to show booster shots do successfully increase the frequency of SARS-CoV-2-specific T cells circulating in the blood,” says Blankson. “The added bonus is finding that this response also is likely strong for the delta variant.”

    Along with Blankson, the members of the study team from Johns Hopkins Medicine are study lead author Bezawit Woldemeskel and Caroline Garliss.

    This study was supported by the Johns Hopkins COVID-19 Vaccine-related Research Fund.

    The authors do not have financial or conflict of interest disclosures. 

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