We know there have been many questions regarding the recent changes to the DSM. Your membership in NASW provides access to breaking information and updates about the profession. Please mark the upcoming dates on your calendar.

Save the Dates
NASW Practice Webinar
What Clinical Social Workers Should Know About the DSM-5
Registration details will be available soon on NASW’s website.  
(www.socialworkers.org)

Exclusively for NASW Members
Dates: Wednesday, July 24 and Thursday, August 8
Time: Noon to 1:00 pm EST

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5*) was released in May 2013 and includes new disorders and revised criteria for existing mental disorders. This Webinar will assist clinical social workers in transitioning from the DSM-IV to the DSM-5. Changes will be highlighted including the reorganization of the chapters, creation of new diagnoses and categories, consolidation and deletion of diagnoses, and the deletion of the multiaxial diagnosis with changes that include an emphasis on assessment measures. This Webinar benefits clinical social workers who diagnose and treat mental illness in all settings.

Presenter: Mirean Coleman, LICSW, CT
NASW Senior Practice Associate for Clinical Social Work
Center for Workforce Studies & Social Work Practice

*Clinical social workers should be aware that changes in diagnoses codes may not occur until October 1, 2014. Note: NASW is planning a series of training for its members which will include workshops, Webinars, teleconferences, question and answer sessions, and practice updates.  

Student Members and Limited Licensed Members: Please feel free to take any of these courses as well, even though you may not need continuing education credits.

·         For a listing of NASW’s Lunchtime Series of FREE CEs click here

·         Check out NASW’s WebEd for additional FREE CE opportunities (including Ethics) here

·        Every social worker needs career protection. Every social worker needs liability insurance. Do not practice without protection. Let NASW liability insurance help protect your license, your practice, your career. Everything we do at NASW is focused on making your professional life better.

LeBron James and the Miami Heat were not the only team to score a significant victory last week when the

Story Courtesy of CRISP

Heat bested the San Antonio Spurs to win the NBA championship.  Last week social workers also scored a decisive victory.  Though diminutive in height compared to King James, U.S. Rep. Barbara Lee (D-CA13), chair of the Congressional Social Work Caucus, stood tall among her peers in Congress last week leading the fight against $20 billion in cuts to the Supplemental Nutrition Assistance Program (SNAP) in the farm bill offered by House Republicans.  SNAP provides food stamps to about 47 million low-income Americans.

Any parallels between the two may be a stretch, but both James and Lee have taken much heat (no pun intended) for being who they are.  James who wants to go down in history as the best player to have ever played the game of basketball, caught much flack for his widely castigated “The Decision” episode when he had the temerity to predict he and the Heat would win multiple championships.  Three straight appearances in the NBA Finals and two championship rings is a pretty good start.  Lee, on the other hand, has been in the crosshairs of her critics since being the lone member of the House to vote against giving war authority to President George Bush before the Iraq War.  Both were willing to go out on a limb.  So they should get their props when they win.

In a statement released by her office, the congresswoman from Oakland said: “The Republicans’ proposed $20 billion in cuts to the Supplemental Nutrition Assistance Program (SNAP) were unconscionable and short sighted, and beating the Farm Bill today is an incredible victory for the nation’s poor and vulnerable. The President’s veto threat went a long way in garnering support for the defeat of this bill.”

According to the Center for Budget and Policy Priorities, the proposed cuts to food stamps would eliminate benefits for nearly 2 million families, mostly households with children and senior citizens.  Reducing SNAP benefits would be particularly devastating because the increase in benefits provided by the American Reinvestment and Recovery Act (ARRA) will end in November, reducing food stamps about $25 monthly for a family of four.  Approximately 210,000 low-income children could lose free school meals if their families lose their SNAP benefits.

Led by Lee, 26 members of the House took the challenge of eating on a $4.50 a day food budget for the week which is the average SNAP benefit for one person.  In addition she took her fight to the floor of the House floor of the House and to the airways appearing on numerous news programs.  Lee is the ideal spokesperson because as a young mother she relied on food stamps to feed her children.  She wrote on her blog: “When I was a young, single mother, I was on public assistance. It was a bridge over troubled water, and without it, I wouldn’t be where I am today. I spent hours debating what to buy and what to skip, all the while keeping my sons in my mind. I could go without breakfast; my sons couldn’t.”

The defeat of H.R. 1947, the Federal Agricultural Reform and Risk Management Act of 2013, was a blow to Speaker of the House John Boehner (R-OH8) who was blind-sided once again by members of his party after bringing the $940 billion bill to the floor for a vote.   The bill went down in defeat by a margin of 195-234 votes, with 62 Republicans joining the majority of Democrats voting against the bill.  Boehner expected more than the 24 Democrats who eventually voted for the bill to back the legislation.  However a significant number of Democrats abandoned the legislation after a last-minute amendment by Rep. Steve Southerland (R-FL2) was added that would require applicants for food stamps to be either working or in a work-related program.

Needless to say, the farm lobby was up in arms over this latest debacle.  They worked ferociously to get a plan through the House only to see their efforts go up in smoke with no resolution in sight.  Hopefully, one lesson that might come from all of this, is that policymakers will begin to understand that feeding the hungry should not be entangled with farm policies.  There is much reform needed in our farm policies but these should be addressed separately from the need for Americans to put sufficient food on their tables.  Ask Paul Ryan.  He just said it on Morning Joe.

Twitter: @CharlesELewisJr.
Email:    celewisjr@gmail.com

Dr. Charles E. Lewis, Jr. is President of 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. He was a full-time faculty member at Howard University School of Social Work prior to joining Rep. Towns’ staff and now is an adjunct associate professor. As staff coordinator for the Social Work Caucus, Dr. Lewis helped to plan and to coordinate numerous briefings and events on the Hill and in the 10th Congressional District in Brooklyn, New York.

Originally Posted at http://crispinc.org/?p=832

Contact Your Senator Regarding Immigration Reform

Take Action!

June 20, 2013

The U.S. Senate continues floor debate on S. 744 – the Border Security, Economic Opportunity, and Immigration Modernization Act of 2013. Last week, Senators filed amendments and more are to come. Some will help improve the bill, others unfortunately will create additional hurdles and requirements for low-income immigrants on the road to citizenship than what are already required by the bill.

Specifically, Senator Rubio (R-FL) and Senator Hatch (R-UT) filed four amendments that could effectively prevent many low-income immigrants from being able to obtain lawful status through the bill and punishes rather than rewards those who become lawful permanent residents (LPRs) after they have met the bill’s current tests and requirements. These amendments taken together could undermine the goals of immigration reform and leave millions of immigrants without the opportunity to fulfill their American Dream.

Because these amendments are harmful and will likely come up for a vote or be negotiated on in the next few days, it is critical that to let your Senator know TODAY to oppose these 4 Hatch-Rubio amendments because they are extreme, unfair, and are bad public policy. The Senate must stop these punitive attacks on low-income immigrants and focus on creating a fair and achievable road to citizenship that allows immigrants to fully participate in society.

On the positive side, Senator Boxer (D-CA) has an amendment, 1282, that would allow time in provisional status to count towards the five year bar for public benefits. Her other amendment, 1275, adds U visa holders to the list of qualified immigrants who are eligible for federal benefits. U visa holders include survivors of domestic violence. Senator Hirono’s (D-HI) 1317 amendment, the Taxpayer Fairness amendment, states that if lawfully present, working and paying taxes, an individual shall not be ineligible for federal programs or tax credits because of their immigration status.

URGE YOUR SENATOR TO OPPOSE THESE AMENDMENTS TO S.744:

• Hatch-Rubio #1246: Prohibits the U.S. Department of Health and Human Services (HHS) agency from waiving federal work requirements for the Temporary Assistance for Needy Families (TANF) program, even though aspiring Americans will not be eligible for TANF assistance for at least 15 to 20 years from now.
• Hatch-Rubio #1247: Requires documentation and payment of back taxes, interest, and penalties from an individual’s original date of entry to the U.S. in order to obtain registered provisional immigrant (RPI) status. This is unworkable for individuals as well as employers and the IRS.
• Hatch-Rubio #1248: Adds an additional 5 years to the existing exclusion in S. 744 for aspiring citizens from being able to buy affordable health care under the Affordable Care Act (ACA) after they become LPRs. This would effectively deny affordable health care to lawfully present, aspiring citizens for 15 years. The amendment would also exclude from the ACA already eligible, lawfully present individuals who have a non-immigrant status and who are not otherwise affected by this bill.
• Hatch-Rubio #1249: Denies aspiring citizens credit for work history and earnings worked while undocumented, despite having paid payroll Social Security taxes, which will affect their future Social Security retirement benefits and eligibility for Medicare.

June 18, 2013
The Honorable John D. Rockefeller, IV
531 Hart Senate Office Building
Washington, D.C. 20510

Dear Senator Rockefeller:

As organizations committed to improving the health and well-being of children and women, we are writing to thank you for your leadership on behalf of these important populations. As a result of enactment of the Children’s Health Insurance Program Reauthorization (CHIPRA) in 2009, which gave states the option to provide Medicaid and CHIP coverage to lawfully present children and pregnant women within the 5-year bar, approximately half of states have seen the benefit of providing insurance coverage to this population of children and pregnant women. This provision was passed by strong bipartisan majorities in the both the Senate and House and is critical for the health and well-being of lawfully-residing children and pregnant women.

We thank you for championing this provision. Five years is a lifetime to a child. Pregnant women cannot wait 5 years for care. Timely coverage can mean the difference between preventing or treating conditions that can affect a child’s long-term prospects for a healthy, productive life, and leaving those conditions undetected and untreated. Prenatal care is essential to promoting positive health outcomes among women and preventing harmful and potentially life-threatening health complications. Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care.

As Congress considers S. 744, the Border Security, Economic Opportunity and Immigration Modernization Act of 2013, it is vital that lawfully present children and pregnant women who qualify for Registered Provisional Immigrant (RPI) or blue card status or obtain a V nonimmigrant visa be treated the same as other children and pregnant women who are lawfully present under current law.

All children should have the opportunity to grow up healthy, and all women should have access to prenatal care. Having health insurance coverage through CHIP and Medicaid means children are more likely to access preventive care, immunizations, and treatments for asthma, autism, and hearing impairments. With health coverage, pregnant women can access the routine care and screenings necessary to ensure a healthy pregnancy. RPI children and pregnant women are aspiring U.S. citizens. It is critical that under S. 744, they have the opportunity to access cost-effective, affordable insurance coverage just like other lawfully-residing children and pregnant women.

Every adult was once a child, but unfortunately, not every child has the opportunity to become an adult. We thank you for recognizing the public health and financial benefit of ensuring that children are able to grow up healthy, which starts by ensuring that women have healthy pregnancies.

Sincerely,

NASW-Michigan

Amidst your journeys into the world of aging care, you may hear about social workers. If you’re not quite sure what they do or how they could be of assistance to your family, we’ve got the information you need. As a field, geriatric social work has grown in parallel with the aging of the American population. According to the Administration on Aging, people age 65+ represented 12.4 % of the population in 2000 and are expected to grow to be 19% of the population by 2030, totaling about 72.1 million older persons.  As the nation’s aging population grows, particularly those over 85, they need more assistance to remain active and independent.

At its essence, the social work profession is focused on the welfare of individuals, families, and communities.  Social workers use their skills to help others live happy, more effective lives.

A geriatric social worker is a professional social worker with expertise working with adults age 65 and over. Often, these are social workers that have graduate level education and field experience in geriatrics, gerontology, aging, or social work with older adults.

Geriatric social workers help find solutions for older adults and families that address the personal, social, and environmental challenges that come with aging. Geriatric social workers’ main priority is maintaining and enhancing the quality of life of their older adult clients. This may include developing an understanding not only the physical complications of aging, but mental health, cultural barriers, and organizational challenges faced by the older adult.

What Services Do Geriatric Social Workers Offer?

Aging-savvy social workers serve as “navigators” through the complicated healthcare and social service systems. They help families by gathering information about the array of services available to them, coordinating care across various health systems, facilitating family support, and providing direct counseling services.

According to the Consortium of New York Geriatric Education Centers, “Gerontological social work interventions are directed at enhancing dignity, self-determination, personal fulfillment, quality of life, optimal functioning, and ensuring the least restrictive living environment possible.”

Here are just a few ways social workers help:

• Clinical interventions – They may provide therapy for an elderly client who feels lonely or who is suffering depression or anxiety. Geriatric social workers encourage their clients to pursue stimulating activities, helping to arrange group outings. They can help clients cope with aging by recording “life stories” and help people say their goodbyes through writing letters, phone calls, videos, etc.

• Service interventions – Many social workers act as a link between their clients and the numerous public and private programs designed for the aging. Social workers help clients apply for appropriate services. They help sort out any problems in the delivery of these services.

• Advocacy – A geriatric social worker can provide an older adult with an Advance Directive form and explain how to correctly complete it. They are also a frontline defense for stopping elder abuse: a geriatric social worker is mandated by law to report to any suspected elder abuse to Adult Protective Services.

For families in a caregiving situation, geriatric social workers are an invaluable resource. Social workers also offer direct assistance for families, such as providing family-support services, suggesting useful technologies, and facilitating the coordination of medical care.

Many geriatric social workers also offer counseling services, which often deal with end-of-life issues, bereavement, and other concerns common to senior citizens. They can help guide families through the transition from the home environment to long term care, assist with filing necessary paperwork, and help with access to end-of-life care planning (living wills, advance directives, DNR orders).

They act as a liaison between the patient, family members, and health care staff and can make sure you stay informed about your loved one’s condition.

My Parent or Spouse Receives Home Care Services. How can a Geriatric Social Worker Help Us?

To help older adults remain at home as long as possible, many geriatric social workers work within the home health care setting.

These types of social workers often coordinate discharge planning from hospital to home and conduct home visits to ensure the client is safe, healthy, and thriving in their environment.

They may help assess when home care is or is not appropriate for the client, help locate in-home assistance services, transportation services, Meal on Wheels, and recommend in-home care tracking technology.

Geriatric social workers are trained to recognize normal and abnormal aging patterns. They can suggest when an elderly client needs to see a doctor and can arrange for a visit.

With the help of geriatric social workers, some older adults may be able to live in their own home when they would otherwise need nursing home care.

Where Can I Find a Geriatric Social Worker?

Contact your Local Agency On Aging (AAA), which provides linkage to community services and resources. You can find your local AAA here. Ask your family physician or hospital to suggest a geriatric social worker they have worked with in the past. Senior centers, religious community members, friends, and family are additional sources to turn to for trusted recommendations.


Reposted from eCaring.com (http://blog.ecaring.com/what-does-a-geriatric-social-worker-do/)
Posted on July 18, 2012 by Melody Wilding

Michigan Legislative Updates
Noah Smith, Capitol Services Inc. (NASW-MI's Lobbyist)

Medicaid Expansion

After weeks of intense negotiation, HB 4714 – Michigan’s Medicaid Expansion bill – was voted favorably out of the House, 76-31.  The bill moves to the Senate for action as early as next week.  Further, the Senate is poised to act on a “Medicaid supplemental” appropriations bill that would allocate the anticipated federal dollars, thus truly paving the way for Medicaid expansion.

The bill has some changes from the originally-introduced version.  These changes were considered after several weeks of testimony, and really came from an odd coalition of groups:  Blue Cross, the Health Plans, the Small Business Association, the Chamber of Commerce, and MDCH.  While a ways from an “ideal” bill, HB 4714 as reported out of committee and the House floor included enough changes to bring almost the entire Democratic caucus along to vote for it, and a majority of the Majority.

The previous draft of the bill had a 48-month cap on benefit eligibility for “able-bodied” recipient between 100 and 133% of the federal poverty level.  The new version keeps the 48-month cap, but allows the recipient to either opt-out of Medicaid and join an Exchange-based plan (whenever those start), or stay in Medicaid, but have an increased copay from “up to” 5% to “up to” 7%.  Further, the cost sharing can be reduced (see below), but never to less than 3%.

The previous version of the bill also had two points at which the bill became void:  if either the federal government doesn’t approve the waivers to do this, or federal funding falls below 100%.  New language in the bill keeps the first clause, but adds to the second that federal funds fall below 100% and state savings from expansion aren’t enough to cover the costs.

Other waiver details include:

·         Enrollees get a health savings account, into which money from any source can contribute (employer, the enrollee, etc.);
·         Money is returned to ineligible enrollees in the form of a voucher to use to purchase private insurance;
·         Enrollees can choose a health plan;
·         All enrollees must have access to a primary care physician and to preventive services;
·         Out-of pocket contributions to the account can be reduced to zero and copays to not less than 2% if “healthy behaviors” are met;
·         Enrollees must either complete or decline to complete advanced directives;
·         Incentives for enrollees to detect fraud and abuse must be created;
·         Some services can be provided via telemedicine,

The bill also requires a number of studies and policies:
·         Health status of enrollees and assisting individuals back into the workforce;
·         Use of high-value, low-cost prescriptions, generics, and 90-day supplies;
·         Examination of hospital data on the policy’ effect on uncompensated care;
·         Examine the policy’s impact on insurance rates.
·         Costs to administer the expansion cannot exceed 1% of the Department’s portion of all Medicaid funds;
·         The Department has to measure each enrollee’s contracted health plan’s performance on application of standards of care related to appropriate treatment of substance abuse;
·         DCH and health plans have to create financial incentives for meeting population improvement goals, for providers to meet quality and cost targets, and for enrollees to improve their health or maintain healthy behaviors

·         Provide a single point of entry through only one department for enrollees.

All of the content for HB 4714 was designed to “reform” Medicaid, which was politically important for otherwise reluctant Republicans to vote for the bill.  However, equally important is the Medicaid Supplemental, anticipated for action in the Senate within the next week.  This simply appropriates the anticipated federal money into the Medicaid line.  Truthfully, this last step is really all the state had to do in order to expand Medicaid.  But HB 4714 was important to bring along a party that felt no compulsion to vote for expansion otherwise.

 

It will be very important to have constituent calls come in to state senate members, particularly those in Republican districts, by early next week!

 

Welfare Drug Testing Moves

HB 4118 (Jeff Farrington, R – Utica) establishes a suspicion-based substance abuse screening and testing program for FIP applicants and recipients.  At initial application and at redetermination, DHS must screen applicants for suspicion of substance abuse using “empirically validated substance abuse screening tools.”  If the result gives the department reasonable suspicion that the applicant is using drugs, that applicant would have to take a substance abuse test.  If the applicant refuses, they are ineligible for benefits (but can reapply after 6 months).  If the applicant tests positive, they are referred to treatment.  Those who test positive also have the cost of the test taken from their first benefit payment, once they qualify for benefits.  This will first be piloted in three counties starting April 1, 2014, concluding March 31, 2015.  Further action may go from there depending on the outcome of the pilot. 

The bill has passed the Senate Families committee and awaits final action on the Senate floor.

 

Health Navigators

SB 324 (Senator Jim Marleau, R – Lake Orion) is a bill to provide for the licensure and regulation of “insurance navigators.”  The job of a health navigator is to assist consumers in selecting health insurance plans when the federal exchanges go live in the fall.

Navigators cannot themselves sell insurance or provide advice about recommending a particular plan.  However, they can provide public education and facilitate enrollment once a consumer selects the best plan for them, so long as that plan is an Exchange-based plan.

The primary crux of the bill, however, is to set up a training and licensure program within the Department of Insurance and Financial Services (DFIS), including license suspension, revocation and fines for violations of the licensure requirements.  DFIS would act as the regulatory body for these licensed professionals.

The bill passed the Senate health Policy committee, and awaits a final vote in the Senate.

NASW encourages social workers to run for office because social workers are a profession of trained communicators with concrete ideas about how to empower communities. Social workers understand social problems and know human relations, and the commitment to improving the quality of life brings a vital perspective to public decision-making.

Social workers across the country serve in a range of political institutions, from school boards to city and county offices and state legislatures. There are six social workers in the US House and Senate.

Social workers make good political candidates because they:

• are well educated
• are articulate and experienced in public speaking
• are comfortable at persuasion
• are knowledgeable about their communities
• understand social problems and are committed to social justice
• understand how policies affect individuals and communities

Social workers run for public office because they:

• are attracted to politics through an issue or cause.
• realize they are just as capable as many officeholders.
• see the opportunity to make changes on a broader scale.
• want to provide leadership to improve their community.

NASW also encourages social workers to offer their professional expertise to campaigns. Social workers can use their skills as campaign managers, volunteer coordinators, and political directors. These jobs can also translate into legislative jobs in which social workers can shape policy, and help constituents by working with federal, state and local agencies to get individuals appropriate assistance. Social workers can also translate their involvement in campaigns into key appointments in state and local agencies in which they can oversee key government agencies to influence the practice of social work and seek social justice.

Contact NASW at pace@naswdc.org or 800/638-8799, ext. 418 for the contact information of other social workers who have run for office.

The Michigan legislature is considering expanding Medicaid, but now in the form of extensive Medicaid reform. HB 4714, under review in the Michigan Competitiveness Committee, would expand Medicaid under the Affordable Care Act but also make drastic reforms.

HB 4714 proposes:

• Expand Medicaid. Currently ineligible non-disabled adults within the income guidelines (earning less than 133% of the Federal Poverty Level) will become eligible to enroll in Medicaid or seek private insurance.

The Michigan League for Public Policy estimates that between 400,000 and 600,000 low-income uninsured Michigan citizens would gain access to health coverage, including mental health and substance use disorder services, if Medicad were expanded.

• The Department of Community Health has to develop incentives for “healthy behavior” and for “helping detect fraud and abuse.”

The question remains as to how would wellness incentives work for individuals living  with limited access to services? (ie. no transportation, limited access to fitness facilities, lack of healthy food access etc.)

• Enrollees must contribute as much as 5% of their annual income to their coverage (via copays, deductibles, or premiums), paid into a health savings account.

For many, 5% of annual income would be unaffordable. With the savings of Medicaid expansion, there would not be a need for a health savings account paid for by enrollees. Both the House and Senate Fiscal Agencies estimate that Michigan could save more than $1.1 billion during the first 10 years, which the governor proposed using to fund the program when the federal payments drop below 100%. 

• Non-disabled adults would face a 48-month lifetime limitation on Medicaid insurance coverage (not including time currently on Medicaid).

This raises several issues. Will providers be willing to offer services to people who they know will no longer have insurance after a few years? Will those who are “non-disabled” under Medicaid coverage become “disabled” once their coverage runs out due to lack of health care? What happens to a woman who becomes pregnant at the end of her 48-month limit? There is also great likelihood that the federal government will not provide a waiver for this component.

Please take the time to contact your legislator, especially if they are a member of the Michigan Competitiveness Committee (see list below). Let them know how Medicaid expansion will affect you or those you know.

Tell your legislator to:

• Expand Medicaid
• Remove the 48-month limit
• Remove the 5% fee component
• Create a comprehensive wellness program that includes everyone.

Thank you for your time and continued advocacy,

TAKE ACTION!!! 


Link to full bill: HB4714

Link to Michigan League for Public Policy analysis: MLPP

More info: ExpandMedicaid


Michigan Competitiveness Committee Members:

Mike Shirkey (R) Committee Chair, 65th District

Ken Yonker (R) Majority Vice-Chair, 72nd District

Gail Haines (R) 43rd District

Kevin Cotter (R) 99th District

Frank Foster (R) 107th District

Ray Franz (R) 101st District

Ken Goike (R) 33rd District

Dan Lauwers (R) 81st District

Tom Leonard (R) 93rd District

Dave Pagel (R) 78th District

Paul Clemente (D) Minority Vice-Chair, 14th District

Jim Townsend (D) 26th District

Andy Schor (D) 68th District

Harvey Santana (D) 9th District

Kate Segal (D) 62nd District

Clinical Considerations When Supporting Lesbian, Gay, Bisexual, and Transgender Families: An Infant Mental Health Perspective
Lisa Garcia, LMSW, IMH-E™ (III)
Northeast Guidance Center, Detroit, MI

Recently the media has been focused on the subject of gay marriage and marriage equality. For many years there has been controversy about whether gay men and lesbians should be allowed to become foster parents or adopt children. Despite the increase in prevalence of gay/lesbian issues in the media, stigma, homophobia, and discrimination continue to affect the lives of lesbian, gay, bisexual and transgender individuals and their families.

As social workers, infant mental health (IMH) specialists, nurses, and educators, we are less concerned with the controversy of whether gay men and lesbians should or should not be parents. Our focus is, and must be, how to support all families parenting infants and young children. Lesbian, gay, bisexual, and transgender (LGBT) parents/families do exist and we, as clinicians, need to bring sensitivity, warmth, and understanding as we provide services.

The work we do with each parent/family is the same, yet different. This may sound paradoxical but consider that we each approach families from certain theoretical models, knowledge base and skill sets. We bring our own unique personalities, histories and experiences, ethnic and cultural perspectives, and our individual intention to provide services. Although what we bring to each family is the same, the way in which we interact and provide services will be different. The interventions we choose and the focus of treatment will be shaped by the unique needs and nuances of the particular individual or family we are supporting. The same is true for LGBT families. The clinical presentations, stressors, and concerns the parent or child brings to treatment are not unlike any other family; yet there are specific constructs to consider when assessing an LGBT parent or family’s needs.

Considerations for assessment and clinical work with families

Create a welcoming and inclusive environment for all families; Do not assume a parent or child has a traditional/heterosexual family configuration; Be aware of heterosexism in your agency and in your approach to families (assumptions, wording on forms, etc.); Be respectful of the relationships within the family (how they identify); Listen closely to learn about and understand the stresses that impact the members of this family; Use welcoming and inclusive language; and, have pictures of all types of families in your agency (same-sex parents, adoptive parents, single parents, families of color) and display inclusive posters, books, and reading materials.

Questions are an integral part of assessment, but we need to ask ourselves, is my question necessary or am I asking it for my own curiosity?  What do I know? What do I need to know? How do I ask this in a sensitive way?

The most critical consideration in clinical work with LGBT families is for the clinician to reflect on his/her own biases and internal dialogue. We may think we are comfortable and open, but we must acknowledge the reality that all individuals hold biases of which they are not aware. If you are not sure how you feel, go to Gay Marriage USA or LGBTQ Nation (or similar site) on Facebook, which has pictures of LGBT couples and families, or go to a Gay Pride parade/festival. Pay close attention to how you feel, not to what you think.  Are you comfortable with same-sex couples expressing affection; kissing or holding hands? We owe it to ourselves and to the families we serve to know our biases and comfort zones.

LGBT Families:

The configuration of LGBT families, like heterosexual families, consists of single parent households, parenting couples, and ex partners who are co-parenting. Many gay parents have biological children from previous marriages or heterosexual relationships. This may be confusing for some clinicians, but is often the result of self-denial, internalized homophobia, an attempt to be “normal”, late coming out, bisexuality, or a strong desire to have children. Therefore, many LGBT families are blended families, often with the same challenges that other blended families face. In other LGBT households, the decision to become a parent is usually intentional. LGBT individuals and couples become parents through insemination, surrogacy, in-vitro, adoption, and/or foster care. As in heterosexual families, the majority of LGBT parents raise confident, emotionally secure, children. There are also families that need support and will present for IMH or other family services.

Considerations

How does this parent/couple identify themselves and their family? Does the ethnic, racial, religious, or culture of either parent (or their extended family members) impact the couple’s relationship or their views about parenting? If children are foster or adopted, are there racial, ethnic, or cultural issues of the child that impact the parent-child relationship? Does the parent(s) demonstrate the ability to respond to the infant/toddler’s needs with sensitivity and understanding? Does  this family have age/developmentally appropriate expectations of their infant or young child? Is there domestic violence, substance abuse, infidelity, or other issues impacting this parent/family? What does each parent prefer to be called by their child (which parent is mom, mommy, dad, daddy, momma, poppa, etc)?  How has this parent/family been impacted by social discrimination or homophobia (violation of rights, job loss, hate crimes, etc.)?

There are multiple variables that impact families and some that are unique to LGBT families. The dynamics and/or attachment concerns between a birth parent and the non birth parent can be different in families that choose for one partner to be the biological parent. For example, the role of the non birth parent and how to identify or what to call the other parent can be a challenging decision, or a non birth parent may feel left out/jealous of the biological parent’s relationship with the child. In many States, co-adoptive parents do not have the same legal rights, which may impact the child/parent in many ways, especially in the event of a separation. Many LGBT parents experience the chronic fear of losing their children.

Transgender Families:

Transgender individuals experience many of the same concerns and discriminations that gays and lesbians experience.  However  discrimination against an  individual based on the expression of their gender identity is referred to as transphobia. One of the significant considerations when working with someone who identifies as transgender is the use of pronouns. Each person will have their own preference for how they choose to be addressed. Some individuals may prefer to use he or she, or prefer the use of a gender neutral pronoun such as “ze”, while others may prefer not to use any pronoun at all. It is important to ask about the use of pronouns, but be sensitive.

Considerations

How does this individual identify themselves in the broad term of transgender? Has their gender expression impacted their relationship with their children? How does the child and extended family understand the individual? Is the person’s family respectful in their use of pronouns? Are they careful to use pronouns  that are aligned with the person’s gender identity and gender expression rather than their assigned gender? Is the transgender person comfortable/accepting of their current expression or identity? What, if any, costs are associated with the individual’s gender identity or gender expression (loss of employment, family, or friends)?

Many transgender individuals are secure and well adjusted in the way they experience themselves and in their gender identity and expression. They have rich and satisfying relationships with their children, partners, spouses, and extended family members. However, those persons who present for treatment, may have endured abuse or negative experiences related to their expression of self. 

Coming Out:

All LGBT individuals will experience “coming out”. This is a process that typically begins with awareness of, and coming to terms with, one’s sexual orientation. This process can begin at any age and, depending on the balance of self-denial and self-acceptance, can last any length of time. Although gay men tend to be aware of their sexual orientation at an earlier age than lesbians, coming out is a uniquely individualized process that happens in stages. When it happens and how well it happens is influenced by a multitude of variables, including internalized homophobia, the presence of positive/negative role models, ethnicity, culture, religious beliefs, family beliefs, etc. After coming out to oneself, there is the process of deciding whether or not to come out to parents, family members, and friends; and when, where, and how to do that. Each time the person is put into new or unfamiliar situations (new job, school, or neighborhood), they may need to come out all over again. Coming out is a lifetime process.

Considerations

Where is the parent in their coming out process? Where is their partner in their own process? Were their experiences of coming out supportive/uplifting or alienating? Have they been rejected by family members or lost friendships? How is the baby/children regarded by extended family, if the child was adopted? Does the baby/child enjoy relationships with the non birth parent or partner’s family members? Does the parent experience extended family/friend relationships? Do the parents have connections or involvement in the LGBTQ community?

Many gay and lesbian headed families enjoy rich relationships with family and friends. Some create their own families and natural supports within the LGBTQ community. However, negative coming out experiences and a lack of support can contribute to isolation and impact the family. Also, if one partner is open or “out” and the other is “closeted”, this can place a great deal of stress and strain on the couple’s relationship. We know that parental stress and isolation can negatively affect the parent-child relationship and place risks to an infant or toddler’s attachment.

Discrimination:

LGBT families, like other minorities, are burdened by the influences of social stigma, oppression, and discrimination.  Systematic homophobia perpetuates myths, bias, stereotypes, and inequalities that permeate across the lifespan. LGBT individuals and families are personally affected by a lack of positive gay parent role models and negative messages about their ability and right to parent. Internalized homophobia is a damaging outcome that can influence a person’s ability to form a healthy identity and sense of self, and can ultimately interfere with their ability to form secure relationships with others, including their children.

The inability for same-sex parents to marry or have their relationships legally recognized can have far reaching implications for LGBT couples, parents, and families. Parental rights are affected.   A non-biological same-sex co-parent does not have any legal rights to their child(ren), including medical or educational rights.  Even in cases where a co-parent has adopted, they may not be recognized as a legal parent.  A non  legal parent can be prevented from attending their child’s school functions, visiting their child in the hospital, getting medical care for their child, and has no parental  protections in the event of a separation. This has far reaching implications for attachment and parent-child relationships.

The differences between same-sex and heterosexual couples are not in the quality of their parenting but in society’s response to their families.

An IMH Story:

A single lesbian mother sought infant mental health services because she had adopted the biological child of her ex partner, before they separated, and was ambivalent about caring for her ex partner’s subsequent children.. The ex partner was abusing substances and became pregnant. She continued using drugs during her pregnancy and gave birth to twins who were exposed to cocaine. She was homeless and continued using drugs as she attempted to care for her infants. The mother overdosed in a crack house and her infants were found with her. They had their names and her ex’s phone number pinned to their coats. The twins were placed with the ex partner, who had adopted the older brother.

This mother needed support to cope with the death of her ex, and her feelings of anger and ambivalence. She felt trapped by her desire to “do what was right” and she was angry that the babies were neglected and prenatally exposed. She feared she would not be able to care for the babies’ special needs and the three year old she had adopted.

This single mother and her children received services from an IMH specialist who met this family with openness and did not make judgments about sexual orientation, how the children came into the family, the mother’s feelings of confusion/ambivalence, or the biological mother’s drug use. The family received IMH interventions of parent-infant psychotherapy, developmental guidance, advocacy, emotional support, and case management services to address concrete needs. During treatment, the mother revealed a history of physical and emotional abuse during her childhood and the early death of her own mother. These were some of the issues that challenged this family’s ability to form secure attachments

The IMH therapist held and nurtured this overwhelmed young mother; helping her to experience trust through the therapeutic relationship and to learn what each of her children needed from her to begin to trust and become secure. This family received home-based services for two and a half years. The mother was able to support each child’s physical development and learned to be more responsive to their social-emotional needs. Before services ended, this mother legally adopted the twins.

References
•       See American Psychological Association. Lesbian and Gay Parenting: A Resource for Psychologists, District of Columbia, 1995; Child Welfare League of America, Issues in Gay and Lesbian Adoption: Proceedings of the Fourth Annual Peirce-Warwick Adoption Symposium, District of Columbia, 1995.
•       Petit, M. & Curtis, P., Child Abuse and Neglect: A Look at the States, 1997 CWLA Stat Book, Child Welfare League of America, Washington, D.C., 1997, p. 72, 124.
•       Petit, supra note 2.
•       Sokoloff, B., "Antecedents of American Adoption," The Future of Children. Vol. 3, No. 1 (1993), pp. 17-26; Cole, E. & Donley, K., "History, Values, and Placement Policy Issues In Adoption," in The Psychology of Adoption. Eds. David Brodzinsky & Marshall Schecter, (New York: Oxford University Press, 1990), pp. 273-294.


Resources
Websites
•       Human Rights Campaign Family Project (National) http://www.hrc.org/issues/8399.htm http://www.hrc.org/documents/parenting_laws_maps.pdf http://www.hrc.org/documents/gayandlesbianfamilies.pdf
•       Coalition for Adoption Rights Equality, Inc (Michigan) http://www.secondparentadoption.org/ http://www.secondparentadoption.org/library/researchmenu.htm
•       Rainbow Sauce – Children’s Books for LGBT Parents  http://www.rainbowsauce.com
•       American Civil Liberties Union  (National)    http://www.aclu.org/lgbt/parenting
•       American Psychological Association (Research on LGBT parents/families)
o   http:www.apa.org/pi/parent.html 
•       Proud Parenting   http//:www.proudparenting.com
•       Gay and Lesbian Adoptive Parents: Resources for Professionals and Parents http://naic.acf.hhs.gov
•       All Children Matter: How Legal and Social Inequalities Hurt LGBT Families http://action.familyequality.org/site/PageServer?pagename=AllChildren

Organizations
•       Lambda Legal Defense Fund (National) www.lambdalegal.org
•       PFLAG (National and local) www.pflag.org
•       Family Pride Coalition www.FamilyPride.org
•       American Civil Liberties Union (National/MI) www.aclu.org
•       Affirmations LGBT Community Center (Michigan) www.goaffirmations.org
•       Triangle Foundation (Michigan) www.tri.org
•       Ruth Ellis Center (Michigan) www.ruthelliscenter.com
•       Lesbian Mom’s Network (Michigan Parent Support) www.lmnetwork.org
•       National Adoption Information Clearinghouse 330 C St., SW Washington, DC 20447 (888) 251-0075 or (703) 352-3488   http//,naic@caliber.com  http://naic.acf.hhs.gov

Books
•       Gay Parenting Complete Guide for Same-Sex Families  by Shana Priwer and Cynthia Phillips
•       Gay Men Choosing Parenthood  by Gerald P. Mallon
•       Loving Someone Gay  by Don Clark, Ph.D
•       For Lesbian Parents  by Suzanne Johnson & Elizabeth O’Connor
•       LGBT-Parent Families: Innovations in Research and Implications for Practice  edited by Abbie E. Goldberg and Katherine R, Allen
•       Lesbian and Gay Parents and Their Children: Research on the Family  by Abbie E. Goldberg
•       Prejudice to Pride: Moving from Homophobia to Acceptance by Ann Marie Petrocelli

NASW-Michigan June Events

June 4, 2013   Activism: Advocacy in Action    1.5 CEs
6:30-8:00pm 
NASW-Michigan Chapter Office
741 N. Cedar St., Ste. 100.
Lansing, MI 48906
Cost: Free
Presenter: Maxine Thome, PhD, LMSW, ACSW, MPH
Activism: Advocacy in Action will provide insight and tools for change that social workers can use when advocating in the legislative and political arenas. The purpose of this workshop is to motivate action of attendees through the use of stories of activism, personal experiences, and current legislative efforts; this workshop is one that cannot be missed. Additionally, come learn easy advocacy tools NASW-MI has put together and how you can keep up to date on important issues and take immediate action.
Contact Region 6 Representative Sara Stech at sarastech938@gmail.com with any questions.

June 4, 2013   NASW Lunchtime Series   The Power of Linking Social Work Practice and Policy   1 CE
June 04, 2013
1:00 PM - 2:00 PM  
Cost: Free
This presentation focuses on the essential linkages between social work practice and policy. Presenters will provide an analysis of the ways that the issues and challenges addressed by social workers can also be tackled on a broader, policy level in order to benefit larger communities and populations. This training has been approved for 1 contact hour of social work continuing education credit.
Presenter(s):
  •  Kelsey Nepote, MSW
  •  Elizabeth Hoffler, MSW, ACSW
Register here

June 7, 2012 NASW-MI Work Groups
NASW-MI offers members the benefit of joining one of our special work groups. These work groups provide a great way for both new and experienced members of the profession to come together, network and discuss important topics related to a specific area of practice, as well as work on special projects to help advance the profession.
NASW-Michigan Chapter Office
741 N. Cedar St., Ste. 100.
Lansing, MI 48906
Private Practice/Clincal Social Work
10:00-11:30am
Addictions and Recovery
11:30am-1:30pm
Aging/Geriatric Social Work
1:30-3:30pm

June 12, 2013   NASW-MI LGBT Work Group

7:00 – 8:30pm  

All NASW-MI members are welcome to the LGBT and Ally work group meeting on June 12th! We will meet to discuss issues affecting the LGBT community, LGBT social workers, legislation/policy concerns as well as to plan the upcoming pride march and rally. Bring friends and colleagues. Anyone may attend up to two work group meetings without joining NASW, so come see if we are right for you!

NASW-Michigan Chapter Office
741 N. Cedar St., Ste. 100.
Lansing, MI 48906



June 17, 2013   Humor = Health. Region 10     1.5 CE
Monday, June 17, 2013
12:00-1:50pm
Allegiance Health Diabetes Center,
817 W. High St.
Jackson, MI  49203
Cost: Free
Presenter: Bonnie Holiday, LMSW & Catherine McAllister, LMSW, ACSW
Join Region 10 NASW-MI members for a free 1.5 CE Humor=Health event on June 17, 2013 from 12-1:50pm. There will be education on the healthy benefits of humor and laughter on the bio/socio/emotional areas of life. To be covered are the definition of humor, types, how to recognize humor, benefits and healing power and where and when humor is beneficial to the Social Work venue.
Please send RSVPs and questions to Bonnie Holiday at bonnie.holiday@arbor.edu.

June 27, 2013   NASW Lunchtime Series   Enhancing Palliative Care: Introduction to the National Consensus Project's Clinical Practice Guidelines    1 CE
June 27, 2013 1:00 PM - 2:00 PM  
Cost: Free
As a member of the National consensus Project for Quality Palliative Care, NASW helped revise the recently released Clinical Practice Guidelines for Quality Palliative Care, developed for palliative care programs across the continuum of care. This presentation provides an overview of the Guidelines and explores practice applications. This presentation has been approved for 1 contact hour of Pain/Symptom Management continuing education credit for social workers.
Presenter(s):
  •  Stacy Orloff, EdD, LCSW, ACHP-SW
  •  Chris Herman, MSW, LICSW
Register here