Earlier in the month, NASW Illinois Chapter President-Elect Candi Gray and I attended the NASW Annual Leadership Meeting (ALM) in Washington, DC. We were also joined by Kathy Wehrmann, past NASW Illinois Chapter President and current national NASW Board Member (Region IX). This gathering brings together executive directors and presidents or president-elects from all of the NASW Chapters. The meeting took place against the backdrop of two major issues currently impacting the association. The first is the transition in national leadership with the retirement of current NASW National CEO Elizabeth J. Clark to Angelo McClain, our new CEO who assumes his position in early May. The second is the ongoing challenges related to membership revenue following changes in NASW’s private liability insurance product last fall. 

The following includes brief highlights of the ALM meeting:

We met with staff of the following members of the Illinois Congressional Delegation: http://naswil.org/volunteer/gallery/41113-nasw-annual-leadership-conference/, as well as attended the Illinois Constituent breakfast hosted and attended by our two U.S Senators, Dick Durbin and Mark Kirk:

• Senator Dick Durbin
• Senator Mark Kirk
• Representative Jan Schakowsky (9th District)
• Representative Rodney Davis (13th District)
• Representative Aaron Schock (18th District)
• Representative Bill Foster (11th District)

We were able to actually meet with Congressman Foster thanks to NASW Illinois Chapter Board Member Chasity Wells-Armstrong who serves as constituent services director for the congressman. 

Our 2012 NASW Illinois Chapter Public Citizen of the Year, Judge Jeffery Ford, received the national NASW Public Citizen of the Year Award at a ceremony during the meeting. A video of Judge Ford’s accomplishments was shown and can be viewed here. 

Frederic Reamer, PhD, was awarded the International Rhoda G. Sarnat Award. He delivered a lecture entitled, "Technology and Ethics." The most recent edition of the NASW journal Social Work includes an article by Reamer entitled, “Social Work in a Digital Age: Ethical and Risk Management Challenges, ” and is available for review here. Reamer was a plenary speaker at our 2009 statewide conference. 

We also received a report from NASW Assurance Services, Inc. Executive Vice-President Tony Benedetto. The major news item is that the lawsuit filed by the previous insurance broker against NASW and ASI has been settled. The settlement agreement is being treated as confidential by the parties. ASI will be sending out new marketing materials that comply with the settlement's requirement that we not identify the prior broker by name and that we not provide any detailed coverage comparisons in charts. We may talk about the new professional liability program offered through CPH and Associates, and we will outline the terms of the NASW/ASI professional liability program that have been improved. We will keep the prior brokerage firm and the insurance company out of our marketing materials and out of our verbal presentations. We will discuss the improved terms of the new program, new insurer, and improved application and renewal process.

A farewell dinner for Betsy Clark took place at ALM as well, highlighting her years as NASW CEO. 

Incoming NASW CEO Angelo McClain attended the national NASW board meeting during ALM and briefly met with chapter directors. He will start his new position on May 13, 2013. 

Our 2013 NASW Illinois Chapter Conference Committee, chaired by NASW Illinois Southern District Chair Lindsey Adams of Mt. Vernon, Illinois, is currently reviewing the many workshop proposals submitted for the fall statewide conference. Complete conference registration and advertising, sponsorship, and exhibitor opportunities, can be found here. 

Brief Notes

The 2013 NASW Illinois Chapter election results will be posted on the chapter website (http://www.naswil.org) later this week. 

Best wishes to our outgoing NASW Illinois Chapter social work interns from the current academic school year: Katie Connelly from the University of the Illinois at Urbana-Champaign and Patrick Needham from the University of Illinois at Chicago. We really appreciate all of their hard work over this past year. 

After close to five years, Christina Polus, the chapter’s manager of events and education will be leaving us and moving to Michigan. Christina joined us first as a meetings intern during the summer of 2008, endured the move to our current offices at 404 South Wells, and has been a real asset to the chapter by servicing our members. Christina, you will be missed. We wish you the best of success in your new state. 

I hope you will enjoy the May 2013 issue of the Networker. Longtime forty-five-year NASW member Karen Beyer, famous for her role in protecting the privacy of a client in the Jaffee v. Redmond case that went to the U.S. Supreme Court, has written the feature article in honor of National Mental Health Month: “Social Workers at Illinois’ Community Mental Health Centers.”

Lastly, six years ago I wrote a blog post titled, “Jackie Robinson and Social Work.” Jackie Robinson’s efforts on the baseball field helped launch the modern civil rights era in the United States and paved the way for the full integration of American sports. One of Jackie Robinson’s most famous quotes, that “a life is not important except in the impact it has on other lives,” resonates with the social work profession. The work that we carry out in all practice areas is designed to impact the lives of the people that we serve. The newly released film, 42, starring Chawick Boseman and Harrison Ford is about the life of Jackie Robinson. I’d encourage our members to see it. http://42movie.warnerbros.com/

Joel L. Rubin, MSW, CAE, has served as executive director of the 7,000 member Illinois Chapter of the National Association of Social Workers (NASW) since October 1999. He has over twenty-five years of nonprofit management and fundraising experience including extensive work with boards of directors, committees and volunteers, and advocacy around a wide variety of social work, human service, and international political issues. Joel is a graduate of the Wexner Heritage Fellowship Leadership Program and a current adjunct professor at the University of Illinois at Chicago Jane Addams College of Social Work as well as Loyola University Chicago School of Social Work.

Social workers generate money to finance community mental health centers’ operations. They provide services that bring in revenues through fees for service billing, grant writing, events, and other forms of fundraising. Since community mental health center clients tend to be poor, outside funding sources finance a majority of services. These funders require detailed reports on how their money is spent. As a result, financial, service quantity, and treatment outcome reports are continually generated by social workers that work at all organizational levels. Each outside funder decides how their money can be used or earned by the organization, and this means that supervisors and administrators, case managers, therapists, psychiatrists, psychosocial rehabilitation, vocational, and residential program staff must continually check to ensure that they are following the various funding sources’ rules. Because funding is currently very tight, supervisors regularly monitor staff productivity, and administrators use benchmarking and productivity statistics to manage and lead the organization. Social workers throughout an organization help supply the organization’s board members with the information they need for governance.

Advocacy and political action play an important role in mental health services, and social workers have always advocated and promoted social justice and change that benefits clients. At a personal level, community mental health center social workers advocate for their clients to receive fair hearings, entitlements, and subsidized services of various kinds. At a state and national level, mental health agency executives and public policy and/or advocacy staff members engage in social and political action to obtain favorable legislation and administrative decisions for people with mental illnesses. Working with their own staff, other professionals in the field, as well as groups and organizations like the National Alliance on Mental Illiness (NAMI) and the National Council for Community Behavioral Healthcare, they seek to suggest, introduce, and advance legislation that benefits people with mental illness through funding of human services, housing, research, pilot service projects, and more. 

Currently in Illinois, the delayed payments and funding reductions by the state, managed care middle men, and increased compliance requirements have necessitated adjustments and increased efficiencies at community mental health centers. As more resources are required to meet increasingly complicated billing and prior authorization of service requirements, social workers are called upon to multitask and be more expert users of information technology and masters of the latest software programs. An example of this is concurrent note-taking where a social worker writes case notes while working with the client. 

Social workers redesign service delivery systems and restructure services to be more effective by adopting more evidence-based practices and investing in information technology such as electronic medical records and the use of mobile devices for communication and note-taking. As funding for services is reduced, clients must become increasingly more responsible for their own recovery; social workers must rely on techniques like motivational interviewing to help clients invest in their own recovery. Social workers at all levels of the organization scan the environment in search of assistance needed by their clients and the organization. Sharing newfound information about resources is an important part of communication amongst staff and even board members.   

Some mental health centers have integrated their services, often at the same site, with primary care, substance abuse, or pharmacy services, and some have joined other human service organizations to form their own managed care companies. The leaders of these innovations have become entrepreneurial to enhance client services and meet the requirements of healthcare reform. 

The current environment requires community mental health centers to be adaptable, innovative, and nimble, and that their staff be continually learning new skills to be more productive and to meet compliance requirements of funders. Core values of the social work profession help to make social workers valuable team members in such an environment. Social workers know the importance of human relationships as the vehicles for positive change, and they know that this applies to organizations where they work. Being ethical, trustworthy, and cooperative in order to help people in need exemplifies social workers’ values and also makes work relationships within their organizations run smoothly. As social workers we are used to doing whatever it takes to bring the best services we can to our clients. Social workers’ willingness to learn and grow in direct practice, supervision, administration, advocacy, and political action skills in order to serve clients contributes to the success of mental health organizations. Both new and continually evolving employee skill sets combined with social work values are key elements in producing the highest quality case management, therapy, psychiatry, and crisis and residential services at Illinois’ community mental health centers. 

Karen Beyer, MSW, MPA, MBA, LCSW, is currently executive director of Ecker Center for Mental Health and a Network of Social Work Managers board member. Prior to this she was an American Association for Marriage and Family Therapy (AAMFT)–approved supervisor and worked in child welfare and elder and family services and had a private practice of marital therapy and divorce mediation. She was also the social worker/therapist in Jaffe vs. Redmond, the U.S. Supreme Court case in which the Court created a psychotherapist-patient privilege in the Federal Rules of Evidence. 

The NASW Illinois Chapter has started a shared interest group (SIG) devoted to the issues of private practitioners around the state. To be become involved in this group, please contact NASW Illinois Chapter office: http://naswil.org/naswil/contact-us/. 

Private practice means slowly building a one-on-one psychotherapy practice, right? That's what I thought. But that's not how it turned out for me. One of the joys of social work practice is that our skills allow us so many options.

I have worked as a contractor for most of my professional social work career. This has provided a defined structure for services to be provided and for my pool of clients while maintaining the freedom of self-employment. This has been a good balance for me—while not the most lucrative way to practice, it is quite satisfying for someone who values flexibility.

Colleen Clark Lay, LCSW, who practices in Yorkville agrees that flexibility is a key benefit of contract work. “When I went into private practice, I marketed myself online and scheduled face-to-face meetings. Through one of these meetings, I was offered a contract position at a local university. It offered flexibility in hours, a guaranteed hourly salary, and the ability to self-refer for long-term cases. I enjoyed the variety of clients and the short-term cases. A contract position is a nice addition to a private practitioner’s schedule. It provides a steady additional income and allows the counselor to remain autonomous.”

My goal out of graduate school was to work in a college counseling center, which I was able to do on a part-time basis with a contract (not as an employee). I was newly married and planning to start a family. My husband worked odd hours and could make more money than I could, so we jointly decided that I would pursue my goals but in a way that was flexible enough for our family. 

I set my own hours with input from the my director as to what would work best for the center. My work doing one-on-one psychotherapy in this setting provided an entrée to more opportunities in other areas of campus, like psychoeducational programming and teaching a for-credit course. The variety was appealing, and the flexibility worked well for creating balance with my family life.

The hourly fee I was paid was established by the center director. At other times, though, the social worker has control over setting fees when you bid for a contract. Setting fees can be difficult but can be done by taking into consideration your overhead costs, supplies, and the value of your time. It’s important to survey the going rates in your area so you can realistically place a value on your time.

Other financial considerations were mentioned by Cathi Hendricks, LCSW, of Batavia, when I spoke with her about contract work. “I would recommend speaking with a financial advisor and getting your own personal CPA. That way you will know what you can write off on your taxes as expenses—supplies, food, CEUs, etc. You’ll have to pay quarterly taxes yourself, so you want to know what you’re doing. A SEP (Simplified Employee Pension) IRA is a good idea to have to put money away for retirement.” 

After several years with the college, I left to open my own office in another town. Away from the limits of clientele drawn from the college population and wide open to anyone who might walk in off the street, I was a bit intimidated. I found the marketing and networking necessary to build a practice quite challenging. Like many in our field, I am introverted and found it difficult to sell myself.

Like Clark Lay, I held meetings with various contacts to market myself. I met with a colleague I had worked with at the college who had moved on to oversee an employee benefit program at a major corporation. He offered me a life-work planner position. We negotiated the terms of a contract, which included services to be provided, a defined time frame and a set fee, as well as what would not be provided, such as benefits and transportation costs. I provided workshops in career planning and retirement planning. I traveled to various employee locations to provide counseling for individuals and to proctor certification exams. The work was varied, and I enjoyed the travel. I then supplemented the base income from this contract with individual clients in my office.

Usually the employer will provide a contract for your work but sometimes you must create a contract. You always have the right to question or modify any points in the contract. It’s important to understand the expectations before signing. A sample contract can be found here: http://www.comptroller.illinoisstate.edu/downloads/20-factor-test-for-independent-contractors.pdf. The sample contract also provides an outline for ways to tell whether the worker is a contractor or an employee, in the eyes of the IRS. It highlights the three most important factors in determining an employee versus an independent contractor:

1. Instruction to workers: Your worker is probably an employee if you require him/her to follow instructions on when, where and how work is to be done. 
2. Job training: If your company provides or arranges for training of any kind for the worker, this is a sign you expect work to be performed in a certain way; therefore, the worker is your employee. 
3. Worker's ability to make a profit or suffer a loss: An employee will always get paid; an independent contractor, however, has a financial stake in his enterprise.

A few years later, I was offered the directorship of another college counseling program. I missed the energy of a college campus so I took the job as an employee. After an eight-year run in that position, I ventured back out on my own in private practice which meant for me doing contract work. This time, I’m working for two nonprofits in Chicago and Cicero. I have the freedom to create programs in both of these places, doing work that is geared toward building futures in college and careers. It's less mental health than my work at the colleges, but it is social work in the sense of helping disadvantaged people build better lives.

Marcia Hanlon, LCSW, has been a clinical social worker in the Chicagoland area for twenty-five years. She spent twenty years as a therapist in the mental health counseling offices of two private colleges. At the 2011 NASW Illinois Chapter Statewide Conference in Oak Brook, she presented a program on the needs of and strategies for helping first-generation college students graduate from college. She currently leads the College Completion Initiative for the Associated Colleges of Illinois and maintains a college access website: http://www.CollegeScoop.com. She can be contacted at marciahanlon@gmail.com.

The objective of play therapy is to give kids a palliative way to learn tools or strategies to solve their problems and cope with the demands of their life. Over the years I have borrowed or created a variety of short-term playful techniques to help kids deal with anxiety and distress. 

I often show kids magic tricks and draw an analogy between the trick they saw and the tricks that can help them navigate a life situation. For example, one trick involves a magic purse. I give the child a frowning face plate to put in, say the magic word (often the word okay), and then instruct them to draw out a smiley face. Similarly we can turn frowning situations into smiling ones with the right strategies. Saying okay to an adult usually results in smiles. Many simple magic tricks can be purchased that require no sleight of hand skills, and applications are limited only by your own creativity. It is the hook that gains initial attention. Similarly, optical illusions are both fascinating and have a message to impart. I use them to introduce the concept of perception, or how different people may have different interpretations, ideas, or opinions without anyone being wrong or to blame. 

If worries were put into words, they would usually begin with “What if….” or “Oh no…”. I identify this as the language of worry and help children put their worries into actual language. When children worry, the first thing we usually talk about is three kinds of worry: 

1. There is the type of worry that children have the resources to solve themselves. Examples: What if I get in trouble for having a messy room? What if I get an F on my spelling test?
2. There is the type of worry that someone can help the child to solve, often a parent, teacher, or doctor. Examples: What if this stomach ache means I have a horrible disease? What if we can’t pay our bills? 
3. The third type of worry is one that is not under our control. Examples: What if I get a disease and die? What if our house gets robbed? 

I introduce the worry concept by playing tic-tac-toe. They circle the worries in category one to which we can brainstorm logical solutions. We also brainstorm to what degree we have control or what factors can be controlled in the second and third categories. For example, if an adolescent worries about getting in a car accident, we establish that one can control wearing a seatbelt, declining to text or drink and drive, and follow road rules such as speed limits. But no one can control whether other drivers are taking these same common sense precautions. The strategy then becomes two-fold. First, do all of the things that you can control. Second, practice the strategy of if and when. That is, if and when the dreaded event happens, then you will brainstorm what coping skills are required, what course of action to take, and what resources or support systems to tap into. 

Several related techniques involve giving the child a worry stone to hold onto these worry thoughts for them, and/or drawing or creating a solid, strongbox tied with ropes and chains with combinations and key locks to hold the worries. The child is encouraged to schedule a worry time. This is a convenient, planned time to sit for a contracted amount of time (say twenty minutes) and focus entirely on the worry thought. This may be called worry immersion because during this time, one immerses oneself in this thought; but when the time is up, the thought is once again given to the worry stone or put in the worry box. Some youngsters report that they are tired of the thought after ten minutes and find their minds wandering away from the thought before their twenty minutes is up. If this is the case, they might even be allowed to write the thought on paper, put it in an ashtray, and burn it. The idea is to help the child take charge of the worry by being in charge of setting up a time and place to devote to the worry rather than getting pulled into the thought by Mr. Worry. Kids often enjoy drawing a picture of their worry monster and naming it. This makes worry an entity that becomes their foe, their enemy to defeat. Little boys may enjoy the analogy of using army men to represent their strategies and coping skills and a different color army to represent their worries. This allows them to define and act out their worry tug of war with both language and actions.

The shut up list is a strategy that is attractive due to the allure of the forbidden. “Shut up,” is a phrase that is banned or punished in most settings, but we make an exception by allowing this phrase to be used only in responding to Mr. Worry. I have kids create a shut up list in which we list as many ways as we can think of to say shut up to Mr. Worry. For example, we might list the following phrases:

Talk to the hand. 
Leave me alone. 
Go jump in the lake. 
Callete. (Spanish)
Be quiet, la la la la la la la, I can’t hear you.

This activity usually generates a lot of laughter, which is certainly inconsistent with anxiety. Kids are encouraged to use this list to talk back to Mr. Worry and find that the humor that accompanies it is incompatible with worry. 

The brain remote control is another useful technique. I draw several buttons on a large, rectangular paper. Kids are instructed to draw or write two things that they worry about on two of the buttons, then we generate two things that are relaxing to them to draw or write on the remaining two buttons. These are often techniques that we have practiced such as diaphragmatic breathing/progressive muscle relaxation, taking an imaginary sensory trip, calming self-statements, petting their cat/dog, or listening to music. I usually add a simple optical illusion at the top which is a face that appears to be frowning if held in one direction and smiling when turned upside down.

The nightmare is a universal experience. It provides an understandable analogy for fight or flight. I ask kids to describe a nightmare, then ask if the event actually happened or if it was a creation of their mind. Using this as a backdrop, we discuss all of the things that occur in the mind and body during fight or flight (tense muscles, wide eyes, defensive posturing, heart pounding, upper chest breathing, mental images, etc.). Then we focus on those that can be consciously controlled (mainly muscle tension and breathing patterns) and teach the difference between healthy and anxious breathing patterns and muscle tension vs. relaxation. This can be done in a very playful format, i.e. with Simon Says and exaggerated motion. When kids have had a chance to practice relaxing their muscles, I put them to the test by asking permission to hold one of their arms in the air until they tell me they are relaxed; then I release it. If they are truly relaxed, the arm will fall to their lap. If not, it will remain in the air after I have released it, giving us a laugh and a chance to try again. 

Fact vs. Feeling is a very important concept in anxiety management. Whether using optical illusions or a simple homemade test (Fact or feeling: This wall is blue. Blue is the prettiest color in the world.), I teach the difference. The nightmare is a great example of events that appear to be factual but are, in fact, feelings or perceptions. The body cannot help but respond to thoughts; thoughts are actually real in terms of neurological processes. If thoughts are present, the body will be reacting, as in the nightmare. Nightmares, as well as so many anxious thoughts, are false alarms. They are based in feelings/perceptions but are not facts. By distinguishing facts from feelings, we can learn to recognize that feelings might be uncomfortable, but they do not represent a threat to our well-being and can be viewed as false alarms. (I used to have a fire hat that could be turned on to produce a siren and flashing light. It was a perfect prop to illustrate this concept in a playful way.) If a child can recognize that a thought is a feeling but not a fact, he/she will be better able to tolerate the distress that the thought triggers, while still choosing to cope with the distress without avoiding, ritualizing, or acting out feelings of frustration, worry, etc., because the threat is minimized. Scooby Doo and Wizard of Oz are both excellent analogies for the power of threatening thoughts vs. reality. If you’ve seen one episode of Scooby Doo, you know what I’m talking about. Often they literally pull off the mask of the bad guy to reveal that he is just a common guy with no real powers and is up to no good. Similarly, Mr. Worry may appear to be powerful and in control, but when confronted with these techniques, his power fades quickly and can be recognized as an illusion. 

Most school social workers are not set up to provide long-term therapy. They need quick, solution-focused techniques that are attractive for kids and can be utilized in short-term situations. These types of techniques are solidly based in cognitive behavioral theory (CBT) and meet this short-term, solution-focused model at very little cost. 

There has been a lot of attention given to the problem of bullying both in the media and in state legislatures across America. The number of bully prevention programs offered to school districts has increased significantly in recent years. Legislators rush to pass laws requiring school districts to come up with anti-bullying policies that include a component to teach children how to respond to bullying. In Sticks and Stones: Defeating the Culture of Bullying and Rediscovering the Power of Character and Empathy, Emily Bazelon tackles this high profile subject with an honest look at what bullying is and, more importantly, what bullying is not. She spends time in delineating the difference between bullying and what could be considered adolescent drama. She notes that the first person who conducted research on the systematic victimizing of students by their peers was a Swedish professor named Dan Olweus. He stated that bullying had to satisfy the following three criteria: “[I]t had to be verbal or physical aggression that was repeated over time and that involved a power differential—one or more children lording their status over another.” Bazelon will go back to that definition throughout her book stating that it stands up even though Olweus’ research was conducted in 1969. The one unique feature of bullying is that it is found in all cultures, societies, and economic groups.

The book is divided into three sections and uses three events (two have had media coverage). She narrates the circumstances of three teenage students—Monique, Jacob, and Flannery—to illustrate how complex lives are for teenagers in this country. Not only does she describe the events in detail but also in sections following she shows that when adults are brought into the situation, matters became either more traumatic or the adult intervention was able to diffuse the situation for all of the students involved. One of the unique features of this book is that one of the students she writes about was considered a bully in a narrative that had tragic results—the suicide of the targeted student. In the third and more critical section she describes ways to make positive changes in a school’s culture to decrease the number of incidents of bullying.

It is the third section that school social workers should read to get an understanding of how schools can play a part in developing a school climate that fosters empathy and diffuses the victimization of students by their peers. She looks at two particular curricula, Olweus’ American version of bully prevention and Second Step, a well-regarded character education program; both have shown positive evidence-based results. She goes to schools that have utilized these programs to see their efficacy. She examines Positive Behavior Interventions and Supports (PBIS) and showed the dramatic results at one school both in terms of behavior and academic improvements once PBIS is implemented with fidelity. 

Throughout the book, Bazelon discusses how social media has made an impact on bullying. Social media adds a new form of bullying and drama. In 2011, Consumer Reports estimated that about one million preteens and adolescents were bullied, threatened, or harassed out of the approximately twenty million of those age groups who used Facebook in the previous year. There has been a new type of bully added which is called the Facebook thug, a person who can be a different persona in social media. Recently there have been news reports of two teenage girls committing suicide due to having compromising photos of themselves going viral either on the internet or being sent by text messaging. 

What is special about this study by Bazelon is her willingness to talk with the targeted adolescent, the adolescent’s friends, and those who target the young adult and bystanders. She speaks to the adults that are involved: parents, teachers, school administrators, and public officials. Her ability to gain the trust of those involved in the three vignettes is admirable and makes reading very compelling. There is no rush to judge any of the participants in the three scenarios, but Bazelon gives the reader some thought-provoking conclusions about how we can handle bullying by developing children’s character and empathy.

We are heading into the final month of the spring session of the Illinois General Assembly. Most live legislation is now in the second chamber, and there will be a lot of committee activity the next two weeks. Major issues to watch in the next five weeks include pension reform, Medicaid expansion under the Affordable Care Act, freedom to marry, concealed carry of guns, gaming, taxation, and the state budget for fiscal year 2014. 

The following is a summary of some important bills:

SB 10 (Steans/G. Harris)
The bill addresses Freedom to marry legislation that would allow same-sex couples to legally marry in Illinois. The bill has passed the Senate and was favorably approved by a House committee. It is pending on the House floor. NASW supports.

SB 26 (Steans/Feigenholtz)
The bill would expand Medicaid to include low-income individuals up to 133% of the federal poverty level (and in some cases up to 138%) who are currently not eligible. The bill passed the Senate in February and is in the House. It has not been assigned to a House Committee yet. NASW supports.

SB 1159 (Hutchinson)
The bill would raise several hundred million dollars in revenue by closing some corporate tax loopholes. The bill itself is dead, but the issue is very much alive. NASW supports.

SB 1194 (Haine)
The bill creates the Insurance Navigator Act. Navigators would, among other things, assist individuals in the process of accessing health plans under the Affordable Care Act and selecting the plan that best suits the needs of the individual. This bill started out as an insurance brokers' proposal that was opposed strongly by health care advocates. However, the bill has now been amended after negotiations with advocates and most of the advocates have withdrawn their opposition. The bill passed the Senate and is now in the House.

SB 1609 (Koehler/Cassidy)
This is an NASW bill that would make it a Class 3 Felony to threaten harm to a social worker, investigator or caseworker, or family member who is employed by a human services provider agency that has a grant or contract with the Department of Human Services (DHS), the Department of Children and Family Services (DCFS), the Department of Healthcare and Family Services (DHFS), or the Department on Aging to provide human services if the threat is related to the performance of those duties. This is an expansion of the criminal offense of threatening a public official, which includes social workers, caseworkers, and investigators employed by certain state agencies. The bill has passed the Senate and is now in the House.

SB 1845 (Mulroe/Hartwick)
This bill amends the Illinois School Code by adding language regarding bullying prevention to the section that describes the role of school social workers. The bill passed the Senate and is assigned to the House Elementary and Secondary Education Committee.

SB 2187 (Harmon)
The bill would allow clinical psychologists to issue prescriptions for certain types of medications after successfully completing a pharmacology education program. The bill has passed the Senate and is now in the House.

SB 2199 (Frerichs/Jakobsson)
Amends the Illinois School Code to fix a problem regarding school social work internships that was created by Public Act 97-607 in 2011. Under the bill, a school social work student would not need to first pass a content area test before starting an internship. The bill has been passed in the Senate and is now assigned to the House Elementary and Secondary Education Committee. NASW supports.

HJRCA 2 (Jakobsson)
This bill would put on the ballot for the next election a constitutional amendment that would allow Illinois to have a graduated income tax rate. The bill is in the House Rules Committee. NASW supports.

SJRCA 17 (Frerichs)
Same as HJRCA 2 above.

HB 2 (Bellock)
The bill creates a Single Audit Commission to study and report on ways to make Illinois' grant process more effective, efficient, and improve accountability. The commission is due to issue a report and sunset on April 1, 2014. The bill has passed the House and is now in the Senate.

HB 61 (Ford)
This AIDS Foundation of Chicago bill moves to remove a requirement from the Illinois School Code first enacted in the 1980s that school principals must be notified when a student tests positive for HIV or is diagnosed with AIDS. The bill has passed the House and is now in the Senate.

HB 948 (G. Harris/Haine)
The bill creates the Adult Protective Services Act which shifts the persons with disabilities domestic abuse, neglect, and exploitation reporting and investigation functions from DHS's Office of Inspector General to the Department on Aging's Older Adult Protection program. The bill also makes other changes and has passed the House and is now in the Senate.

HB 1017 (Feigenholtz/Steans)
This bill is an initiative of the Governor's Office of Health Information Technology to amend the Mental Health and Development Disabilities (MH-DD) Confidentiality Act with respect to the disclosure of recipient information within Health Information Exchanges. The bill has passed the House and was assigned to the Senate Human Services Committee.

HB 1538 (Golar)
A Community Behavioral Healthcare Association of Illinois (CBHA) bill that creates the Mental Health First Aid Training Act. NASW supports. The bill has passed the House and is now in the Senate.

HB 2262 (Gabel/Hunter)
This bill provides that DHS no longer would apply an asset limit in determining eligibility for the Temporary Assistance for Needy Families (TANF) program. This is an initiative of Heartland Alliance and the Shriver Center on Poverty Law. The bill has passed the House and is now in the Senate Human Services Committee. 

HB 2404 (Currie)
The bill would raise the juvenile court delinquency age to eighteen for certain offenses. The bill has passed the House and is now in the Senate.

HB 2420 (Chapa Lavia/Martinez)
The bill would allow licensed marriage and family therapists to work in schools after satisfying training and educational requirements to be determined by the State Board of Education by rule. The bill has passed the House and was assigned to the Senate Education Committee. NASW opposes.

HB 2675 (Lilly)
The bill amends the sex education provisions of the Illinois School Code to require medically accurate sex education and adds a reference to contraception as part of the curriculum. The bill has passed the House and is now in the Senate. 

HB 2869 (G. Harris/Steans)
Requires nonprofit state grant applicants to disclose certain information regarding the entity's relationships with for-profit businesses and to make other disclosures. The bill has passed the House and is now in the Senate.

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Blind Spots in Ethical Thinking: How to Make the Unconscious Conscious

Nancy was a social worker in private practice. Sara had been her client for five months. Ruth S., an obstetric nurse at a local hospital, sought counseling to address issues that had surfaced related to sexual abuse she had experienced as a child.

Nancy was also struggling in her own life. She and her husband had been through a wide range of infertility tests and medical procedures, all without success. The couple was distraught about their infertility and equally upset about all of the difficulty they were having in their attempt to adopt a baby.

During a counseling session, Sara talked about how happy she was that she was able to refer an unmarried birth mother at the hospital to one of Sara’s close friends who was interested in adopting a newborn. Sara explained that her friend had undergone “terribly painful and intrusive infertility tests and procedures.” Sara spoke at length about how fulfilling it was for her to be able to “get my friend a baby.”

Nancy was feeling so desperate about finding a baby to adopt that she began to think seriously about asking her client, Sara, whether she might be able to help her and her husband. (1)

We would all like to believe that we would never consider asking Nancy to help with an adoption in this scenario .What about the client who has skills in IT, finance, car repair, law, or construction? Have you ever wanted to run a question by a client for their input or ask for a recommendation? What about the client with that car they have not been able to sell that would be perfect for your family. 

Brent C. was a social worker at the Burrilville Family Service Center. His caseload consisted primarily of adolescents enrolled in the local school district. The school district had a contract with the agency to provide counseling when a referral was made by a school social worker or counselor.

Courtney R., age sixteen, was recently referred to Brent C. for counseling. According to the school counselor who made the referral, Courtney R. had been “sullen and depressed.”

Brent C. and Courtney R. spent several sessions exploring various issues in Courtney R.’s life. They talked about her relationship with her parents, three siblings, and boyfriend, and about the difficulty Courtney R. had been having in school.

During the fourth session Courtney R. told Brent C. she had something important to tell him. After Brent C. reminded Courtney of confidentiality limits, Courtney told Brent C. that she was pregnant. Courtney explained that the pregnancy was a surprise to her, that she and her boyfriend had always been “real careful.”

Courtney R. told Brent C. that she was apparently six weeks pregnant and that she was seriously considering an abortion. Courtney R. asked Brent C. to help her think through this decision.

It happened that Brent C. was adamantly opposed to abortion on religious grounds. He was raised to believe that abortion is morally wrong and that he must not do anything to encourage or facilitate abortion. (2)

There are many forms of blind spots that impact our perceptions, awareness and reasoning when making critical decisions. Blind spots are those unseen and unconscious factors that prevent us from attending to relevant data, different points of view, alternative solutions, and foreseeable consequences crucial to effective ethical decision-making. It is common to fail to notice or act on information when dealing with ethically relevant decisions.

Ethics is based on our deeply held values, those distinguishable elements denoting preference based on belief or obligation. Our values inform our attitudes about the worth of people, concepts, or things and underlie our judgments as to the goodness or badness of human action. Though we may identify values on a cognitive, rational basis, they are first and most powerfully experienced on an affective, emotional level. 

Ethical practice involves critical analysis of what is right and wrong, good or bad in a given situation. Ethical dilemmas force us to rank order by competing values. Because our values have such a strong emotional component, it is human nature to automatically interpret the stimuli in various situations on an affective level. Ethical judgments can be egocentrically biased, arising through unconscious and automatic psychological mechanisms. In the area of moral reasoning, people are much less accurate when predicting their own behavior than when predicting others'.

Our judgments about what is good or bad, positive or negative, are informed by these unconscious reactions. Subjective perceptions can appear objective and unbiased if we are unaware of all the factors impacting our perceptions. Because the outcome of our conscious reasoning can be so impacted by these unconscious dynamics, it is crucial to take steps to bring them into awareness. Key steps will be detailed later in this article.

The following are common examples of blind spots that can affect all of us. This article assumes, as the NASW Code of Ethics states, that “principles and standards must be applied by individuals of good character who discern moral questions and, in good faith, seek to make reliable ethical judgments.” Blind spots are not a character flaw or personal weakness. Individuals of “good character” and with the best intentions are still vulnerable. 

In their article “False Beliefs, Partial Truths: Personal Myths and Ethical Blind Spots,” Crina Archer and Laura Pincus Hartman (3) describe three myths that can interfere with effective ethical reasoning.

Myth of Moral Self-Image 

Research demonstrates most people believe themselves to be more moral than they sometimes are and therefore develop blind spots that prevent them from accurately assessing their decisions and actions. When questioned, most people could identify the moral limitations of others but tended to minimize or deny their own. 

Myth of Self-Sufficiency

“Admitting that our view of the world is not only partial and subject to bias, but is deeply dependent upon the views of those around us—from peers and colleagues, to authority figures and even advertisers—is not only difficult but it contradicts our sense of personal autonomy and independent thought. Although this admission is fundamental to the ethical decision-making process, it can also leave decision-makers with a sense of disempowerment.” 

The Myth of the Bystander

“Ethical blind spots are significantly affected by how others behave. It is easy to mistake bystander effects for apathy, since it appears as if the bystander does not care about the crisis. However, Darley and Latané (4) show us that the problem is not that bystanders do not care about the crisis at hand; rather, the problem is that they are misled by social cues to fail to see the crisis as a crisis.”

The authors point out the difficulty in maintaining “fidelity to one’s deeply-held convictions, when pressured by personal desires and situational factors to violate them. This difficulty is eased by telling ourselves that we are moral, regardless of our actual behavior; that we are the masters of our minds and environs, regardless of evidence that we are dependent upon others; or that we are mere bystanders, rather than responsible agents. Courage is needed to resist the temptation to accept one’s personal myths as accurate descriptions of reality, rather than partial and incomplete interpretations that are needed of continual interrogation.”

NASW has processed several professional review complaints that exemplify well-intended social workers being affected by these common blind spots. The following are a few examples:

A social worker doing custody evaluations for the court where the unofficial expectation was that each parent was only evaluated for one hour. Additional time could be utilized, but everyone understood this could result in a negative evaluation and risk job security. A newer practitioner inaccurately assessed a case involving domestic violence and made a recommendation to the court that resulted in the son being physically abused by the father. The mother then filed a complaint against the social worker. The social worker felt pressured to conform to the norms of the department despite assessing a high risk case.

A case manager for child welfare nearly ruined the career of a social worker involved with one of her clients in a small community. The client had been angry with the social worker for setting appropriate boundaries. In retaliation the client made up a story that the social worker had been verbally and emotionally abusive. The case manager automatically believed the client and took several steps that resulted in damaging the social worker’s reputation in the community. During the professional review process, it became clear that the case manager’s behavior was the norm in her department and therefore considered ethical.

Bounded Awareness

Systematic patterns of cognition that prevent people from noticing or focusing on useful, observable, and relevant data lead to systemic decision-making errors. Human beings constantly make implicit choices about what information to attend to in their environment and what information to ignore. Unconsciously, our minds imperfectly filter information when dealing with ethically relevant decisions. As a result of these limits, we routinely ignore accessible and relevant information. (Bazerman and Chugh 2005) (5). 

Bounded awareness interacts with bounded rationality, cognitive limitations that affect the choices people make based on their own preferences. When a teenager asks a school social worker not to tell her parents she is pregnant, the details of the situation that have the most emotional weight and are the most in awareness will differ between practitioners. Factors such as the social worker’s own history, whether he/she is a parent, beliefs about pregnancy, parenting, abortion, job pressures, and other factors will impact what information seems initially relevant to making a an ethical decision.

Confirmation bias, or myside bias, creates an unconscious tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true. 

Normalcy Bias: Shutting down and pretending everything is normal when we find ourselves in some unsettling circumstance. We see, but we don’t see and don’t intervene. One example is social workers at a Catholic social service agency that are not allowed to discuss abortion with clients, even though they may be pro-choice themselves. Another example could be an agency where the norm is inaccurate statistical reporting on forms for grants or public money.

These situations set social workers to be affected by bounded ethicality, the tendency of people to engage in behavior that is inconsistent with their own ethical values. Change blindness causes individuals to be less likely to notice others’ or their own unethical behavior when it occurs in small increments rather than when it occurs suddenly. Bounded ethicality can result from a slippery slope—a visual and perceptual failure to register important information. A frequent example is in dealing with impaired or incompetent colleagues. Feelings of frustration, overwhelming powerlessness, or fear in addressing the unethical behavior can cause social workers to fail to register the severity or impact of the problem.

Motivated Blindness

Individuals who have a vested self-interest in a situation have difficulty approaching the situation without bias, even when they view themselves to be honest (Ross & Sicoly, 1979).(6) Not seeing what is not in our interest to see can result not from conscious or malicious motivations, but from unconscious beliefs that generate fear. It takes tremendous moral courage say no to a principal or non–social work supervisor who is asking for confidential information we believe should not be shared. Factors or actions that we perceive to threaten our job security, physical safety, or self-esteem can result in ignoring pertinent information necessary for ethical decision-making.

How do we avoid or minimize blind spots? The expectation is not that social workers will be perfect and never be impacted by these natural phenomena. The duty we have is to show we have taken steps to minimize their interference in daily practice and ethical decision-making.

The following is a list of potential antidotes to blind spots:

1. Regular clinical supervision or consultation with professionals who have expertise in your area of practice. This may mean seeking out consultation beyond what is available in your agency or organization.
2. Ethical consultation as needed, particularly when dealing with ethical dilemmas. Ethical consultation differs from clinical. Ethical consultation is designed to not only provide relevant information about ethical duties and guidelines, but to assist with appropriate critical thinking and ethical analysis.
3. Recognizing ethical dilemmas and applying an appropriate procedural standard of care for decision-making. This requires willingness to take the time necessary to successfully resolve dilemmas.
4. Actions that promote and enable ongoing self-awareness. These may include consultation or support groups, discussions with trusted friends/colleagues, self-care steps to avoid burn out and compassion fatigue, and seeking professional support for our own life challenges or crises.
5. Consciously explaining the reasoning underlying the preferences, judgments, and decisions we make can often clarify or change them. Why do I believe the parents’ right to know information outweighs the student’s right to self-determination and confidentiality? In an example of an elderly client joyfully revealing to a nursing home social worker that against the homes rules, he was having consensual sex with another resident, why would that worker rank the client’s rights above the home’s rules and his obligation to employers (or visa versa)?

Decisions in daily practice and ethical dilemmas can have more than one “right” or “good” outcome. We are human beings doing our best to follow the best social work practices. Our roles require us to be aware of potential blind spots and take steps to make the unconscious conscious, to exhibit humility and moral courage.

As Aristotle said, “The moral virtues, then, are produced in us neither by nature nor against nature. Nature, indeed, prepares in us the ground for their reception, but their complete formation is the product of habit. Developing a moral virtue requires one to practice the choices and feelings appropriate to that virtue.” (From Nicomachean Ethics)

REFERENCES

1. Reamer, F.1995. Social Work Values and Ethics. Columbia University Press
2. Reamer, F.1995. Social Work Values and Ethics. Columbia University Press
3. Archer, Crina, and Pincus Hartman, Laura. “False Beliefs, Partial Truths: Personal Myths and Ethical Blind Spots.” DePaul, From the Selected Works of Laura Hartman. Available at http://works.bepress.com/laurahartman/36
4. Darley, J., & Latané, B. 1968. Bystander intervention in emergencies: Diffusion of responsibility. Journal of Personality and Social Psychology 8(4), 377–383.
5. Bazerman, M., Chugh, D. 2004. “Bounded Awareness: Focusing Failures in Negotiating.” Frontiers of Social Psychology: Negotiations. 
6. Ross, M., Sicoly, F., “Egocentric Bias in Availability and Attribution.” Journal of Personality and Social Psychology, 37(3), March 1979. 

Ruth Lipschutz, LCSW, ACSW, is a licensed clinical social worker with postgraduate certification in ethics, mediation, Transformational Imagery, hypnotherapy, and Eye Movement Desensitization and Reprocessing (EMDR). She received her MSW from the University of Illinois in 1978 and went on to complete the two-year postgraduate training program of the Institute for Family Studies at Northwestern University. She has extensive experience in the areas of ethics, mental health, addictions, traumatology, program development and implementation, supervision, consultation and Alternative Dispute Resolution. She is the chairperson of NASW’s National Ethics Committee and has served as a panelist, consultant, mediator, and trainer for the NASW Illinois Chapter Ethics Committee. She is currently in private practice.

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

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NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/.

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National Child Abuse Prevention Month provides social workers in the field of child welfare to educate the community about ways to prevent child abuse and neglect as well as provide awareness to the public through various forums, workshops, and trainings. One of the areas that I enjoy speaking about is the six protective factors. These factors consist of six areas that are considered paramount in keeping children safe and keeping families together. The protective factors, according to the U.S. Department of Health and Human Services are as follows:

1. Nurturing and Attachment: When children are nurtured and have strong connections with their parents, this impact their development and their behavior. They are able to trust that their parents will provide them with what they need.
2. Knowledge of Parenting and Child Development: It is important for parents to understand how to set and enforce limits with their children and encourage appropriate behaviors based on the child’s age. When parents have a better understanding of this, discipline becomes more effective and nurturing.
3. Parental Resilience: It is important for parents to be resilient. It is the ability to handle everyday stressors and recover from occasional crisis. Resilience breeds positive attitudes and more thoughtful ways to solve problems in difficult times.
4. Social Connection: Evidence links social isolation and perceived lack of support to child maltreatment. Trusted and caring family and friends provide emotional support to parents by offering support when parents are facing challenges. Parental networking is especially important when parenting children with special needs.
5. Concrete Supports for Parents: There are outside factors that play a role in a parent’s ability to care for their child. It is important that parents are able to meet the basic needs of the family as well as their own. All children are in need of food, shelter and clothing and many families are in need of support in this area.
6. Social and Emotional Competence: Children must learn how to identify and express their emotions effectively. This allows parents to respond to his or her needs, which strengthen the parent-child relationship.

*Adapted from the U.S. Department of Health and Human Services

If we can infuse these factors into direct programs that are servicing our children and families, as well as demonstrate through our daily interactions with children and families the importance of these factors, we can reduce child maltreatment and child abuse and increase family capacities that will keep families together.

This article was originally printed in Social Work Today, Vol. 9 No. 1 P. 28. Reprinted with the permission of Social Work Today ©. Great Valley Publishing, Co.

Social work shared the public health spotlight following Hurricanes Katrina and Ike, when the important and varied roles of social workers emerged in press coverage. The social worker response to such devastation ranged from medical and environmental actions, such as managing infectious disease threats and access to clean water, to therapy and care assistance, such as grief counseling and assisting with new placements in mental health and long-term care facilities. 

Interest in the collaboration of public health and social work has emerged—or reemerged—as evidenced by the growing number of schools offering dual-degree programs, a master’s degree in social work and public health. Enrollment in MSW/MPH programs is increasing as social workers realize the value of public health training and skills. 

This combination of public health and social work is not new, says Betty J. Ruth, MSW, MPH, a clinical associate professor and director of the MSW/MPH program and certificate program in clinical social work and behavioral medicine at the Boston University School of Social Work, which has the largest MSW/MPH program in the country. Ruth has written extensively on public health social work and participates in a working group, the Group for Public Health Social Work Initiatives. “Social work has forgotten its roots. Social work originated and grew up alongside public health in the early 20th century, when social workers partnered with doctors to combat sexually transmitted diseases and other infectious diseases and to improve maternal/child health in settlement houses,” she explains. 

However, as the field of social work evolved, its early partnership with public health became obscured, perhaps due to an emphasis on therapy and case management for the individual in social work education programs. Of the 500,000 social workers in the United States, the majority work in healthcare settings, but only a small minority are considered public health social workers, Ruth notes. But many healthcare social workers may be practicing public health without full awareness and without recognition (Ruth & Sisco, 2008). For example, social workers often lead prevention and health promotion efforts in field such as HIV/AIDS, child welfare, and gerontology. 

Despite the historical link between public health and social work, public health professionals rarely acknowledge the contributions of social workers to their field. “It is a detriment to the social work field that we think of ourselves as visitors to the field of public health,” Ruth notes. “Public health should come to us for assistance in cultural responsiveness and community-based work because social workers are exceptionally good at these,” she says. 

More social workers are beginning to realize their potential in the public health arena, according to Michael A. Lindsey, PhD, MSW, MPH, an assistant professor in the School of Social Work and the School of Medicine (psychiatry) and the MSW/MPH joint-degree program coordinator at the University of Maryland. “We’ve had a tendency to work myopically in our own world, even though social work skills lend very well to other disciplines,” he says.

Two Perspectives, One Mission

Public health social workers approach their work from an epidemiological and a social perspective and have the benefit of training in both prevention and intervention. “Public health focuses on prevention at the community level, and social work focuses on intervention at the individual level,” says Bari Cornet, MSW, MPH, a graduate of the MSW/MPH program at the University of California at Berkeley. She has worked as a public health social worker for both governmental and nonprofit agencies and is currently on the faculty at the University of California coordinating the MSW/MPH programs. She also manages the listserv for MSW/MPH program coordinators across the United States. 

Because public health social workers function well at different levels, they can effectively use their multidisciplinary skills and training to serve as program directors, community services administrators, policy analysts, and other positions in fields such as maternal/child health, HIV/AIDS, disaster response, trauma intervention (e.g., related to war, terrorism, disaster), disease prevention and surveillance, substance abuse, outreach services, and advocacy. 

“A joint degree provides students with the ability to fuse two different perspectives and contextualize social work in the broader public health sphere,” says Lindsey. Social workers are trained to be caseworkers and provide individual intervention, while public health professionals focus on prevention at the population level and look at the larger significance of health issues. For example, one MSW/MPH graduate is developing a program for smoking cessation in Native American groups, and another is coordinating a program for the prevention of child abuse in maternal/child health services, Lindsey notes. 

Often, public health social workers will translate community-based work to assist in the development of policies and prevention at a population level. “Public health and social work are naturally complementary fields. Social workers trained in public health possess a broader knowledge and skill set that emphasize community health, safety, and welfare,” says Vikki Vandiver, DrPH, MSW, a professor in the School of Social Work at Portland State University and a clinical associate professor in the psychiatry department at Oregon Health & Science University. For social workers, adding an MPH degree to an MSW boosts research skills by providing training in epidemiology and biostatistics and expanding knowledge in prevention and health promotion techniques across the individuals’ life spans, as well as across public and private spheres such as government, she explains. Training in both fields has enabled Vandiver to advocate for policies and legislation to improve mental health services for individuals with brain injuries.

Vandiver refers to herself as a public health social worker who is “bilingual”—referring to her ability to speak the language of both fields. The MPH degree gives social workers an understanding of public health methods and terminology so they can “talk the talk” in public health circles. “My MSW/MPH training allows me to operate in both worlds and share perspectives. When I am in the public health world, I contribute the social worker’s perspective on the individual, and when I am in the social work world, I question the implications on group or community as a public health professional,” Cornet adds.

Bridging the Gap

Speaking the language of public health allows social workers with a dual MSW/MPH degree to operate in a unique niche, bridging the gap between research and practice, individual and community, and services and policies. Ruth calls the MSW/MPH dual degree a “powerful combination” because graduates have the good cultural response and communication skills of a social worker combined with the rigorous scientific training of a public health professional. 

Cornet adds that public health social workers can also bridge gaps from the individual to the community to policy by helping develop policies and legislation that more effectively impact services for individuals and the community. A public health social worker would have the skills to apply the science of diabetes prevention not only in educating individuals about diabetes, but also in setting up community programs to reach, for example, African American populations with a high prevalence of diabetes. “The skills learned in a social work and public health dual program can be applied to bridge the gap between research and practice to improve quality of life,” says Lindsey, who did his postdoctoral community-based participatory research to create better access to mental health services for inner city children. 

Public health social workers are often the problem solvers, applying their skills and knowledge to address inefficiencies, deficiencies, and lack of infrastructure in community services. Ruth believes that graduates with the dual MSW/MPH degree can be pioneers, bringing public health methodology to social work programs. At a recent national public health social work conference, presenters described ongoing initiatives that demonstrate the pioneering and problem-solving abilities of dual-trained social workers, including the following: 

• a community-based program combining epidemiological indicators with client-based interventions to improve health outcomes of those with HIV/AIDS; 
• the Pediatric Mental Health Screening and Intervention Project, which promotes mental health screening for pediatric patients with access to therapy and consultation; 
• a public health approach to family violence and sexual assault applying empowerment-based intervention and prevention strategies; and 
• an evidence-based intervention for frail older adults to reduce unnecessary hospitalization by integrating social work into primary care settings. 

The Future of Public Health Social Work

While the future is bright for MSW/MPH program graduates, there are problems related to increasing awareness of the field, marketing the value of the dual degree, and establishing standards and competencies. The MSW/MPH degree opens the door for twice as many career opportunities, says Ruth, but interviews with graduates indicate that the majority of potential employers do not understand the value of the MSW/MPH combination or view graduates as overqualified (Ruth, Wyatt, Chiasson, Geron, & Bachman, 2006). Including strategies for marketing the dual degree in job searching and establishing networking opportunities for public health social work jobs in graduate programs may help. Lindsey hopes to track graduated MSW/MPH students and devise a feedback loop to help inform current students about career options. 

Although published studies on public health social work are increasing in social work journals, awareness of the dedicated field still needs to increase in both public health and social work circles, says Ruth. The Group for Public Health Social Work Initiatives hopes to promote MSW/MPH programs, initiate a national dialogue on public health social work, and conduct and disseminate research on the dual program to further establish public health social work as a dedicated field and enhance collaboration with public health. 

The role of social work in public health is also being promoted by a social work section of the American Public Health Association and the Association of State and Territorial Public Health Social Workers. Standards and competencies for public health social work have been developed by the social work section of the American Public Health Association under the leadership of Kathleen Rounds, PhD, MSW, MPH, of the University of North Carolina School of Social Welfare, and evaluation of MSW/MPH programs with the intent of accreditation are underway. A 2006 call for research on social work practice and concepts in health by the National Institutes of Health is also expected to increase the visibility and value of social work in the eyes of public health. 

Public health professionals have acknowledged a current crisis in public health: a dwindling workforce (Ruth, Sisco, Wyatt, Bethke, Bachman, & Piper, 2008). There is no doubt that graduates of MSW/MPH programs can rise to the challenges faced by the public health field in the near future. Cornet says, “Training in both public health and social work becomes more important and relevant to solving the ongoing interrelated problems in health and human services.”

At Boston University’s conference, “Public Health Social Work in the 21st Century,” Betsy Clark, PhD, MSW, MPH, executive director of the National Association of Social Workers, suggested that public health social work may be the future of social work. Recent political changes are expected to affect the future delivery of healthcare, possibly leading to more emphasis on preventive healthcare and integrated healthcare and wellness services. The ability of the public health social worker to bridge prevention and intervention, individual and community, and practice and policy will be increasingly valued by our changing society.

— Jennifer Van Pelt, MA, is a Reading, PA-based freelance writer with 15 years of experience as a writer and research analyst in the healthcare field. She has written on depression, attention-deficit/hyperactivity disorder, schizophrenia, mental wellness, and aging.

References

Ruth, B. J., Wyatt, J., Chiasson, E., Geron, S. M., & Bachman, S. (2006). Social work and public health: Comparing graduates from a dual-degree program. Journal of Social Work Education, 42(2), 371-381. 

Ruth, B. J., Sisco, S., Wyatt, J., Bethke, C., Bachman, S. S., & Piper T. M. (2008). Public health and social work: Training dual professionals for the contemporary workplace. Public Health Reports. 123(Supp.2), 71-77. 

Ruth, B. J., & Sisco, S. Public health social work. In: Mizrahi, T., & Davis, L. (Eds). Encyclopedia of Social Work (20th ed). (2008). New York: National Association of Social Workers, Oxford University Press. 

Choosing an MSW/MPH Program

The first dual-degree program was started in the early 1980s, and there are currently about 21 schools offering MSW/MPH programs. Students considering a dual-degree program should examine several factors before making a final decision, including the following: 

• the number of current students and alumni;
• the availability of current students and alumni to contact for information on their experience;
• the number of faculty and clear identification of both public health and social work faculty;
• mentoring opportunities;
• choices for specialization;
• the relationship between social work and public health schools;
• whether the program is joint or concurrent (one application or separate applications to each school required);
• options for internships or field placements;
• a predefined curriculum; and
• clear mechanisms for communication and problem solving between the school of social work and school of public health.

The NASW Illinois Chapter is starting a shared interest group (SIG) devoted to the issues of private practitioners around the state. To be become involved in this group, please contact NASW Illinois Chapter Executive Director Joel L. Rubin at office [at] naswil [dot] org.

I have always considered myself to be a compassionate person. I grew up in a suburb of Chicago, in a modest home alongside my brother and mother. Despite being a single mother and a diagnosis of heart disease at age 38, I always remember how much my mother helped friends, family, and people in our community. She was an inspiration and a great role model. Fast-forward thirty-five years later and I find myself married, living in the suburbs, raising three children, and now starting my own private practice. All I can say is I am loving it!

I graduated from Loyola University Chicago with my MSW in 1995. I worked for several nursing homes and psychiatrists through St. Francis Hospital in Evanston, Illinois. I worked for a short period at a drop-in center that served the homeless population and found that to be a very humbling experience.

When I became a parent I spent many years volunteering at schools, churches, community events, and more. I began to realize as time went on that I was here to serve a greater purpose, and that was to be messenger of hope and inspiration.

In October 2010 I was diagnosed with stage 2 breast cancer. My recovery took eighteen months, and during that time I began to seriously think about opening my own practice. I had thought about it for years as I was raising my children, and when I became ill I figured I should get in gear and fulfill my dream. And that’s exactly what I did.

In December 2012 I picked out a name for my practice. I developed a website and established my own LLC. I rented an executive office in a building that has a full-time administrative assistant. I ordered business cards and applied to several insurance companies for credentialing. These are all the things that I knew I could do own on my own.

If you are considering on opening your own practice, you should apply to become a member of The Council for Affordable Quality Healthcare (CAQH); having a CAQH number is essential to have if you want to minimize the amount of time you spend on administrative tasks. The CAQH website has a professional database that stores your professional information if you decide to join insurance panels. There is a catch though: in order to get a CAQH number, you must first be invited by an insurance company first. For more information you can go to the CAQH website: www.CAQH.org.

If you plan to be credentialed on any insurance panels, you should apply for a National Provider Identification (NPI) number. There are two different types of NPI numbers that you should research first before making a choice. If you are not familiar with NPIs, go to the Centers for Medicare & Medicaid Services website: www.cms.gov.

The biggest challenge for me in opening up a private practice has been getting actual clients. I opened my practice in early December but did not have my first client until the end of January. I spent most of my days networking. I called several social workers in the area and asked if I could meet with them. I asked for and appreciated any advice they could give. I also introduced myself to other professionals in the area at doctor offices, schools, and churches. I went to any community event where I knew I would be around other professionals, mental health or not, and I utilized these events to network. I made it a point to reach out and connect with at least four to five new people each day. I opened the phone book and looked up therapists that were geographically close to my office and asked for ten minutes of their time. I have met so many incredible people. I keep business cards with me all the time.

I spent so much time at The Cardinal Bernadine Cancer Center in Maywood and knew so many professionals there. I sent them each a letter with some business cards. I also reached out to my own doctors and dentists. As playwright John Guare portrays in his play, Six Degrees of Separation, we are only six people away from knowing everyone in the world. It does get frustrating and scary to have to pay rent on an office that is not being utilized. However if you remain vigilant and reach out to as many people as possible, you will see results. I now have six clients after four months. This keeps me very busy as I am doing my own billing until my caseload increases.

I had reservations about going out on my own because I knew nothing about private practice. To this day I frequently call NASW to ask questions, plus there is some wonderful information for private practitioners on the NASW website. The anxiety is now decreasing as I gain more clients and get used to working solo. It is really a very rewarding experience.

What I least expected to happen was to work so hard to build my client load. Everything else is fairly easy but does require some organization. Once you network and reach out, you will see you can get a client or two. My first client was referred to me by a friend who is a psychologist. I gave her a stack of cards and she still continues to hand them out. My other clients were all referred to me by people in the community. When you are out and about, even at the grocery store, really talk about your practice and your specialty. Word will get around very quickly. The important thing is to remain patient.

Below are some other issues I considered before starting my private practice:

• Determine if you want to work solo or with a partner(s). Each has its advantages and disadvantages. If you are unsure, reach out and connect with clinicians from both private and group practices. You will get mixed reviews, but it will force you to consider things that you may not have though about. I personally chose solo because I like to work at my own pace and I wanted to be the only decision-maker. Some people I know just love partnerships because they like the comfort of knowing there is someone with whom they can collaborate. I participate in both private and group consultation. I personally feel more comfortable knowing I have that resource. It is a great idea, but totally optional.
• Next decide on your specialty. I have been told by my private practice colleagues that people prefer to seek out help with someone who is specialized in an area versus a therapist who has no specialty. Although we all at some point may treat people with a variety of issues, narrowing your focus will get you more referrals.
• Decide if you will accept private pay or accept insurance. There are advantages and disadvantages to working with insurance panels. Many of my colleagues accept private pay, but due to the fact that I am still in the process of building my client base, I am taking Blue Cross Blue Shield and billing other insurance companies as an “out-of-network provider.” Let me caution you that if you decide to go the insurance route, it requires an extreme amount of patience and time which is manageable when you are first building your practice. As I become more established, my goal is to outsource my billing so that my focus can remain on my clients, not paperwork.

There are many more issues to consider when deciding on private practice. Thank goodness for NASW and the advice and support that I have received from them. I wish anyone reading this article the best of luck if you are considering private practice.

Kimberly Oddo, MSW, LCSW, practices in Wheaton, Illinois, and has been in social work for sixteen years. She specializes in women's issues, anxiety, depression, cancer survivors, relationship issues, empowerment, spiritual guidance, and body image issues. She works in her practice to help alleviate negativity in her clients’ lives. She avoids focusing on pathology and labels with the intention of creating a more positive and hopeful environment for her clients to flourish.

For School Social Workers: The School Social Worker’s Role with Children Who Witness Domestic Violence

Children who witness or are exposed to domestic violence can be considered collateral victims in the family. Witnessing violence between parents is traumatic at any age for children, but experiencing this form of trauma during early developmental years can cause long-term disruptions or alterations in child development. Given that children are in school for most of their wakeful hours in a day, school social workers are in a unique position to be an advocate, interventionist, and resource for children who have witnessed domestic violence. School social workers who are knowledgeable about the impact of witnessing domestic violence on children are far more likely to accurately assess when this issue is present, determine how to intervene, and be able to direct and advise the education team. 

It is difficult to say how many children are impacted by exposure to domestic violence because reliable data is not recorded. The most widely cited statistic is from Carlson (1984) who states that 3.3 million children a year are exposed to parental domestic violence. Straus (1992) estimates that one-third of children have witnessed their parents’ violence. These data indicate that the likelihood of children who have been exposed to domestic violence may be present in every classroom, in every school. The problems associated with witnessing domestic violence can impact behavioral, emotional, social, and cognitive development; all of which will likely have an impact on children’s ability to be academically successful. 

Children who witness domestic violence are much more likely to manifest externalizing behavior such as aggression, acting out, and antisocial behavior (Adamson & Thompson, 1998; Mathias, Merton, & Murray, 1995; O’Keefe, 1994). Several studies report that children who are exposed to parental violence are much more likely to respond to conflict with aggression and physical fighting (Adamson & Thompson, 1998; Mathias et al., 1995). Boys seem to have a greater propensity to manifest externalizing behaviors than girls (Jaffe, Wolfe, Wilson, & Zak, 1986; Jouriles & Norwood, 1995). Parental aggression is documented as a significant predictor of conduct disorder in boys (Jouriles, Murphy, & O’Leary, 1989). 

Children are also more likely to manifest symptoms for elevated internalizing scores such as anxiety, depression, fearfulness, and inhibition (Fantuzzo et al., 1991; Hughes, 1988; Hughes, Parkinson, Vargo, 1989; Sternberg et al., 1993; Wolfe, Jaffe, Wilson, & Zak, 1985). Children who witness violence are described as having a lowered self-concept (Hughes & Barad, 1983) and are likely to accept guilt for the violence (Grych & Fincham, 1990). Children who score high on internalizing characteristics were more likely to be clinging to adults, complain of loneliness, complain of sadness, engage in worry, and be jealous. Children who are exposed to violence experience post-traumatic stress responses such as re-experiencing the trauma event, numbing of responsiveness, avoidance, and increased arousal (Osofsky & Fenichel, 1994; Osofsky, Fick, Flowers, & Lewis, 1995; Singer, Anglin, Song, & Lunghofer, 1995). Girls seem to be more likely to engage in internalizing behavior than boys (Cummings, Hennesey, Rabideau, & Cichetti, 1994; Cummings & Zahn-Waxler, 1992). 

Socially, children who grow up in families characterized by domestic violence are less competent with problem solving, perspective-taking, and resolving conflict (Adamson & Thompson, 1998). They are more likely to resort to aggression to resolve conflict than other means that include the use of empathy and verbal negotiation. They may also be more withdrawn and lonely due to anxiety and the need to keep the abuse a secret. 

Children who witness parental domestic violence are more likely to evidence cognitive deficits or problems in learning. This may be related to post-traumatic stress symptoms. Children have more difficulty paying attention in school and are more preoccupied with intrusive thoughts of violence and concern for safety which inhibits concentration on academic material (Osofsky, 1999; Rossman, 1998). These children have more difficulty exploring and playing (Osofsky, 1999). Children in homes characterized by domestic violence experience disruptions in stability that also disrupt school performance. Many of these families experience frequent moves, inconsistent school attendance, and economic hardships (Jouriles, Barling, & O’Leary, 1987). 

Much of the recent work from Bruce Perry and his colleagues have documented that exposure to trauma, including witnessing domestic violence in the first critical years of neurodevelopment, may literally alter brain development (Perry, 2009). Due to the use-dependent nature of neuronal development, children who are exposed to trauma may become hard-wired to respond to threat at any moment. The result is a child who may be hyper-aroused, anxious, impulsive, and more prone to aggression than what he or she would have been without the early exposure to trauma. This has obvious implications for a child’s capacity for learning if their hyper-arousal and anxiety keeps them distracted from being able to take in new learning. This also has implications for a child’s capacity for social skills, conflict management, and peer relations that are often acquired in a school setting. 

School social workers are uniquely trained to serve as a central role in responding to children who have witnessed domestic violence. Ideally, school social workers could refer children exposed to domestic violence to resources in the community that are especially trained to deal with children’s resolution to trauma. An excellent resource is the Safe from the Start program funded through Illinois Violence Prevention Authority if the school is in a community that provides one of these programs. However, if the school is in a less populous or rural area, specialized services may not be available. In these situations, school social workers are trained to deliver Tier 3 direct therapeutic interventions with children who are struggling with their home life. School social workers can provide an outlet for children to talk about their challenges, fears, and anger regarding the domestic violence at home and can provide coping strategies. School social workers may also be a resource for referrals for the non-offending parent to seek services for safety. 

School social workers can be a resource to the education team by helping others understand students’ behavior. Teachers may misunderstand the etiology of children’s behavior due to their lack of formal training on the effects of exposure to violence. There is the potential for inappropriate responses to such challenging behavior such as disciplinary responses rather than therapeutic intervention. Teachers may misinterpret challenging behavior, such as externalizing behavior, as attention deficit-hyperactivity disorder (ADHD) or attention deficit disorder (ADD). Externalizing behavior, such as aggression and acting out, can also be misunderstood simply as a child who needs greater behavioral controls rather than the child’s way to express that violence is a part of his/her home life. 

As with externalizing behaviors, school social workers can help teachers identify and understand children’s behavior when they respond through internalization of the issue from home. Children who manifest symptoms of internalizing as a response to violence exposure are at great risk for being overlooked in the educational system. Children who engage in internalizing behavior may appear socially self-conscious, shy, or withdrawn, but they will likely not be disruptive. Children who internalize have learned at an early age to walk on eggshells and to not disrupt the status quo at home to prevent angry eruptions. It is usually the disruptive students in the classroom who get noticed and receive therapeutic attention. However, a student who is manifesting internalizing behavior will be easily overlooked when other students attract attention by acting out. Social workers may provide professional training regarding the internalizing method of coping with family violence to sensitize teachers to recognizing this in children. Some children may indeed simply be more introverted in personality style; however, a particularly withdrawn child—when coupled with characteristics that appear as anxiety or post traumatic stress disorder (PTSD) symptoms—should be an indicator for further assessment. Training for teachers may increase accurate identification of students exposed to domestic violence and reduce the likelihood that these students will get through school with significant social issues overlooked. 

Children who are exposed to their parents’ domestic violence often have challenges with academic performance. Teachers may identify that children who are not working up to their capacity, are attention-challenged in the classroom, and perhaps experiencing excessive absences. School social workers are uniquely trained to ask appropriate assessment questions as to whether this behavior is a result of exposure to domestic violence or from many other possible reasons. 

School social workers can also play a role in developing and implementing curriculum for violence prevention or conflict resolution skills training for students. Numerous violence prevention or conflict resolution skill–building curricula are available. Although a cross-disciplinary team may be involved in student training using violence prevention curricula, school social workers are uniquely positioned with their knowledge base to take a leadership role. 

It is unfortunate that not all children come from homes that are always safe, nurturing, and stable. Children who witness domestic violence have unique needs that can easily be misunderstood or easily overlooked in a school setting. School social workers have an opportunity to be a stable resource and advocate for the child who is struggling to cope with parental violence. No child should continue to be the silent victim. 

REFERENCES

Adamson, L., & Thompson, R. (1998). Coping with interparental verbal conflict by children exposed to spouse abuse and children from non-violent homes. Journal of Family Violence, 13, 213–232.

Carlson, B. (1984). Children’s observation of interparental violence. In A. R. Roberts (Ed.), Battered women and their families (pp. 147–167). New York, NY: Springer. 

Cummings, E., Hennesey, K., Rabideau, G., & Cicchetti, D. (1994). Responses of physically abused boys anger involving their mothers. Development and Psychopathology, 6, 31–41.

Cummings, E., & Zahn-Waxler, C. (1992). Emotions and the socialization of aggression: Adults’ angry behavior and children’s arousal and aggression. In A. Fraczek and H. Zumley (Eds.), Socialization and aggression (pp. 61–84). New York, NY: Springer-Verlag.

Fantuzzo, J., DePaola, L., Lamber, L., Marino, T., Anderson, G., & Sutton, S. (1991). Effects of interparental violence on the psychological adjustment and competencies of young children. Journal of Consulting and Clinical Psychology, 59, 258–265. 

Hughes, H. (1988). Psychological and behavioral correlates of family violence in child witnesses and victims. American Journal of Orthopsychiatry, 58, 77–90.

Hughes, H., & Barad, S. (1983). Psychological functioning of children in a battered women’s shelter: A preliminary investigation. American Journal of Orthopsychiatry, 53(3), 525–531.

Hughes, H., Parkinson, D., & Vargo, M. (1989). Witnessing spouse abuse and experiencing physical abuse: A “double-whammy?” Journal of Family Violence, 4, 197–209. 

Jaffe, P., Wolfe, D., Wilson, S., & Zak, L. (1986). Similarities in behavioral and social maladjustment among child victims and witnesses to family violence. American Journal of Orthopsychiatry, 56, 142–146.

Jouriles, E., & Norwood, W. (1995). Physical aggression towards boys and girls in families characterized by the battering of women. Journal of Family Psychology, 9, 69–78.

Jouriles, E. Barling, J. & O’Leary, K. (1987). Predicting child behavior problems in maritally violent families. Journal of Abnormal Child Psychology, 15, 165–173.

Jouriles, E., Murphy, C., & O’Leary, K. (1989). Interspousal aggression, marital discord, and child problems. Journal of Consulting and Clinical Psychology, 57, 453–455.

Mathias, J., Mertin, P., & Murray, A. (1995). The psychological functioning of children from backgrounds of domestic violence. Australian Psychologist, 30, 47–56. 

O’Keefe, M. (1994). Adjustment of children from martially violent homes. Families in Society: The Journal of Contemporary Human Service, 75, 403–415. 

Osofsky, J. (1999). The impact of violence on children. The Future of Children: Domestic Violence and Children. Los Angeles, CA: Packard Foundation.

Osofsky, J., & Fenichel, E. (Eds.) (1994). Hurt, healing, and hope: Caring for infants and toddlers in violent environments. Arlington, VA: Zero to Three/National Center for Clinical Infant Programs. 

Osofsky, J., Fick, A., Flowers, A., & Lewis, M. (1995). Trust in children living with violence. Poster presented at the biennial meeting of the Society for Research in Child Development, Indianapolis, IN. 

Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical application of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14(4), 240–255. 

Rossman, B. (1998). Descartes’ error and post-traumatic stress disorder: Cognition and emotion in children who are exposed to parental violence. In G. W. Holden, R. Geeffner, & E.N. Jouriles (Eds.), Children exposed to marital violence (pp. 223–256). Washington, DC: American Psychological Association.

Singer, M., Anglin, T., Song, L., & Lunghofer, L. (1995). Adolescents’ exposure to violence and associated symptoms of psychological trauma. Journal of the American Medical Association, 273(6), 477–482. 

Sternberg, K., Lamb, M., Greenbaum, C., Cicchetti, D., Dawud, S., Cortes, R., Krispin, O., & Lorey, F. (1993). Effects of domestic violence on childrens’ behavioral problems and depression. Developmental Psychology, 29, 44–52.

Straus, M. (1992). Children as witnesses to marital violence: A risk factor for lifelong problems among a nationally representative sample of American men and women. Report of the Twenty-Third Ross Roundtable. Columbus, OH: Ross Laboratories. 

Wolfe, D., Jaffe, P., Wilson, S., & Zak, L. (1985). Children of battered women: The relation of child behavior to family violence and maternal stress. Journal of Consulting and Clinical Psychology, 53, 657–665. 

Diane Zosky, PhD, ACSW, LCSW, is director of the School of Social Work at Illinois State University. She is a clinical social worker and completed her MSW from the University of Illinois at Urbana-Champaign and her PhD in clinical social work from Loyola University Chicago. Her interest of teaching, practice, and research has been in the area of domestic violence, and she has worked part-time for seven years with The Center for the Prevention of Abuse in Peoria as a facilitator for the Family Violence Intervention Program. 

CEU Opportunity for Reading This Article! 
NASW Illinois members can earn one CEU by completing an online quiz (LINK) regarding this article! The free CEU opportunity is only valid until June 1, 2013, after which the CEU fee will change to $15.00. Nonmembers must pay the regular $10.00 rate for the CEU, which will increase to $15.00 after June 1, 2013.

As Chicago experiences an increasing Latino population, there is a need to respond to the current challenges such as access to social services, housing, and education. Addressing the needs of the Latino population starts with fully understanding their historical and local context, remembering as author Lilia Fernandez states, “that Mexicans, Puerto Ricans, and other Latinos/as have been here longer than we realize” (p. 268). Cultural competency is not just about being “open” to other cultures; rather it begins with a meaningful understanding of the historical context of a group. Despite the longtime presence of Latinos in Chicago, few social workers know much about these groups, seeing Latinos primarily as recent arrivals in need of assimilation. 

Fernandez’ book, Brown in the Windy City: Mexicans and Puerto Ricans in Postwar Chicago, is a much-needed portrait of the history of Mexicans and Puerto Ricans in Chicago. Fernandez contributes to the understanding of the history of these two groups, the complexities of race, the parallels between the historical experiences of Puerto Ricans and Mexicans, and the role that social service organizations played in the settlement of these two groups in post-war Chicago. Finally, Fernandez presents how both gender and youth activism shaped these experiences. 

Because Latinos fall outside of our binary understandings of race, they are often neglected from urban historical accounts altogether; and according to Fernandez, have been rendered invisible as historical actors with experiences that are distinct from African Americans and European immigrants. Fernandez describes how the dynamics of immigration, settlement, and urban revitalization in Chicago contributed to the racialization of Mexicans and Puerto Ricans as “other” and placed them in a distinct racial position that remains flexible, fluid, and context dependent. 

Particularly relevant to social workers is the history of Mexican Americans and the settlement house movement. Fernandez not only describes how Mexican Americans utilized the services but also discusses the critiques of the settlement houses for failing to incorporate Mexican Americans in leadership roles despite over a generation of servicing this population. In chapters five and six, Fernandez describes the role of a growing political consciousness and activism reflected in both communities. As a part of this commitment to community, both groups develop social services such as free health clinics and youth services. In Pilsen, a settlement house known as Howell House becomes Casa Aztlán, reflecting a growing emphasis on culturally specific services and Latino leadership within the organizations. 

In discussing the parallels between the two groups, Fernandez documents their shared history as transnational labor migrants during and after World War II through state-sponsored programs, their settlement patterns in the Chicago’s near West Side, and their eventual displacement from this area due to urban revitalization policies, race-based housing policies, and federal highway construction. Later in the book, Fernandez describes the response of the second generation to these policies and continued experiences of racial discrimination in all aspects of social life. The second generation realized that “claiming whiteness” did not shield them from discrimination and instead focused on social activism as well as embracing the racial difference that had been ascribed to them. Unique to the Chicago experience was the recognition of the need for an inclusive Latino identity and formation of alliances with other groups. While Puerto Ricans and Mexicans maintained a sense of pride affiliated with their national origins, many of the organizations such as Mujeres Latinas en Acción and the Young Lords were intentionally inclusive and reflected that in their organizing strategies. 

Finally, Fernandez illustrates the complexity of gender and the role that women played in meeting the needs of the community, defying the still often portrayed stereotype of the “submissive” Latina. Women were at the forefront of many struggles and challenged both the patriarchal city politics as well as the patriarchal politics that shaped the activism within their communities. This book is a must-read for social workers as it frames historical themes in social welfare from a new lens, that of a group often ignored and still seen as foreigners despite their long time presence in the United States. 

While the substantive bill process continues, the budget for fiscal year (FY) 2014 will become a hot topic as appropriations committees conduct hearings regarding the budgets of various state agencies.

The bill synopsis below is not a comprehensive list of all bills of potential interest to our members. At this stage of the session there are many bills that will not survive the Third Reading deadline in the second and third weeks of April. This summary highlights some of the bills that should be given close attention.

SB 1609 (Koehler)
This NASW Illinois Chapter bill makes it a Class 3 felony to threaten a social worker, caseworker, or investigator employed by a human services provider that receives a grant or contract from the state to provide human services if the threat is made against the employee in connection with such employment. The bill expands an existing law regarding threats to public officials, which covers social workers, caseworkers, and investigators employed by the Department of Human Services (DHS), the Department of Children and Family Services (DCFS), and the Department of Healthcare and Family Services (DHFS). The bill is on Second Reading in the Illinois Senate.

SB 1455 (Delgado)
This is the NASW Illinois Chapter's bill to implement recommendations of a special NASW task force concerning licensure continuing education unit (CEU) requirements. The bill provides that at least one-half of the required CEU hours each renewal cycle must be earned through in-person participation in a CEU program unless a variance is granted by the Illinois Department of Financial and Professional Regulation (IDFPR). It also provides that at least three hours must be related to cultural competency in the practice of social work. The bill is not being moved this session due to favorable negotiations with IDFPR over new proposed administrative rules that would incorporate these and related changes.

HB 1 (Lang)
This bill creates the Compassionate Use of Medical Cannabis Pilot Program Act and a fund in the state treasury for the costs of administrating the program. The bill is on Third Reading in the Illinois House.

HB 2 (Bellock)
This bill authorizes the governor to create the Illinois Single Audit Commission that would be required to conduct research regarding the practices of other states in the administration of grants and to issue a report summarizing the commission's recommendations regarding the uniform administration of grants in Illinois to promote effective and efficient oversight of grants, ensuring quality programs, and limiting waste, fraud, and abuse. The commission would sunset on January 1, 2015. The bill is on Second Reading in the Illinois House.

SB 26 (Steans)
This bill would implement the Medicaid expansion provisions of the federal Affordable Care Act, which became a state option instead of a mandate as a result of the US Supreme Court's decision last June in NFIB v. Sebellius. The bill has passed the Illinois Senate and is currently pending in the Illinois House. NASW Illinois strongly supports the bill.

SB 2199 (Frerichs)
This bill would amend the Illinois School Code to remove a provision enacted in 2011 that prohibits a candidate for licensure from beginning an internship or residency required for licensure until he or she has passed the applicable content area test. NASW strongly supports the bill, which is on Second Reading in the Illinois Senate.

HB 2322 (Chapa Lavia)
This bill would amend the Illinois School Code to more fully describe the responsibilities of school social workers, including anti-bullying interventions and social and emotional learning. The bill is on Second Reading in the Illinois House.

HB 2420 (Chapa Lavia)
This bill would allow licensed marriage and family therapists to practice in the schools after meeting licensure and endorsement requirements to be developed by the Illinois State Board of Education (ISBE). NASW Illinois opposes the bill. The bill is on Second Reading in the Illinois House.

HB 3070 (Farnham)
This bill would amend the Illinois School Code to require in-service training of social workers, teachers, counselors, and other personnel to identify mental illness. The bill passed the Illinois House on March 22, 2013, by a vote of 93 to 12 and is now in the Illinois Senate.

HB 1017 (Feigenholtz)
An initiative of the Illinois Office of Health Information Technology which would amend the Mental Health and Developmental Disabilities Confidentiality Act with respect to the electronic sharing and transmission of mental health information and records under the Illinois Health Information Exchange (ILHIE). The bill has passed the Illinois House and is now in the Illinois Senate.

HJR 17 (Madigan)
This resolution establishes the Illinois House's estimate of General Revenue Funds available for the FY 2014 budget at $35.081 billion. The measure is pending in the Illinois, which can amend this measure if it disagrees with the estimate. 

In the aftermath of widely reported instances of multiple deaths due to violent criminal acts,  social workers face heightened concerns about when and whether to report suspicions about  clients who could pose a risk of harm to others.  This article will highlight recent federal guidance on this topic with additional information about “duty to warn” laws among the states.

To read the rest of the article, click here. NOTE: NASW login required.

I grew up in Naperville, Illinois, in a four bedroom, three bath home. I had my own car in high school, and I vacationed every summer. I have now helped individuals living in conditions I have never experienced. I love what I do and will strive to make a difference; however I cannot fathom the circumstances and experiences my clients have lived through. Sometimes it feels as though there are not enough hours in the week between school, work, internships, volunteering, and of course, keeping in touch with my family. Even when the stress of schoolwork or the lack of time to sleep presents itself, I always think about the resiliency of the populations I have been able to watch and serve. I think of the everyday struggles they face and of the struggles the agencies I have worked for face in attempt to ensure adequate resources and advocacy for such vulnerable populations. 

I do not profess to have any solutions or to properly advocate what is right or wrong. I am reporting on what I have experienced during my education. It is our job as social workers to acknowledge the barriers and obstacles of our clients, though sometimes these barriers feel like brick walls. As a student in my first year of an MSW program, my first lesson was to learn how to maintain strength and optimism in the workplace. With burnt-out staff, inadequate resources, and populations with diverse vulnerabilities, the work can appear to be overwhelming. It is difficult and even painful to not be able to find a solution in the limited time we have. The classroom does not initially teach us how to withstand agency budget cuts, or how to balance client demand and the reality of inadequate resources. We do not learn certain real world experiences or client struggles in a textbook, and teachers do not lecture on the harsh realities of the profession. Certain social work aspects can only be learned in fieldwork experience. 

I write this article not only to advocate for my clients and agencies, but to advocate for students, interns, and even seasoned social workers. The truth is our work may feel endless and sometimes unsatisfying. Clients will struggle and may even resist, values will clash, funding will fluctuate, and secondary trauma will attempt to hinder our perseverance. However, I dare you to push harder, to always place yourselves in your client’s position, understand their circumstances, and most importantly, maintain the enthusiasm that has inspired us to be in a helping profession. 

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

OFFICE FOR RENT - Chicago: Attractive Chicago Loop Office in for Rent: Three and a half days per week . All day Mon, Wed, Sat and Fri Mornings. 30 N. Michigan Ave, Chicago, Ill 60602. Suitable for Child Psychoanalysis and Psychotherapy and for Adult Psychoanalysis and Psychotherapy Amenities include: Wireless Internet, Refrigerator, Sink, Microwave Oven. The Suite Has a Waiting Room , a Consulting Room & Separate Desk Study and Storage Room Contact: Edward P. Kaufman LCSW, BCD 847-997-7444 

OFFICE FOR RENT - Oak Park: Oak Park: Part time office space available in a beautifully furnished & well-maintained, secure building. Friendly atmosphere, potential referrals, free parking. Flexible leasing. 708.524.0532 Lee Madden

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/.

• Executive Director - AFSCME Personal Support Program (PSP)
• Grants Administrator - AgeOptions
• Program Director (Peoria) - Illinois Mentor
• Psychotherapist in Private Practice - Justin Tobin & Associates
• Social Service Coordinator, Martin Health Center - Westminster Village, Inc.
• Mental Health Care Advocate - OptumHealth - UnitedHealth Group
• Psychotherapist - Contract - Professional Consultations Inc
• Individual Family Therapist and Small Group Facilitator - ParentsWithPromise,LLC
• Life Guide/MCR Unit - Lutheran Life Communities
• Social Work Department Coordinator - New Trier High School
• Transition Engagement Specialist - AgeOptions

In February 2013, over 700 social workers and social work students across the state gathered in Springfield, Illinois, to participate in the NASW Illinois Chapter’s annual Advocacy Day. The day began by honoring Representative Kelly Cassidy (D-14) with the 2013 NASW Illinois Chapter Legislative Award. Representative Cassidy has worked tirelessly to improve the well-being of residents in her district and throughout Illinois, demonstrating to all in attendance the importance and the power of living out the principles outlined in the NASW Code of Ethics. We also had the privilege of hearing from a panel of experts including Phil Milsk, the legislative affairs consultant for the NASW Illinois Chapter and the Illinois Association of School Social Workers (IASSW); Bobby Otter, educational and fiscal policy analyst at the Center for Tax and Budget Accountability; Stephanie Altman, programs and policy director at Health and Disability Advocates; Marvin Lindsey, consultant with the Community Behavioral Healthcare Association; and Lawrence Benito, executive director of the Illinois Coalition for Immigrant and Refugee Rights. The day’s panelists helped to increase our knowledge of significant issues currently facing our state. 

With these individuals as examples, we traveled to the Capitol to bring our causes to those directly responsible for creating the policies that greatly impact, for better or worse, the social work profession and its mission to enhance human well-being and promote social justice. While we were putting our newfound lobbying skills to use, the Illinois Senate voted in favor of expanding Medicaid eligibility, proving in an invaluable way that we do have the power to effect change in our society. 

The most important lesson I have taken from my Advocacy Day experiences is that our representatives are not only accessible, but also that it is our duty both as citizens and social workers to make our voices heard in that arena. Thank you to all the participants of Advocacy Day 2013, particularly the students at the following schools—you ensured that we were loud enough to be heard by all. 

Aurora University – 49
Bradley University – 1
Chicago Center – 12
Chicago State University – 4
DePaul University – 17
Dominican University – 55
Governors State University – 112
Illinois State University – 98
Lewis University – 2
Loyola University Chicago – 53
Northeastern Illinois University – 101
Olivet Nazarene University – 28
Trinity Christian College – 10
University of Illinois Chicago – 60
University of Illinois Springfield – 17
University of Illinois Urbana-Champaign – 37
University of Chicago – 5
University of St. Francis – 38
Western Illinois University – 41
Other – 26

“Obviously these are some exceptional young people, but what they have in common is that they were ordinary people who cared. They wanted to act, to do something, to make life better for other people—and they have.” Morgan Carroll, Take Back Your Government: A Citizen's Guide to Making Your Government Work for You

In March 2013, the NASW Illinois Chapter launched a consumer awareness website that helps people to better understand the role of social workers in their community. The Social Worker Spotlight website (http://ilsocialwork.com/) is available to the public, and we encourage all social workers to share the site with their friends, family, and colleagues. 

To submit a profile of your own, click here. 

Joseph Walsh, PhD, LCSW
Psychotherapist & Consultant Chicago, Illinois
NASW Member since 1968

I am a social worker because…to some extent, it is in my DNA. In my family of origin there are six MSW-level social workers. Our family’s religion played a big role in teaching us to be of service to others and to get the proper skills to do this effectively, and thus, professionl degrees. I have had the privilege of observing and participating in the increased professionalization of social work over the past forty years. Licensure has been a crucial important progression as has been the increased valuing of doctoral training. Social work’s commitment to the poor and marginalized has never been compromised in the midst of its professionalization, a fact that gives me great pride.

It has been my privilege and pleasure to be involved in the direct practice of social work for my entire professional career. For most of these years I also served as a professor in a school of social work. It was delightful to have a role in the development of the knowledge base, attitudes, and value perspective of new members to the profession. It also has been a joy to contibute to social work’s foundation through research and publication.

I have been a member of NASW since my first days in graduate school in 1967. It was easy to join with discounted student rates, and it helped me to achieve a wider view of the profession. Having been active on both the state and national level on NASW boards and committees, I continue to be impressed by the high-level thought and action NASW provides to its members, for its clients, and for the general well-being of society. Its efforts in promoting ethical behavior by social work practitioners and its legal defense commitments are of special note.

Visit the Social Worker Spotlight website: http://ilsocialwork.com/. 

Before highlighting some of the upcoming activities that will celebrate our profession during the month of March, I wanted to note some significant events of this past month that reflect on the profession’s history and lessons for leadership. 

In mid-February, the NASW Illinois Chapter partnered with Illinois Public Media and Chicago Community Cinema to present advance screenings of the film, The Powerbroker: Whitney Young’s Fight for Civil Rights, in Champaign and Chicago. The film aired on PBS nationwide on February 18, 2013. In both venues, a panel followed each of the screenings. NASW Illinois Chapter President Yolanda Jordan served as a panelist following the Chicago screening. I had the opportunity to attend both of these screening. I would venture to say that if you asked most social workers if they knew of Whitney Young, they would respond by saying he was a great civil rights leader. What they might not know was that he was a social worker and that early in his career before joining the Urban League, Whitney served as dean of Atlanta University (now Clark Atlanta University). He also served as NASW President in 1969. The film is a tribute to a great social work leader and should be required viewing in every social work school throughout the country. For more information on the film, go to http://www.itvs.org/films/powerbroker.

The NASW Illinois Chapter is near completion on a public awareness website that will help to highlight the work of social workers and the positive contributions they make to society. Check back with the chapter website (http://www.naswil.org) as it should launch in the early part of Social Work Month. If you are interested in submitting a profile, click here: https://naswil.wufoo.com/forms/social-worker-spotlight/. 

This month, the March Networker highlights the district winners for Social Worker of the Year, Lifetime Achievement Award, and Public Citizen of the Year. I hope you will have an opportunity to attend one of eight district award events taking place during the month, not only to celebrate the awardees but the work all of you do.

• March 2: West Central District Awards Event (Peoria) 
• March 5: Chicago District Awards and CEU Event (Chicago) 
• March 7: Jane Addams District Awards Event (Rockford) 
• March 7: Calumet District Awards Event (Bourbonnais) 
• March 11: Three rivers District Awards and CEU Event (River Forest) 
• March 15: Northeastern District Awards and CEU Event (Northbrook) 
• March 20: East Central District Awards Event (Normal)
• March 21: Southern District Awards Event (Mt. Vernon) 

For complete information about Social Work Month events, visit the NASW Illinois Chapter website calendar: http://www.naswil.org/education-career-development/calendar/. 

As of the time of this writing, the NASW Illinois Chapter is preparing for Advocacy Day 2013 to take place on Thursday, February 28, 2013, down in Springfield, IL. With an advance registration of over 700 people, we expect to advocate on behalf of programs and services provided by social workers throughout the state—the programs and services that constitute much our safety net for the vulnerable in our society. This advocacy supports the primary mission of the social work profession: to enhance human well-being and help meet the basic needs of all people, especially the most vulnerable. Watch for post on the NASW Illinois Chapter website about the event as well as legislative alerts. 

Joel L. Rubin, MSW, CAE, has served as executive director of the 7,000 member Illinois Chapter of the National Association of Social Workers (NASW) since October 1999. He has over twenty-five years of nonprofit management and fundraising experience including extensive work with boards of directors, committees and volunteers, and advocacy around a wide variety of social work, human service, and international political issues. Joel is a graduate of the Wexner Heritage Fellowship Leadership Program and a current adjunct professor at the University of Illinois at Chicago Jane Addams College of Social Work as well as Loyola University Chicago School of Social Work.

Congratulations to this year's 2012 NASW Illinois District Social Work Awards! The below individuals have exemplified in their professional and personal work the basic tenets of the social work profession—giving voice to those who are without voices. Award ceremonies will be held in the corresponding district across the state. To find out more information about the award ceremonies, be sure to check out district page: www.naswil.org/naswil/districts/. 

CALUMET DISTRICT

Public Citizen of the Year: Patricia Polk

Social Worker of the Year: Cini Bretzlaff-Holstein
Cini Bretzlaff-Holstein (MSW, Baylor University; LSW) is assistant professor of social work and has worked at Trinity Christian College since 2008. Before concentrating her career on social work education, Cini spent six years working in the field of social work in a variety of areas. Her areas of practice include child welfare, residential youth services, community development, and program development. She has most recently been involved in exploring sustainable food systems and the impact of nutritional food on youth and their communities.

Lifetime Achievement Award: D. Frank Elam
D. Frank Elam (MSW, University of Illinois at Chicago; LCSW) has been employed in many areas of social work since 1968 including public welfare, school, community mental health, child welfare, developmental disabilities, and domestic violence working with children and adults. He has been employed as a clinical supervisor, administrator, and consultant. He has been a field instructor for interns in the field of social work. He has taught at the college level for many years and presently teaches at Governors State University as adjunct faculty. He is also the clinical consultant at South Suburban Family Shelter, a domestic violence agency, and maintains a private practice.

Click here for details about the Calumet District awards event in Bourbonnais: http://www.naswil.org/calendar/events/2593/. 

CHICAGO DISTRICT

Public Citizen of the Year: Karen Lewis
Karen GJ Lewis is president of the Chicago Teachers Union (CTU). A member of CTU since 1988, Karen taught high school chemistry in the Chicago Public Schools for twenty-two years. She received National Board Certification in 2002 and renewed in 2012. Karen is a vice president of the more than 1.7 million-member American Federation of Teachers, and in 2010, Karen was elected executive vice president to the 70,000 member Illinois Federation of Teachers. She works tirelessly to effectuate excellence in the teaching/learning experience, guard against opportunistic self-interest groups who would eradicate public education, advocate for equal quality education for all students, and protect the rights of educators throughout the state of Illinois.

Social Worker of the Year: Ellen J. Benjamin
Ellen J. Benjamin (PhD, The University of Chicago; MSW, The University of Michigan) is associate professor emerita at DePaul University after serving as a full-time faculty member in The School for New Learning for eighteen years. For more than thirty-five years she has been involved in advocacy work on social causes, having served as an employee, co-founder, and trustee of nonprofit organizations such as The American Friends Service Committee, Planned Parenthood, and The Midwest Women's Center. She has also directed two philanthropic institutions within Chicago: the Borg-Warner Foundation and The Mayer and Morris Kaplan Family Foundation. 

Lifetime Achievement Award: Dan Rosenfeld

Click here for details about the Chicago District awards and CEU event in Chicago:http://www.naswil.org/calendar/events/2616/ and http://www.naswil.org/calendar/events/2608/. 

JANE ADDAMS DISTRICT

Public Citizen of the Year: Mary J. Nicholls

Social Worker of the Year: Karen Haggard
Karen Haggard (MSW, University of Illinois at Chicago; LCSW) is readjustment counselor at the Rockford Vet Center, specializing in the treatment of PTSD. She has many years of progressively responsible clinical and leadership experience, providing mental health services within a variety of settings including federal, state, and community agencies. Karen has sought to provide comprehensive and holistic services to her clients in an environment promoting teamwork among her colleagues and within the community. She provides professional trainings for educators, health and mental health professionals, and family members of veterans. Karen is also a Red Cross volunteer and mental health trainer.

Click here for details about the Jane Addams District awards event in Rockford: http://www.naswil.org/calendar/events/2619/. 

NORTHEASTERN DISTRICT

Social Worker of the Year: Justin Evan Tobin
Justin Evan Tobin (MSW, Washington University in St. Louis; LCSW) is owner of Justin Tobin and Associates, a group psychotherapy practice in downtown Chicago. As therapist, he helps individuals, couples, and families manage depression, anxiety, stress, and work through trauma. He has helped couples improve their communication and build trust and honesty in their relationships. Prior to working in private practice, he provided individual and group therapy in residential care facilities, drug treatment centers, and community mental health agencies. His therapeutic style is blended with empathy, sincerity, and genuineness. He truly enjoys working with clients and helping them find the answers they seek.

Lifetime Achievement Award: Nancylou M. Morgan
Nancylou M. Morgan (MSW, University of Illinois at Urbana-Champaign; LCSW; ACSW) has been with the Village of Mount Prospect Human Services Department since 1984 as human services director. She successfully led the department through continual growth and development, resulting in expanded nursing and social services for the village's at-risk residents of all ages. Nancy was a member of the Community Connections Center development team, a resource center located in an emerging immigrant and ethnically diverse area of town, and now oversees its operation. Nancy believes in giving back to her community. She has been active and taken a leadership role in Rotary, United Way, American Cancer Society, and other civic, educational, and social councils.

Click here for details about the Northeastern District awards and CEU event in Northbrook: http://www.naswil.org/calendar/events/2623/. 

SOUTHERN DISTRICT

Public Citizen of the Year: Rita Winkeler
Rita Winkeler (MSEd, Southern Illinois University Edwardsville; NBCT) has been a third grade teacher for the past eighteen years. The mother of three sons, her severely disabled son Mark lives at Murray Center in Centralia, IL. She is president of the Murray Parents' Association and has worked tirelessly leading 220 parents/guardians in their fight to keep Murray Center open for the special residents who call Murray Center home. She is also president of the parent/guardians' group for Community Link in Breese, where her disabled brother lives in a community integrated living arrangement (CILA). She is also his guardian. Rita is also on the Illinois League of Advocates for the Developmentally Disabled Board of Directors.

Social Worker of the Year: Carla Bauer
Carla Bauer (MSW, Washington University in St. Louis; ACSW) began her professional social work career in 1982 as mental health therapist at the Washington County Community Counseling Program in Nashville, IL. Following the addition of other duties such as substance abuse counselor, she became coordinator of counseling services. During this time she was also employed privately in a psychiatrist's practice. After twenty years with the Counseling Program, she began working for the state of Illinois at Murray Developmental Center in Centralia, IL as a social worker. She currently serves as social work administrator at Murray Center.

Click here for details about the Southern District awards event in Mt. Vernon: http://www.naswil.org/calendar/events/2618/. 

WEST CENTRAL DISTRICT

Public Citizen of the Year: Ron Tyler and Aruna Mathur
Ron Tyler has worked with at-risk youth and families for twenty years in the Peoria area in a variety of settings including residential, delinquency prevention and intervention, and community and school-based programming. He has served as director of outreach for FamilyCore in Peoria, IL, for the past fourteen years. He developed and implemented unique programming, such as the Day Respite Program, to serve the needs of youth and families in the tri-county area. Ron and his wife Jonna have two children and reside in Peoria.

Aruna Mathur (MS, Agra University – India; ASCP) and her husband Ravi Mathur have lived in Springfield, IL, since 1969. They have two children and five grandchildren. Aruna worked at the Southern Illinois University School of Medicine from 1976 to 2001. In 1991 Aruna started the Asian Indian Women's Organization (AIWO) with the objective of giving back to the Springfield community. Her goal was accomplished through volunteering and donating to charities locally, nationally, and internationally. The biannual fundraisers held for the local Ronald McDonald House Charity (RMHC), has raised over $150,000.00. She is founding and past president of AIWO and is now a board member of RMHC of central Illinois.

Social Worker of the Year: Dennis Crowell

Click here for details about the West Central District awards event in Peoria: http://www.naswil.org/calendar/events/2624/. 

THREE RIVERS DISTRICT

Social Worker of the Year: Malinda Dobyne
Malinda Dobyne (MSW, Florida State University; LCSW; QCSW; CMFSW) has always had a passion for helping people. She began her career twenty years ago working with military members and their families. Over the past eighteen years, she has worked with culturally diverse individuals experiencing an array of mental and/or behavioral health problems. Malinda has provided services in the home, hospital, and office settings. In addition to helping people directly, she has managed departments, provided clinical supervision to students, and conducted mental health trainings to the community. Malinda finds her work rewarding and will continue to serve others.

Click here for details about the Three Rivers District awards and CEU event in River Forest: http://www.naswil.org/calendar/events/2626/. 

EAST CENTRAL DISTRICT

Public Citizen of the Year: Larry and Vivian Lefferts
Larry and Vivian Lefferts raised John and Eleanor in central Illinois. After John died from an aortic dissecting aneurysm on October 11, 2004, John's eyes, bones, and tissues were donated. To honor him, Larry and Vivian are tireless advocates for donation, John's story, volunteering for Gift of Hope Organ and Tissue Donor Network (GOH), Illinois Eye Bank, Donate Life, and Secretary of State Jesse White's office. To honor them, GOH sponsored them on the Donate Life Float at the 2013 Rose Bowl Parade. When facing tragic loss, their message is one of hope, emphasizing the benefits of donation for donor families. They know, through donation, that life goes on!

Click here for details about the East Central District awards event in Normal: http://www.naswil.org/calendar/events/2628/. 

Click here to view the Social Worker Spotlight website: http://ilsocialwork.com/. 

To add your own profile to the site, please submit a profile here: https://naswil.wufoo.com/forms/social-worker-spotlight/. 

Conducting psychotherapy groups in private practice presents the clinical social worker with many complex issues affecting the success of this undertaking. In an era when insurance dilemmas permeate, time-limited and technique-focused therapies are emphasized, and little training in groups is available, it is difficult to deal with the many factors which make conducting an interactional, interpersonally-focused group especially challenging. In particular, the boundary issues involved in conducting such a group can be difficult hurdles which must be comprehended before attempting to provide this especially valuable form of therapy. What often is underappreciated is how satisfying an experience it can be to evolve a highly functioning, effective group where much can be accomplished. Unfortunately, the inaccurate notion of groups being only utilized in in-patient settings or with regressed populations has prevented sufficient use of therapy groups, but this perspective appears to be changing.

One very significant issue is the requirement for understanding the differences between individual and group psychotherapy and receiving the necessary training and supervision which enables one to effectively conduct groups. Unfortunately, many therapists mistakenly conclude that group psychotherapy is ineffectual or only for the most regressed patients because of lacking an understanding of issues involved in preparation for and the evolution of phases of a group's development.

The issue of preparing a potential member for a psychotherapy group is ideally addressed in individual sessions during which an assessment is made of the individual and his/her problems. Additionally, a beginning therapeutic alliance is established with the potential member, a formulation regarding the individual's needs and dynamics is made, and the potential member contracts (not a legally binding decision) to utilize the group in ways agreed upon during the preparatory sessions. Each member agrees to uphold the group contract to 1) regularity and timeliness of attendance, 2) work on problems actively, 3) put feelings into words not actions, 4) stay in the group until problems are resolved; 5) use group contacts therapeutically and not socially, 6) be responsible for fees, and 7) protect the identities of fellow group members (Rutan, Stone, & Shay, p.110). Actually in Illinois, the latter is written into law. It is important to remember that the group contract is not a legally binding document but an understanding of how the group needs to operate effectively. Obviously, the initial sessions must also involve gaining diagnostic perspective and a historical picture of the client which is more available over time in individual psychotherapy.

One of the most significant boundary issues regarding group treatment is the effective and ethical collaboration with an individual therapist who refers the patient to group (called conjoint treatment). What needs to be clarified with the patient as well as the referring therapist (with the patient's permission) is the importance of mutual communication. The therapeutic work must be coordinated so that two therapists are not working at cross-purposes. Sometimes a group referral is made when there is a negative countertransferential issue in the individual treatment which makes the decision to relate to the new therapist and join the group a complex one. These are obviously not concerns when the individual work is being done with the group psychotherapist (called combined treatment). However, even in this situation clarity must be established about whether the therapist assumes the therapeutic authority to bring individual material into the group sessions. Therapists differ on this issue but most often the patient, with the therapist's guidance, reserves the right to decide about what is shared and when. Despite these concerns, it is important to note that the addition of group psychotherapy often provides an opportunity to work on relationship issues that have been addressed individually but require a peer arena for further examination.

Another significant boundary issue in group therapy is the recognition of the phases of group development. Often in a beginning group, the therapist is seduced by the disclosures of one group member and begins prematurely to work with this identified patient. This bodes badly for the individual as well as the group in that this person can become a scapegoat and, most importantly, it avoids the opportunity for all group members to deal with the necessary examination of connection issues (i.e., how to make the group a safe arena for everyone) without premature sharing of intimate secrets. 

Tuckman (1965) is credited with formulating the phases of a team's development, and his perspective has tended to inform the view of an evolving therapy group: forming, storming, norming, and performing. Forming has to do with creating a safe environment which involves all members exploring their anxiety about connection and the sharing of significant personal material. The second phase, storming, often accompanies some feelings of dissatisfaction when, having established safety, unrealistic expectations regarding progress have not been met. This allows for the examination of negative feelings regarding the members and the leader. As this phase is traversed, the group comes to recognize that positive and negative feelings can be expressed productively, and that it is normal to consider all of these in the group (called norming). Subsequently, the group moves into a phase that involves the most therapeutic work (performing). As individual patients make progress, the issue of termination is most effectively contemplated when group members are able to provide feedback and deal with the feelings involved in ending the relationships. It is important for the group therapist to keep in mind the notion of phases so that expectations of the group's process are realistic which in turns helps the group therapist to utilize phase-appropriate interventions. 

One of the complex boundary issues with which groups struggle is the issue of contact outside the group. In certain settings it is impossible for individuals to avoid seeing each other outside of the group session. Even in a private practice setting, there are opportunities for contact outside—walking to a parking area, meeting in the waiting room, and so forth. Subgrouping (making connections with like-minded or supportive members) can be a form of secondary gratification. In the preparatory process, members need to recognize the significance of their contact with others and to understand that anything that happens between group members is part of the here-and-now of the group; it therefore needs to be examined as an element of the group process. Groups have floundered when two members develop close outside contact—the relationship affects their ability to be open in the group and to be confrontational when necessary. The therapist's role is to help the individuals discuss occurrences and to explore their feelings without maintaining a critical, punitive stance. 

Another highly significant issue is the utilization of co-therapists. In many training settings, individuals are paired as co-therapists to meet training requirements, and often seasoned therapists are paired with inexperienced ones. This can result in an effective collaboration if the individuals are able to deal with the potential power and experience differences effectively. There is an opportunity to recapitulate the family group with two co-leaders, but consultation should be available to enable the partnership to evolve effectively. The issues of fee splitting and responsibilities for recording and other administrative tasks must be discussed as well. All of the issues involved in creating a good marriage must be considered.

Most importantly, beginning a successful private practice psychotherapy group involves evolving a reasonable source of referrals since groups require membership replacement as people make gains and terminate their therapy. It can be advisable to use one's own individual patients as a core membership base. However, the mixing of combined, conjoint, or patients without individual therapy is another complexity with which to deal. What one cannot overlook is the satisfying and engaging experience which an effective psychotherapy group can provide its leader—with significant opportunity for individual patient growth.

BIBLIOGRAPHY

Cohen, B. (2005). Creating the group envelope. In Motherwell, L. & Shay J. (Eds.), Complex dilemmas in group therapy: Pathways to resolution (pp. 3–12). New York, NY: Brunner-Routledge.

Cooper, E. (2005). Sizing up the group. In Motherwell, L. & Shay, J. (Eds.), Couples dilemmas in group therapy: Pathways to resolution (pp. 17–25). New York, NY: Brunner-Routledge.

Dies, R. & MacKenzie, K. (Eds.). (1983). Advances in group psychotherapy: Integrating research and practice. New York, NY: International Universities Press.

Dublin, H. (2005) Complex defenses. In Motherwell, L. & Shay, J. (Eds.), Complex dilemmas in group therapy: Pathways to resolution (pp. 87–92). New York, NY: Brunner-Routledge.

Hawkins, D. (2005). All for one and one for some. In Motherwell, L. & Shay, J. (Eds.), Complex dilemmas in group therapy: Pathways to resolution (pp. 30–33). New York, NY: Brunner-Routledge.

Rutan, J., Stone, W., & Shay, J. (Eds.). (2007). Psychodynamic group psychotherapy (4th ed.). New York, NY: Guilford Press.

Schermer, V. (2005). All for one and one for some. In Motherwell, L. & Shay, J. (Eds.) Complex dilemmas in group therapy: Pathways to resolution (pp. 33–37). New York, NY: Brunner-Routledge. 

Tuckman, B. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384–399.

Hylene S. Dublin, LCSW, BCD, CGP, LFAGPA, is currently in private practice in downtown Evanston, Illinois, working with individuals, couples, and groups, and provides consultation to other clinicians—particularly group psychotherapists. As an American Group Psychotherapy Association (AGPA) Life Fellow, Hylene has recently completed a four-year assignment as institute co-chair with the responsibility for planning and maintaining the two-day experiential Institute Program at AGPA's annual conferences. Formerly on the faculties of Evanston Hospital/Northwestern Department of Psychiatry, the University of Illinois Neuropsychiatric Institute, University of Chicago Department of Psychiatry and School of Social Service Administration, Summer Programs, Hylene has published numerous book chapters and articles on issues in psychodynamic group psychotherapy. She is currently visiting professor at the Institute for Clinical Social Work.

This month, the NASW Illinois Chapter features a Q & A with Chicago Teachers Union President Karen Lewis. Karen is also the recipient of the Public Citizen Award for the NASW Illinois Chicago District. The Chicago District will be hosting an awards ceremony for awardees on March 5, 2013. For more details about the awards ceremony, please click here: http://www.naswil.org/calendar/events/2616/. 

On the evening before the Chicago Public School (CPS) strike began, you called for more social workers to serve the children of Chicago by noting the following: 

“In the third largest school district in Illinois there are only 350 social workers—putting their caseloads at nearly 1,000 students each…. Our children are exposed to unprecedented levels of neighborhood violence and other social issues, so the fight for wraparound services is critically important to all of us." 

At that time, the NASW Illinois Chapter lauded your statements, noting that the NASW Standards for School Social Work Services recommends the following: 

“[S]chool social work services should be provided at a ratio of one school social worker to each school building serving up to 250 general education students, or a ratio of 1:250 students [italics added]. When a school social worker is providing services to students with intensive needs, a lower ratio, such as 1:50, is suggested.”

What efforts have been made at CPS to work towards this goal?

At this moment, not anything that I know of, but this is really a question for CPS. The union still has concerns about violence and other issues in our neighborhoods and the ratio of students to social workers remains severely disproportionate.

During your years of teaching, can you provide an example of a school social work intervention that made a difference in the classroom?

Absolutely. I had a student at King College Prep who was very, very bright and was doing extremely well at the beginning of school when all of a sudden his attention and his grades just dropped. I was trying to get to him, but I had just started teaching at King so personally, I didn't know the kids that well. I asked the social worker if could she talk to him, and she found out that his kid's mother had died and he hadn't told anyone. He was living with his grandmother, his mother, and his sister, and he was feeling extremely isolated in terms of sharing his feelings about losing his mother. But he was such a great student, so I had him talk to the social worker and she was literally able to bring him back. She showed him that if he worked on certain things— not that it would take his mind off or distract him—it would allow him to work through his problems.

During the current Illinois General Assembly in Springfield, a revised anti-bullying bill will be introduced once again. Can you describe CPS efforts to deter bullying behavior?

I think CPS understands the nature of bullying among children, although the CTU did have to put a Respectful Working Environment article in our contract to address the issue of bullying among adults.

Please describe your biggest success vis-à-vis social work services at CPS?

Personally, my biggest success was helping to get the previously mentioned student back on track after his mother's death, but in terms of social work services at CPS, I think our biggest success as a union has been bringing the inadequacies of the social work numbers in CPS to the public's attention.

What are the top three challenges the CPS faces in the next five years?

Some stability in leadership; a real educational plan that addresses core problems instead of providing Band-Aid solutions; and, like any other governmental body, shoring up the challenges that come with a lack of resources, and gaining a real understanding of how resources should be equitably delivered.

Karen GJ Lewis is president of the Chicago Teachers Union (CTU). A member of CTU since 1988, Karen taught high school chemistry in the Chicago Public Schools for twenty-two years. She received National Board Certification in 2002 and renewed in 2012. Karen is a vice president of the more than 1.7 million-member American Federation of Teachers, and in 2010, Karen was elected executive vice president to the 70,000 member Illinois Federation of Teachers. She works tirelessly to effectuate excellence in the teaching/learning experience, guard against opportunistic self-interest groups who would eradicate public education, advocate for equal quality education for all students, and protect the rights of educators throughout the state of Illinois.

It is fitting to be reviewing a book about the American welfare state almost eighty years to the day of President Franklin Roosevelt’s inauguration for his first term in office (March 4, 1933). Fast forward almost a hundred years, and we are still debating the fundamental questions of the breadth of federal power in providing relief. And dare I mention that the impact of sequestration is possibly only days away? As an adjunct instructor for the past twelve years, teaching social welfare policy to social work students, Michele Landis Dauber's The Sympathetic State: Disaster Relif and the Origins of the American Welfare State has provided a deeper perspective on the tradition of providing federal relief. Several themes in her book will certainly weave their way into my social welfare policy classes. 

Dauber, a professor of law at Stanford University, has contributed significantly to the literature on the evolution of our welfare state. Her book’s major premise is that federal relief has had a longer history than many of us realize, with precedents going back to the early nineteenth century. As Dauber notes, requests for government relief of loss began in the earliest days of the American republic, with initial requests coming from individual citizens who lacked sufficient resources to pay their debts or taxes. “The history of disaster relief has been driven by two intertwined logics: appeals to precedents that governed settled practices of federal aid and efforts to expand the scope of that precedent to cover funding for new eventualities.” Dauber also notes that the constitutionality of providing relief throughout our country’s history is rooted in the General Welfare Clause of the U.S. Constitution. She cites examples as far back as the massive relief outlays following the War of 1812 and the Alexandria, Virginia, fire of 1827. 

Dauber’s detailed discussion of the debate over maintaining short-lived Freedman’s Bureau (the federal government’s response to the disaster that had befallen blacks at the end of the Civil War) was yet another example used by later New Deal advocates such as Senator Robert La Follette Jr., Frances Perkins, and others who “needed authorizing precedents for the relief of unemployment.” I was especially intrigued by this since my understanding of the lack of federal response to relief was that the Freedman’s Bureau was just a blip on the radar until the federal government assumed a great role in the welfare state. The concept that there had been significant federal precedent of relief for well over a hundred years prior to the New Deal was enlightening. 

By the 1930s it was widely (although not universally) accepted that the General Welfare Clause gave congress a broad power to spend as it saw fit. The army of New Deal lawyers in the Roosevelt administration learned that the federal government’s spending was clearly established. The plain fact is that the U.S. Supreme Court has never struck down a federal law—neither before, during, or after the New Deal—because congress has exceeded its constitutional authority to spend. 

One of more compelling chapters of Dauber’s extremely well-researched book was her chapter on crafting the Depression. Whether in the photography of Dorothea Lange, Ben Shahn, Walker Evans, or the fiction of John Steinbeck, the message of disaster and how the message of need was conveyed was definitely crafted. All kinds of relief were described as being disasters, whether they be the effects of industrialization, farm foreclosure, or even the aging process (as pertains specifically to old age insurance promised in the Social Security Act).

In her postscript, “Living in a Sympathetic State,” Dauber notes that “disaster turns on its head the ordinary American moral economy of individualism and fate in which we feel comfortable leaving people to the circumstances in which they find themselves, no matter how deprived.” Perhaps this formula should have been provided to members of the U.S. Congress during the recent debate of disaster funding for the victims of Hurricane Sandy. Moreover, it is a formula that should be heeded as we continue the experience the effects of the greatest recession since the 1930s. 

This article addresses ethical and legal implications for social workers who consider engaging in an organized work stoppage as part of or in support of union action. It also considers situations where there may be the potential for harm to clients where services are withheld in support of a union called strike. 

Social Work Ethics and State Licensing Boards

The NASW Code of Ethics and state social work licensing laws are two crucial sources of standards for social workers to review when contemplating an activity that may have a negative impact on clients.  The professional standards for licensed social workers are published by each state’s social work licensing board (e.g. Maryland Board of Social Work Examiners, Illinois Department of Financial and Professional Regulation, etc.).  Generally, state licensing boards implement a core mission of protecting the public by assuring high standards of professional practice.  Activities that may have the effect of harming the public are suspect.  For example, Illinois law (225 ILCS 20/19) indicates that disciplinary action may be taken for actions by licensees that are harmful to the public in a manner defined by the rules of the social work licensing board. 

To read the rest of the article, click here. NOTE: NASW login required. 

Of those bills, two are NASW Illinois Chapter initiatives. SB 1609 (Koehler) would make it a criminal offense to threaten a social worker, caseworker, or investigator in connection with their work on behalf of a human services provider that is funded by grant or contract with DCFS, DHS, or DHFS. The bill has yet to be assigned to a committee.

Senate Bill 1455 (Delgado) would implement new continuing education policy sought by the NASW Illinois Chapter and recommended by a task force convened by NASW Illinois. The bill would require that at least three (3) hours of continuing education relate to cultural competence in the practice of social work. Furthermore, the bill would limit the number of hours of continuing education credits earned by means other than face-to-face instruction or experience to 50% of the required number of hours unless a waiver or variance is allowed. This bill has been assigned to the Senate Licensed Activities Committee. 

Of the other bills we are supporting, SB 10 (Freedom to Marry) has advanced from the Senate to the House. The Senate passed the bill on Valentine's Day by a vote of 34–21 with two members voting present. The bill is now assigned to the House Executive Committee and is scheduled to be heard at 3:00pm today. Sponsors of the bill are Sen. Heather Steans (D-Chicago) and Rep. Greg Harris (D-Chicago).

We are also supporting HB 1017/SB 1186. These bills are an initiative of the Illinois State's Office of Health Information Technology would change the Mental Health and Developmental Disabilities Confidentiality Act by incorporating provisions that align the Act with the Illinois Health Information Exchange and HIPAA. There are concerns on the part of some mental health advocates regarding the consumer “opt-out” provisions of the bill and an amendment to HB 1017 has been filed this week to address those concerns. NASW Illinois has been promised a role in the development of rules and policies to implement this legislation if it is enacted.

NASW is also monitoring the gun control debate in the Illinois General Assembly. Illinois was given until June by the 7th Circuit Court of Appeals to pass a concealed carry law. Debate is now going on in the Illinois House regarding the limitations on concealed carry, training requirements, etc. Discussion will be on language to add to a “shell bill” that has been filed in the House.

Finally, the governor's budget message will be delivered on March 6th in Springfield. A budget briefing will be held jointly by the human services agencies in the Howlett Auditorium immediately after the speech.

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

OFFICE FOR RENT - Oak Lawn: Social Worker has office space available for Subletting. Office location is 10448 S. Pulaski, Oak Lawn, Il. Office is 108 square feet, beautifully furnished, utilities are included. Rent is 500.00 month. Office is handicap accessible, near public transportation and free parking. Interested parties should contact Rochelle Cross @ 708-499-2030 or email at rochellejohnsoncross@yahoo.com

OFFICE FOR RENT - Chicago: Bright, sunny office available two days a week (can be flexible), evenings and Saturday in a professional, centrally located building. Suite has a kitchen area, shared waiting room, separate entry and exit, soundproof offices. Great view of Lake Michigan, office is on the 16th floor of 30 N. Michigan Ave. Perfect for a therapist or solo entrepreneur. To see pictures go to http://youtu.be/50226wDs-4o. If questions or interested call Antoinette, 312-719-8498.

OFFICE FOR RENT - Oak Park: Part time office space available in a beautifully furnished & well-maintained, secure building. Friendly atmosphere, potential referrals, free parking. Flexible leasing. 708.524.0532 Lee Madden

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/.

• Social Worker - Fletcher Allen Health Care
• Therapist - Mercy Home for Boys & Girls
• School Psychologist/Social Worker - The Menta Group
• Social Work Intern - NASW Illinois Chapter
• Transition Engagement Specialist - AgeOptions
• Psychiatric Social Worker - Good Samaritan Hospital

Since its inception, social work has recognized the importance of the broad environmental forces that contribute to and address problems in living. In recent decades, more focused attention has been given to the importance of the mind-body connection and the value of non-traditional modes of treatment, including yoga.

Through simple, practical yoga techniques, therapists can learn a variety of techniques to help clients alleviate symptoms of anxiety, depression, somatization, and other difficulties that may hinder an individual’s emotional development. The yoga techniques presented in this article can be used with groups, in individual settings, schools, and agencies. 

The word “yoga” comes from the Sanskrit meaning to yoke, to unite, to join together. Yoga’s aim is to unite the body, mind, and spirit, thus connecting various parts of the self into an integrated whole. 

In my professional and personal experience, yoga and the practice of therapy represent a parallel process. Some of the benefits of therapy and yoga include the following: learning to trust one’s instincts; increasing self-esteem; learning about somatic responses to anxiety, stress, and sadness; knowing that the quiet, still place within exists for our clients through changes, challenges, and times of confusion; and learning to draw on one’s inner center of calm and stability.

Utilizing the following yoga techniques as an adjunct to my clinical work with clients represents a fluid process of moving back and forth between the two modalities. Similar to a cognitive behavioral approach, I use affirmations (or “I” statements) with clients as a method of creating change based upon the belief that the body is pliable to human thought and feeling in both negative and positive ways. Using positive messages encourages and enforces peacefulness, confidence, joy, honesty, and compassion in ourselves. For younger clients, I ask clients to write specific “I” statements that counteract the negative thinking process, based upon the belief that our thoughts create our reality. 

My work with Rachel, a nine-year-old girl, focused on helping her resolve an incapacitating phobia of vomiting (emetephobia). Rachel’s affirmations centered on thoughts of safety and control. When her anxiety peaked, she read her affirmations which she kept in her desk at school. “I am safe. I am healthy. I am OK,” were the three affirmations that Rachel returned to throughout the course of our work together. Other affirmations might include: I trust myself; I am wise; I am powerful and strong; I am calm; I am peaceful; I am worthy. The very act of helping clients devise their own affirmations becomes therapeutic in itself, as it helps the client focus on goals and internal resources. 

Another simple but highly effective yoga technique that I use in my practice focuses on breath work. Yoga teaches proper breathing—inhaling slowly and deeply through the nose and drawing breath down into the lungs. This breathing creates a calm, focused, receptive state of mind. The rhythm of breathing affects the functioning of all the systems of the body. Breath work is about making the involuntary voluntary. The key to health is awareness and becoming conscious of the action of breathing and controlling its flow. Fast, shallow breaths in the upper lungs and chest produce a state of agitation that makes it difficult to concentrate and relax. Breath work is particularly beneficial for clients with ADD/ADHD, anxiety, insomnia, and before test-taking.

When a client enters my office and is in a state of tension or anxiety, I begin the session by asking the client to put both feet firmly on the floor and begin breathing slowly through the nostrils. I always breathe along with my clients as a mirror and as a way to help them regulate their breathing. Just several deep, diaphragmatic breaths enable the client to refocus and recenter.

Diaphragmatic breathing provides the body with the optimum amount of oxygen for the least amount of effort, calming the entire central nervous system. For clients of all ages, the most simple and effective breathing technique involves counting the breath. On the inhalation, the client counts (verbally or by holding up fingers) the seconds it takes to complete the inhale; on the exhale, the client exhales the same amount of time. For example, if the inhale is five seconds long, the exhale must be also five seconds long. The very act of counting the breath not only focuses the mind but centers the breathing. 

With child clients, I teach diaphragmatic breathing by asking clients to lie on the couch, placing a small stuffed animal on their abdomen. On the inhale, the stuffed animal will move upward, and on the exhale the animal will “take a ride down the hill.” If, however, a client feels vulnerable or unsafe in a reclined position, have clients remain seated for breathing exercises. Simply instruct clients to place their hands on their belly, inhale, and notice that the lungs fill like a balloon and the fingers move apart. On the exhalation, the middle fingers will touch. This breathing can be taught to clients of all ages in all therapeutic settings. Another centering breathing method is to place one hand over the heart and another on the abdomen and breathe slowly through the nostrils.

Progressive relaxation and visualization techniques are extremely beneficial to clients of all ages, particularly clients who exhibit symptoms of anxiety, insomnia, somatic complaints, and phobias. There are several ways to help clients achieve a state of deep relaxation in the therapy office. Again, relaxation can be taught sitting or lying down, in a group or in an individual session. It is optimal for clients to close their eyes to block external stimuli and begin to center inwardly. 

During a visualization exercise, the client is guided by the therapist’s cues. For example, while using a calm, quiet voice, I guide the client to travel to a safe place. I invite the client to explore, experience, and imagine this uniquely constructed safe place. Rachel’s safe place became what she called Candyland, a place where she could eat sweets unhindered by her emetephobia. Her phobia abated after two months of talking, practicing relaxation and visualization techniques, and using “I” statements. 

I slowly and methodically guide clients through deep relaxation by having them visualize a color of light. This light progressively travels down the body, relaxing the thoughts and the various parts of the body. I ask that the client breathe into any part of the body that feels uncomfortable, which could be a thought, physical feeling, or emotional state. On the exhale, the client releases anything in the body that is not benefiting him/her. 

When a client feels safe, trusting, and contained in the therapy office, the relaxation response is immediate. A dialogue with the client about the imagery that surfaced during any of the relaxation exercises reveals clients’ often sub- or unconscious fears, aspirations, dreams, and therapeutic goals. When conducted gently and in concert with our clients’ inner resources and strengths, these simple but effective yoga techniques help instill a sense of peacefulness, closeness with the therapist, and a growing awareness of the connection between mind and body.

Mary Leopold, MA, AM, LCSW, is a yoga instructor certified in Yoga for the Special Child and Radiant Child and incorporates her knowledge of yoga into her psychotherapy practice with clients of all ages. With private practice offices in Northbrook and Evanston, Illinois, Mary focuses on the treatment of young children and adults. For questions or for further reading, please contact Mary at mary [dot] leopold [at] gmail.com or visit her website: www.maryleopold.com.

CEU Opportunity for Reading This Article! 

NASW Illinois members can earn one CEU by completing an online quiz (LINK) regarding this article! The free CEU opportunity is only valid until April 1, 2013, after which the CEU fee will change to $15.00. Nonmembers must pay the regular $10.00 rate for the CEU, which will increase to $15.00 after April 1, 2013.

February is Black History Month, a time set aside to celebrate significant contributions of African Americans in our country. Although there have been countless African Americans who have contributed greatly to our communities in terms of social justice and social work, I would like to highlight some of the contributions of Whitney M. Young.

Whitney Young was former president of the National Association of Social Workers (NASW). He became president in 1969 during a time when our country—as well as the organization—was at a point of economic uncertainty. He didn’t let the challenges that lay ahead of him discourage him; instead he sought to empower and challenge social workers across the country to advocate not just for those unable to advocate for themselves, but to move to the front lines of negotiations and development and create changes in our communities. He sought to wipe out poverty and to level the playing field for African Americans when it came to employment and access to areas in society where they were underrepresented. I am inspired by his spirit, and I am inspired by his boldness at such a difficult time in the history of our communities and in our country. 

When I think about my career as a social worker, I have to question myself. Am I an agent of change or am I merely building a career as a social worker? Have I done enough to use the power that I have to bring about a change to the powerless? These are hard questions, but I am encouraged to know that I still have time. I have time to make a difference in the community, and I challenge each member of the NASW Illinois Chapter to ask themselves those same questions and think about our role as agents of change and how we can utilize our skills and abilities to uplift those that are unable to do it for themselves. I am reminded of a quote by Whitney M. Young that still remains true in our communities today because we are really all in this together: “Every man is our brother, every man’s burden is our own. Where poverty exists, all are poorer. Where hate flourishes, all are corrupted. Where injustice reins, all are unequal.” 

Please join us on Saturday, February 16, 2013 at 2:00pm as we participate in the screening of the documentary The Powerbroker: Whitney Young’s Fight for Civil Rights. This will take place at the Claudia Cassidy Theater on the 2nd floor of the Chicago Cultural Center located at 78 East Washington Street in Chicago, IL 60602.

Yolanda Jordan, MSW, LCSW, has an extensive background in abuse/neglect issues in the field of child welfare. As a placement manager with the Illinois Department of Children and Family Services, she is responsible for managing supervisors who are responsible for children who are placed in the foster care system. Yolanda is also a practicing psychotherapist and has been in private practice for the past ten years. Services are provided to children, couples, and families with a special emphasis on relationship issues that African American women face.

Yolanda is a graduate of Western Illinois University where she received her bachelor of arts in mass communications and master of arts in public communications human relations with a minor in African American studies. Due to her extreme love for people and having the heart of a servant, she continued her education and received a masters in social work with an emphasis on child and family practice from the University of Illinois at Chicago’s Jane Addams College of Social Work. Yolanda has been an active member of the NASW Illinois since 1996 and enjoys the work of advocating for the profession of social work and the community that social workers serve.

We are social workers so perhaps this is an image from the life of Jane Addams, the founder of our profession? Jane Addams was a social reformer and a peace advocate who took tremendous personal risks to pursue her vision of healthy communities, healthy people, and healthy cities. 

Or perhaps this was an image from the Chicago Teachers Union (CTU) strike of September 2012. Certainly the vignette above is etched in my memory as I was one of 25,000 marchers, along with 350 or so other school social workers in Chicago, our clinician colleagues (psychologists, occupational, physical and speech therapists, and nurses), paraprofessionals, and teachers. In Chicago, school-based clinicians are members of the Chicago Teachers Union. Contractual provisions that apply to teachers also apply to clinicians. 

There are about 350 school social workers in Chicago Public Schools. We played an active role in the strike—demonstrating at the Chicago State Board of Education, picketing at schools, coordinating strike activities. In addition, we have a Clinician Steering Committee within the union that works hard to defend the interests of all the clinicians, and to support the union to appreciate the vital role we play within the schools. 

You may think it an exaggeration to compare a teachers’ strike for better pay and benefits to the tremendous accomplishments of social justice made by our famous founder, Jane Addams. In fact it is not. The Chicago Teachers Union has specifically dissociated itself from old-style unionism, which is often called “business unionism” or “service unionism.” They have specifically aligned themselves with struggles for transformation of schools and communities—for education designed by educators, for better health care, for mental health, for jobs, for schools envisioned as shining centers of community life. The primary demands of the strike were smaller class sizes; more social workers, psychologists, and other clinicians in the schools; a fair contract; and a better school day (More gym, art, music, etc.). 

In Chicago and in most communities around the country, teachers unions are facing the forces of privatization of education. These forces are extremely powerful, they are both Democrat and Republican, and they often own the media. They have used the rhetoric of failing schools, bad teachers, and so on, to enrich themselves. The public money that has gone to public education is now viewed by venture capitalists, hedge fund managers, and their ilk as a big pot of gold. Their profit funnels are charter schools and testing schemes.

Charter schools in Chicago and elsewhere are almost entirely funded by tax dollars, yet they are privately run with little to no oversight. By law in Illinois, charter school employees cannot join the CTU. Hence charter school employees are paid about 15% less than unionized teachers/social workers/etc. The largest study done so far of all charter schools in the nation found that 37% had gains that were significantly below those of public schools; 46% had gains that were no different; and only 17% showed growth that was significantly better (1). Where growth was better, the charter often practiced implicit or explicit selective enrollment. 

Chicago is the third largest school system in the county. In 1995 it was placed under mayoral control—the school board was no longer an elected body but one appointed by the mayor. In 2004 an organization of the 200 most powerful corporations created a blueprint for education that envisioned a “marketplace” of education, imagining that competition among schools would make them better (2). 

The forces that seek to impose a marketplace of education also seek to decrease pensions to close the mental health centers in Chicago, to close the school-based mental and physical health clinics. At the same time, they advocate to lay off or privatize thousands of teachers, social workers, and workers in the private and public sectors. They advocate for lower taxes for the rich and are instrumental in shipping US jobs overseas. Here is the action plan of those who seek to impose a marketplace of education:

1. Denigrate teachers and teaching, despite data showing that poverty is the primary causal factor in school success, or lack thereof (3)
2. Flood the media with the idea that there is a crisis in education, when in fact there is a crisis of poverty 
3. Fund popular movies that mendaciously glorify charter schools and denigrate teachers’ unions (4)
4. Encourage the idea that “quick fixes” (packaged as new testing schemes and faddish ideas about education management) will fix education
5. Deregulate education (read: establish charter schools with no scholastic or management oversight; smash teachers’ unions)
6. Create “accountability” and data-based decision–making (excessively test students; base teacher pay on test scores)
7. Privatize every enterprise possible in order to crush unions and lower salaries for all workers (In Chicago they have privatized the parking meters, a major tollway, and many city services.)
8. Close hundreds of public schools, claiming to do so for financial reasons, while opening expensive new charter schools
9. Ignore the destabilization and destruction of communities caused by joblessness and the closing of neighborhood schools
10. Accept billions from the Gates, Walton, and Broad foundations to distort educational policy with no public input, and crush teachers’ unions (5)

We know that this marketplace philosophy did not work for the banks. Despite their rhetoric about smaller government, when they failed, they went to the government for billions in handouts. So what can work? As social workers, we can provide that vision with one hand tied behind our backs! A good starting place is to advocate what the Chicago Teachers Union has advocated—almost a page torn out of Jane Addams’ playbook. 

1. Advocate to make schools centers of community health—mental health, physical health, recreation, and political empowerment. Don’t close hundreds of schools, as Chicago is doing, but revitalize them.
2. Increase mental health services in schools—more social workers, psychologists, and other health-related professions.
3. Reduce class size; educate the whole child; address disproportionate harm to students of color and poor students; provide good facilities; fully fund education.
4. Partner with parents! In Chicago, thousands of outraged parents have formed up into anti-charter and anti-testing organizations. (6)

This may seem huge and overwhelming. What are some specific steps one can take? If you have a union, become active. If you need research to counter the lies of politicians, partner with your nearest university to assist. Speak to parents at PTO meetings and community meetings of all types. Gather three or four like-minded folks together and pick one school or community project to focus on—Have they closed a community mental health center? Find your allies. Meet with local and statewide politicians. When they ignore you and your research-based ideas, picket them, write editorials about them, and keep up the public pressure. And never forget to keep your eye on social justice. Read about the Civil Rights Movement. Read Jane Addams. And remember Margaret Mead’s words: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.”

REFERENCES

1. www.credo.stanford.edu
2. www.ccachicago.org 
3. http://epicpolicy.org/publication/poverty-and-potential
4. www.dissentmagazine.org/article/?article =37
5. www.dissentmagazine.org/article/?article =37

For additional information, go to http://www.ctunet.com. 

Carol Hayse, LCSW, is a school social worker for Chicago Public Schools. She has been involved in organizing for social justice all of her life. As a clinician she specializes in complex trauma in children and has presented on the topic for the Illinois Association of School Social workers (IASSW), the NASW Illinois Chapter, and the Chicago Teachers Union. She will present on the teacher’s strike for the School Social Work Association of America (SSWAA) in March. She lives with her partner, a singer-songwriter for social justice, and their dog on Chicago's north side.

Chicago’s culture has been sculpted by generations of immigrants and migrants from all over the US and the world. Distinct ethnic groups vying for territory, alliances, and power creates volatile and sometimes unsavory communities. Natalie Moore and Lance Williams provide a nonfictional depiction of how one street gang, The Almighty Black P Stones, got wrapped up in social and economic injustice that plagued or protected the black community and eventually spun the Black P Stones out of control and disarray. 

Home to The Almighty Black P Stone is Chicago, illustrated by Carl Sandburg’s famous poem as a wicked, crooked, and brutal city of big shoulders. Chicago has produced some of the most notorious street and organized crime outfits in America’s history. Yet Chicago has bred many great people, such as the first African American president of the United States, Barack H. Obama. According to Moore and Williams, Eugene “Bull” Hairston, a young, black Chicago native, and his partner, Jeff “Angel”Fort, co-founded of one the largest and most organized street gangs in the country. Eugene and Jeff organized many different factions of smaller gangs to join what would eventually become a gang territory so large that at one point it included even the neighborhood where our current president owns a home. 

The story of the Almighty Black P Stone Nation occurs mainly between the early 1960s and late 1980s. The book thoroughly demonstrates the street gang’s powerful influence over the community as well as various government entities. The details about the gang’s rise are historical, factual, and supported by solid sources. Social workers, particularly those less experienced in street knowledge, will benefit from reading this book by gaining a precise understanding of how and why organized and structured gangs are formed to the etiology of youth violence. The detailed descriptions of youth’s role in gangs and violence is no different than what is happening today in the streets of Chicago, particularly when powerful gangs like the Almighty Black P Stones become fractured by various local and federal law enforcement efforts. National public policy initiatives such as the War on Poverty, the War on Drugs, and the War on Terrorism contributed to the rise, fall, and resurgence of the Black P Stones. Furthermore, aspiring community organizers and youth development practitioners should be encouraged to study certain details highlighted in the book, such as references to Saul Alinksy’s organizing theories and how these strategies were similar Hairston and Fort’s ability to influence, lead, and bait their targets. 

This book could be even more of a learning tool for social workers, community organizers, sociologist, and youth developers if it concluded with lessons learned and strategies to redirect young people from the power and influence of street gangs. Although it can be implied through the historical content presented throughout the text that certain programs were ineffective, irresponsible, and borderline illegal, if not completely illegal. 

As mentioned, the numerous sources provided at the conclusion of the book support the claims and reports provided throughout the reading. Natalie Moore and Lance Williams deliver a valuable resource for all aspects of social work. 

Antwan A. Turpeau, MSW, is executive director and co-founder of Struggling Youth Equals Successful Adults. He and two other African American men were honored by the Illinois House of Representatives 97th General Assembly for being the first former foster youth to co-found a nonprofit youth organization in the history of Illinois. Antwan has over twelve years of youth development and child welfare experience. He also played a significant role in organizing the Woodlawn 1,000 Man March Against Violence and acquired five years of community organizing experience with the Chicago Area Project as project manager. Antwan has resided in Englewood, Bronzeville, Hyde Park, and Woodlawn. 

The 98th General Assembly was sworn in on January 9, 2013. Sixteen out of fifty-nine members of the Illinois Senate are new. This includes several former Illinois House members who were elected to the Illinois Senate. The Democratic Party holds forty out of fifty-nine seats this session. In the Illinois House there are twenty-three new members out of 118, including one former Illinois Senate member who was elected to the Illinois House. Getting to know the new members and educating them on our issues will be a huge challenge.

As usual, the big issue this year will be the state budget. Cuts to education and human services are inevitable unless something is done about the state's fiscal condition. Focus will be on the state's pension systems and ways to control the state's pension fundng obligations. Another significant budget issue is the backlog of unpaid bills to service providers and vendors.   We expect to see legislation again that authorizes the refinancing of back due bills.  

The NASW Illinois Chapter plans to have bills introduced dealing with social worker safety and CEU requirements. We are also strongly in support of the expansion of Medicaid under the Affordable Care Act (see SB 26 and HB 106).  

A new Marriage Equality bill, HB 110, has been filed by Rep. Greg Harris.  

Since the bill filing process is now ongoing and the deadline for bill introduction is Feburary 15th, I will not report on any other specific bills today. Thousands of bills will be filed in the next two weeks.   

Not much happened during the Lame Duck Session in early January. One noteworhy bill that passed and was signed last week by the governor is House Bill 6193, now Public Act 97-1147, which amends the School Code to require age-appropriate sexual abuse and assault awareness and prevention education in grades pre-K to twelve. Last Sunday the governor signed SB 957, now Public Act 97-1157, which creates a temporary visitor's drivers license for undocumented immigrants. The licenses are valid for three years and cannot be used for idenfitication purposes. The holder must produce proof of liability insurance as a condition of issuance.

Upon the occasion of a social worker’s death, the social worker’s next of kin, the executor of the will or the administrator of the social worker’s estate may face the challenging and uncertain task of tying up the business and legal affairs of the deceased, including the steps involved in closing a private practice and managing confidential mental health records.  Prior legal articles have addressed issues involved in closing a social work practice due to retirement, death and  disability of the social worker (Morgan, S. and Polowy, C., 2011).  This legal article will focus on the obligations regarding the disposition of client records when a social worker dies.  Specifically:

• Once a social worker has died, what are the legal obligations to maintain client records? 
• Must a social worker make arrangements for the maintenance of client files for the same period of time as if the social worker were still living?

To read the rest of the article, click here. NOTE: NASW login required. 

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

OFFICE FOR RENT - Chicago: Bright, sunny office available two days a week (can be flexible), evenings and Saturday in a professional, centrally located building. Suite has a kitchen area, shared waiting room, separate entry and exit, soundproof offices. Great view of Lake Michigan, office is on the 16th floor of 30 N. Michigan Ave. Perfect for a therapist or solo entrepreneur. To see pictures go to http://youtu.be/50226wDs-4o. If questions or interested call Antoinette, 312-719-8498.

OFFICE FOR RENT - Arlington Heights: Furnished Arlington Heights, IL psychotherapy office just off I-90. Available Mon., Wed., Fri., Sat., Sun., days and/or evenings. Part of a suite of offices with restroom and waiting area. Heat, a/c, electricity and cleaning included. Rental based on days needed. Contact Steve Coen, 847-845-2007 or Jim Buchholz, 847-228-6440.

OFFICE FOR RENT - Oak Park: Oak Park: Part time office space available in a beautifully furnished & well-maintained, secure building. Friendly atmosphere, potential referrals, free parking. Flexible leasing. 708.524.0532 Lee Madden

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/. 

• Psychotherapist - Partners for Change
• Paraprofessional - The Menta Group
• Transition Engagement Specialist - AgeOptions
• Licensed Therapists - Core Therapy Associates, Ltd.
• Social Worker LCSW - PRS, LLC Dialysis
• Social Work Department Chair - New Trier High School
• Psychiatric Social Worker - Good Samaritan Hospital
• LTC Insurance Clinical Reviewers $31/hr - Managed Care Staffers

Happy 2013 to all NASW Illinois Chapter members and the Illinois social work community! As I write this article on the first day of the new year, the entire country cleared the fiscal cliff (at least temporarily) as the U.S. House of Representatives approved the U.S. Senate’s fiscal cliff legislation. Let’s hope for the many people we serve as professional social workers that 2013 will bring in a spirit of working together both in Washington, DC, and here in Illinois, and usher in a new year of meeting challenges in a constructive and fair way.

It is always good to look back on some of the NASW Illinois Chapter’s accomplishments during the past year, and to also look ahead to the significant chapter activity that is on the horizon for 2013. All of these events have been chronicled in detail on the NASW Illinois Chapter website.

EAPrefer™: New Member Benefit

This member benefit became available in Illinois a major way at the beginning of 2012. EAPrefer™ provides members with the opportunity to receive referrals from employee assistance program (EAP) network providers who match qualified social workers with the employees who need them. Read more here: http://naswil.org/news/chapter-update/new-nasw-member-benefit-eaprefer/.

2012 Social Work Jobs Summit

On Friday, February 24, 2012, over forty attendees representing fourteen schools of social work and fifteen human service employers gathered at the NASW Illinois Chapter offices in Chicago. The group initiated a discussion on the many challenges that the current economic downturn has had in our state and country as well as its impact on the social work force and the future of social service delivery in Illinois. The summit came about through the cooperation of the NASW Illinois Chapter, the Illinois Association of Deans and Directors, and social work employers statewide. Working groups of summit participants met throughout spring and early summer, and in late October a set of recommendations was drafted. The group came up with the following recommendations:

• Establish a standardized approach to data collection for schools of social work for students immediately upon graduation.
• Conduct a “forward-thinking, positive, and future-focused survey (using Survey Monkey and coordinated by NASW IL) to be sent to agencies/employers about what skills the market is requiring of social workers.” Questions regarding skill sets should cover four areas: 1) Theoretical preparation; 2) Business/administrative functions (billing, Medicaid, fee for service, etc.); 3) Technology; and 4) Functioning in a professional environment. What type of basic skills are agencies requiring from student interns and prospective employees? The survey should consider CSWE core competencies as well as address BSW and MSW types of preparation. A survey was distributed to over 600 employers in early December 2012.
• Develop ways to incentivize agencies to receive student work student placements. For example, social work faculty could help agencies by providing needed research.
• Develop an online course to be used by all schools of social work in the state of Illinois on basic principles of private insurance, e.g., precertification and recertification issues. Connect this possible online course with field seminar classes that are required of most students in social work programs around the state. This type of training would take the burden off agencies and prepare the best candidates for positions in field placements, as well as best candidates for employment.
• Develop more of business partnerships between schools and agencies, with both investing resources.

Read more here: http://naswil.org/news/chapter-update/2012-social-work-jobs-summit/.

Private Practice Shared Interest Group (SIG)

Responding to the needs of the close to 1,000 private practitioners in the membership, the NASW Illinois Chapter established a Private Practice Shared Interest Group (SIG) whose focal point has been its own Google Groups discussion forum. This active forum serves as an important resource for clinicians. The SIG is currently in the process of launching networking groups in different parts of the state. To get involved in the SIG, send an e-mail to office [at] naswil [dot] org.

New and Enhanced NASW Professional Liability Insurance (PLI) Program Introduced

In September, NASW Assurance Services Inc. (ASI) developed an enhanced endorsed program. Major improvements to the PLI program included a reduced premium for part-time practice, tail coverage at no cost to retired members, advocating for members whose coverage was dropped, and taking out unnecessary questions from applications, to name a few. Read more here: http://naswil.org/news/chapter-update/important-information-about-improvements-to-nasw-member-liability-insurance/.

NASW Illinois Chapter Inaugural Virtual Townhall Meeting

In a new effort to reach our members and keep them up to date on association activities, the chapter held two virtual townhall teleconference calls on March 19, 2012, and on October 4, 2012. A combined 800 callers participated in the calls. The second townhall meeting held an in-depth focus on the new NASW Professional Liability Insurance product. Read more here and here.

Public Service Announcements: WLS-AM Radio

In early 2012, the NASW Illinois Chapter was approached by WLS-AM radio in Chicago to write public service announcements (PSA) on a variety of issues regarding mental health and treatment issues. Together with the national NASW office (who helped prepare the language for the PSAs), the chapter worked closely with the station to develop language for these PSAs. WLS-AM ran five PSAs on anxiety, depression, eating disorders, relationships, and suicide during the 4:00 pm time slot, five days a week, from January through May, August, September, December 2012, and January 2013. Funding for the PSAs was secured through sponsorship by Rogers Memorial Hospital in Wisconsin. The PSAs have resulted in some great free publicity for NASW as well as the national consumer website: www.helpstartshere.org.

2012 Regional Virtual Symposium on Healthcare

The 2012 NASW Illinois Chapter Regional Virtual Symposium on Healthcare took place on Thursday, September 20, 2012. The chapter partnered with the NASW Missouri Chapter, which presented the middle portion of the day’s presentation. I would like to thank Mary Gollings, NASW Illinois Chapter Member At-Large, for her presentation on veterans issues and healthcare. http://naswil.org/news/chapter-update/2012-nasw-regional-virtual-symposium-announced/

Strategic Planning Efforts: Focus on Membership Development

In the fall of 2011 the NASW Illinois Chapter Executive Committee, following a significant discussion at the board level, approved funding to conduct a membership marking survey that would research member and nonmember markets. The research would then be used in the development of strategic membership recruitment initiatives for the state chapter.

During 2012, Kerr and Downs Research conducted surveys over a period of several months, using online focus groups and online surveys with members and nonmembers. As noted in their summary, 668 surveys were completed by members while 62 surveys were completed by nonmembers. Below are the initial results and recommendations from Kerr and Downs, as well as the actual transcripts of the member and nonmember research.

The NASW Illinois Chapter’s Strategic Planning Committee, appointed by NASW Illinois Chapter President Yolanda Jordan, ranked the top four of Kerr and Downs’ recommendations. They include the following recommendations:

Strategic Recommendation #1

Market more aggressively: 1) Select a subset of potential members and market repeatedly to them over a six month period; 2) Keep track of what works and the characteristics of those who have a higher acceptance rate; 3) Use this information to inform future marketing efforts.

Strategic Recommendation #2

Extensively market the savings on liability insurance, CEUs, etc., so social workers can see how these savings help their day-to-day bottom line.

Strategic Recommendation #3

Position the NASW and NASW Illinois Chapter as THE community fighting for financial and professional recognition of social work and advocating for funding for social work jobs in all practice areas.

Strategic Recommendations #4

Develop a less expensive PR campaign: 1) To have member social workers tell their stories to those they speak to every day and 2) To have savvy social workers utilize social media and traditional press to shape perceptions of social workers.

Legislative Advocacy

Over 700 attendees took part in the 2012 Social Work Advocacy Day in Springfield, Illinois. The chapter was active on a variety of issues in 2012 that impacted the profession and the individuals and communities we serve. Utilizing Capwiz, our legislative alerts system, we now reach over 9,000 people statewide.

As well as our active work in Springfield, the chapter worked on the following issues: 

• Medicaid expansion under the Affordable Care Act
• Medicaid reform and coordinated care
• Temporary visitor’s driver’s licenses
• School bullying prevention
• Budget and debt refinancing
• Social Work Practice Act rule recommended changes

2013 will prove to be an even more crucial year for the social work profession and the human service sector. Please refer to our 2013 Legislative/Social Policy Agenda (http://naswil.org/news/chapter-update/2013-legislativesocial-policy-agenda/) which will serve as a guide for action.

NASW PAC Illinois

2012 was an election, and our NASW Illinois Chapter Political Action Committee (NASW IL PAC) was very active again in making candidate endorsements as well as developing a legislative scorecard. To learn more, visit the NASW IL PAC site: http://naswilpac.org/.

NASW Illinois Chapter Trainings and Courses

During 2012 the NASW Illinois Chapter produced:

• 25 shared interest group (SIG) events
• 45 district events around the state, 30 of which were CEU events
• 11 licensure review courses
• Three supervision classes
• Four ethics trainings

Sandy Mills Memorial Fund

We received some sad news to end 2012. Longtime NASW Illinois Chapter lobbyist Sandy Mills passed away in December. To honor her memory, the NASW Illinois Chapter has established the Sandy Mills Memorial Fund. More information on the fund can be found here: http://naswil.org/news/chapter-update/in-memoriam-sandra-sandy-j-mills/.

Looking Forward to 2013

The 2013 year is the second of the current social work licensure cycle. Make the NASW Illinois Chapter your home for all of your CEU needs and professional development. Starting off the year we will have a variety of district and chapter-wide events. You can view all upcoming events on the NASW Illinois Chapter calendar: http://naswil.org/education-career-development/calendar/. 

Joel L. Rubin, MSW, CAE, has served as executive director of the 7,000 member Illinois Chapter of the National Association of Social Workers (NASW) since October 1999. He has over twenty-five years of nonprofit management and fundraising experience including extensive work with boards of directors, committees and volunteers, and advocacy around a wide variety of social work, human service, and international political issues. Joel is a graduate of the Wexner Heritage Fellowship Leadership Program and a current adjunct professor at the University of Illinois at Chicago Jane Addams College of Social Work as well as Loyola University Chicago School of Social Work.

My eleven-year-old daughter came home from school one day and told me that she had to write an essay on the topic of survival. She said it had to demonstrate a how-to approach to a task or challenge. I asked her if she had any ideas—I thought maybe surviving sixth grade, zip-lining, or performing for the first time. She quietly responded, “Mom, I want to write about surviving cancer. One half will be the medical stuff like treatments, doctors, and side effects. The other would be the important stuff like family, friends, and faith. You know, the stuff we learned when you had cancer.”

Humbled by her point that we had learned so much from my illness and treatment, I realized my experience with cancer helped me grow professionally by managing my practice while in treatment.

I was diagnosed with cancer as a toddler and was treated with surgery, chemotherapy, and radiation therapy. I had been challenged with some resultant chronic health issues throughout my young adulthood, but nothing that really slowed me down. I am certain that this life experience is what fueled my interest in graduate school in health care. I pursued a career in medical social work, employed by hospitals, community-based nonprofits, and ultimately private practice.

Then four years ago I was diagnosed with two cancers thought to be the late effects of treatment as a child. Suddenly I found myself in the unique space of walking the same journey as many of my clients. But I knew in my gut I did not want to give up my practice. 

My practice was a sole proprietorship, and I was subleasing office space. My colleagues were among the first wave of those that I called upon when diagnosed, not only for comfort and support, but for guidance about what to do. I began where so many of us do—the internet—and researched not only my illness and treatment options but also about my practice. I landed on the NASW website and consulted these two pertinent sections from the Code of Ethics.

1.15 Interruption of Services
Social workers should make reasonable efforts to ensure continuity of services in the event that services are interrupted by factors such as unavailability, relocation, illness, disability, or death.

4.05 Impairment
(a) Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility.
(b) Social workers whose personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others.

I knew I had to disclose some of my personal circumstances to clients. But how much, I asked myself. Do I have the same responsibility to active clients as to those not actively in my caseload, but that I had been seen in the recent past? And what about referral sources? The most important thing to convey, I determined, was my reduced caseload. But there would be no way to conceal my illness and the visible aspects of treatment and side effects.

My hope was to create a therapeutic culture with my active clients, balancing my personal privacy with sufficient disclosure in order to support them in making the best decisions for their care. It was a simple enough idea but not an easy one. I was not even sure what I was facing in my future. How ill would I be at times? Would there be unforeseen complications? I knew the chances of that were high from my professional experience in health care. I decided to approach each conversation individually, just as I approached their care. One by one I provided the information I considered most important to help each client determine whether to remain with me or transition to another practitioner based upon their needs and my ability to meet them. 

There are many reasons why I chose to keep my practice, but in retrospect there are many more reasons I’m so glad that I did.

Working through my illness and treatment presented a unique opportunity to walk in a parallel way with my clients, experiencing the challenges and successes on the path of healing. I had worked very hard at building my practice, and I was very fortunate to share office space with professionals who know health psychology very well and were therefore uniquely understanding and supportive. They were regularly available, honest, and encouraging, often anticipating my needs even before I did. With their guidance and flexible work hours, I had an ideal work environment. I also had a great network of colleagues from my former jobs that were excellent consultants, also well-schooled on the relationship of social work professionalism and health. 

More importantly, social work in practice was an integral part of my identity. I knew that practicing would allow me to feel like myself in a time of such challenge. This much I had learned over the years working with my clients, the need for self-determination. What a unique opportunity I was given in demonstrating to my clients how to be resilient and courageous.

What I didn’t expect was the powerful effect the disclosure of my illness would have on my ability to do the work. Some of my clients began comparing their suffering to mine based upon what they saw but also imagined; they tended to discount their experiences as being less severe or trivial. Some initially felt uncomfortable in disclosing this to me, but once they did it provided for a great therapeutic discussion about the universality of pain and suffering, how to have perspective in one’s life, and how to be present for others amidst your own challenges.

As I counseled my clients on being present, I saw my capacities to do so likewise grow, along with my appreciation for myself and my talents. I was walking my own talk indeed. I became more empathetic and patient, especially as I struggled, realizing that even for those of us well-educated practitioners, some days the strategies just do not work. Walking this parallel journey with my clients provided clarity of focus and renewed understanding. 

Surprisingly I had to work much harder, not only physically but intellectually, emotionally, and spiritually. Even with a reduced caseload, I was more regularly mindful of my responsibility to actively address my own feelings, strategies, and countertransference. Recognizing that this is a dynamic process, I started asking more rigorously for feedback from clients and consultation from colleagues. I’ve added the process of asking for feedback as a matter of policy and to this day get great benefit from doing that which came out of my experience.

Four years later I continue to deal with the physical symptoms that resulted from my cancer experience and treatment. That is part of my reality. But as the result of keeping my practice open—and keeping open to what I could learn from my practice—every aspect of my life is healthier. 

Anne G. Walker, MSW, LCSW, is a native of the Detroit area and graduate of the University of Michigan School of Social Work. She has worked in a variety of health-related settings such as hospitals and community nonprofit health organizations and is currently in private practice in Arlington Heights, IL, specializing in work with adult individuals, couples, and families. She has special interest in issues of chronic and acute illness, grief and loss, and marital relationships. In her spare time with her family she enjoys travel, music, and being outdoors. 

Similar to many school social workers, I began my career not far from where I resided, in a suburban town with a population of 48,000. But in the spring of 1993, our family relocated to a rural community with a population of 6,000. This move of 120 miles west would bring not only a new home but also a new place of employment. No longer working for a district, I was (and continue to be) employed by a cooperative that serves fifteen districts, is comprised of over two counties, and has a school social work staff of nine. Unsure of the changes and challenges that lay ahead, I braced myself for the transformations which I felt would accompany working in this new geographical location. 

To my surprise, very few differences exist. Students presented similar issues, expectations of our profession remained a constant, and paperwork, unfortunately, had not decreased. On the other hand, the variances which became apparent were directly correlated to working within a small, tight-knit community. The challenges which were most prominent consisted of boundary issues, confidentiality, resources available within our catchment area, public transportation, and travel distances.

Recognizing that I would be new to the rural lifestyle, my supervisor provided me with two wise thoughts prior to relocating: 1) Do not purchase a home that requires a great deal of renovation as it will never be completed, and most importantly, 2) Everyone is related. While I appreciated and heeded her first piece of advice, the latter has served me well over the past twenty years. Small communities afford one the opportunity to be part of a larger family. Those who choose to take part find themselves intimately affected by the happenings within their own town. In turn, these events are intensified by the mere size of the community in which they transpire. Close ties are fostered within the rural community. Self-reliant individuals who display this lifestyle value autonomy within their own neighborhoods, churches, and service organizations. 

My working environment now depicted an attached neighborhood where daily occurrences took on a state of amplification. The intimacy experienced within these communities skewed my working environment in a manner I had not yet been exposed. Residing in a rural setting and working within the schools brings with it a unique set of circumstances. In a society that values self-sufficiency, it is difficult to impress upon individuals the importance of obtaining professional assistance. Earning the trust of families with whom we work is paramount to continued success within this setting. Becoming involved in the community appears effortless when members of your family participate in extracurricular activities and/or social organizations. Alternatives which will aid in community immersion may include volunteering your time within your school or neighborhood as well as attending sporting and musical events of children with whom you work. A delicate balance must be found between functioning as a member of a society in which you reside while simultaneously maintaining a separate personal and professional existence.

As school social workers residing within the rural community, we are constantly being observed in both our professional and personal lives. I quickly discovered that one of the issues we encounter is a loss of anonymity. It is helpful to be cognizant of intersecting relationships. A quick trip to the grocery store is no longer merely a task to be completed. This moment of running errands can easily become an unscheduled parent conference. One must always be mindful of the possibility of a parent in aisle seven. Dual relationships may include working with a child of a co-worker, hairstylist, or family physician. In dealing with relationships such as these, it is imperative for a social worker to establish boundaries. Establishing expectations at the beginning of a professional relationship is essential. 

Maintaining confidentiality is of utmost importance. This can be a difficult task to uphold throughout any environment, but in a setting where individuals perceive themselves as a cohesive unit it can be difficult to impart. As dual relationships abound in small towns, the line between teacher, paraprofessional, support staff, and parent begin to blur. Although well-intended, individuals not directly involved struggle with the inability to be incorporated into a student’s life. It can be difficult to maintain the privacy of information when working within a small community, particularly with the availability of social networking. 

Although there is a web of informal support, there is a scarcity of formal resources within our rural environment. With an insufficiency of health care services and mental health practices as well as public transportation, school social workers in this vicinity find themselves expanding their professional role. On occasion social workers will assist parents in transporting their children to specialist appointments. While families may be open to seeking outside counseling, financial means, coupled with ease of access, may deter this option. Parents do not always possess a readily-available vehicle, and public transportation is nonexistent in this setting. The request to attend meetings throughout a school year may be compounded by transportation as well as time availability issues. In order to accommodate and encourage parental involvement, we have provided the opportunity for meetings to be conducted via telephone conference. The social worker may also meet with parents in their home, place of employment, or other mutually convenient and safe locations.

Traveling a distance of up to ninety miles round-trip in order to meet the needs of the cooperative is not an uncommon practice. Many school social workers in this rural community service multiple districts. In order to make the best of this situation, we carpool with fellow teammates, become proficient at time management skills, and possess a back-up plan whenever possible. Also important is to keep an ever watchful eye on the weather. While snow snaking across the road from an open field can be mesmerizing, finding yourself in the country in whiteout conditions and two-foot snow drifts can lead to a rural school social worker’s undoing. A constant reminder of safety first is enforced within our organization. 

As it once was, working within this setting is no longer unfamiliar. Unaware of where the road may lead, for now I will continue to enjoy the copious challenges and benefits which accompany functioning within the rural setting: close-knit communities, being employed as a member of a cooperative, and the opportunity to drive for miles with amazing views of the countryside.

Susan Ernst, MSW, has been employed as a school social worker for the past twenty-two years, working with students grades Pre-K through twelve. Susan is certified as a Clinical Trauma and Loss Specialist, has written and received funding for a technology grant, and co-presented at the 2012 Illinois Association of School Social Workers Conference.

Positive change is a fairly standard goal for social workers, whether for individuals, groups, or society as a whole. The Power of Habit: Why We Do What We Do In Life And Business, by Charles Duhigg, addresses the issue of change in all three of these areas. Social workers will recognize the micro, mezzo, and macro framework that serves as the structure for his book. 

Duhigg, an investigative reporter for The New York Times, first became interested in the science of habit when he was covering the war in Iraq. He was intrigued by the impact of habit formation on military personnel, the way that behaviors became automatic through repetition. An army major there had identified a habit in the way violence broke out among crowds. By analyzing videotapes, he observed that crowds would gather in open areas and grow in size. Food vendors would show up, and eventually a riot would begin. The major asked the mayor of the town to keep the food vendors out of these areas. When crowds began to gather and spectators arrived, those who had been in the habit of purchasing food during these events started leaving when they got hungry. The crowds never grew to the size and energy of a riot. The book is filled with additional examples of how individuals, groups, and communities develop habits and describes the situations in which they were able to change those habits.

At the core of habit emergence and change is a three-step habit loop comprised of a cue, a routine, and a reward. The routine can be a physical behavior, an emotional response, or a specific thought process. Duhigg describes how decisions become automatic behavior once the cue and routine become linked. The adage of “neurons that fire together wire together” kicks in, and neurological patterns develop. Once a behavior becomes automatic, it is a habit. When individuals are able to change their habits, a shift in neurological activity is observed. The golden rule of habit change is to maintain the same cue and reward while changing the routine. This aligns well with cognitive behavioral therapy (CBT) in which an individual who responds to an event (cue) with an irrational belief or thought process (routine) is taught to replace the irrational thinking with healthier, more realistic thoughts (a new routine). 

While social workers are more concerned with the life component in the book’s subtitle (“Why We Do What We Do In Life and Business”), there are many who focus more on the other aspect of this book’s title. This book is currently among the best-selling business books; those who aim to sell things are certainly interested in changing habits and behavior. The development of desire for white teeth (Pepsodent) and for a home that smells as clean as it looks (Febreze) demonstrate the application of new habit formation in consumers. Target’s ability to predict consumer behavior based on purchasing habits is downright frightening. In the chapter “How Target Knows What You Want Before You Do,” there is a story about a man who came into a Target store to complain about an ad for baby items sent to his teenage daughter. He later returned to apologize, claiming that there were apparently things he was unaware of going on in his home. 

Many individuals and groups have multiple habits that would benefit from change. As in many areas of social work, the idea is to begin with one change and generate a ripple effect. Duhigg provides examples of individuals and organizations (including a woman who turned her life around and an aluminum company that changed its entire culture) that began by changing one keystone habit which led to additional changes. 

At minimum, a reader of this book will be entertained, and possibly fascinated as I was, by the multiple anecdotes of the applications of habit development and change described by Duhigg. On a deeper level, there are many lessons that can be applied to social work practice. If you are a social worker in private practice, work for an organization, or seek societal change, this book will enhance your understanding of the process of change and provide research-based strategies to help develop your skill set.

We are in a season where many people reflect on what has meaning and importance in their lives. Resolutions are made, forgiveness is given or sought, needs and desires come to the surface. All these activities involve our values. In our professional and personal lives, it is ultimately beliefs about right and wrong, good and bad, acceptable and unacceptable that inform our choices and behaviors. Knowledge of codes, laws, and policies can serve as aspirational guides, but in practice they cannot control our actions. Values are those traits or qualities we considered worthwhile; they represent an individual’s highest priorities and deeply held driving forces and beliefs. 

Aristotle stated that “the moral virtues, then, are produced in us neither by nature nor against nature. Nature, indeed, prepares in us the ground for their reception, but their complete formation is the product of habit. Developing a moral virtue requires one to practice the choices and feelings appropriate to that virtue.” 

As social workers and individuals living in a morally complex world, it is important to take moments to assess the consistency between our stated values and our daily habits of behavior. Most social workers are caring, compassionate, honest, and deeply committed to the “primary responsibility to promote the well-being of clients.” Moral courage is “the bridge that links our capacity for moral reasoning with the will to engage in moral action. It takes courage to stand up for what we believe.” (Chahin, 2008) In today’s economy, very real financial fears may interfere with social workers addressing ethical problems in their work environments. Fear of rejection, judgment, or punitive consequences may prevent a practitioner from addressing impairment or incompetence in colleagues, supervisors, or agency administration. Social workers are more and more frequently confronted with impossible performance expectations including overwhelming caseloads and job responsibilities. These situations create the conditions for unintentional unethical choices.

Moral sensitivity is the capacity to recognize that one has encountered a moral dilemma. There are several factors that can interfere with our ability to identify when we are confronted by competing values. It is common to fail to notice or act on information when dealing with ethically relevant decisions. Bounded awareness refers to systematic patterns of cognition that prevent people from noticing or focusing on useful, observable, and relevant data, leading to systemic decision-making errors. Human beings constantly make implicit choices about what information to attend to in their environment and what information to ignore. Unconsciously, our minds imperfectly filter information when dealing with ethically relevant decisions. As a result of these limits, we routinely ignore accessible and relevant information. (Bazerman & Chugh, 2005) Examples of common bounded awareness include:

• Bounded Rationality: Cognitive limitations that affect the choices people make based on their own preferences (Simon, 1947)
• Confirmation Bias (also called confirmatory bias or myside bias): A tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true (Plous, 1993)
• Normalcy Bias: Shutting down and pretending everything is normal when we find ourselves in some unsettling circumstance; we see, but we don’t see and don’t intervene 
• Bounded Ethicality: Tendency of people to engage in behavior that is inconsistent with their own ethical values; situations in which people make decision errors that not only harm others, but are inconsistent with their own consciously espoused beliefs and preferences—decisions they would condemn upon further reflection or greater awareness (Bazerman & Moore, 2008); research indicates that people think they are fairer than others, are routinely more willing to be critical of others‘ ethics than of their own (David Messick), and are more suspicious of others‘ motives for committing good acts (Epley & Caruso, 2004; Epley & Dunning, 2000)
• Motivated Blindness: Individuals who have a vested-self interest in a situation have difficulty approaching the situation without bias, even when they view themselves to be honest (Ross & Sicoly, 1979); not seeing what is not in our interest to see; not looking at the things that make us uncomfortable (Brooks, 2011); fear of financial or emotional consequences increases the likelihood of our decisions being unconsciously impacted by motivated blindness

Ethical dilemmas are stressful. When the brain is calm, it takes 8 to 10 seconds to process new information. Stress slows the process. When the brain cannot find an acceptable response to a situation, it fixates on a single solution that may or may not be correct. Even when a dilemma is consciously identified, it is a common reaction to jump to a conclusion about the best resolution. Nevertheless, our moral obligation is to self-awareness and critical thinking. As social workers, we have a fiduciary duty to protect our clients. Regardless of setting or position, this duty puts us in a leadership role. The key qualities of leadership bring us back to Aristotle and the need to observe our habits. How do our beliefs and values play out in our everyday life? Leaders know what they value, take responsibility for their own life (strengths and challenges), recognize the importance of ethical behavior, engage in critical thinking, and exhibit their values and ethics in their leadership style and actions daily. We become what we practice. 

REFERENCES

Artistotle. (350 BCE). Nicomachean ethics. 

Bazerman, M. H., & Chugh, D. (2005). Bounded awareness: Focusing failures in negotiation. In L. Thompson (Ed.), Frontiers of social psychology: Negotiations. College Park, MD: Psychology Press.

Bazerman, M. H. & Moore, D. (2008). Judgment in managerial decision making (7th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

Brooks, D. (2011, November 14). Let's all feel superior. The New York Times. 

Chahin, Jaime. (2008). Ethical leadership and values. [PowerPoint slides]. 

Epley, N., & Caruso, E. M. (2004). Egocentric ethics social justice research, Social Justice Research, 17(2). 

Epley, N., & Dunning, D. (2000). Feeling "holier than thou": Are self-serving assessments produced by errors in self or social prediction? Journal of Personality and Social Psychology, 79, 861–875. 

Messick, D. M., & Sentis, K. P. (1983). Fairness, preference, and fairness biases. In D. M. Messick & K. S. Cook (Eds.), Equity theory: Psychological and sociological. (pp. 61–94). New York, NY: Praeger.

Plous, S. (1993). The psychology of judgment and decision making. Philadelphia: Temple University Press. 

Ross, M. & Sicoly, F. (1979). Egocentric biases in availability and attribution. Journal of Personality and Social Psychology, 37(3), 322–336. 

Simon, H. A. (1983). Reason in human affairs. Stanford, CA: Stanford University Press. 

Ruth Lipschutz, LCSW, ACSW, is a licensed clinical social worker with postgraduate certification in ethics, mediation, Transformational Imagery, hypnotherapy, and Eye Movement Desensitization and Reprocessing (EMDR). She received her MSW from the University of Illinois in 1978 and went on to complete the two-year postgraduate training program of the Institute for Family Studies at Northwestern University. She has extensive experience in the areas of ethics, mental health, addictions, traumatology, program development and implementation, supervision, consultation and Alternative Dispute Resolution. She is the chairperson of NASW’s National Ethics Committee and has served as a panelist, consultant, mediator, and trainer for the NASW Illinois Chapter Ethics Committee. She is currently in private practice.

The final days of the 97th Illinois General Assembly begin today. The new 98th General Assembly will be sworn in on Wednesday, January 9, 2013. 

The Illinois Senate returns to Springfield today, tomorrow, and Friday. It will be taking up issues such as marriage equality and Medicaid expansion. Both bills will be heard this evening in the Executive Committee.  

We believe the marriage bill, which will recognize same sex marriages, will be an amendment to HB 5655. The amendment should be filed this morning and posted on the Illinois General Assembly website later today.

The Medicaid bill is HB 5019, and the Senate Amendment should be filed this morning. This would implement part of the Affordable Care Act to cover individuals aged 18 through 64 who are below 133% of poverty (and some up to 138%), who are currently not Medicaid-eligible. These are people who typically use free clinics, emergency rooms, and general assistance for medical care in a haphazard way.   Many of them have chronic illnesses, high-incidence disabilities, and behavioral health issues.

NASW supports both of these bills.

The Illinois House will be returning to Springfield on Sunday, January 6, 2013.  

Pension reform will also be discussed in the next six days, but there is no apparent agreement yet on legislation. A supplemental funding bill for DCFS is also likely to come up.

As a first year MSW student, I feel I learn something new about the field each day. Through classes, field hours, textbooks, articles, professors, and more, I am constantly learning about the field of social work and the endless opportunities it provides. When beginning my first field experience at the American Red Cross of Greater Chicago, I learned that social workers are found everywhere, even in the middle of disasters. I also learned how important and needed they are there, especially when disasters reach unfathomable proportions.  

I learned these lessons first hand in Chicago and beyond. On November 4, 2012, I was deployed to New York City with the American Red Cross to work with the Hurricane Sandy relief operation. I was assigned to Disaster Mental Health which is also what I worked with in Chicago. My primary responsibilities included in-processing mental health professionals into the operation and maintaining statistics from the professionals in the field. My in-processing duties required me to talk with mental health professionals from all parts of the country doing outstanding work. For any first-year MSW student searching for the right career path, this is a dream come true. I talked with an LCSW from the Midwest who runs a program for at-risk teenage girls; a retired military social worker who also worked with police and fire departments on the East Coast; a counselor from the West Coast who runs a private practice that focuses on people with addiction; and many, many more. It was required to get their personal and professional information. It was a gift to hear their inspiring stories of impacting individual lives, creating social change, and leaving this world a little better than they found it. 

My other major responsibility required me to use a tool called PsySTART. PsySTART includes a worksheet that disaster mental health workers use to record interactions with clients and assess a client’s risk level from exposure to a disaster. This worksheet contains a series of statements that the worker observes and/or listens for when talking with the client. Each day these records are combined to create a summary which can tell Disaster Mental Health which clients were impacted the most. Affected clients are most often grouped by location, as was the case in New York City. For example, the daily summaries showed us that clients on Staten Island and Long Island were the most affected. These findings make sense since these places endured a lot of damage during and after the hurricane. In having this valuable information, Disaster Mental Health can better assign professionals to affected areas where they are needed most. This information can also help assign professionals with special skills to areas with specific needs, such as areas with lots of children or areas needing bereavement counseling.  

Aside from assisting Disaster Mental Health, PsySTART also benefits the clients greatly. The PsySTART worksheet contains a series of risk factors related to experiencing a disaster. Research shows that these risk factors can increase the likelihood of acute and subsequent psychological distress and/or new disorders. The risk factor questions are color-coded to indicate the level of risk associated with them. For example, factors with higher psychological risk are labeled red or purple while factors with medium risk are labeled yellow. If the client does not have any risk factors now, this is labeled green. Clients experiencing higher psychological risk factors (purple or red) need to be screened by Disaster Mental Health workers with more urgency than clients experiencing yellow risk factors. In screening clients of any risk level, the clients are evaluated and matched with resources to help them cope. 

Specific examples of the above risk factors include:

• Expressed thought or intent to harm self or others (Purple)
• Experienced death of a parent, child, or family member (Red)
• Home not livable (Yellow)

After my assignment with Disaster Mental Health, I was transferred to Sheltering where I worked in shelters on Staten Island and in Queens. In this role, I got to meet the faces behind the statistics that I recorded. While I could not initiate Disaster Mental Health interventions for lack of a license, I was able to talk with clients, listen to them, and build relationships with them. In doing this I learned two lessons that were greater than the lessons I learned while in Disaster Mental Health. I learned 1) To listen and 2) To be present. While learning about the field through my in-processing role and learning about field tools through my statistics role, I realized that none of this knowledge and skill matters if I do not approach clients as people who want to feel heard, cared for, and appreciated. These are, after all, the foundations needed to be a good social worker. 

Over the course of my two-week deployment, I learned many things that will ultimately help me become a better social work professional in the future. I learned that, as a social worker, I will be needed in many places and some of those places will be least expected. I learned that I have many options and opportunities in being a social worker. I learned there are specific tools at my disposal that, when used, can change the work I do for the betterment of my practice and my clients. And finally, I learned that above all else, being a good social worker means always demonstrating honest care for those I work with through simple yet impactful gestures. 

Overall, this was an experience I am beyond grateful for and one that I will truly never forget. 

For more information on ways you can get involved—and learn—with the American Red Cross chapter in your area, visit www.redcross.org/support/volunteer. 

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

• OFFICE FOR RENT - Oak Park: Part time office space available in a beautifully furnished & well-maintained, secure building. Friendly atmosphere, potential referrals, free parking. Flexible leasing. 708.524.0532 Lee Madden
• OFFICE FOR RENT - Chicago: Attractive office three and a half days per week 30 N. Michigan Ave,Chicago Amenities include: Wireless Internet refrigerator, sink, microwave and separate storage area. Contact: Edward P. Kaufman LCSW, BCD 847-997-7444

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/.

• Psychotherapist - Partners for Change

• Paraprofessional - The Menta Group

• Transition Engagement Specialist - AgeOptions

• Licensed Therapists - Core Therapy Associates, Ltd.

• Social Worker LCSW - PRS, LLC Dialysis

• Social Work Department Chair - New Trier High School

• Psychiatric Social Worker - Good Samaritan Hospital

• LTC Insurance Clinical Reviewers $31/hr - Managed Care Staffers

I am convinced that our actions on earth color the world that we live in. I believe that it is up to each of us to sow good seeds through our actions as we provide services to those vulnerable populations in our community that need us the most. Many times we become the light for people who are in difficult places in their lives, and I believe that it is our assignment as social workers to bring light to these places.

The profession of social work is a noble one which carries the spirit of courage, compassion, and generosity. As we enter into this holiday season of giving and spending time with our own families, I often think of the many people in our communities who are not as fortunate to have the supportive family environments that we enjoy each day. As I thought of this, I decided that the season of giving should be about spreading love and joy not just within your family, but to others.

I became a social worker because I had a heart to serve others, but I don’t want to limit my desire to the work that I do on a daily basis—this year I decided to “give myself away.” Giving myself away will mean that I begin this holiday season serving children and families in my community who are struggling during this season by donating small thoughtful gifts and toys for children and their families. I want to continue into the upcoming year by renewing my commitment to serve others and volunteer my time at various organizations that support children and families in my community. As a social worker, it’s difficult to do the work that I do on a daily basis and not think about the lives that I touch each day. I often walk away wondering what happens when the providers go home. How do families manage without support?

I believe that we all have a purpose in this life, and there is an assignment that each of us carries. Life is more than just the pursuit of happiness for ourselves; it is universal. To give is to love and to withhold is to wither. There are so many people who are numb to life and frustrated about their circumstances as a result of things that are out of their control. It is important to me that I walk in my purpose. For I know that one word can encourage a doubting spirit and one light can brighten a darkened path, so in this season I will “give myself away” to the service of others. What will you do?

Yolanda Jordan, MSW, LCSW, has an extensive background in abuse/neglect issues in the field of child welfare. As a placement manager with the Illinois Department of Children and Family Services, she is responsible for managing supervisors who are responsible for children who are placed in the foster care system. Yolanda is also a practicing psychotherapist and has been in private practice for the past ten years. Services are provided to children, couples, and families with a special emphasis on relationship issues that African American women face.

Yolanda is a graduate of Western Illinois University where she received her bachelor of arts in mass communications and master of arts in public communications human relations with a minor in African American studies. Due to her extreme love for people and having the heart of a servant, she continued her education and received a masters in social work with an emphasis on child and family practice from the University of Illinois at Chicago’s Jane Addams College of Social Work. Yolanda has been an active member of the NASW Illinois since 1996 and enjoys the work of advocating for the profession of social work and the community that social workers serve.

A storefront on the corner advertises “Free HIV testing” in its windows. Matta Kelley, a 65-year-old Iceland native with spiky blond hair, often stands outside talking to passersby about their lives, asking whether they need anything.

But on this late Wednesday morning in June, Kelley stood inside her office smiling, arms folded across her chest. She gazed at Diana Boughton, a 56-year-old African-American woman who grew up on Chicago’s South and West Sides.

A former drug runner and heroin addict and now proud grandmother, Boughton is HIV-positive. Kelley is her medical case manager. They reflected on their first encounter in 2009.

“I can’t believe you called me a white lady!” Kelley said, shaking with laughter.

“Yes, I did. I said, ‘Who is this white lady?’” Boughton said, grinning before turning serious. “She was here for a reason. Yes she was.”

Kelley is one of 150 HIV case managers in the vast Northeastern Illinois HIV/AIDS Cooperative managed by AIDS Foundation of Chicago (AFC). AFC oversees care management for more than 5,000 people per year who are living with HIV in the Chicago area and collar counties. In addition to managing the funding, AFC provides intake, training, and data evaluation for the cooperative.

From rural communities to gritty Chicago neighborhoods, the clients and their case managers are wildly diverse in geography, race, and in their personal stories. The clients’ needs can vary dramatically. Some need at-home medical assistance and daily caretaking. Others merely need guidance—and sometimes a little tough love—to encourage them to take care of themselves.

But they share common ground too. Most of the people in HIV case management are low-income; many of them face challenges beyond HIV such as mental health issues, substance abuse problems, or homelessness.

As such, an HIV case manager’s job is rarely limited to helping clients locate and obtain consistent medical care. Many case managers also help their clients find housing, employment, and transportation. At the Community Outreach Intervention Project (COIP) Clinic, which is run by the University of Illinois-Chicago, Kelley said they even collect clothing for their clients and help them obtain prescription glasses when needed.

The COIP Clinic on the West Side has become much more than an HIV clinic, though it is that first and foremost. In addition to case management, the clinic offers primary care, a bustling syringe exchange program, and free walk-in testing.

“People in the community need everything,” Kelley said. “You can’t be from the community and just do one thing. People walk through our doors, and you can’t turn them away if you can help or if you know where they can go get help.”

When Boughton found out she was HIV-positive in 2004 right there in the same West Side clinic, she didn’t react like you would think.

“I said, ‘Yeah, and what? What am I supposed to do? Cry?’” Boughton recalled. “They were looking for me to break down and cry or something. But I’m not going to do that. I’m going to fight this thing.”

But it took some years for her to truly begin that fight. She struggled to keep up with the anti-retroviral medicine and found it difficult to really engage in her own care. Boughton credits Kelley with helping her make the change. She now has an undetectable viral load.

Despite her first impression, Boughton ended up finding some of herself in Matta Kelley.

“Matta understands me. I could relate to her, and she could relate to me,” Boughton said. “God works in mysterious ways, don’t he?”

The Hustler 

Juanita Knowles is, by her own admission, a straight hustler.

But where she used to run games on the streets to feed her heroin habit, she now hustles for her clients, helping them find jobs, housing, and other supportive services. Formerly a Vice Lord queen, a drug dealer, and a convicted criminal, Knowles is now a successful HIV case manager.

Tall with short dyed-blonde hair, a tattoo of her dead son’s face on her left shoulder, Knowles sits in her Uptown office where Haymarket Center, which offers HIV case management and substance abuse counseling. Like Kelley, her history on the streets allows her a deep understanding of her clients’ needs.

“I know in this world that nobody’s perfect,” said Knowles, 58. “Don’t lie to me, tell the truth, and we’ll try to find the best route to go. It’s all about building trust.”

Knowles has a caseload of 52 clients, all referred through the AFC. Her clients are part of the Ryan White case management system, funded by the city and state Departments of Public Health.

Some of her clients struggle with addiction, but finding affordable independent-living housing is the biggest challenge, Knowles said. And so in addition to helping her clients manage their medical care, Knowles walks the neighborhood looking for housing too.

“I tell them they hit the lottery when they got me!” Knowles said, laughing. “My clients call me for everything because I’m always resourcing. And I just won’t take no for an answer.”

Born on Chicago’s West Side, Knowles was the oldest of six siblings. She fought a lot growing up, she said, looking out for her younger siblings. She became involved with the street life, specifically with the Vice Lord gang.

She dealt drugs and stole to support her own heroin habit, spending years cycling in and out of prison.

Her life has been marked by tragedy. Her brother, Joseph Brown, died of AIDS in 1995. A talented fashion designer, he was in his early 20s when he died, Knowles recalled.

In 2000, Knowles’ only child, Anthony, was killed in a gang-related shooting while she was incarcerated. She decided to get clean once and for all.

“I made a decision when I was in the penitentiary that I had to break the cycle for my grandchildren,” she said.

She landed a desk job with the Community Outreach Intervention Project and then, in time, began work in the detox unit at Haymarket Center. Knowles went back and earned her high school diploma at the St. Leonard’s Adult High School. Now she’s known as an HIV case manager who fights for her clients.

“I love to help people. And I don’t like for people to tell me you can’t do that,” Knowles said. “That’s just a challenge to me. My heart is in it.”

The Social Worker

Each month, Jennifer Genzlinger logs about 400 miles on her minivan to visit her clients, navigating the highways and back roads of northwestern Cook County and parts of McHenry, Lake, and Kane counties.

She doesn’t mind.

“I don’t find it just a job where I go home and that’s it,” said Genzlinger, 40. “I’m a social worker; it’s always with me.”

Genzlinger works out of the Open Door Clinic in Elgin, a suburban town in Kane County. Walking downtown near the clinic, there’s nothing that evokes the immense, dire need of Chicago’s most at-risk neighborhoods.

But looks can be deceiving. The needs are just different—and spread throughout a region.

“We find finances and transportation to be the biggest issues for most of our clients,” Genzlinger said. “Almost all of my clients are on disability of some sort.”

She manages a caseload of 55 clients, a wide-ranging mix that includes those with substance abuse and mental health issues, rural white gay men, African-born women, and those who can’t the leave their own homes most days.

They are a mix of Ryan White clients and what’s known as DRS clients. DRS stands for Division of Rehabilitation Services, overseen by the Illinois Department of Human Services.

Many of Genzlinger’s Ryan White clients are young, gay, and struggle with substance abuse issues. They need support, education, and help with transportation. For most of them, they must travel to the Open Door Clinic or to the Core Center for their primary care.

AFC provides gas cards and transportation funds, which helps, Genzlinger said.

“Any incentives we can try to give them to follow up with their care, we’ll do our best. When they come in, if they’re getting multiple services, we’ll try to do it in all in one day.”

It can be more complicated for the DRS clients. Simply put, they are the sickest of those in the case management network. They need at-home caretaking and often have multiple medical issues, not just HIV. Genzingler’s DRS clients range in age from 18 to 70.

“They all have other issues besides just the HIV,” Genzlinger said. “Many of them have been diagnosed for twenty years. It’s at the point where their body is breaking down.”

One of her DRS clients is HIV-positive, has Hepatitis C, diabetes, and struggles with both substance abuse and mental health issues. Another client, 18, was born HIV-positive, has cerebral palsy and can’t walk.

“It took me over a year to get her a wheelchair ramp so her parents wouldn’t have to carry her up the stairs every time,” Genzlinger said. “That’s some of what I do—trying to make things simpler so they can live a little better.”

Genzlinger, of Des Plaines, Illinois, worked as a domestic violence social worker in a previous career, but she needed a change. She made the switch when she started at Open Door in August 2008.

“Some people said ‘It’s a big change going from domestic violence to HIV.’ They’re still people,” she said. “They still need support. They still need help.”

The Legend

Matta Kelley silently hunched over a three-ring binder, its worn pages filled with hundreds of names, past clients from her early days of HIV case management in the early 1990s.

“I don’t know why I’m holding onto this,” said Kelley. “Every once in a while I pull it out and I read the names and can see their faces, you know? It was horrible times. Everybody died, you know?”

Kelley saw the change first-hand, from the early days of “rip-and-run” medical case management where death was the likely outcome, to today where the challenges are more nuanced and less immediately life-and-death.

Her story, too, has had monumental shifts over the years. Her remarkable past has been chronicled in books and in news reports. It won’t be fully told here.

Once she belonged to the streets, once she was beholden and reduced by addiction, once she survived by selling her body. As a young woman, Kelley fell in love with an American GI soldier. She left her native country of Iceland at age 21, arriving in Chicago in 1967. The romance did not last and she fell in with the wrong crowd, and with it, a life of drug addiction and prostitution.

In time, she found her way out. At a methadone clinic she learned of an HIV outreach job with COIP. She began work in 1989 and eventually outreach led to case management. It took her years to overcome the residual effects of heroin addiction.

“You’re insane for years,” she said. “You talk too fast, you’re constantly with anxiety, everything is overwhelming.”

When she speaks now, her clients tend to listen.

“People have to trust you. And people aren’t going to trust you the first day they meet you; that takes time,” Kelley said. “You have to let them know you can relate to what they’re going through, some of it, and little by little the trust grows.”

Given her own experiences, Kelley understands you can’t force someone to change, particularly when it comes to adherence to care. The stigma tied to HIV remains a persistent challenge, she said. Kelley strives to “walk them to a place where their health becomes important.”

“I want very bad to take the guilt and shame out of HIV, and over the years I have tried to do that,” she said.

Frankly, it’s all hard to imagine Kelley in her earlier years, or as anything less than a legendary HIV case manager, which is how she’s now regarded. Her commanding but somehow nurturing presence fills the room like the scented candles burning in her office.

Kelley plans to retire next spring. But that doesn’t mean she’s checked out.

“I know the fear people feel to make a change. It’s frightening. However bad your life is that is your little thing, your little life,” Kelley said. “Many people become bullies because that’s better than to sound stupid. There are many people who have sit in that chair who have sort of fell apart from the bullying, when they realize with me—you don’t have to do that.”

“Because I’ll close the door and tell you about yourself,” she said, laughing. “That’s pretty much the way it is, honey.”

Gregory Trotter, MSJ, writes for the AIDS Foundation of Chicago (AFC). Prior to coming to AFC, he worked as a newspaper reporter in Missouri and New Hampshire, winning awards for business and features reporting. His stories have appeared in the Washington Post, USA Today, Dallas Morning News, and on Politifact, among other news outlets throughout the country. Among his other duties at AFC, Trotter provides most of the content for the Inside Story blog, a source of news, analysis, and human stories pertaining to HIV/AIDS. 

CEU Opportunity for Reading This Article! 

NASW Illinois members can earn one CEU by completing an online quiz (LINK) regarding this article! The free CEU opportunity is only valid until February 1, 2013, after which the CEU fee will change to $15.00. Nonmembers must pay the regular $10.00 rate for the CEU, which will increase to $15.00 after February 1, 2012. 

I practice in a group setting on the border between Libertyville and Grayslake, IL, about forty miles north of Chicago. The surrounding communities emphasize excellent schools and competitive athletics, and the majority of high school graduates attend four-year colleges. As a function of location and clients’ access to insurance, I work primarily with middle-class to upper-middle-class families. Over the years I have worked with a number of adolescents who initially present with mood disorders, anxiety/obsessive compulsive disorder (OCD), and eating disorders, but the underlying issue is a pattern of addictive and obsessive behavior related to academic achievement. While many clinicians have already written wisely about the broader topics of perfectionism and addiction treatment, I would like to suggest opportunities for concrete guidance and behavior shifts that help performance-addicted teens break away from an obsessive mentality about schoolwork. 

As perfectionistic students relinquish control in these specific, agreed-upon tasks, the process tends to generate anxiety and confusion. As they arise, these uncomfortable feelings can be addressed and tied back to the larger themes about identity, idealization, cultural pressures, and family expectations. In this sense, the concrete suggestions provide an opening for deeper therapeutic gains.

For example, many overachieving high school students need specific guidelines about time management and how to prioritize health over achievement. I attempt to teach reasonable limits on study time, lengths of papers, and the amount of effort to put into various assignments. When I work with anxious students, we often set goals such as, “I will only study for Advanced Placement (AP) History for thirty minutes a night,” or, “I will not let myself study past 10:00 at night. Whatever I don’t finish, I can complete on the school bus, or I can use my study hall.” We talk about priorities and the importance of downtime, daydreaming, and the development of noncompetitive interests, hobbies, and relationships. I also provide psychoeducation about the importance of meeting basic health needs: sufficient sleep, healthy meals, water, exercise, and time with family and friends. To me, it is startling, sad, and revealing that so many teens seem surprised when I suggest pursuits beyond academic success and scheduled extracurricular activities. 

In this technological age, students and parents often have 24/7 online access to school websites that provide weekly (sometimes daily) grade reports. For less-motivated students, this opportunity for parental monitoring can be crucial to school success. For the academically-obsessed, however, the easy access to grades provides another outlet for obsessive checking and feeds into negative beliefs about a critical outside world. These students often tell me, “My counselor, my parents, and all my teachers look at my grades and evaluate my progress—every day.” I often suggest that perfectionistic students completely refrain from checking their grades online—as these competitive schools frequently send midterms and quarterly progress reports in the mail, which provides more than sufficient feedback about grades. 

In addition, many of my anxious teens obsessively calculate and re-calculate their GPAs (“weighted” and “un-weighted”) and possible numerical outcomes with different exam results. I try to teach how these behaviors feed the “obsession monster.” Sometimes I compare the GPA calculation behavior to the behavior of an eating-disordered person who obsessively counts calories, which is a more easily-identifiable symptom, This analogy seems to resonate with perfectionistic students. Teens often need additional reassurance from their parents, though, before they will fully abandon the checking and calculation behaviors. 

Academically-obsessed teens also need guidance from their parents and social workers regarding their course schedules. I teach teens how to pick an appropriate number of challenging classes. I strongly support the substitution of a study hall instead of another AP class, and I offer my clients permission to take an elective class in an area of interest. As a general guideline, I prefer that my clients wait until junior year to take AP courses, and I suggest a maximum of three AP/honors-level classes per semester. For many over-achieving students, if the schools determined their schedules without parental/clinical oversight, these students would be automatically enrolled in five to seven AP classes during their senior year. Considering that each AP course represents a year-long college course (or three credit hours at large universities), this schedule would be equivalent to 15 to 21 college credit hours, in addition to a handful of required high school classes, per semester—all within a five day week, full day schedule. It’s no wonder that so many suburban teens report that college is easier than high school! 

When it comes to decisions about schedules, parents often need encouragement to advocate for their child’s best interests. Along with their teens, parents can be swept up in the college preparatory marketing that suggests all students must be in The Most Challenging classes at all times, without exception. With some guidance, however, many parents can help their children advocate for more reasonable schedules. If I lack confidence in parents’ ability to advocate, or if the parents need more support, then I ask for a signed release form, and I speak directly with teens’ guidance counselors. In my experience, school counselors readily accommodate students who are visibly at-risk, but I have encountered resistance regarding students who appear higher-functioning. School personnel sometimes argue that students are capable of doing higher-level work across the board based on their high test scores. This makes it harder for parents and teens to justify the need to drop to lower levels of coursework, and they can begin to second-guess the original decision to decrease academic pressure. It is important that we use our leverage as professionals to emphasize the teen’s health as the highest priority. Sometimes school social workers can be good allies in this discussion. 

As clinical social workers, we can be powerful advocates for a child’s right to a healthy, well-rounded adolescence. Of course we should also ask big picture questions about the cultural factors that create such academic pressure-cookers; how could schools attend to the social-emotional needs of these high-achieving students? Why does our society continue to reward academic addictions with accolades and scholarships, creating a generation of young adults with trophies and ribbons, but also anxiety, depression, and other addictions? As parents, how do we encourage our children’s ambition but still teach balance and moderation? These broader questions are beyond the scope of this article. In the meantime, we can use our knowledge of school systems and the cultural context to help affected teens escape from the confines of academic obsession. We can model a simpler, healthier path to adulthood.

Jen Underwood, LCSW, began her clinical journey with The University of Michigan Center for Child and Family. She has worked with hospices, therapeutic day schools, and outpatient mental health centers. Currently a therapist with Counseling Connections, she co-facilitates a support group for mothers of special needs children, and she is a provider for the practice's Autism Spectrum Disorder Clinic. She enjoys working with children, teens, and adults from an integrated treatment model, combining cognitive-behavioral and family systems perspectives with more traditional play therapy and attachment theory approaches. Jen has a special interest in the unique emotional needs of gifted children and adolescents. 

“I didn’t know why she was missing practice. I didn’t know anything was going on with her. I still can’t believe it. I keep wondering if there was something I missed. Thank God she’s ok.” *Mary’s coach shared these thoughts with me after learning from Mary’s parents that Mary had attempted to kill herself a few weeks prior. Mary was absent from her freshman softball* team practices and games for two weeks while in the hospital receiving treatment for attempted suicide stemming from clinical depression. What struck me about this situation was how Mary’s coach, an important, caring adult in Mary’s life, was out of the communication loop regarding the health and well-being of one of her athletes. If Mary had been suffering from a sprained ankle, the coach would have likely identified the injury, sent Mary to the athletic trainer, alerted the parent to the injury, and received updates on Mary’s healing process from the trainer. However, because Mary was suffering from depression, the coach may not have known what symptoms to look for or what to do if she had concerns about Mary. Additionally no one communicated to the coach once Mary was receiving care. As a school social worker, I saw an opportunity in Mary’s story to leverage the power of the coach/athlete relationship in order to increase the identification of student-athletes who are in emotional distress. 

Why Should School Social Workers Partner with Coaches?

• Coaches are uniquely positioned, caring adults who spend a good deal of time with their student-athletes
• Coaches care about the health and well being of their student-athletes
• Coaches see their athletes in a different context than teachers or parents and may notice signs or symptoms of emotional distress
• Coaches develop trusting relationships with their student-athletes that may increase the likelihood that an athlete in distress will accept and access recommended supports

Given the natural partnership between school social workers and coaches, my colleague Felix Caceres and I worked to develop a training for coaches on how to identify emotional distress in student-athletes and what to do when concerns arise. Although many colleges and universities have developed student mental health trainings for coaches, the Illinois High School Association (IHSA), which coordinates athletic programs at the statewide level, currently offers no such training.

Top 5 Reasons It Can Be Difficult for Coaches to Identify Athletes in Distress

1. Kids hide it.
2. Mental health challenges in athletes are often seen as weakness. 
3. Coaches do not always know what signs to look for. 
4. It can be tough to tell how far to push mental toughness and when to suggest a player may need help.
5. Kids hide it.

For instance, when I asked Jack*, a swimmer, what it felt like to be a student-athlete who has depression, he stated, “I feel like I’m in the closet…except I’m not gay. I just have depression.” Jack felt that he had to keep his mental health difficulties separate from his athletic world. He said, “I don’t want my coach to know…I just don’t think he’d get it. He’d think I was weak.” Jack’s attempts to compartmentalize his depression grew more difficult as his grades dropped, his athletic eligibility was at risk, and frustration at practices was growing. Thankfully Jack’s coach noticed Jack struggling, and ultimately Jack allowed his coach and I to work with others to support him. Our goal is for more coaches to feel comfortable and competent in identifying emotional distress in student-athletes and knowing how to make the right connections to school social workers or other supportive individuals.

Giving Coaches the Tools They Need

As my colleague and I developed the training for coaches, we included a number of key components. First we established a general knowledge of the signs and symptoms of common mental health concerns such as depression, anxiety, and eating disorders. We tried to speak about general symptoms but also highlighted signs a coach might notice in the context of working with student-athletes at practices or games.

Second we included a simple request for observation and communication. We wanted coaches to feel comfortable staying within their role, understanding there was no expectation for them to function as the social worker or secret keeper. Instead we asked that they simply communicate to the school support team any concerns they had about their athletes.

Third, we recognized that there may be times when coaches receive information about the mental health or safety of a student-athlete that requires urgent action. We worked with the school athletic director and assistant principal for student services to create an emergency action plan for coaches. We kept the actions required of coaches simple and clear.

Finally, we asked coaches to respond to case studies based on real student-athlete situations. Coaches were challenged to use their heightened understanding of the signs of emotional distress and of the action plans given to respond to the theoretical situations presented. 

With 1 in 10 young people like Mary and Jack suffering from depression or other mental health concerns (National Institute of Mental Health, 2012), school social workers must partner with all caring adults in a child’s life to provide early detection and supportive intervention. Because of their unique position in the lives of student-athletes, athletic coaches should be a natural ally in this effort.

*All names and identifying details have been changed to protect those involved.

REFERENCE

• National Institute of Mental Health. (2012). Depression in children and adolescents fact sheet. Retrieved from http://www.nimh.nih.gov/health/publications/depression-in-children-and-adolescents/index.shtml 

Stephanie Hentz, LCSW, is a school social worker in Niles Township District 219. She knows that it is critical to engage all caring adults in students' lives, including coaches, when working to provide support. Stephanie and colleague Felix Caceres, LCPC, developed a training aimed at increasing the competence and comfort of athletic coaches in identifying and intervening with student-athletes in emotional distress.

The economist William Baumol and his co-authors argue that the cost of health care, education, and many other personal services will continue to rise at a rate much higher than inflation no matter what interventions are enacted to reverse it. Baumol notes that the cost of healthcare will continue to rise from 15% of the average person’s income in 2005 to 62% by 2105. Since personal services require significant labor resources, their costs cannot be significantly mitigated by automation or other labor-saving technology. Baumol skillfully uses the disease metaphor to illustrate the pervasive and chronic nature of this phenomenon. There are many examples in the book that evidence the continued growth of education and healthcare costs. One such example is the increasing cost of undergraduate education. In 1980 it cost on average $3,500 per year to attend an undergraduate college in the United States, including room and board. In 2008 the cost per year climbed to $20,000, or an average increase of 6% per year, which is well above the rate of inflation. 

One of the chapters that I found especially interesting addresses the question of why healthcare costs keep rising. A few of the reasons for the increase in spending as Baumol states are familiar to many of us in healthcare: “an aging population, technological change, perverse incentives, supply induced demand and the fear of malpractice litigation.” He goes on to explain that the main cause is not misbehavior, greed, or incompetence, but the labor- intensive services that healthcare requires. Healthcare requires face-to-face contacts with consumers that can’t be easily addressed by improvements in productivity. The rate of increase in costs is not unique to the U.S. but is common to all industrialized nations no matter what healthcare model has been adopted. Thus the Affordable Care Act will not significantly decrease the cost of healthcare.

What are the causes of the cost disease? Although the costs of healthcare, education, and other services will continue to rise faster than the rate of inflation, Baumol asserts that these costs are an inevitable part of economic progress. Baumol refers to this group as the “stagnant sector” in a nation’s economy. The personal services sector is stagnant because innovation has failed to bring labor-related savings as it does with other industries. He identifies two possible reasons: resistance to standardization and the fact that quality is highly correlated with the amount of labor extended in healthcare. 

In addition to the stagnant sector, Baumol goes on to identify a second sector present in the economy which he has labeled the “progressive sector.” This sector of the economy employs innovation and standardization to increase productivity, thereby significantly lowering its labor costs. One example is the automobile industry where output per work hour is increasing at the annual rate of 4% per year. This is in contrast to the number of members of a symphony orchestra which remains relatively constant from year to year. All social workers are familiar with another class of services in the stagnant sector, government welfare and related programs. Baumol argues that although technology has been introduced to this class of services, its productivity has not changed.

As a society, how can we continue to tolerate these increases without compromising our standard of living? Much of the book focuses on this question, and Baumol’s conclusion is that, with some caveats, we can afford these increases as a nation. This is possible because of the rise in purchasing power of the average worker and the unprecedented increase in productivity since the Industrial Revolution. As the progressive sector of the economy (through ever increasing gains in productivity) continues to lower the costs of items we purchase, more dollars are available to be spent on the costs of healthcare and education without lowering the standard of living. There are some excellent examples used by the author to support this trend. One of the most revealing is the cost of computers. The capability of a computer is standardized by the number of MIPS (millions of instructions per second) the computer can handle. In 1997 one MIPS of computer capacity cost about 27 minutes of time labored at the average wage. In 1970 the cost was 1.24 lifetimes of expended labor. Wages for those who remain employed in the progressive sector can be increased because employers will be able to afford them. Baumol notes that the labor intensive areas of the stagnant sector will absorb the loss of jobs in the progressive sector thus keeping the economic engine running.

Although Baumol’s view of the future is largely optimist, there are symptoms of the cost disease that are apparent to all of us. Cuts in government service jobs and the related lack of needed public services are a couple of the cost disease’s most telling symptoms. We continue to hear from our politicians and others that our society cannot afford the spiraling healthcare costs. The authors argue, however, that we can afford it and any draconian effort to treat the disease will do more harm than good. Reducing the quality of or access to healthcare would not only be unpopular but would jeopardize our quality of life and the increase in longevity that many Americans now enjoy. Baumol argues that the greater risk to our way of life is actually from the progressive sector. More readily accessible, inexpensive weaponry is falling into the hands of terrorists.

Although healthcare costs will continue to rise at a higher rate than inflation, the co-authors challenge the healthcare industry to cut healthcare costs through reducing hospital-acquired infections, use technology such as the electronic medical record to reduce medication errors, process improvement efforts to limit waste, and produce better outcomes, tort reform, and other cost-saving practices. Many of these have already been initiated in healthcare settings with mixed results. But in spite of all of these efforts, Baumol argues that the cost increases will continue to outpace inflation.

In conclusion I would recommend this book as further support to the rebuttal of claims by politicians, economists, and others that we cannot afford the costs of healthcare, education, and social services. As worker purchasing power and productivity continue to rise, our society can afford these services. Among the caveats that Baumol identifies is the acknowledgement that the cost disease disproportionately affects the poor. As social workers we have an obligation to continue to advocate for their needs. 

The first week of the Veto Session is over and little action was taken on major issues facing the state of Illinois. However, action was taken on the following measures:

Federal and state law, and the NASW Code of Ethics, all have requirements for the release of records to the client.  From time to time social workers receive requests from clients for access to the notes or records of the professional services provided.  Social workers who have been rigorously trained to protect clients’ privacy may be alarmed or disturbed by such requests and concerned about how to respond appropriately.  This Legal Issue of the Month article will address the legal and ethical provisions regarding client access to social workers’ professional records.  Requests for access to records by a third party or by the parents of minors are not covered in this article and are referenced in other LDF resources.

To read the rest of the article, click here. NOTE: NASW login required. 

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

• OFFICE FOR RENT - Oak Park: Part time office space available in a beautifully furnished & well-maintained, secure building. Friendly atmosphere, potential referrals, free parking. Flexible leasing. 708.524.0532 Lee Madden
• OFFICE FOR RENT - Chicago: Attractive office three and a half days per week 30 N. Michigan Ave,Chicago Amenities include: Wireless Internet refrigerator, sink, microwave and separate storage area. Contact: Edward P. Kaufman LCSW, BCD 847-997-7444
• OFFICE FOR RENT - Olympia Fields: Furnished office for rent in Olympia Fields in a suite for three mental health professionals. Waiting room, convenient location, reasonable rent. Available January 1. Contact Alexis at 708-692-0228.
• OFFICE FOR RENT - Rolling Meadows: Rolling Meadows and Crystal Lake: Attractively furnished, self-contained office suites. Handicapped accessible. Ample parking. Call: 847-358-0707.
• OFFICE FOR RENT - Chicago/Lakeview: Spacious, fully furnished private office with lots of light near Diversey and Sheridan available full-time, by day or for shorter blocks of time. A comfortable waiting room, kitchenette, bathroom, copy machine, fax and internet connection are included in this three office suite occupied by mental health professionals. Close to public transportation; street parking available. Call Kitty Mann at 773-248-3701 or 773-469-9084 or email kbmann@uchicago.edu.

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/.

• Social Work Department Chair - New Trier High School
• MOSAIC On-Site Clinician-Licensed - Mental Health Centers of Central Illinois
• Talent Sourcing Specialist - Mental Health Centers of Central Illinois
• Psychiatric Social Worker - Good Samaritan Hospital
• LTC Insurance Clinical Reviewers $31/hr - Managed Care Staffers
• Psychotherapist - Justin Tobin & Associates
• Chemical Dependency Therapist - Elmhurst memorial Healthcare

I am proud to say that over the years, the NASW Illinois Chapter has embraced Standard 6:04 Social and Political Action of the NASW Code of Ethics by encouraging social workers to “engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully.” This current election has been no different in encouraging member involvement in the political process. Our NASW Illinois Chapter Political Action Committee (NASW IL PAC), the political arm of the NASW Illinois Chapter, has put together a list of statewide endorsements while the national NASW Political Action for Candidate Election (NASW PACE) has put together a list of federal election endorsements. We have worked with many of our endorsed candidate’s campaigns to provide opportunities for membership involvement. There is still time to volunteer until the election or on election day itself. Please contact Eric Mount at emount [at] naswilpac [dot] org. 

In the middle of September, the NASW Assurance Services (NASW ASI) unveiled an enhanced Professional Liability Insurance program that's better than ever. This is the only program endorsed by NASW, and it offers you many new and attractive benefits. It is insurance by and for social workers. Instead of working on behalf of corporate shareholders, NASW ASI works to serve you and the social work community. You may have received correspondence concerning our enhanced professional liability program from the former insurance program administrator, American Professional Agency (APA). Answers to some questions that members have asked as a result of these correspondence can be found on the NASW Illinois Chapter website. Many members were able to ask specific questions directly to Tony Benedetto, Executive Vice President of NASW Assurance Services during the chapter’s second town hall teleconference on on October 4, 2012. 

The NASW Illinois Chapter’s 2012 Strategic Planning process is well under way. The following board members comprise the committee which has met three times this fall. Committee members include:

• Yolanda Jordan, President, Bolingbrook, IL 
• Candi Gray, President-Elect, Bloomington, IL
• Barry Ackerson, Treasurer, Champaign, IL 
• Alexander Brown, Chicago District Chair, Evanston, IL
• Monica Guilhot-Chartrand, Member At-Large, Naperville, IL 
• Cheri Sinnott, Secretary, Buffalo Grove, IL 
• Mary Garrison, East Central District Chair, Decatur, IL

The basis of the group’s work is to review the data collected from a statewide membership survey conducted earlier in 2012. The research firm of Kerr and Downs used online focus groups and online surveys with members and nonmembers. 

On the evening of November 1, 2012, the NASW Illinois Chapter will be holding its 2012 Annual Awards Dinner recognizing the 2012 Social Worker of the Year, Public Citizen of the Year, Lifetime Achievement, and Emerging Leaders. Complete information about the awardees can be found on the chapter website. Don’t forget the chapter is also accepting nominations for next year’s social work awards! Be sure to nominate a colleague. 

Congratulations to all of our award winners. 

This month’s Networker once again includes a wide array of articles conceived and written by chapter members. Michael Kocher, in addition to writing this month’s feature article on “Hope in Alzheimer’s Disease,” is also one of our 2012 Emerging Leaders Awardees. Lindsey Adams of Mt. Vernon, IL, joined the NASW Illinois Chapter Board of Directors in July and explores her recent leap into the world of private practice in this month’s Private Practice article. I hope you will enjoy these articles as well as our other regular Networker features and also consider contributing your own article in the future. 

Joel L. Rubin, MSW, CAE, has served as executive director of the 7,000 member Illinois Chapter of the National Association of Social Workers (NASW) since October 1999. He has over twenty-five years of nonprofit management and fundraising experience including extensive work with boards of directors, committees and volunteers, and advocacy around a wide variety of social work, human service, and international political issues. Joel is a graduate of the Wexner Heritage Fellowship Leadership Program and a current adjunct professor at the University of Illinois at Chicago Jane Addams College of Social Work as well as Loyola University Chicago School of Social Work.

November is also National Alzheimer’s Disease Awareness Month, and it offers us the challenge to increase awareness of this growing epidemic and to impart the power and necessity of hope to our clients affected by this disease. Social workers are uniquely positioned to address the challenges and struggles of living with Alzheimer’s with our person-in-environment model. Furthermore our strengths-based outlook facilitates hope and celebrates resiliency by recognizing our client’s creativity and together exploring new avenues of response, or simply affirming the tried and true.

Traditionally the care of persons with the disease and their families has been the purview of social workers with medical and geriatric specialties. A quick look at the numbers below reveals that these sub-specialties will soon be unable to keep up with need. A broader response by the profession is necessary. 

• Nationally, an estimated 5.4 million people are living with Alzheimer’s Disease
• In Illinois there are 210,000 people with Alzheimer’s over the age of 65; this is projected to increase to 240,000 in 2025 
• Nationwide the cost of care for Alzheimer’s and other dementias is estimated at $200 million a year 
• In 2011, 15.2 million family and friends provided 17.4 billion hours of unpaid care to those with Alzheimer’s and other dementias—care valued at $210.5 billion
• More than 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high; one-third report symptoms of depression 
• Due to the physical and emotional toll of caregiving on their own health, Alzheimer’s and dementia caregivers had $8.7 billion in additional health care costs in 2011

The reality is that this disease is ruthless. Its deadly nature and ability to rob us of memories demands a strong response. The above numbers may look far from hopeful, but the truth is there is a collaborative response to this disease that is bearing fruit.

Researchers across the world are conducting trials and sharing data with each other at unprecedented levels in an effort to disseminate relevant results at a faster pace. Large data banks—such as the World Wide Alzheimer's Disease Neuroimaging Initiative with data from a multitude of studies—allow us to mine and learn from other’s work. This research has helped identify biological markers that assist in diagnosis at an earlier stage when treatment may prove more effective. While medication trials have thus far failed to produce a drug to treat the disease process, even the failed trials lead researchers in a direction toward further research. 

Social workers and their colleagues in research are identifying needs and best practices in caregiver support, effective behavioral intervention, and identification of systematic obstacles and opportunities. Policy advocates in conjunction with national and local governments are working to establish comprehensive and robust responses to this disease. These include increasing research dollars, establishing caregiver respite, and statewide silver alert systems to assist when an older adult wanders or is missing. These interdisciplinary and inter-system collaborations truly offer hope for an effective treatment and response to this unwieldy disease. While we wait for science to catch up with the disease and for policy to address the needs, there is great hope in the person-centered interactions that comprise current treatment.

The support group remains one of the most basic but powerful tools in the social work intervention bag. Gathering those affected by Alzheimer’s provides an experience that one is not alone. A safe, supportive space is needed to discuss the challenges of care, the uncertainty, the demands of decision-making, the loss, and occasionally, the funny. While group members may differ in the specifics, the camaraderie and shared experiences they provide each other brings a sense of belonging which in and of itself generates hope. To belong, to be seen, to be heard, to receive concern, to extend outside of oneself, to provide concern and support all remind group members of a reality outside of what they live on a daily basis. This knowledge and the subsequent relationships provide sustenance beyond measure. 

With the economic downturn and the increase in life expectancy, we are witnessing a rise in intergenerational households and “sandwiched” caregivers (those with younger children or grandchildren at home while also caring for a parent or grandparent). These complex family dynamics give rise to the need for social workers in all practice settings to be aware of the challenges of Alzheimer’s disease and allow yet another opportunity to provide support. Children and teens exposed to uncharacteristic behavior of a person with dementia need dedicated support systems. Those receiving less than optimal attention need a space to discuss and process these realities. Their caregivers who are being pulled at with competing priorities also need systemic and individual support. As with other chronic diseases, the socio-psycho-economic impact on all members of the family is immense. The opportunity to provide hope is abundant, and clinicians are rising to meet the demand. Art-based groups, online communities, telephonic support, and respite programs all serve to keep this care system afloat and are able to provide the needed care. What is more hopeful than this?

In whichever way we as individuals or as a larger association choose to respond to the Alzheimer’s disease epidemic, we must remember to meet those affected in the present. This disease demands our focus in a way that other chronic diseases do not. Recent history is often irrelevant and cannot be drawn on. The ability to process multi-step plans is often gone or unreliable. It is truly the immediacy of the present and the emotions of this moment that hold sway and mark the victories of a good interaction. Social work’s greatest gift is the ability to give witness to and stand in solidarity with the individuals, families, and systems in this unique reality. The hope and human capital we support and provide for the management and cure of Alzheimer’s disease asks us to do this. Social work is powerful and as we use that power to raise awareness about Alzheimer’s disease during November, please be cognizant of your own power to cultivate hope. 

For more information on Alzheimer’s disease and ways you can help, please visit the websites below: 

• Alzheimer’s Association: http://www.alz.org
• Eldercare Locator: www. http://www.eldercare.gov
• Department of Health and Human Services: http://www.alzheimers.gov
• National Institute on Aging: http://www.nia.nih.gov

REFERENCES

Alzheimer's Association National Office. (2012.) 2012 Facts and Figures. Chicago, IL. 

Michael B. Kocher (MSW, University of Illinois at Chicago; LCSW) is passionate about working with older adults and enjoys looking at the impact of organizational systems on service delivery and direct care providers. He is employed by the Alzheimer’s Association’s National 24/7 Helpline as team leader. In this capacity, Michael supervises both clinical and non-clinical staff, providing consultation, and ensuring quality. He is adjunct professor at the Adler School of Professional Psychology in the Gerontological Counseling Program.

Okay, maybe I'm not Wonder Woman, but I do pretend to portray her every now and then. As a wife, a mother of twins, and a career woman, I definitely have the mindset of, There's nothing I can't do! This belief is exactly why I ended up recently opening my own private practice. 

I can't do it all. I am aware of this. However I do know that I am a hard worker with a good head on my shoulders and that I can and do want to make a difference.

I went into my undergraduate social work program knowing that my ultimate goal was to one day have my own private practice. That day became a reality just three short months ago when I saw my first client in my own office. I had been working at a group practice, so when I made the decision to open my own place, it seemed like a fairly easy transition. The social worker part comes rather naturally to me, but in private practice you are also a business owner, and that part did not come so naturally. However I have always been the type where if I don't know the answer, I will look until I find it. I didn't know the different entities that went into having a practice, so I brought numerous questions to my accountant as well as my attorney. Terms such as “sole proprietor”, “corporation,” and “LLC” were popping up, and I wanted to know which one was the best option for me. I listened to their advice, took notes, asked questions, and made my decisions based on all of that information. Both my accountant and attorney recommended that an LLC, the Limited Liability Corporation, was the best option for me. My attorney drew up the paperwork, but when he informed me that it could take up to six weeks to get approval from the state, I panicked. Six weeks did not meet the diagnostic criteria for my plan. When he explained that another option was to hand-deliver the application to Springfield and pay an extra fee for it to be processed that same day, I immediately knew I would be taking a drive. It took exactly seven minutes from the time I handed over my paperwork to having them them hand it back to me with the seal of approval. It was official. I was a business owner. 

Then the real work began. I began coordinating all the necessary contracts for rent, phones, utilities, and internet service. I also applied for my federal tax ID number with the help of my accountant. I researched billing software, computers, phone systems, and fax machines. I set up my bank account and renters insurance. I shopped for office furniture. I picked out paint colors and carpet options. It was also at this time that I began the arduous task of filling out paperwork to update my provider information for insurance companies. It was during this period that I began to feel extremely overwhelmed. There were so many decisions. Big ones such as what billing software do I actually go with, and how do I go about marketing? Smaller decisions such as how many chairs do I need in the waiting room? What font style and size would I like for the sign? What color of business cards would I prefer? What about a website? Wonder Woman's strength was fading. 

The decisions got made. The work got done. The office is now very professional looking yet comfy and inviting. I am so very proud that my name is associated with this place. Structurally it is a building, but it is way more than that. It's a place where people can find compassion, acceptance, and hope. 

I still have so much to learn, and I hope I never get to a point where I think I can stop learning. I have two other wonderful ladies that share office space, which is so vitally important in private practice, not only for consultation purposes but for camaraderie as well. I have a supportive base of family and friends who have done nothing but encourage me, and I have other professionals who believe in my abilities and send me referrals. 

So how are things three months later? I grew up with the movie, Field of Dreams, so I have that mentality, “If you build it, they will come.” It didn't necessarily happen that way. Clients didn't start walking in just because I was now open for business. However, the referrals are coming, and I believe that I am seeing the people that I'm suppose to see. The business mindset is still a work in progress. I foresee that developing over time and with experience. 

There was never a doubt that this was what I was supposed to do. I'm not sure if Wonder Woman was a spiritual woman, but for me, I leaped out on complete faith. Even though it's only been a few months, I see myself being here for a very long time. 

Lindsey Adams, MSW, LCSW, began her career as a family counselor and adoption caseworker at United Methodist Children’s Home working with families in her community. She then went on to become a school counselor in a K–12 unit school district in the small community of Waltonville, IL. She has also been employed by Catholic Social Services of Southern Illinois as a family therapist where she worked primarily with children and families in the foster care system. Taking the knowledge and experiences from each of these settings, she is now in private practice, continuing to serve the families in her community.

Paul Tough is an author and regular contributor to The New York Times Magazine, The New Yorker, and This American Life on various topics concerning education, politics, parenting, and poverty. His latest book hosts a collection of stories about public and private education, addressing how students can learn to succeed through their management of adversity and the character traits that are built from these experiences. 

Tough takes the reader on a sometimes dizzying journey across North America, exploring what contributes to school success and school reform. The opening pages take the reader to a New Jersey pre-kindergarten classroom where Tools of the Mind, an innovative program that focuses on emotional regulation and impulse control, is being implemented. Researchers assert that skills in emotional regulation offer more positive outcomes than academic skills alone. 

Tough is not simply concerned with academic success but also positive life chances. Central to this notion is character development. Character is the missing link to life success. Character is not just the moral traits of fairness, generosity, and integrity. It also includes traits of performance: effort, diligence, perseverance, zest, optimism, social intelligence, and curiosity. Further, character is a construct molded by life circumstances, challenges, adversity, and even failure. It is rooted in brain chemistry and molded in measurable ways by the environment. 

Readers learns of inner-city Chicago programs OneGoal and Youth Advocate Programs (YAP) which help youths attain character performance and experience school success at the high school and college levels. 

One of the strengths of How Children Succeed is Tough’s hopeful outlook. He highlights that even when children have not faired well in an educational system, adolescence can be a turning point offering the most profound sort of transformation. Through strategies that support character development as well as academic excellence, youth can recover from bad grades, persuade teachers for extra help, and show persistence to stay focused on goals. 

There are also practical suggestions for the reader. For instance, in the chapter “How to Build Character,” the reader is introduced to the Character Report Card based on the performance side of character. The Character Report Card is not simply an add-on to the academic report card, but carries as much weight in evaluation of student performance. 

Tough’s manner of storytelling is indicative of the complex twists and turns of obtaining life success. Yet Tough often gets trapped in the weeds of his interviewees’ stories. For instance, in the chapter on “How to Think,” Tough takes the reader to New York City public schools where youth learn the benefits of cognitive flexibility as they master the game of chess. While entertaining, these side stories become somewhat distracting. 

Although, Tough is diligent in gathering a multitude of research, the book lacks a critical commentary concerning school reform. Some school reformists note that present schooling is simply the perpetuation of societal inequality. Statistics reveal that between 1990 and 2000, the rate of BA attainment among wealthy students with at least one parent who had graduated from college rose from 61 to 68 percent, while the rate among the most disadvantaged students whose parents were not college graduates actually fell to 9.5 percent. Although Tough is not a college graduate, these statistics seem to guide his pursuit in finding ways to close this class divide. 

Yet surprisingly Tough only minimally analyzes the racial and class differences between affluent and low-income schooling, and then only offers his analysis at the end of the book. In fact it is implied that character development can act as a joiner to the resources of those more privileged. Although character is powerful, it is naïve to ignore the embedded disparities that plague American education and the need to dismantle unjust structures. In the end, this is a missed opportunity for Tough to add to the American school reform conversation. 

Overall How Children Succeed is informative. Teachers, social workers, school administrators, or any professional open to learning about other metrics of school success would find it timely and inspiring. 

Our task of educating new members in the Illinois House and Senate next year will be challenging, to say the least. My review of candidate web pages have shown that human services issues are not on most candidates' radar screens.

VETO SESSION AND LAME DUCK SESSION DAYS

Veto sessions are scheduled for November 27, 28 and 29, and December 4, 5 and 6. Before the new 98th Illinois General Assembly takes the oath of office on January 9, 2013, there will probably be several "lame duck" session days in early January for the 97th General Assembly to finish business. One override vote to watch for is on SB 1849, the gaming expansion bill that the governor vetoed. Among other things, the bill would allow a land-based casino in Chicago. It would expand funding for gambling addiction treatment grants. Another lame duck session possibility is a vote on a marriage equality bill. 

We expect the school bullying policy legislation that stalled in the Illinois Senate last spring to be called again in the senate during the veto session or in the final days of the 97th General Assembly. The bill, HB 5290, will be amended onto another bill for procedural reasons. We do not have that new bill number yet. We strongly support the bill. The bill would establish some basic common sense requirements for school bullying prevention policies with a focus on restorative measures instead of just using punitive disciplinary action such as suspension or expulsion. Sponsors are Rep. Kelly Cassidy and Sen. Heather Steans.

PROTECTION FOR ADULTS WITH DISABILITIES AGES 18–59

The issues raised by a series of articles in the Belleville News Democrat concerning deaths of fifty-three people over an eight year period and how reports were handled by the Office of Inspector General's (OIG) office at the Department of Human Services (DHS) has generated a great deal of activity with state government. The House Human Services Committee held a subject matter hearing in August, and there have been several meetings with DHS, the governor's office, and other stakeholders. The governor recently announced a proposal to create a new agency for Adult Protective Services to replace the OIG. This proposal would be similar to the one used for adults aged sixty and over by the Department on Aging. Another option is to overhaul the way OIG functions to focus on protection services instead of investigations after someone has died.

NONPROFITS AND EXECUTIVE SALARIES

Chicago Tribune articles regarding undisclosed high salaries of some nonprofit CEOs hidden through for-profit affiliates has resulted in new legislation. Rep. Greg Harris has introduced HB 6237 which would amend the Illinois Procurement Code to require nonprofit organizations receiving funding from the state to disclose any ownership interests, operating agreements, partnerships, or other relationships between the nonprofit agency and its related for-profit owners, subsidiaries, partners, or affiliates, including business identification of the for-profit entity, a list of the services provided to the nonprofit organization, and whether more than 50% of the nonprofit provider's management is delivered from the relationship. 

Julie is an eighteen-year-old in day treatment for anorexia nervosa. She lives with her parents and is on their insurance. Despite several months of interventions, her weight has continued to drop. She has been lying to the staff about her eating behavior at home and has not wanted to attend family sessions. Her body mass index (BMI) is dangerously low, and the treatment team is concerned that she may require inpatient interventions. Julie has expressed that she does not want to be hospitalized. Her parents are concerned for her health but also anxious about the potential financial implications of a hospitalization and are minimizing the severity of her symptoms.

Treating eating disorders presents multiple ethical dilemmas. Does Julie’s desire not to be hospitalized take priority over potentially dangerous medical need? How is “life-threatening” being defined? How should the financial and emotional concerns of her family come into the decision-making? What is the role of the social worker and teams’ personal values?

This article will explore the key concepts of autonomy, beneficence, non-maleficence, and capacity when treating clients with anorexia nervosa, bulimia nervosa, binge eating disorder, compulsive overeating, and other forms of eating disorders. Autonomy is a central ethical obligation to protect a person’s right to self-determined choice. The principle of autonomy recognizes that an individual who is competent has the right to make informed choices without coercion or undue influence. Kitchner describes autonomy as involving “liberty, the responsibility for personal behavior, freedom of action and freedom of choice.” He adds that an important aspect of autonomy includes respecting others’ autonomous decisions despite believing that another’s choice is mistaken, wrong, or harmful (Kitchener, 1984).

Autonomy is embodied in the social work value of dignity and worth of the person which states that social workers should “promote clients' socially responsible self-determination.” The concept is further articulated in Ethical Standard 1.02. Self-Determination (NASW Code of Ethics). Eating disorder clients frequently experience a lack of control or empowerment in their lives. Developing or restoring a sense of autonomy may be an important component of healing.

The concept of beneficence entails doing good for others by contributing to and promoting overall human health and welfare (Beauchamp & Childress, 2000). It is embodied in the social work concept of service that states “social workers' primary goal is to help people in need and to address social problems” and Standard 1.01 Commitment to Clients. 

The concept of non-maleficence comes from the Hippocratic Oath to “above all do no harm.” There are active and passive forms of potential harms. Eating disorder (ED) clients can be challenging and engender strong counter-transference responses. Though unintended, an active form of harm would be inappropriately terminating or abandoning a client who is stirring up feelings of rejection, incompetence, or powerlessness 

Non-maleficence requires professionals to work within areas of competence. Examples of passive harm include failure to appropriately refer a client either for diagnostic confirmation when the client requires interventions outside the skill range of the practitioner or when a more experienced level of care is needed based on the seriousness or complexity of the illness. Another example is failure to develop a biopsychosocial or integrated approach instead of relying on single modalities that have proven insufficient by themselves. 

The ethical principles of autonomy, beneficence, and non-maleficence are often in conflict with ED clients. Julie does not want to be hospitalized, but she is at a dangerously low weight. Her parents remain ambivalent about a higher level of care despite feedback from the treatment team and physician. Resolving ethical dilemmas requires social workers to identify the conflicting duties and rank the order of competing values. In Julie’s case, self-determination is in conflict with commitment to clients. 

Determining how to balancing autonomy and beneficence requires a thorough assessment of the client’s decision-making capacity. Autonomous decisions are contingent upon one’s ability to use rational deliberation and whether or not one is competent to make a particular choice (Kitchener, 1984). The Illinois Health Care Surrogate Act (755 ILCS 40) defines “decisional capacity" as “the ability to understand and appreciate the nature and consequences of a decision regarding medical treatment or forgoing life-sustaining treatment and the ability to reach and communicate an informed decision in the matter as determined by the attending physician.”

Criteria for determining capacity to consent to or refuse treatment include the ability to understand information, the ability to believe it, and the ability to weigh it in the balance in order to reach a decision. Competence is the clinical equivalent to the legal concept of capacity. In practice, mental health professionals use a wider working definition of competence in clients than the strict legal criteria of capacity and take into consideration other factors such as the client’s ability to apply the knowledge to his or her own situation, the consistency of decisions over time, and the value systems of the client (Grisso & Appelbaum, 1998). It is also important to assess global versus specific competence. Global competence refers to overall competence whereas specific competence pertains only to a particular domain. ED clients may continue to have adequate or even highly functional insight and decision-making ability in other areas of their life yet be severely impaired in their capacity related to the eating disorder. 

Two additional considerations in determining competence among clients with eating disorders pertain to the client’s lack of or fluctuating insight about the gravity of her disorder and health status as well as the presence of organic impairments that affect the client’s cognitive abilities (Webster, Schmidt, & Treasure, 2003). In particular, anorexic clients suffering from the effects of starvation may struggle with impaired reasoning and cognitive abilities (Werth et al., 2003). Anorexia nervosa (AN) clients may experience cerebral pseudoatrophy and/or biochemical changes as a result of nutritional deficiencies (Vitousek et al., 1998). In all starvation-related situations, a physical threshold may exist where a person can no longer think rationally as a result of chemical changes in the body related to the effects of starvation (Carney et al., 2006). Ideally an agreement has been made at the start of treatment with the client and, if appropriate, their family, discussing possible medical risks and what course of action should be taken in that situation. It is important to discuss and define what symptom level is considered life-threatening.

In her book Understanding Eating Disorders: Conceptual and Ethical Issues in the Treatment of Anorexia and Bulimia Nervosa, Simona Giordano describes two kinds of autonomy relevant to assessing competency. Substantive autonomy is satisfied when the content of the person's action is deemed rational, that is, the majority of people would act similarly in similar circumstances. Formal or procedural autonomy is satisfied when the person's process of reasoning and deliberation is judged appropriate to her decision-making. The person requires an assessment of her understanding and her ability to balance the costs and benefits of proposed alternatives (rather than the result of the choice). This capacity for decision-making is relative to the specific decision and to the time it has to be made—a disturbance of body-image, a faulty awareness of signals of hunger and satiety, and cognitive distortions (“I'm different, 300 calories a day is plenty for me'”). 

Capacity and competence can be different over time and situation. Any assessment is only valid for the time and circumstances for which the assessment is made.

In summary, the following are essential guidelines in addressing ethical dilemmas with ED clients:

1. Be aware of your own values, beliefs, and potential biases.
2. Be honest and humble about your own level of professional expertise. Make referrals and collaborate with other professional as indicated.
3. Discuss and document limitations of confidentiality and plans in the case of medically dangerous or life-threatening situations at the start of treatment.
4. Clearly define the competing values, codes, laws, or policies relevant to the dilemma.
5. Document all discussions relevant to the ethical dilemma including any discussions of confidentiality or informed consent (with client, family, team members, etc.).
6. Do a thorough assessment of the client’s decision-making capacity and document findings. Update this assessment as needed.
7. Utilize and document clinical, ethical and, if necessary, legal consultation.
8. Be conscious of personal needs and potential compassion fatigue. Take proactive self-care steps.

REFERENCES

• Baran, S. A., Weltzin, T. E., & Kaye, W. H. (1995). Low discharge weight and outcome in anorexia nervosa. American Journal of Psychiatry. 152, 1070. 
• Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). Oxford, England: Oxford University Press. 
• National Eating Disorder Information Centre. (2002). Addressing issues of autonomy and beneficence in the treatment of eating disorders. Toronto, Canada: Karen E. Faith. 
• Giordano, S. (2005). Understanding eating disorders: Conceptual and ethical issues in the treatment of anorexia and bulimia nervosa. Oxford, England: Oxford University Press. 
• Matusek, J. A., & O’Dougherty Wright, M. (2010).  Ethical dilemmas in treating clients with eating disorders: A review and application of an integrative ethical decision-making model. European Eating Disorders Review, 18 (6), 434–452. 
• Verkerk, M. (1999.) A care perspective on coercion and autonomy. Bioethics, 13 (3¬4): 358–368. 
• Watson, T., Bowers, W., & Anderson, A.  (2000). Involuntary treatment of eating disorders. American Journal of Psychiatry, 157: 1806–1810. 

Ruth Lipschutz, LCSW, ACSW, is a licensed clinical social worker with postgraduate certification in ethics, mediation, Transformational Imagery, hypnotherapy, and Eye Movement Desensitization and Reprocessing (EMDR). She received her MSW from the University of Illinois in 1978 and went on to complete the two-year postgraduate training program of the Institute for Family Studies at Northwestern University. She has extensive experience in the areas of ethics, mental health, addictions, traumatology, program development and implementation, supervision, consultation and Alternative Dispute Resolution. She is the chairperson of NASW’s National Ethics Committee and has served as a panelist, consultant, mediator, and trainer for the NASW Illinois Chapter Ethics Committee. She is currently in private practice.

Work, family, classes, readings, internships, and so on. Every social work student goes through this routine daily. I am surprised that we are able to find time to eat and sleep let alone be involved in extracurricular activities. But they do exist, and they are not only important for the collegiate and Illinois community but also for us as social workers. So the question is why they exist, why should we be involved, and how to do we create time for them? 

First, why do extracurricular activities exist? Well I am going to give a little history lesson. (Please do not fall asleep!) The first extracurricular activities appeared in the nineteenth century as a kind of laboratory for practical and vocational interests. It was a way to get away from the doldrums of academics and to either learn a new skill or practice a skill. Throughout the years, extracurricular activities have become an integral part of high schools, colleges, and universities. 

So that brings us to why extracurricular activities are important. As I mentioned above, it is a way to get away from academics. This could be viewed as either self-care (which we need as social work students) or a way to practice using the skills we have learned. How else would you become a better social worker if you are not able to practice? Like the old adage, “Practice makes perfect,” extracurricular activities provide another way to use what is learned in the academic world to the real world. It is in the NASW Code of Ethics to not only be competent (which will only happen if we practice) but to also be dedicated to service. Not only are we helping ourselves, but we are also helping others! It is truly a symbiotic relationship. It goes to our roots as social workers and the Settlement House Movement. 

Through extracurricular activities you can also learn a new skill or trade. When I was an undergraduate student my major was elementary education and psychology. I was involved in activities surrounding education, but I was also involved in the Radio Club. I had a show on the college radio station on Saturday mornings. Of course no one in the college realm is awake on a Saturday morning, but it gave me a way to learn something new. Will I ever have my own radio show or use radio equipment again in my life? Probably not, but I am a better person for having a radio show and having knowledge about a radio station. Think of all the other skills and trades that you want to learn. Why not join a club and learn them for free! 

Extracurricular activities also can give you an advantage when it comes to getting a job. First, you are able to network with others who are in the field. Networking is important since it may help you learn about a specific job prospect that might be available. Also you could get a great reference from the extracurricular activity. The more references you have the better your chances of finding a job you really want. Additionally being in extracurricular activities helps to build up your resume. Employers do not only look at grades, programs, and certifications—they also look at the other experiences you had while in training. This could help you land the job that you want, and isn’t that why you are currently in college? 

I bet you all are thinking, “You know, this all sounds good and dandy, but where is the time?” I really don’t know how to be honest! Well, I guess I do know. I think it is important that we learn to organize our time so that we can be more productive. I was able to do this by reading for classes during my lunch breaks and using my calendar on my cell phone to organize my schedule. These small steps helped me budget my time and responsibilities so that I could be involved in extracurricular activities. If you have children, why not read to them at night from your textbook? What better way to help a child go to sleep! (Of course I am just kidding.) What other small steps could you take to make time? Maybe getting textbooks on tape so you can listen to them on your way to school (or at the grocery store, or anywhere on the go). Why not read during halftime of a football game or during commercials of your favorite television show? The more small steps we make, the more time we create for extracurricular activities. 

I am not suggesting that you all should be heavily involved in extracurricular activities. You do not need to be president or a board member. I am suggesting that you should all try to give at least some time to one or more extracurricular activities. I truly believe that the benefits outweigh the risks of getting involved. Even a couple hours a semester would not only benefit you but also the community. Please consider giving some time to the other activities outside the classroom. Collegiate clubs need you. It will make you a better social worker and a better person. 

Tim Feltman is currently an MSW student at Loyola University Chicago. He is also president of the School of Social Work Student Organization (SSWSO) and is co-liaison at Loyola University Chicago for the NASW Illinois Chapter. 

Nominations are now being accepted for the 2013 Social Work Awards! This year, we are looking for outstanding individuals whose work has supported and promoted the social work profession and the people it serves. Nominations will be accepted through January 31, 2013. 

Nominations will be accepted for the following categories: 

• Social Worker of the Year: An NASW Illinois member in good standing who: reflects the values espoused in our NASW Illinois Chapter Mission Statement; promotes the NASW to the public and advocates for the populations social work serves; represents the highest ethical standards of social work as defined in the NASW Code of Ethics; contributes to improvement of the social fabric in tangible and intangible ways; takes risks and enlists public support for improved human services.
• Lifetime Achievement Award: An NASW Illinois member in good standing who: has accomplished stellar successes in his/her social work career which have enhanced the profession, supported clients, upheld social work values, and advocated for the betterment of all people.
• Public Citizen of the Year: A non-social worker who: exemplifies the social work profession with outstanding service to individuals served by social workers; reflects the highest ethical standards in his/her field of endeavor; takes risks and enlists public support for improved human services; advocates for and contributes to the public’s awareness of social problems.

PLEASE NOTE: The chapter is committed to diversity among award recipients. Nominations MUST be submitted using this online nomination form. We will be contacting your nominee for additional information. You are encouraged to work closely with your nominee to complete the nomination. 

For a list of past winners and more information about the annual social work awards, go to http://www.naswil.org/news/chapter-awards/. 

The NASW Illinois Chapter Board of Directors is looking for YOU!

Do you want to make a difference for social workers in Illinois and beyond? Do you have expertise in a particular method or field of social work practice? Do you have a unique perspective that you believe is under-represented? Joining the NASW Illinois Chapter Board of Directors is a great way to implement change, share your knowledge, and voice your opinions! Consider getting involved in your professional association, or or nominating a colleague for a leadership position.

The 2013 Leadership Recruitment Packet is now available to download. The packet further outlines in great detail the importance of leadership and the requirements of elected leadership. Please consider getting involved in your professional association, or or nominating a colleague for a leadership position. Nomination forms can be submitted online here. The deadline is Friday, March 15, 2013, so be sure to nominate someone today!

"Serving on the NASW Illinois Chapter Board of Directors is a unique opportunity that enables social workers to network with social work leaders and members around the state, and at the same build up one’s list of contacts as well as advance one’s own professional standing. Serving on the NASW Illinois Board of Directors also brings visibility and exposure to your organization and/or practice. A board position also helps develop and apply one’s leadership skills and make a difference by being involved in advocacy efforts that impact social workers statewide. I encourage members to review the 2012 Leadership Packet to learn more about how a potential leadership position in your professional association can enhance your own professional standing as well as the status of the social work profession." —Joel L. Rubin, MSW, CAE, NASW Illinois Chapter Executive Director

“I have been an active member of the NASW Illinois Chapter for the past fourteen years. My experience with serving in different capacities on the NASW Illinois Board of Directors has provided me with an excellent opportunity to share ideas and information with colleagues in the field of social work. One of the most valuable experiences has been to stand with other social workers to ensure that the voices of social workers and the people that we serve are heard.”—Yolanda Jordan, NASW Illinois Chapter President

“When I was initially approached with the offer to run for district chair, I thought it would be just another set of meetings to attend, and I did not know how I could possibly fit any more meetings or responsibility in to my schedule. But, the reality was far from what I had imagined. The reality became an enriching and overwhelmingly positive experience! I have gained not only leadership training, but friendships throughout my district and state.” —Candi Gray, President-Elect

“Joining the NASW Illinois board of Directors has given me an opportunity to really understand the valuable work NASW Illinois does and add to its impact on social workers, providers, and communities. There have been certain issues of importance to me for some time, and now I really feel that I have a seat at the table to where they are being discussed and acted upon.” —Alexander Brown, Chicago District Chair

"As an NASW Illinois Chapter Board Member, I have been fortunate enough to connect with colleagues that I would otherwise not have had the opportunity to meet, thus expanding my personal and professional community. My experience as a board member has provided me with the experience to continue to grow and learn as a professional social worker and make a difference." —Mary Garrison, East Central District Chair

"Being an NASW Illinois Chapter Board Member has gotten me directly involved in furthering the goals of the profession and nurturing the intellectual curiosity of NASW members and social workers in general." —Martha Neira, Three Rivers District Chair

"Being an NASW Illinois Chapter Board  Member has provided me with a unique opportunity to be part of the decision-making process in a profession that is in constant evolution. It has also allowed me to be instrinsically involved with what matters to our constituency and to make a difference. Furthermore, this involvement has given me the opportunity to meet wonderful people in the field and enhance my professional growth." —Monica Guilhot-Chartrand, Member At-Large

"Serving as a board member has afforded me the privilege of getting to know a board that joins together dedicated, practicing social work leaders across a wide range of service areas and the state of Illinois. Being a part of the board has opened my eyes to personal and professional social work perspectives and experiences that I surely would not be able to find elsewhere." 
—Jennifer Tan, Graduate Student Representative

Nominate yourself or someone else today! 

Don't forget to join the NASW Illinois Chapter for its second tele-town hall meeting! Learn about new CEU opportunities, legislative updates, and the new NASW liability insurance. All NASW Illinois Chapter members are eligible for one free CEU! Read more here. 

Reflections from This Year’s 2012 NASW Regional Virtual Symposium

On September 20, 2012, the NASW Illinois Chapter held its Regional Virtual Symposium along with the NASW Missouri Chapter. The symposium focused on healthcare. It was great to join with another state and discuss programs that affect us all. We received extensive and up-to-date information on the Affordable Healthcare Act (ACA). We had the privilege of having very knowledgeable presenters give detailed information on the upcoming changes regarding the ACA and the impact that it will have on the elderly population as well as working class folks who would normally be unable to afford healthcare. With the insight that I gained from this symposium regarding this act, it will be a great resource for children, families, and the elderly population in terms of preventative healthcare and ensuring that pre-existing health issues do not prohibit anyone from receiving the care that they need.

We also had the opportunity to learn more about services that veterans are receiving through the Veterans Administration (VA) and some of the steps that they have made in their quest to ensure that veterans receive the best mental health services and support possible. One of the participants, a Vietnam War veteran, acknowledged that many of the things that are offered to veterans today were not available for many of the veterans who fought in previous wars, which is unfortunate. But this really speaks to the advances that have been made in the VA’s comprehensive care of veterans.

The virtual symposium was a great way to connect with participants in other states and get ideas on how other states are managing the new healthcare changes. It is also interesting to have an understanding on how other states are responding to the changing face of healthcare in their communities.

Yolanda Jordan, MSW, LCSW, has an extensive background in abuse/neglect issues in the field of child welfare. As a placement manager with the Illinois Department of Children and Family Services, she is responsible for managing supervisors who are responsible for children who are placed in the foster care system. Yolanda is also a practicing psychotherapist and has been in private practice for the past ten years. Services are provided to children, couples, and families with a special emphasis on relationship issues that African American women face.

Here are the numbers: over the past forty years, Illinois' adult prison population has increased by about 700%, going from around 6,000 to over 48,000 adult inmates and about 1,000 juveniles today. While many factors have contributed to this growth, drug policies and trends in mental health have played a particularly important role. As elected officials increased penalties for drug-based offenses and slashed state mental health budgets, they created laws and policies that have sent an increasing number of mentally ill and drug-addicted people to our state prisons. 

For instance, 60% of female prisoners in Illinois could potentially be diagnosed as having post-traumatic stress disorder. [1] More than half of all prison and jail inmates (people in state and federal prisons and local jails) meet criteria for having mental health problems, six in ten meet criteria for a substance use problem, and more than a third meet criteria for having both a substance abuse and mental health problem. [2] The use of seclusion and restraint on persons with mental and substance use disorders has resulted in deaths and serious physical injury and psychological trauma. [3] 

While policies and practices have turned our prisons into revolving-door treatment (or in many cases, non-treatment) facilities, we have not funded or staffed them to provide the care and services that inmates need. Although we spend about $1.3 billion on our prison system, which means we spend about $20,000 a year to house an adult inmate and almost $90,000 to house a youth, only about 2% of that money goes to rehabilitative programming. Faced with limited and diminishing resources inside prison, offenders often encounter even less rehabilitative services when they are released, which produces unsurprising results. Every year, the Illinois Department of Corrections receives and releases about 35,000 inmates. More than half of these inmates will return to prison within three years of being released.

Given these facts, it is clear that social workers have an important role to play in all aspects of correctional policy and operations, from entry to release, from creating smart and safe alternatives to incarceration to monitoring prison practices. The problem in most states is that prisons are closed and secretive environments, offering almost no access to anyone who is not incarcerated or employed by corrections. 

For 112 years, Illinois has been one of the few states that offers opportunities for people outside of corrections to monitor and help shape prison policy and practice through the nonprofit John Howard Association (JHA).  Based in Chicago, JHA was founded in 1901 by social workers who believed that all citizens, whether they realized it or not, should have an investment in a safe, humane, and cost-effective prison system. Through our longstanding Prison Monitoring Project and Juvenile Justice Project, JHA staff and trained volunteers regularly tour all facilities in the Illinois Department of Corrections and the Illinois Department of Juvenile Justice. During these tours, monitors are able to observe the challenges faced by both inmates and correctional staff and ensure that policies are implemented in a way that promotes public safety.  

Following our visits, JHA issues a written report that focuses on critical matters such as education, medical and mental health care, disciplinary procedures for youth and adults, and the physical condition of the facilities. These widely disseminated reports are read by everyone from lawyers to legislators, wardens to reformers, members of the governor's office to members of the public at large; they provide essential transparency and oversight to an otherwise overlooked institution and drive safe and cost-effective criminal justice reform.

While JHA's Executive Director's training and experience as an attorney is invaluable to the organization's success, as a social worker, one of the authors (A. Brown) has found his involvement as a volunteer board member and prison monitor to be a clear expression of social work's core values of service: social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. 

As outlined in the NASW Code of Ethics, the primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. "Serving on the board allows me to apply my social work skills on a macro level. By visiting prisons I engage at the micro level," says Brown. 

"One of the most powerful experiences of my professional career was talking to a young woman-through a crack in the steel door of her cell-who had been in prison for five years and isolation for the past eighteen months. She was agitated, panicky, and scared as she was scheduled to be released the following week and had nowhere to go. She was someone who was almost certainly abused as a child; had some degree of mental illness; had not made a meal or done laundry in years; had no high school degree; and had been alone for the last year and a half in a room smaller than my bathroom, and would soon be released without support or assistance. I couldn't imagine that she would not end up in some type of prison or mental health facility. Without extensive support and involvement from social workers both before and after release, which our current system does not allow,this young woman is almost certain to fail."

However you look at it, our prison system is in need of significant reform. Perhaps the most fundamental problem facing prison reform is that it has for too long been narrowly focused on criminal justice. As long as prison reform is merely about what happens inside the four corners of a prison cell, it will fail. To improve outcomes for everyone and to create a more just and humane system, prison reform needs to focus on the impact of correctional policies on people, communities, and our systems of care.  On every level, prison reform needs social workers.

If you want to learn more about the Illinois prison system and how you can be part of reform efforts as a prison monitor, please visit JHA's website: http://thejha.org.

1. Reichert, J., & Bostwick, L. (2010). Post-traumatic stress disorder and victimization among female prisoners in Illinois. llinois Criminal Justice Information Authority Retrieved from http://www.saferfoundation.org/files/documents/PTSD_Female_Prisoners_Report_1110.pdf.
2. U.S. Department of Justice, Office of Justice Programs. (2006) Mental health problems of prison and jail inmates. Retrieved from http://bjs.ojp.usdoj.gov/content/pub/pdf/mhppji.pdf. 
3. Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA National Action Plan on Seclusion and Restraint, Revised and Adopted May 2003. Retrieved March 25, 2011, from http://www.samhsa.gov/seclusion/sr_handout.aspx. 

FURTHER READING

• Unasked Questions, Unintended Consequences: Fifteen Findings and Recommendations on Illinois' Prison Healthcare System: http://www.thejha.org/unaskedquestions

Alexander Brown, MBA, PHD, LCSW, serves on the NASW Illinois Chapter Board of Directors and is executive director of Parents Allied with Children and Teachers for Tomorrow (PACTT), a nonprofit serving children and adults with severe autism.

John Maki, JD, is executive director of the John Howard Association (JHA), which works to achieve a fair, humane, and cost-effective criminal justice system by promoting adult and juvenile prison reform, leading to successful re-integration and enhanced community safety.

CEU Opportunity for Reading This Article!
NASW Illinois members can earn one CEU by completing an online quiz (LINK) regarding this article! The free CEU opportunity is only valid until December 1, 2012, after which the CEU fee will change to $15.00. Nonmembers must pay the regular $10.00 rate for the CEU, which will increase to $15.00 after December 1, 2012.

It's 1:30pm on a Tuesday afternoon, and I have been called into an unscheduled meeting. As I find a seat amongst the crowded conference room, I am informed about a student who has been showing increasing disruptive behaviors in the classroom. Each minute is filled with details about the student's family circumstances, negative interactions with teachers and students, noncompliance with classroom requests, and refusal to complete schoolwork. Within the classroom he does not respond to praise and sabotages any positive incentive. When his teacher tries to assist him, he refuses with moans and complains that he does not know how to complete his work after numerous explanations. At this point, the strategies are not working and the negative behaviors continue to increase.

With all the information that was discussed, I will build upon these two details: the student's name is David* and he is in second grade. All those in the meeting agreed to continue to be a positive reinforcer for David during his school day. I made arrangements to meet with David first thing Friday morning, and this is when our journey together will begin. By using principles of the Child-Centered Play Therapy (CCPT), the goal is that David will be able to process and proceed at his own pace. It is not just play, but a means to repair, rebuild, and restore David. I will use my eyes more than my ears and be led by a child more than by my own agenda. 

The purpose of this article is to describe CCPT, developed by Virginia Axline, in a simplified and practical format. The principles of CCPT described by Axline (1989) consists of the therapist developing a warm and friendly relationship, accepting the child for who he or she is, and does not attempt to direct the child's actions or conversations in any way. Landreth (2002) explained the goal of CCPT this way:

In this approach, the child and not the problem is the point of focus. When we focus on the problem, we lose sight of the child. Diagnosis is not necessary, because this is not a prescriptive approach. The therapist does not vary the approach to meet demands based on a specific referral problem. The relationship that develops and the creative forces this relationship releases in the child generate the process of change and growth for the child. (p. 85)

It's Friday morning and many thoughts are going through my mind as I walk toward David's classroom. Focusing on the child and not the reason for the referral, I am reminded that David is someone's child, someone's grandchild, and someone's friend. The teacher tells him that I am here to see him. As we walk out of his classroom, his head is down and he is asking me numerous questions, from why he needs to meet with me to various shows on television. He leads the way and walks into my office first. He touches everything, from the wind-up toys on my desk to opening my cabinet of games and art materials. After I explain that he has access to the cabinet, David asks if he could make a science experiment with the art materials. 

Side by side, we gather the materials as he explains his experiment. He continues to keep his head down and talk without letting me interject a single word. Handing him the materials, I watch David as he moves throughout the space. He stops before each movement and is cautious about not spilling. Any statement I make is left in the air without a response; at the same time, David speaks nonstop about what he is working on. This is where we both sit, an arena of unknowns and uncertainties. 

David needs a chance to start over today, or even start over each minute if need be. I am privileged to sit with David, and I know that he will teach me more than I can teach him. He is my lesson. I understand that we have been brought together for him to decrease his negative behaviors and complete his work within the classroom. I choose to accept that it is going to be a process and that it cannot be hurried. Easily I can question him about his disruptive behavior, then create a behavior management plan, and lastly, tack on a positive reinforcer for his success. Instead I choose to say, "Think about what science experiment you want to create next time. See you next Friday." 

David is an imaginative, creative, and intelligent boy. In our first session, David questioned me and continuously tried to cross boundaries. Manipulation was the common thread in his conversation and actions. Looking for a negative reaction from me, David called me by my first name and refused to leave the office. After explaining that it was time to return to class, David sat there and did not acknowledge my request. After restating the request numerous times, he started walking with me, very slowly. According to CCPT guidelines, the therapist establishes only those limits that help the child accept personal and appropriate relationship responsibility (Axline, 1989). If a limit was challenged, I simply restated the initial request. When the following Friday arrived, I returned to David's class. David walked toward me saying, "I didn't think you would come." I responded, "Of course, I'm here. I've been looking forward to Friday all week."

Each session was a new science experiment and also new information about David. As we poured a solution, tied string, or taped something together, David talked about his family and the disappointments he felt. In exchange, David used his passion for science to connect in a positive way. It created an avenue for him to communicate words such as excitement, disappointment, frustration, and anticipation that before now were not in his vocabulary. Periodically, he shows his peers his new science experiments and they ask him questions about his knowledge. 

Over the course of five months, David's behavior improved overall within the classroom with minor setbacks from time to time. School personnel became his everyday cheerleaders. We entered into his world alongside him. Those who surrounded David continued to gain more understanding of him and looked past the exterior, the disruptive behaviors. We were able to see a little boy who needed to be heard and was crying out loud for it. When you take yourself out of the equation and put aside your own personal agenda, you allow growth to transpire within a child. I am hopeful that David will continue to know that he can make good decisions for himself and believe that those around him want the best for him. 

There is the curiosity to answer the unknowns of the reason for David's disruptive behaviors at school. What was the underlining reason for the disruptive behaviors? What is the need to sabotage any positive activity? One question I am left with is, Do we go back and try to understand why the bridge was broken, or do we just fix the crack? I choose to work on fixing the crack with David and continuing on. I know for certain that I am here as a witness to watch a child take flight. 

*Names and specific details have been changed to protect the identity of those within this article while reflecting actual scenarios. 

REFERENCES

• Axline, Virginia (1989). Play therapy. London: Ballantine Books.
• Landreth, G. (2002). Play therapy: The art of the relationship. New York: Brunner-Routledge.

Jaime Callan, MSW, is a school social worker in Homer Consolidated School District 33C. She incorporates her filmmaking knowledge as an avenue to assist students. She is the creator of the program, Project Light Box, which allows us to see the world through a child's eyes by using a camera's lens as the vehicle. Also, she enjoys creating games to connect all kids from all walks of life. Having congenital hearing loss, Jaime uses her life experiences to be her driving force to advocate for children. 

Karl Pillemer is a renowned gerontologist at Cornell University who is best known for his translational research in the fields of aging, family caregiving, and nursing home care. Out of professional and personal curiosity, he launched the Legacy Project in which he and his team of researchers interviewed thousands of older adults (average age of 75) about their views on marriage, children, work, aging, health, and happiness. Rather than presenting the results of this study in a peer-reviewed journal or a text for professionals, Pillemer decided to publish his findings in this highly readable book for the general public. It is a gem.

Pillemer stays clear of statistics and instead uses a qualitative approach with so-called “experts on living.” He distills in-depth interviews into thirty lessons, although several of them include useful tips too. He highlights these lessons with dozens of quotes based on decades of experience. Anyone at any age can benefit from these important lessons learned by older Americans. Social workers will want to recommend this book to young people, particularly those who have few opportunities to interact with older adults. This book is chock-full of collective wisdom for navigating life’s challenges.

In addition to weaving together interesting themes, Pillemer departs from his professional perch and shares his own reflections on these thirty life lessons from his view as a baby boomer. He argues that our society is at risk of losing out on the wisdom of our elders. Generations are often separated by time and distance in sharp contrast to past generations when two and three generation households and close proximity to relatives were commonplace. Pillemer states that our culture fears old age, and that young people are missing out on valuable insights from older adults who have triumphed over tragedy and have learned to live with unanswerable questions. Pillemer’s elders gladly share their life experiences that are seldom heard by younger generations today.

While at times the thirty life lessons may appear obvious (“marry someone a lot like you”), it is the richness of the quotes that make them fresh and interesting. I particularly liked the lessons about parenting in the fourth chapter: share time with your children; it’s normal to have favorites but never show it; don’t hit your kids; avoid a rift at all costs; and take a lifelong view of relationships with children (“parenthood lasts forever”). These experts on living tell poignant tales about what they did right and wrong with their children. All parents can learn from this helpful chapter.

Anyone in the second half of life will appreciate the final lessons about aging, health, and happiness. An eighty-nine-year-old woman who grew up in poverty declares, “I’ve learned that happiness is a choice, not a condition.” A seventy-five-year-old man agrees: “You are not responsible for all the things that happen to you, but you are completely in control of your attitudes and reactions to them.” Following a disabling stoke, a seventy-seven-year-old woman realizes the futility of feeling sorry for oneself and making the most out of one’s abilities: “You know what happens in a pity party? Satan brings chips!” Such wisdom applies at any age.

There are some notable limitations to this book. It would appear that most of the participants in Pillemer’s study were financially well-off. It is unclear how well the voices of poor and middle-class Americans are represented. Likewise, it is unclear if the views of ethnic minorities or LGBT men and women are represented. Lacking such demographic details, it is difficult to judge if Pillemer’s experts are truly representative of older Americans. A mild criticism is that Pillemer asserts that older adults are wise because of the years they have lived. However, age alone is no guarantee of wisdom as any old fool attests. Plenty of children and young adults who have faced illness and death with dignity have shown that age alone is not a condition for wisdom. In spite of these caveats, 30 Lessons for Living is an interesting and helpful book to be read and shared with family, friends, and clients. For further reading on the wisdom of elders, I recommend What’s Worth Knowing and Life Gets Better by social worker Wendy Lustbader.

Daniel Kuhn, LCSW, is community educator for Rainbow Hospice and Palliative Care based in Mount Prospect, Illinois. Since 1987, he has focused on dementia care, end-of-life care, and family caregiving issues as a social worker and educator. He has authored or co-authored more than fifty publications and the third edition of his book, Alzheimer’s Early Stages: First Steps for Family, Friends and Caregivers, will be released in 2013. He is currently directing a three-year project to enhance the care of people with advanced dementia and to create the first “dementia-friendly” hospice organization in the Midwest. He can be reached at dkuhn [at] rainbowhospice [dot] org. 

ELECTION

The campaign season is heading into the final five weeks. The ads, solicitations for contributions, and pundit interviews will only overwhelm us more in the next few weeks, spiced by debates and polling. We strongly encourage our members to be informed voters. Instead of listening to ads and slogans and too often slanted news shows, go to your candidates' websites and follow their social media pages to get a clear picture of where they stand on issues, or if they even consider your issues important enough to mention. Almost all candidates use the web and social media now. Also do not hesitate to call your candidate's campaign office to ask where he or she stands on a particular issue. It is disappointing (but frankly not surprising) that most candidates do not mention human services at all in their issue statements and materials. We will have a lot of new members in the Illinois House and Senate next year, and educating them on health, human services, and education issues will be a huge task.

Remember that in addition to the election for president, all United States Congressional seats are up this year with newly drawn districts. All Illinois House and Senate seats are up this year too, also with new district boundaries. If you do not know what district you live in or who your candidates are, please ask us.

VETO SESSION

The veto session begins in Springfield on November 27, 2012. Public pension reform will be at the top of the agenda. Another issue is whether the Illinois General Assembly will override the governor's veto of funding for the state adult and youth corrections institutions he plans to close. Some of the savings from the facility closures could be used to restore funding cuts to the DCFS budget and other programs. We might see a vote on a marriage equality bill during the lame duck session too. Another bill we support that will likely be called for another vote is the school bullying prevention policies bill. The bill was HB 5290, but another bill (number unknown at this time) will be used as a vehicle for the language. The bill would add some basic requirements for local school district policies (e.g., you must have a complaint process and a contact person or persons) and require restorative educational elements to bullying prevention rather than one that is totally disciplinary. HB 5290 passed the Illinois House, but failed twice in the Illinois Senate by one vote last spring. An amended new bill would need to pass both houses again.

Another proposal that will be brought forth in the veto session will be a revision of the Mental Health and Developmental Disabilities Confidentiality Act. A draft is due out this week, and we will be reviewing it carefully and seeking member input. This is an initiative of the Illinois Office of Health Information Technology in implementing a Health Information Exchange (HIE) pursuant to the Illinois Health Information Exchange Act.  

OTHER STATE NEWS

The state's Health Care Reform Implementation Council has chosen Blue Cross/Blue Shield Blue Advantage Plan as its benchmark plan for essential health benefits under the Affordable Care Act (ACA). For an excellent source of ongoing information on health care reform, Google "Illinois Health Matters" or follow them on Twitter.

FEDERAL

Congress has passed a six month continuing resolution (CR) to keep the government operating through March 27, 2013. The CR includes a continuation of the TANF program, which was due to expire on September 30, 2012. It also includes funding for the SNAP program (formerly "Food Stamps"). Issues looming after the election include the "fiscal cliff", the possibility of across-the-board cuts of about 8% in discretionary programs as January 1st pursuant to the Budget Control Act of 2011. Other post-election issues include the Farm Bill, Federal Unemployment Insurance for the long-term unemployed, and the possible expiration on January 1st of the Bush era tax cuts for the wealthy.

Introduction

Social workers who are leaving employment for a new work setting or private practice are sometimes surprised and dismayed to discover that they may face legal limitations on their ability to transfer clients to the new work setting due to an existing non-compete clause contained in an employment contract or agreement signed months or years earlier.  The legal status of non-compete provisions varies considerably based on a number of factors including state law, the profession or business at issue, the nature of the non-compete’s  limitations, and the specific facts of the case.  Concerns about continuation of treatment for clients who are receiving mental health services are frequently raised by the clinical social worker who is planning a career transition.  This article will address the legal status of non-compete provisions applied to mental health professionals within health care and the applicable ethics considerations for social work practice.

To read the rest of the article, click here. NOTE: NASW login requried.

This conflict is certainly a complex one, but organizations and groups like the Illinois Mental Health Summit, NASW, and others play a crucial role in advocating on behalf of mental health consumers. Often proposals that affect service provision, like the one described above, are originated by departments or organizations outside the fields of social work, mental health, and other helping professions. While the Illinois Office of Health Information Technology is an expert on the technology and implementation of these databases, it lacks the client-based perspective so strongly emphasized by mental health and social work professionals. The goal of an HIE is quick and efficient access to medical records—certainly something beneficial to patients in many cases. However, professionals who work in mental health have long advocated for the added importance of confidentiality for mental health patients for myriad reasons, including social stigmas associated with mental health, shame felt by the client, and the sensitive nature of information shared by clients with mental health practitioners. Confidentiality laws are essential to best practices. First, the strict standards set forth by the MHDDCA and HIPAA give mental health patients power over the written history of their treatment. These laws give the patient the sole power to release, not release, or release only a portion of their records to another organization or individual. Second, confidentiality laws help clients trust practitioners. The emphasis on confidentiality and privacy in the NASW Code of Ethics are evidence of the centrality of trust to social work and mental health practice. That practitioners are legally—and ethically—bound to these standards is no small factor. 

The matter described above illustrates the necessity of advocacy by social workers on behalf of our clients. This year is an election year, and it provides social workers with an opportunity for advocacy. Election season is a reminder of the importance of interacting with legislators and policy makers. Participation in advocacy efforts requires an understanding of the big picture. Often social work students choose this field because they are drawn to the relational aspects of it—simply put, they are drawn to helping people. Social work has been affected throughout its history by the dual purpose of providing impactful direct services and advocating social justice. 

For information on the Illinois Office of Health Information Technology, visit: http://www2.illinois.gov/gov/HIE/Pages/default.aspx

If you want to get involved in election season, visit the NASW IL PAC site: http://naswilpac.org/volunteer/. 

The NASW Illinois Chapter has a Student Network Shared Interest Group (SIG) to provide support and networking opportunities for our student members. To find out more, visit the Student Network SIG page: http://www.naswil.org/naswil/sigs/student-network-sig/. 

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

OFFICE FOR RENT - Chicago/Lakeview: Spacious, fully furnished private office with lots of light near Diversey and Sheridan available full-time, by day or for shorter blocks of time. A comfortable waiting room, kitchenette, bathroom, copy machine, fax and internet connection are included in this three office suite occupied by mental health professionals. Close to public transportation; street parking available. Call Kitty Mann at 773-248-3701 or 773-469-9084 or email kbmann@uchicago.edu.

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/.

• School Social Worker - The Menta Group
• School Psychologist/Social Worker 3 - The Menta Group
• School Psychologist/Social Worker 2 - The Menta Group
• School Psychologist/Social Worker - The Menta Group
• Part-time Clinical Therapist - In-Home Counseling for Seniors
• Mental Health Therapist- Human Resources Center
• Licensed Clinical Social Worker - Professional Clinical Services

This past summer also kicked off the NASW Illinois Chapter Private Practice Shared Interest Group (SIG). Using the Google Groups platform, the Private Practice SIG is intended to provide a common place for private practitioners in the NASW Illinois Chapter membership to share knowledge and resources pertaining to their work; it also serves as a forum to share knowledge, ask questions, and seek advice. If you are in private practice or are contemplating going into private practice and want to join the online conversation, please contact the office, and we will send you an invitation to the group. 

In late July, over 1,000 attendees attended the 2012 NASW national practice conference Restoring Hope: The Power of Social Work. One of the major highlights of the conference was Jill Biden, PhD, announcing a new Joining Forces commitment aimed at educating all social workers, regardless of practice area or focus, to have a better understanding of issues relating to the care, culture, and lifestyle of our nation’s troops, veterans, and military families. The Joining Forces commitment means that more than 650,000 social workers—the nation’s largest group of mental health care providers—will have access to training and resources to help meet the needs of our service men and women, veterans, and military families. The national NASW office is also soliciting input for its’ Standards for Social Work with Service Members, Veterans, and Military Families. Submit your input here. 

In early August, the NASW Illinois Chapter provided public comments on the Colbert v. Quinn Consent Decree Implementation Plan. The Illinois Department of Healthcare and Family Services (HFS) is managing the Colbert Consent Decree, one of three class action lawsuits brought against the state of Illinois on behalf of persons with disabilities under the U.S. Supreme Court decision in Olmstead. The Colbert v. Quinn lawsuit was filed on behalf of nursing home residents with disabilities in Cook County. The consent decree was approved in Federal Court on December 20, 2011. The consent decree will provide Medicaid-eligible nursing home residents in Cook County with the array of supports and services that they will need in the most integrated settings appropriate to their needs, including community-based settings. The Colbert Draft Implementation Plan has now been filed and can be found on the Public Involvement area of the HFS Web site. HFS is interested in feedback. The NASW Illinois Chapter comments regarding the implementation plan can be found here. 

As of this writing, a delegation of NASW Illinois Chapter members (part of the chapter’s International Activities SIG) is preparing for a study trip to Hamburg, Germany. The delegation includes the following individuals:

1. Viviane Ngwa, LCSW, executive director of the Mentor Network (co-leader)
2. Bob Wolf, ACSW, retired , immediate past executive director of Family Service Prevention and Counseling, NFP (co-leader)
3. Lindsey Trout, school social worker from Champaign, Illinois, Villa Grove School District
4. Shonda King, LSW, medical social worker from the University of Illinois Hospital and Health Science Systems 
5. Richard Bograd, LCSW, educational therapist in private practice (who wrote this month’s “For School Social Workers” article)
6. Leslie Wood, MSW, school social work supervisor with Perspective Charter Schools and Certified Mediator
7. Jessica Bowen, MSW, family support specialist with the March of Dimes at Northwestern Hospital 
8. Kerry Liang, a new MSW from Loyola University 

The delegation will be focusing on the German system of providing social services in the schools as well as reactions to the UN Bill of Rights for Children and, if adapted by the United States, how it could/would impact current services in the U.S. A full report of the delegation’s work will be posted following the trip. 

I am sure you will find the September 2012 Networker feature article, “Veterans Healthcare Services and the Role of the Social Worker,” written by NASW Illinois Chapter At-Large Board Member Mary Gollings, of great interest. To learn more about this topic and other healthcare-related topics, as well as earn up to six (6) CEUs, please join us for our 2012 Regional Virtual Symposium on Healthcare on Thursday, September 20, 2012. Mary Gollings will be one of the featured presenters. For this year’s symposium, the chapter is teaming up with the NASW Missouri Chapter. You can participate from home or work as long as you have a computer with internet access and speakers. Seats are still available to attend the symposium on-site at the NASW Illinois Chapter offices in Chicago. For more information and to register, click here. 

Following the Supreme Court’s decision in late June upholding the Affordable Care Act (ACA), it is even more important that social workers understand the new law’s ramifications for social workers and the social work profession. 

Over the next several weeks, the NASW Illinois Chapter Political Action Committee (NASW IL PAC) will be announcing its endorsements in key Illinois State House of Representatives and Illinois Senate races. The PAC, which is a separately incorporated entity, is the political arm of the NASW Illinois Chapter. As a political action committee, NASW IL PAC endorses and financially contributes to candidates from any party who support NASW’s policy agenda. The PAC will be reaching out to members to get involved with campaigns around the state as we move towards the November elections. 

Enjoy this month’s issue!

Joel L. Rubin, MSW, CAE, has served as executive director of the 7,000 member Illinois Chapter of the National Association of Social Workers (NASW) since October 1999. He has over twenty-five years of nonprofit management and fundraising experience including extensive work with boards of directors, committees and volunteers, and advocacy around a wide variety of social work, human service, and international political issues. Joel is a graduate of the Wexner Heritage Fellowship Leadership Program and a current adjunct professor at the University of Illinois at Chicago Jane Addams College of Social Work as well as Loyola University Chicago School of Social Work.

The VHA is often thought of as a hospital where patients may seek inpatient and outpatient medical and mental health services. However, the VA is a holistic system of care, which aims to assist veterans with their psychosocial needs in order to optimize their medical, physical, and mental health care. As social workers, we identify closely with the need to recognize each component and system within a client's life. The VHA system values our social work perspective, which is evident by the vast roles social workers hold throughout the system. While providing counseling, therapy, supportive services, and case management to our veterans, we also serve as a vital team member in a system that relies heavily on the interdisciplinary model. To maximize one's health, we must address each barrier faced and all strengths our veterans possess. The social worker is depended upon to provide insight to the team on the specific psychosocial factors that can assist the patient achieve optimal care outcomes. 

The Veterans Health Administration has added many new and exciting programs to the already immense system in place to care for our nation’s veterans. The VA is expanding it’s scope to not only treat medical and mental health concerns, but it is also increasing its efforts to tackle housing, legal issues, caregiver support, and community planning. The continuity of care within the VA system is truly all-encompassing. 

There are very few areas within the system where social workers do not play a pivotal role. Whether interested in micro or macro practice, social workers have many options within the VA. Within inpatient areas, such as acute medical and psychiatric units, rehabilitation units, psychosocial residential rehabilitation treatment programs, and community living centers, social workers are key members of the multidisciplinary treatment team. Duties range from assessment and crisis intervention to family education and discharge planning, ensuring veterans return to a safe, supportive environment with the proper services in place to enable the veteran and his/her families to function at the highest level possible. Social workers in other programs assist veterans with readjustment in the community by partnering with residential care homes, homeless shelters and transitional housing sites, community nursing homes and adult day cares, and home care agencies, while others provide intensive outpatient case management to veterans living with severe mental illness. Clinical social workers provide evidence-based therapies such as cognitive processing and prolonged exposure therapies in post-traumatic stress disorder clinics, substance abuse treatment programs, and mental health clinics. We are in small clinics in rural communities as well as in large medical centers in metropolitan areas. 

Social workers also coordinate many programs within the VA system. Social work was leading the charge in developing a program for returning combat veterans from Afghanistan and Iraq. The Caregiver Support Program emerged in 2011 with many VA medical centers throughout the nation looking to social workers to coordinate this effort. Eligible caregivers of post-9/11 injured veterans can receive a stipend, which can help ease the financial burden of caring for their loved one. Social workers also manage programs for spinal cord injuries and disease, visual impairments, polytrauma rehabilitation, palliative care, therapeutic and supportive employment, homelessness, suicide prevention, veterans justice outreach, recovery implementation, medical and residential foster homes, and many more. 

On the macro level, social workers are service chiefs in mental health, geriatrics and extended care, veteran-centered care, and voluntary services. These social workers ensure that comprehensive services are in place for thousands of veterans within each facilities’ catchment area, and they are responsible for policies, procedures, and accreditation. We are health systems specialists, assisting medical center leadership with planning for future needs, public relations, developing new programs, and community planning. Social workers are associate directors and directors of medical centers, with the responsibility of seeing that the necessary services are available for veterans and families while remaining fiscally responsible. Social workers have also been in top leadership positions at the VA Central Office, speaking at congressional hearings on the many challenges facing the multiple generations of veterans today. 

There is great honor in serving those who have served our country. And there is great responsibility. VHA social workers strive to continue their education each year in order to address the unique needs of our population. From traumatic brain injury, suicide prevention, combat exposure, and best practices in therapeutic approaches, to federal guidelines and eligibility laws that govern veterans health care, our social workers are staying on top of cutting-edge research to best serve our patients within the VHA system. VHA social workers encounter the same challenges that social workers face across the nation. We work with loss, with complex medical problems, and the financial hardships our patients face. We see our patients' struggles as they, or their loved ones, advance in age. And we provide support to the families who stand by their sides. Receiving care or benefits through the VHA does not prevent a veteran from community care. In fact, the best care is often provided through a shared relationship between the VHA and the community. Resources seem to always be limited, but with combined efforts, we are able to optimize the support our warriors need. 

Mary Gollings, MSW, LCSW, is a social worker within the Department of Veterans Affairs Healthcare System. She has worked at both the Lovell Federal Healthcare Center (formerly the North Chicago VA Medical Center) and the Jesse Brown VA Medical Center in Chicago, Illinois. Currently, Mary serves our veterans as spinal cord injury program coordinator and the physical medicine & rehab social worker at Jesse Brown VA. She has also served on the Social Work Practice Committee and the Continuing Education Committee, as well as serving on regional and national projects to advance geriatric extended care services and direct patient care services within the VA system. She is currently serves as NASW Illinois Chapter Member At-Large.

Hilary L. Edgerly, LCSW, is assistant chief of social work service at VA Illiana Health Care System (VAIHCS) in Danville, Illinois. Hilary received her MSW from Southern Illinois University Carbondale in 2003 and began her career at the VA the same year. She has worked in many areas of the medical center including care management, community living centers, and returning combat veterans programs. She now supervises 18 social workers throughout multiple programs. There have been many improvements to services and procedures, suggested by Hilary, in her quest to provide the best possible care to our nation's veterans. 

Kaizen, which loosely translates to “change for the better,” is an improvement model first used during World War II. Dr. W. Edward Deming, statistician and quality control expert, helped improve the production and efficiency of American industries by eliciting input from all people involved in production and using this information to make small incremental changes to the process. Altogether, these small changes had a transformative effect, resulting in greatly improved speed and quality of the manufacturing of weapons and equipment (G. Krech, Morita Therapy lecture, July 15, 2012).

The United States used this same model to help rebuild a severely damaged Japan with a demoralized work force. The U.S. Air Force offered Japanese businessmen, a Management Training Program (MTP) that was largely based upon Dr. Deming’s principles of taking small steps toward change rather than spending money on large-scale innovations (Maurer, 2004). One recipient of this management program was Mr. Sakichi Toyoda, founder of Toyota Industries. With Toyota’s success, other Japanese companies embraced this method and in 1986, kaizen was made available to the rest of the world with Masaaki Imai’s book, Kaizen: The Key to Japan’s Competitive Success (Pandita, 2011). Although kaizen did not immediately catch on in other countries, it did get the attention of Dr. Robert Maurer, associate clinical professor at the University of California, Los Angeles School of Medicine. 

Dr. Robert Maurer discovered that kaizen benefited people on any project for change that they chose. Engaging clients to take almost embarrassingly small steps was the key to bypassing human’s innate fear response cycle. He noted that when the goal is too large, the brain triggers the fight or flight response, which blocks one’s access to the cortex (thinking, creative, decision-making part of the brain), resulting in failed responses. When an individual works with small goals, the opposite typically happens, fear is bypassed, and the cortex is engaged, resulting in successful responses (Maurer, 2004). In other words, when an individual’s internal state is regulated, they can use their whole brain, including creativity to address their circumstance. 

Dr. Maurer has identified six kaizen strategies, but for the purposes of this article I will focus on the strategies of asking small questions and taking small actions. The key to this questioning practice is to make the questions small enough so the client is almost guaranteed success. Equally important, the clinician needs to be attuned to the client’s skill-set, vulnerabilities, and past failures to assure that the client will respond to the questions. Finally, the answers need to be generated from the client, otherwise the client may feel like he/she is being manipulated or maneuvered into a change that you want to happen. 

Meet Jim, a high school student, diagnosed with depression, ADHD, executive function disorder, and a master procrastinator. His procrastination created a domino effect of missing or incomplete homework, papers, and projects, which severely lowered his grades, and reinforced feelings of inadequacy. This student had already failed countless times in spite of attending study skills classes and receiving some accommodations. The following dialogue is an example of asking small questions. 

Mr. B.: What is one small, trivial step you can take that might improve your school organization?

Jim: I don’t turn in all of my work, sometimes I forget assignments.

Mr. B.: So, what is one incredibly small, painless action you can take to help you remember your assignments?

Jim: I could write down all of my assignments in the school assignment notebook.

Mr. B.: What’s an even smaller action you can take to help you remember your assignments?

Jim: I could just listen to all of my teachers when they are explaining the homework.

Mr. B.: I know you are a good listener, but this still seems like a lot: listening and trying to remember the assignments of five different teachers.

Jim: Actually, my language arts class is the one where I am missing the most homework. I could make sure that I remember the homework for this class.

Mr. B.: Do you think you can remember just the reading assignment for tomorrow?

Jim: I can do that.

Remembering one reading assignment among all of his other academic responsibilities was hardly enough for him to succeed in high school, but when Jim asserted himself, saying “I can do that,” this marked a micro change, directing his will to do, to take action. It was symbolic of him throwing down the gauntlet, putting an end to waves of failure, and asserting that he can steady his own ship and explore new opportunities. Success builds success and over time, Jim was more energetic, engaged in assignments, and willing to take on more responsibility for his learning. Jim went from remembering assignments, to writing down assignments on pieces of paper and putting them into his pocket, to ultimately creating a three-week, at-a-glance assignment spreadsheet (last week’s work, current work, next week’s work) using Microsoft Excel. Jim’s problems did not magically go away, but he was able to move from idleness and ruminations to creating an organizational tool that supported his school success.

Admittedly, kaizen is the tortoise in a fast-paced, smartphone-savvy culture. Instead of quick fixes, kaizen offers slow and steady progress with the possibility of considerable results in the end. Lasting change can be initiated by simply asking small questions: How can you exercise a few minutes a day in your current schedule? What is one healthy food choice you can make today? What is one small step you can take to improve your relationship with your parents? Even by just thinking about these questions, fear can be bypassed, resulting in creative new answers. Unlike New Year’s resolutions that are attempted with great energy and enthusiasm but typically fizzle out, leaving a dark, dank residue of discouragement and despair, kaizen has traction and can help individuals create lasting changes in pursuit of a meaningful life. 

"The journey of a thousand miles begins with a single step."—Wisdom of the Tao Te Ching

REFERENCES

• Krech, G. ToDo Institute. Available Internet: http://todoinstitute.org
• Maurer, R. (2004). One Small Step Can Change Your Life, The Kaizen Way. New York: Workman Publishing Company.
• Pandita, R. Buzzle. Available Internet: http://wwwbuzzle.com/articles/history-of-kaizen.html.

Richard Bograd, MA, MS, MSW, LCSW, has worked with children, adolescents, and young adults for more than twenty years in various capacities: athletic coach, classroom teacher, learning specialist, educational therapist, director of special education services, and child/adolescent therapist. Richard uses many approaches, including Morita Therapy and kaizen to support children with particular needs and to assist adults navigate their way through college and beyond. Aside from working directly with individuals, Richard has been a tireless child advocate, offering unique perspectives on the way children with challenges learn and adapt, while procuring the necessary accommodations and services through the IEP process.

Susan Jacoby is angry.

She’s angry that marketers have perpetuated some destructive myths about aging in America and that those hardest hit are the oldest of the old, particularly women; angry that seniors are the target of a burgeoning industry designed to take advantage of the fears and false beliefs of those considered to be old; angry that some politicians threaten to initiate budget cuts to those who struggle most, through no fault of their own.

And she’s angry that she played a role in setting this up. 

“Age is just a number.” “60 is the new 50.” How many of us Baby Boomers have heard these statements and either sneered as we felt our aches and pains, or felt guilty when we read about those mighty octogenarians jumping from planes or running marathons? Susan Jacoby used to write those articles. In Never Say Die: The Myth and Marketing of the New Old Age, she attempts to undo the damage and right some wrongs that she sees as pervasive in our current culture.

The “new old age”, per Jacoby, is a myth perpetuated by those who want to keep us buying, uncomplaining, and undemanding of change. “We won’t sink into old age like our parents did,” we say, as if sheer will can halt the natural processes occurring within our cells. Exploding myths of the wisdom of old age, youth-oriented culture as a modern invention, and ever-increasing longevity as a positive societal goal, Jacoby is unapologetic for her biases. She is a feminist, a Democrat, and an atheist. Her thesis is that “junk thought” presents a view of aging as wrapped in a cloak of positivity and limitless potential. Our forced focus on positivity is the stuff of delusional thinking, she tells us, and it starts with our focus on looking, acting, and buying our way into seeming young and vigorous. A belief that we can make this happen eventually undermines the sociopolitical attention that is desperately needed to be drawn to some crucial issues, including health care needs, financial stressors (read: poverty, particularly for old women), and providing care for those over age 80. The ideas that many of us have about living out our old age in a utopian communal living arrangement by the sea, reading and sharing gardens and dinner, working as we please when we please, and caring for each other together as we age are challenged as Jacoby smacks us in the face with reality. Due to the fact that nearly half of us will eventually be living with Alzheimer’s disease and that most will be unable to meet our own daily needs at some point (let alone the needs of others our age), care will need to be provided by younger and stronger people. This will cost money, and lots of it. And many of us will sink into poverty just from medical costs alone. 

Jacoby also looks at American ideals of independence and the current economic realities that necessitate incomes throughout our 60s and into our 70s to enable comfortable retirements. Seeing these as simple shifts that we need to make, she tells us, completely leaves out realities such as the lack of employment opportunities in our “ageist” society. She reminds us that for some, their bodies make them unable to work past the traditional age of retirement due to a lifetime of manual labor that has taken its physical toll. And those in poverty before that age will become even poorer. 

Never Say Die is a book with a few simple messages. One of the most provocative ideas is that we blame the victim when we expect multiple losses to be handled “gracefully”. We would not make comparable expectations of other minority groups today, yet we hang on to the expectation that seniors behave in ways that are undemanding of us emotionally, as we respond much more positively to old people who are uncomplainingly accepting of their lot. 

But perhaps the strongest message of this book is also a call to action. Jacoby issues a challenge—Baby Boomers should drop the focus on what belongs to them financially and begin to join with younger people to leave a legacy for this country of health care for all Americans, regardless of age or income. This, in fact, would truly be a “new old age,” and the oft-cited sense of uselessness that accompanies being old would be replaced with a focus and pride in creating something substantial and desperately needed.

This book is a challenge on many levels. But Never Say Die is a thought-provoking wake-up call to all social workers about the realities of aging in America, a review of the problems that accompany it, and the suggestion of a way to make a lasting difference. 

Yes, Susan Jacoby is angry. And if enough of us get angry too, we just might be able to do something about it.

Ellen Leon Carbonell, MSW, LCSW, is associate director of family programs for the Alzheimer’s Association’s national office. She is responsible for developing and producing dementia-related family programs for chapter implementation nationwide, and oversees caregiver and early-stage support group programs for the association. Trained as a clinical social worker, Ellen has thirty years of experience working with individual and family programs in mental health, vocational, educational, clergy, and voluntary health care settings. She is a Licensed Clinical Social Worker in the state of Illinois and is a member of the American Society on Aging.

This month the Illinois General Assembly actually convened on August 17, 2012. The Illinois House was scheduled to come in on August 17, 2012, to decide whether to expel Rep. Derrick Smith (D-Chicago). The governor then decided to call both houses into a special session to consider pension reform. The Smith expulsion was approved by a large majority of house votes. Rep. Smith is under a federal indictment for allegedly accepting money in exchange for arranging a state grant for a constituent. He is still on the ballot in the November election as a Democrat.

The pension reform effort failed after the Illinois House amended an Illinois Senate pension bill to apply only to the General Assembly Retirement System (GARS) and the GARS bill did not advance. 

In light of Rep. Smith's expulsion, it might be a good idea to report on some of the changes in the Illinois General Assembly going into the veto session. Of course we are electing a new Illinois General Assembly in November with newly drawn district boundaries. However the current Illinois General Assembly may take up some very significant matters in the short time it has left. The recent changes in the Illinois House are as follows:

• 33rd District: Marcus Evans, Jr. (D) has replaced Marlow Colvin
• 34th District:  Elgie Sims(D) has replaced Connie Howard
• 37th District: Charles Krezwick (D) has replaced Kevin McCarthy
• 68th District: John Cabello (R) has replaced David Winters
• 86th District: Lawrence Walsh, Jr. (D) has replaced Jack McGuire
• 102nd District : Paul Evans (R) has replaced Ron Stephens
• 113th District:  Scott Penny(D) has replaced Tom Holbrook
• In the Senate, Pat McGuire (D) has replaced A.J. Wilhelmi in the 43rd District.

NEW PUBLIC ACTS

The governor has recently signed the following bills into law:

• HB 5602 which creates an exception to confidentiality of juvenile records by allowing police to share information about a current pending police investigation of  a student with local school officials regarding alleged criminal offenses. The stated purposes for the exception are (1) to protect the safety of individuals in the school and (2) to target the student for in-school services or interventions by community-based service agencies. 
• SB 278 codifies the Human Services Commission, which was previously created by an Executive Order issued by Governor Quinn. The bill specifies membership, purpose, and reporting responsibilites of the commission. There is no sunset date for this commission.
• SB 3544 amends the Abused and Neglected Child Reporting Act to provide that if an individual is the subject of a subsequent investigation that is pending, the Illinois Department of Children and Family Services (DCFS) shall maintain all prior unfounded reports pertaining to that individual until the pending investigation has been completed, or for twelve months, whichever is longer.

NASW ADVOCACY

We continue to pursue opportunities for social workers to participate in Medicaid Care Coordination networks.  The Department of Healthcare and Family Services is currently reviewing proposals from 20 networks.

Our efforts on new IDFPR rulemaking regarding continuing education is proceeding within the Department and we anticipate that proposed rules will be filed before the end of the year.

Negotiations continue with the Illinois State Board of Education regarding school social work student internships and the new statutory requirement that all interns first pass a content area test.  We are working with the Illinois State Board on proposed rules to ease the 600 clock hours of internship requirement, and we will also be collaborating on legislation to change this requirement as it applies to school social work students.

The increasing presence of human services organizations on social media sites creates new opportunities as well as new challenges for social work practice. An agency’s online presence on social media platforms such as Facebook, LinkedIn, and Twitter, and the use of web-based blogs may strengthen professional networks and increase client access to services and resources. It can also pose ethical challenges. These challenges relate to the need to maintain professional boundaries and uphold ethical standards. In general, the applicable ethical standards pertain to: privacy and confidentiality; informed consent; conflicts of interest, and solicitation of clients.

While most social workers these days would state that they would not accept a client’s “friend request” on Facebook, many find themselves confronted with situations involving social media where the ethical decision is not as easily determined. Consider, for example, the social worker who works for a non-profit agency that incentivizes contact by using a location-based social networking site for consumers to check-in. What implications does this have for privacy and confidentiality? Is informed consent needed? Does the social worker have an ethical obligation to address these issues with his/her employer? Similarly, how should a social worker in a children’s hospital respond to her employer’s request that parents share their child’s story on the hospital’s Facebook page? Are there ethical implications that need to be considered? Alternately, a social worker in a psychiatric unit may face an ethical dilemma about accessing a patient’s Facebook in order to gather information about suicidal risk in a person who presents to his/her department. Should this be done? If so, under what circumstance is it to be considered? These are just a few of the ethical challenges presented by the use of social media that go beyond the question of whether or not to friend a client on Facebook.

What standards in the NASW Code of Ethics (NASW, 1996, rev. 2008) serve to guide the social worker in addressing the aforementioned challenges? The following scenarios offer some suggestions to consider. 

Scenario #1 

Alex is a social worker for a non-profit agency that provides services for young adults, ages 18 to 21 years old. An issue of concern for the agency is frequent missed appointments. As one means of addressing this issue, the director wants to list the agency as a “check in” site on Foursquare. She believes the social game play aspect of the site is a way to engage the youthful population that is served, as well as increase visibility for the agency. As she explained to the staff, users of Foursquare, a geo-location social networking site, can “check in” while visiting a venue by accessing the app on a mobile device. Each check-in rewards users with points and or “badges.” The director hopes that incentivizing visits to the agency through this social networking site will result in greater compliance with appointments. She tells the staff that a client’s use of Foursquare would be completely voluntary as would be the decision to disclose his or her whereabouts.

While Alex understands the importance of encouraging a client’s regular attendance, he is concerned about the ethical implications of listing the agency on Foursquare. He is primarily concerned about client privacy and confidentiality (Standards 1.07a & 1.07c). He wonders what it would mean for a client to become “the mayor” of his agency by having the most check-ins and by that information becoming known to others. Foursquare’s feature called “Friends’ Recent Check-ins” lists all the places that the user and his or her friends have visited. In addition, Foursquare users can post their check-ins to Twitter and Facebook - thus creating another avenue for clients to disclose their connection to the agency. Alex questions whether his agency should encourage clients to identify their connections to the agency by having it listed on Foursquare. Furthermore, although client participation would be voluntary, he feels the agency has an ethical obligation to discuss any associated risks. Standard1.03 (e) in the NASW Code of Ethics which relates to Informed Consent helped guide Alex to understand his obligation to his clients. The standard reads: “Social workers who provide services via electronic media […] should inform recipients of the limitations and risks associated with such services.”

Alex decides to bring his concerns to his director. In doing so, he is guided by the standards in Section 3.09 in the NASW Code of Ethics that relate to social workers “Commitments to Employers.” In particular, Standard 3.09(d) states: “Social workers should not allow an employing organization’s policies, procedures, regulations, or administrative orders to interfere with their ethical practice of social work. Social workers should take reasonable steps to ensure that their employing organizations’ practices are consistent with the NASW Code of Ethics.”

Scenario #2

Nicole is a social worker at a children’s hospital. The hospital has an active social media presence on several platforms including Facebook and Twitter. The purpose of the hospital’s use of social media is multi-fold: to engage in consumer outreach; promote hospital events; disseminate health information; provide support, engage in fundraising, and create an online health care community. Another feature of the hospital’s use of social media is to promote its services by providing a section on its Facebook page for patients and patient’s families to “share their story.” Nicole has worked with many parents who decided to post accounts of their children’s medical condition and the treatment that was provided. 

While Nicole respects client self-determination (Standard 1.02, NASW Code of Ethics) and a family’s ability to make decisions on behalf of a child, she is uncomfortable with the fact that detailed health information is posted, sometimes with a child’s name and picture. The “Terms of Use” on the hospital’s Facebook page advises users that the information is available for all to see and users “post at their own risk.” Nicole wonders, however, if this constitutes informed consent. What about a minor child’s inability to participate in the decision making? As with Alex in the aforementioned scenario, Nicole is concerned about privacy and confidentiality, and informed consent. She believes she has a role in helping family members make informed decisions about the risks and benefits of revealing a confidential relationship. 

Nicole has additional concerns about the hospital’s social networking platform for patients’ stories. These pertain to standards in the NASW Code of Ethics regarding conflicts of interest, as well as solicitations. She is mindful that: “Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests” (Standard 1.06b, NASW Code of Ethics). She wonders if she unwittingly encouraged parents to post about the exemplary social work services she provided during their child’s hospital stay. If so, did she violate this standard and Standard 4.07(b) regarding Solicitations? The standard states: “Social workers should not engage in solicitation of testimonial endorsements (including solicitation of consent to use a client’s prior statement as a testimonial endorsement) from current clients or from other people who, because of their particular circumstances, are vulnerable to undue influence.” (NASW, 1996, rev. 2008). 

Nicole chooses to discuss her concerns with her social work supervisor. He, in turn, presents her concerns to the hospital’s ethics committee, of which he is a member.

Scenario #3 

Sydney is a recent MSW graduate who works in the psychiatric unit of a large medical center. A young man was admitted through the emergency room for an apparent overdose that was a possible suicide attempt. The admitting physician requests her help in locating information about the patient who was brought in by ambulance after being found unconscious in a public place. She suggests that Sydney search for the individual on Facebook and Twitter. She explains that she needs help in determining if the patient made any suicidal statements and if there are any factors that are mentioned that would facilitate his care.

Sydney is conflicted on how to proceed. As a social worker she believes that clients are entitled to privacy. Standard 1.07(a) of the NASW Code of Ethics tells her: “Social workers should respect clients’ right to privacy. Social workers should not solicit private information from clients unless it is essential to providing services […].” Would conducting an online search without the patient’s consent violate this standard? What would be the implications if she did not search for the information? Moreover, how could she be certain that the “John Doe” in the hospital’s care is the person whose Facebook she finds?

Sydney discusses these concerns with the physician and decides to conduct the search. Did she make the right decision? 

The above scenarios are examples of ways in which social workers may be confronted by ethical issues related to social media use in the workplace. Selected standards in the NASW Code of Ethics were used to illustrate the ways in which the code may guide practice. The reader is encouraged to consider additional standards that may also apply.

Conclusion

Social media is not a term specifically mentioned in the NASW Code of Ethics, yet several standards in the Code provide a useful guide for making ethical decisions when using social media. Practice standards contained in the NASW and Association for Social Work Boards Standards for Technology in Social Work Practice (2005) identify the need for technical competence in social work practice. With respect to social media use, it is important to keep in mind that technical competence goes beyond knowing what exists and how to use various social media platforms to also knowing when to use them, as well as when not to use them. Social workers have a role in maximizing the benefits of using social media in their worksites by knowing how to use its multiple incarnations in accordance with professional ethics. Social workers also have an ethical responsibility to shape the social media policies and procedures of the agencies where they practice.

REFERENCES

National Association of Social Workers. (1996, rev. 2008). Code of ethics. Washington, DC: Author. Retrieved June 10, 2012 from http://www.socialworkers.org/pubs/code/default.asp.

National Association of Social Workers & Association of Social Work Boards (2005). Standards for technology and social work practice. Washington, DC: NASW. Retrieved June 10, 2012 from http://www.socialworkers.org/practice/standards/NASWTechnologyStandards.pdf.

RESOURCES

Chernack, K.B. (2010). Professional boundaries in a virtually boundary-less E-environment. Update. (Sept/Oct). NASW-NYS.

ECRI Institute (2011). Social Media in Healthcare. PA: Plymouth Meeting. Author.

Kolmes, K. (2010). A psychotherapist’s guide to Facebook and Twitter: Why clinicians should give a tweet! Retrieved June 10, 2012 from http://www.psychotherapy.net/article/psychotherapists-guide-social-media

Kolmes, K. (2010). Location based check in sites for mental health professionals. Retrieved June 10, 2012 from http://drkkolmes.com/2010/02/26/location-based-check-in-sites-for-mental-health-professionals/. 

Malamud, M. (2011). It’s ‘better to be informed’ about tech tools. NASW News. 56(6), 4.

Reamer, F.G. (2009). Novel boundary challenges: Social networking. Social Work Today. Retrieved March 16, 2012 from http://www.socialworktoday.com/news/eoe/111309.shtml

Ron, M. (2011). Pause before posting: Using social media responsibly. Social Work Today 11(1). 8. Retrieved March 16, 2012 from http://www.socialworktoday.com/archive/020911p8.shtml 

Kathryn B. Chernack, DSW, LCSW-R, BCD, is chairperson of the NASW New York State Chapter Ethics Committee of which she is also a longstanding appointed member. She is director of clinical services for community residential programs at St. Christopher Ottilie(SCO) Family of Services and maintains a private practice.

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/. 

OFFICE FOR RENT - Arlington Heights: Located in north Arlington Heights: Space available in a 5-office suite, full or part time for counseling professionals. Suite has private entrance, large waiting room, bathroom, kitchen area and storage/play area. This contemporary, warmly furnished office provides a great atmosphere for individual, couples, or family practice. Collaborative work, Internet, as well as monthly consultation group is also available. Please contact Debbie at debbietalk@aol.com for more information and pictures.

OFFICE FOR RENT - Northbrook: Large, attractive, very comfortable office space in "condo- style" building with 24 hour access. Available for part time rental. Semi-private waiting area, excellent soundproofing, private washroom, handicap accessable. Fax, copier, shredder, refrigerator, and microwave available for use. On Dundee Rd, 1/3 mile west of Edens Expressway. Call Steve Field, MD (847) 564-5645.

PROFESSIONAL DEVELOPMENT: Announcing Upcoming Conference for Association of Christian Therapists October 4 – 7, 2012 2012 Theme “Reconciling Ethical Challenges in Healthcare & Healing:  Listening with the Heart of Jesus in the Workplace” Marriott Chicago – Schaumburg IL  Please contact: http://WWW.ACTHEALS.ORG Or Phone:  703-556-9222

OFFICE FOR RENT - Buffalo Grove: Buffalo Grove/Long Grove area. 1 office suite left among 8 other Psychology/Psychiatry/LCSW offices. New paint, New carpet. Private waiting room. Possible share situations. Call Susan (847) 913-1400.

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/.

• Social Worker - The Young Center for Immigrant Children’s Rights at the University of Chicago
• Licensed Therapists - Core Therapy Associates, Ltd.
• Child & Adult Therapist - Home of the Sparrow, Inc.
• Licensed Clinical Social Worker - Professional Clinical Services

One of the things that I have always enjoyed about social work and working in the field of child welfare was being able to engage with children and families and offering resources that provided enrichment in their lives. I have worked in the field of child welfare for the past twenty-one years and been employed with the Illinois Department of Children and Family Services for the past nineteen years; for me, it has never gotten old, and I never grow tired of the work that I do. 

I have learned over the years that child welfare is not only about dealing with children, families, abuse, and neglect, but it is also about addressing poverty issues, providing educational opportunities, and advocating for those who are unable to advocate for themselves. I have had the opportunity to work with some wonderful people, the kind of people who had a passion for children and were great teachers and role models for me. I desired to be that person for those who came after me, and I believe that I have. There are many dedicated individuals in the field of child welfare who work tirelessly to provide safety for abused and neglected children and reunify families whenever possible. I understand that family work is serious business because we are dealing with the lives of human beings daily.

Due to budget issues in the state of Illinois, things have gotten very difficult for the child welfare field, and it has caused me to reflect on what is really important when we are serving families across the state of Illinois. What is important is having the resources and staff to adequately address social issues that impact children and families in our communities. Unfortunately, the budget cuts will mean that a layoff will be implemented at the Illinois Department of Children and Family Services very soon, and many social workers as well as many staff who are essential to the work that we do will be laid off. This saddens me because it ultimately impacts the community and people who are the most vulnerable. 

The ideals that I carried as a young social worker just entering the field of child welfare were very simple, and it all seemed possible during that time in my career. Things are different now, not so simple. It is my hope that the legislators and those in power will get back to providing the support for those that are the most vulnerable in our communities. As I go forward, I know that being an advocate will become one of the most important parts of my work with vulnerable children and families because they will always need a voice.

Yolanda Jordan, MSW, LCSW, has an extensive background in abuse/neglect issues in the field of child welfare. As a placement manager with the Illinois Department of Children and Family Services, she is responsible for managing supervisors who are responsible for children who are placed in the foster care system. Yolanda is also a practicing psychotherapist and has been in private practice for the past ten years. Services are provided to children, couples, and families with a special emphasis on relationship issues that African American women face.

Yolanda is a graduate of Western Illinois University where she received her bachelor of arts in mass communications and master of arts in public communications human relations with a minor in African American studies. Due to her extreme love for people and having the heart of a servant, she continued her education and received a masters in social work with an emphasis on child and family practice from the University of Illinois at Chicago’s Jane Addams College of Social Work. Yolanda has been an active member of the NASW Illinois since 1996 and enjoys the work of advocating for the profession of social work and the community that social workers serve.

A workshop on The Affordable Care Act and the Impact on Community Health Providers will be presented by Stephanie Altman at this year’s 2012 NASW Regional Virtual Symposium on Healthcare on Thursday, September 20, 2012. This year’s symposium will be offering up to six CEUs. To read more about the symposium or to register, go to http://www.naswil.org. 

The Patient Protection and Affordable Care Act [2] (ACA) created a framework to provide health care coverage to the uninsured and the underinsured through both public and private avenues. The ACA aims to tackle several longstanding barriers to health care coverage including lack of health insurance portability, pre-existing health condition exclusions, insurance coverage limitations, benefits limitations, and lack of affordability of coverage. The strategies employed by the ACA to overcome these barriers include new mandates to provide insurance, new opportunities to purchase affordable insurance through subsidies, and new opportunities to qualify for public insurance. The theme is “shared responsibility” between the insurance industry, federal and state governments, employers, and individuals. In order to share the responsibility for providing comprehensive affordable coverage, new requirements are imposed on insurers, employers, and individuals. 

The ACA was designed to be implemented by federal and state governments in phases from 2010 until final implementation on January 1, 2014. Some of the provisions of the ACA are already in effect including the prohibition on excluding children based on pre-existing conditions, the prohibition on annual and lifetime maximums for insurance plans, coverage for dependent children up to age 26, elimination of co-pays for preventative services, and small business tax credits [3]. The major provisions of the ACA and the expansion of Medicaid do not go into effect until January 1, 2014 [4]. These provisions include the individual mandate to purchase insurance, the operation of state health benefits exchanges, the prohibition on exclusions based on pre-existing conditions for adults, the closing of the Medicare Part D doughnut hole, and the prohibition on annual limits and rating based on gender or health condition [5]. Although the expansion of Medicaid and major provisions do not go into effect until 2014, behind the scenes, the federal and state governments are currently working to create the data systems to enroll millions into coverage. 

The Individual Mandate and the American Health Benefit Exchanges 

One of the most controversial elements of the ACA is the individual mandate which requires most people [6] who are deemed financially able (and not eligible for Medicaid) to purchase insurance either through an employer or by purchasing an individual plan [7]. According to the Kaiser Family Foundation, almost nine in ten non-elderly people in the United States would either satisfy the mandate automatically or be exempt from it [8]. Exemptions to the individual mandate include religious reasons, undocumented immigrants, and very low income [9]. Those who are not exempt and who fail to purchase insurance will be subject to financial tax penalties [10]. The tax penalties for failing to purchase insurance start at $95 in 2014 and increase each year to $695 in 2016 [11]. The rationale for the individual mandate is to create a more even playing field for insurance so that the risk will be spread throughout both healthy and unhealthy populations.

The ACA also creates the establishment of a “health benefits exchange” in every state [12]. The exchange is intended to provide a user-friendly marketplace to allow consumers to purchase an insurance plan that best suits their needs [13]. The exchange has the potential to create a regulated and competitive environment that will ideally decrease the cost of health insurance [14]. States will have the option to implement increased consumer protections into the structure of the exchange [15]. These factors combined are predicted to make insurance purchased through the exchange more affordable. Furthermore, those persons who have incomes between 133% to 400% of the Federal Poverty Level (FPL) will be eligible for tax credits, which are intended to make purchasing insurance more affordable [16]. States may administer their own exchange or choose to administer the exchange through a federal-state partnership [17]. If a state fails to establish an exchange, the ACA provides for the establishment of a federally administered exchange [18]. 

The Medicaid Expansion

The ACA also significantly expands Medicaid by requiring states to cover nearly all people under the age of 65 with household incomes at or below 133% of the FPL beginning in January 2014 [19]. This expansion will mean that many low-income people who were formerly ineligible due to their failure to meet the categorical eligibility requirements will now be eligible for Medicaid. The federal Social Security Act and conforming regulations govern eligibility and coverage under Medicaid with some variation among the states [20]. Eligibility for and access to medical coverage under Medicaid and other public programs generally depends upon four major factors: categorical eligibility, citizenship/immigration status, income, and assets. Currently, categorical eligibility for Medicaid includes adults over age 65, pregnant women, children under age 19, parents of children under age 19, and people with disabilities [21]. However with the Medicaid expansion in 2014, this categorical eligibility will expand to include non-disabled adults without minor children [22]. Medicaid eligibility will remain the same for non-citizens (e.g., must be a legal permanent resident for five years, except pregnant woman and children; and no coverage for undocumented non-citizens).

Medicaid expansion for each participating state will be covered by the Federal Government at 100% of the state’s costs of coverage in 2014 with a gradual decrease in funding over time to 90% in 2020 [23]. In June 2012, the United States Supreme Court ruled that all of the provisions of the ACA are constitutional [24]. However, the Court held that states cannot be financially penalized if they fail to expand Medicaid to non-disabled adults without minor children [25]. At this time, it is not clear how many states will decide not to expand Medicaid or whether the Federal Government will impose any non-financial penalties on states that fail to expand. The decision to expand Medicaid is a critical one for states and for medical providers, as Medicaid is the largest insurer in the nation for people under age 65 [26]. The decision is especially critical for hospitals that provide uncompensated care to uninsured low income populations. 

Looking forward to 2014, we expect that over one million people in Illinois will be newly eligible for health coverage through the options offered under the Affordable Care Act [27]. The information hub for health care reform implementation in Illinois, www.illinoishealthmatters.org, provides current information, resources, and data on the Affordable Care Act. Providers including social workers, medical personnel, community-based organizations, and consumer advocates will all be critical to the successful implementation of the ACA and the integration of low income and hard to reach populations into care.

REFERENCES

[1] Stephanie Altman, Programs and Policy Director, Health & Disability Advocates, http://www.hdadvocates.org and http://www.illinoishealthmatters.org; Meryl Prochaska, Law Student, Loyola University Chicago School of Law, J.D, expected 2014.

[2] Patient Protection and Affordable Care Act, P.L. 111-148 (Mar. 23, 2010).

[3] Id.

[4] Id .

[5] Id.

[6] The individual mandate applies to lawfully present individuals, which will include citizens and some non-citizens.

[7] Id. Patient Protection and Affordable Care Act, P.L. 111-148 (Mar. 23, 2010).

[8] The Henry J. Kaiser Family Foundation, The Individual Mandate: How Sweeping? THE HENRY J. KAISER FAMILY FOUNDAITN HEALTH REFORM SOURCE, (Mar. 2012), available at http://healthreform.kff.org/en/notes-on-health-insurance-and-reform/2012/march/the-individual-mandate-how-sweeping.aspx 

[9] Id.

[10] Patient Protection and Affordable Care Act, P.L. 111-148 (Mar. 23, 2010).

[11] Id.

[12] Id.

[13] Id.

[14] Id; See also, The Henry J. Kaiser Family Foundation, What’s An Exchange? KAISER HEALTH NEWS, (July 2009), available at http://www.kaiserhealthnews.org/stories/2009/july/10/exchangesqa.aspx.

[15] Id; See also, Sarabeth Zemel, Abigail Arons, Christina Miller, et al., Building a Consumer-Oriented Exchange: Key Issues, NATIONAL ACADEMY for STATE HEALTH POLICY, (Feb. 2012), available at http://nashp.org/sites/default/files/Building_a_Consumer_Oriented_Exchange_final.pdf. 

[16] Patient Protection and Affordable Care Act, P.L. 111-148 (Mar. 23, 2010).

[17] Patient Protection and Affordable Care Act, P.L. 111-148 (Mar. 23, 2010).

[18] Id.

[19] Id.

[20] Social Security Act, 42 U.S.C. § 1396 et seq. (2006); 42 C.F.R. § 430 et seq. (2012). Every state plan consists of a mix of required and optional categories of health services. See also, 42 U.S.C. § 1396d(a) (2006). 

[21] 42 U.S.C. § 1396d(a). 

[22] Patient Protection and Affordable Care Act, P.L. 111-148 (Mar. 23, 2010).

[23] Id.

[24] Nat'l Fed'n of Indep. Bus. v. Sebelius, 567 U. S. ____ (2012)

[25] Id. 

[26] The Henry J. Kaiser Family Foundation, MEDICAID ENROLLMENT: DECEMBER 2010 DATA SNAPSHOT, KAISER COMM’N ON MEDICAID FACTS (Dec. 2011), available at http://www.kff.org/medicaid/upload/8050-04.pdf; See also, Medicaid and Medicare Summaries 2011, Centers for Medicare and Medicaid Services, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/SummaryMedicareMedicaid.html.

[27] www.visualizinghealthreform.org

Stephanie F. Altman, JD, is programs and policy director at Health & Disability Advocates (HDA). Stephanie joined HDA in 1999 as a staff attorney specializing in Medicaid, Medicare, and health insurance issues. She represents children and adults in individual and class actions and also advocates for quality, accessible health care through administrative and legislative avenues. Stephanie co-authored Medical Assistance Programs in Illinois and the Illinois Medical Assistance Action Plan and conducts presentations and workshops on Medicaid and other disability topics for family and community groups, medical providers and hospital staff, and the legal profession. Prior to coming to HDA, she was assistant professor of clinical practice at the Chicago-Kent College of Law, specializing in health and disability law, and staff attorney with the Legal Assistance Foundation of Chicago. Stephanie has her law degree from Loyola University School of Law and a BA in English from Grinnell College. 

On Hope and Transcendence - Reflections on the Intersection of Spirituality and Psychotherapy 

Many years ago, while working on my post-graduate degree, a professor suggested reading a book called On Caring written by Milton Mayeroff. To be honest, the title did not impress me as eloquent, presumptuous, or even complex enough to contribute to my personal quest to be the best version of a therapist I could fathom at that time. Yet, trusting my professor’s expertise and everlasting enthusiasm, I decided to follow his advice. 

As I was reading page after page of this easily understandable material, I came across a passage that would define my theoretical approach to therapeutic interventions. Milton Mayeroff stated: “[H]ope is not an expression of the insufficiency of the present in comparison with the sufficiency of a hoped-for future; it is rather an expression of the plenitude of the present, a present alive with a sense of the possible” (p. 32). 

Having worked with a variety of populations, crossing the intertwining paths of each and every defining characteristic that makes us unique, there has been a unifying voice: a need for transcendence. In its purest form, transcendence can be viewed as a quest for significance and interconnection with the Other. When you are in the shared space of the consulting room, and you as a clinician are allowed in the Other’s ethos, you become a tool to translate, facilitate, and identify the Other’s expression of self. 

Transcendence is a concept that is closely associated with hope in its essence, and a must-have curative factor in the consulting room. Transcendence is defined by Peterson and Seligman as, “strengths that forge connections to the larger universe and provide meaning” (Hood, Hill, & Spilka, 2009, p. 431). Hood at colleagues add that “the virtue of transcendence includes appreciation of beauty and awe, gratitude, hope, humor, and spirituality” (2009, p. 431).

In our role as clinicians, we cannot overlook these factors for the sake of rapid resolution of a client’s presenting problems. These features are an intricate component of our sense of well-being and our sense of belonging. When we connect to our clients as facilitators of change, we need to start from their construct of reality. This starting point leads to their goal-setting and the belief that they can achieve these goals. Hope and transcendence become a pathway towards successful fostering of their possibilities. Life orientations transform into a way of coping and transcending in the world that allows seeing yourself in a positive light.

How do hope and transcendence relate to spirituality and healing? How can we as clinicians effect the process, the continuum of well-being? It has been discussed that spirituality focuses on religious and/or mystical experiences. Yet it could also be argued that spirituality should be defined under strict theoretical and technical considerations according to how the person constructs his/her experience. 

For instance, consider the newly arrived immigrant, attempting to acclimate to her new context. This person’s worldview could be operationally defined as her destiny. This assertion takes us back to Mayeroff’s definition of hope, with the assumption that this person would have a better chance of improving her opportunities of success. In terms of spirituality, her strength to overcome multiple new challenges may rely on her conceptualization of a higher power that would assist her in finding meaning in her new endeavor. In this sense, spirituality transforms into a phenomenon that reveals efficacy in providing support to this person.

Consider the elder that has lost his life partner at a time in his life where it is hard for him to differentiate himself from his significant other. Spirituality may take up the form of security, a way of explaining himself in the here-and-now, towards the near future, for what there is to come. In terms of spiritual development, this elder may access spirituality as a way of explaining and moving through his grief process. Spirituality can be defined at its core as an experience; and as such, prime material for the therapeutic space. 

Spirituality has populated people’s narrative throughout history. When we engage in a therapeutic relationship with the Other, it is a paramount consideration in our work as clinicians to consider—and adopt—such narrative as a curative factor. When transpersonal experiences become the core of our therapeutic focus, we cannot deny the significance of prayer as it is practiced, the importance of meditation when it is used, the magnitude of a church/synagogue/temple/mosque when it is a supporting community. 

In his book Religion and Spirituality in Psychotherapy (2010), Dr. Thor Johansen discusses major developments in the field of psychotherapy in terms of integration between religion and spirituality. He notes that there has been a noticeable increase in publications on the subject, along with the inclusion of the religious or spiritual problem V Code as a diagnostic code in the DSM-IV. He also points out the promotion of professional organizations and degree programs that emphasize the focus on integration. 

In terms of practice interventions, spiritual assessments are gaining support and adherence to build a more integrated and holistic stance to assist in the person’s journey. The application of this information can be materialized through collaboration or referral. Clinical approaches that are spiritually sensitive include art therapies, narrative therapies, meditation, restorative justice, rituals and ceremonies, prayer, and stories of healing. As social workers, we have an ethical mandate for competency. Within the ethical standards of the profession, in particular cultural competence and social diversity, we can operate as clinicians in a safe, respectful, and ethical manner. 

Being a social worker with my own biases and beliefs, my own reservations and accomplishments, I invite and welcome the intersection of spirituality and psychotherapy in the hope, that we have a better chance at becoming more wholesome human beings. 

REFERENCES

Hood, R. W., Jr., Hill, P. C., and Spilka, B. (2009). The psychology of religion: An empirical approach. New York, NY: The Guilford Press. 

Johansen, T. (2010). Religion and spirituality in psychotherapy: An individual psychology perspective. New York, NY: Springer Publishing Company, LLC. 

Mayeroff, M. (1990). On caring. New York, NY: First Harper Perennial. 

Monica Guilhot-Chartrand, MSW, LCSW, is a bilingual clinical social worker, originally from Uruguay, who has served the community as a licensed professional in the states of Minnesota, Kansas, Missouri, and Illinois. She has practiced in the fields of behavioral health and social service with a specialization in clinical social work. She currently provides direct services through her work at Samaritan Interfaith Counseling Services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life-management issues. She also has training and experience in multicultural settings. She currently serves as NASW Illinois Chapter Member At-Large. 

ABOUT AUTISM

Inclusion is commonplace in the general education setting with autism at a growth rate of 10 to 17% per year (Autism Society, 2003). Students with autism can display a number of atypical behaviors that are not easily understood by their peers. Visual distraction, auditory stimulation, unusual eating habits, oversensitivity to touch, repetitive behaviors, and social skill deficits are very often confusing and troublesome for the typically developing child. Awareness of the reasons of these behaviors creates a mutual understanding and a sense of empathy toward students with autism once peers understand the challenges faced by the child.

So often in the past ten years I have been asked to provide classroom support for both a student with autism and classmates challenged by some of the behaviors displayed by a child with autism. Teachers are less concerned about the distraction than the peer relationship issues that arise as a result of the negative attention that ensues. Parents of children with special needs have a great desire for their child to be understood. Parents of typically developing children are equally concerned and have expressed their commitment to reinforce expected behaviors around children with autism. Students have been exemplary in demonstrating appropriate responses once they understand what their classmate is really experiencing. Schools must abide by laws in Illinois that mandate social emotional learning, and we need to educate students.

TEACHING AUTISM

Lessons provided in most preschool and kindergarten programs are sensory in nature. The five senses are used to teach children about how they experience the world around them. The sense of sound, sight, touch, taste, and smell are core concepts that are adapted into many subject areas. The five senses can also be useful when teaching children about autism. People with autism experience the environment differently. Very often there is a difficulty in the proprioceptive, vestibular, auditory, visual, or tactile system. “To improve student understanding and support of classmates with autism spectrum disorders students will 1) identify how the five senses help us gather information…. 3) students will learn how other people make guesses about what other people perceive, know and feel” (Gray, 2002, p. 1). Discussion of the difficulties faced by a person with autism gives the teacher an understanding of just how much children already know about autism and it’s effects.

THE SIXTH SENSE

A colleague heard me speak of this growing need to educate children about autism and recommended the book The Sixth Sense ll by Dr. Carol Gray. The book, together with the knowledge that children learn best through the senses, inspired me to develop a presentation using the five senses to explain autism. Each presentation focused on what children with autism have difficulty doing. The slide that addressed the sense of sight explained the challenges of giving eye contact to others. The slides on sound, touch, and smell focused on either high or low responses to the environment. A bell ringing could cause pain to someone with autism, but a tap on the shoulder may not even be noticed by a student with autism.

Further explanation was needed for the students in order to address the social and communication difficulties of those on the spectrum. People with autism spectrum disorder lack the ability to understand what others experience. “Theory of mind is...the main way in which we make sense or predict another person’s behavior. “ (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001, p. 241). People on the spectrum lack the ability to understand what others experience at varying levels. 

The slide I developed to explain the “sixth sense” listed the ways we learn to understand another person’s experience such as facial expressions and body language. I explained that repetitive behaviors and inability to pay attention cause people with autism to not be able to identify how others are feeling or thinking. Kids can identify with playing a video game or watching television when their parent is trying to get their attention. They can relate to the fact that they would have no idea what their parent was thinking or feeling as they were so involved in what they were doing. They can also attest to the fact that if they ignore their parents for too long, there will be consequences. 

ACTIVITIES

To enhance the learning experience, I developed activities to support the presentation in a fun and engaging manner. Play is an essential activity as it is a very natural way in which children learn. “Moreover peer play forces children to reason about others’ feelings, possibly serving as a unique mechanism for empathy development.” (Brownell, C., Zerwas, S., Balaram, G., 2002, p. 28). Each activity related to a particular challenge faced by children with autism. 

Each station represents one of the six senses: 

1. Bean Bag Toss (with goggles): Visual/Distraction
2. Tunnel Talk (Have a conversation from far away): Communication/Sound
3. Open the Candy (with oven mitts): Tactile
4. Flippers are Fun? (race with scuba flippers): Gross Motor Difficulty
5. Smell the Roses (mislabeled): Smell
6. Taste Test (Not labeled correctly): Salt vs. Sweet
7. Speaking a Foreign Language (Student speaks to others but not in English): The Sixth Sense

After the student completed each station, they were asked what their experience of the activity was like. Their response was written down by a parent volunteer. At the close of the session the adjectives they used to describe their experience were collected and presented. Comments such as “It was hard,” “I was annoyed,” “I could not do it,” are read. The program ends with the comment that this is how it can be for a student with autism every day. The last question asked is, What can or should we do for people with autism? Students have wonderful answers to this question. It should be emphasized that sometimes people with disabilities do not always need or want help.

PARENT INVOLVEMENT

Reinforcement of expected behaviors can be further supported by involving parents in educational programming on autism. “For children, involvement of their parents is reported to lead to improvements in children’s attitudes, behavior and attendance at school, as well as in their mental health.” (Hornby, 2011, p. 2). Parent involvement can serve many purposes. Parents are better able to understand the challenges of autism that their children experience. Parents can also assist in the facilitation of the program by learning and proctoring the activities in which their child can participate. While serving as a volunteer parents are able to help their child integrate the lessons taught. 

ILLINOIS LEARNING STANDARDS

Educating students about autism meets the Illinois State Social Emotional Learning Standards. Teaching awareness of others and interpersonal skills to establish and maintain positive relationships are requirements included in the Illinois Learning Standards. “These standards have been developed in accordance with Section 15 (a) of Public Act 93-0495. This Act calls upon the Illinois State Board of Education to develop and implement a plan to incorporate social and emotional development standards as part of Illinois Learning Standards.” (ISBE, Referenced, 2012). Other social emotional learning goals include “developing self-awareness and self-management skills to achieve school and life success” and “demonstrating decision-making skills and responsible behaviors in personal, school and community contexts.” (ISBE, Referenced, 2012). Any of these goals could potentially be addressed in educating children about autism. 

There are additional benefits of teaching social and emotional learning in the school beyond improving attitudes and behavior. There is compelling research that supports better academic performance. “J. David Hawkins evaluated Seattle elementary and middle schools...in comparison to non-program schools and found...better scores on standardized achievement tests.” (Goleman, D. 1995, p. 307). The fact that social emotional learning correlates with positive academic achievement is critical, as there are so many demands on teacher’s time to produce outcome of student progress. All curriculum needs to be supported by research-based evidence of the efficacy of the program. 

Carol Gray’s research lead to a very successful and well regarded program in the school district that I work. It has reached so many parents, teachers, and students while ensuring confidentiality. It covers topics related to awareness of self and others. It gives parents the opportunity to be a part of affecting change. It gives parents of children with autism the peace of mind that others have a better understanding of their son or daughter. The program is another way that we as school social workers can “pursue social change particularly on the behalf of vulnerable individuals and groups of people” (Social Work Code of Ethics/Principles, Referenced 2012). Disability awareness is another way to immerse students in an environment of understanding and empathy. We need to provide these opportunities to children in school so they recognize and experience the compassion and understanding that they truly possess.

REFERENCES

1. Autism Society of North America (2003). Facts and Statistics. Referenced July 2012, from http://www.autism-society.org/.
2. Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., and Plumb, I. (2001). The “Reading the Mind in the Eyes” test revised version: A study with normal adults with Asperger Syndrome or high functioning autism. Journal of Child Psychiatry, 42(2), 241–251. 
3. Brownell, C., Zerwas,S., and Balaram, G. (2002). Peers, cooperative play and the development of empathy in children. Behavioral and Brain Sciences, 25(1 ), 28–29. 
4. Goleman, D. (1995). Emotional intelligence. New York: Bantam Books.
5. Gray, C. (2002). The sixth sense ll. Arlington, Texas: Future Horizons.
6. Hornby, G. (2011). Parental involvement in childhood education. New York: Springer Science.
7. Illinois State Board of Education. Illinois Learning Standards for Social/Emotional Learning. http://www.isbe.net/ilssocial_emotional/standards.htm. Referenced July 2012.
8. National Association of Social Workers (2008). Ethical Principals to the Code of Ethics. Referenced July, 2012, from http://www.socialworkers.org/pubs/Code/code.asp.

Kathleen Jirasek, MSW, LCSW, is a graduate from Loyola University of Chicago and is employed at Hinsdale Elementary School District 181. She holds a Type 73 school social work certification. She is a member of the National Association of Social Workers and the Illinois Association of School Social Workers. Kathleen is certified as a district trainer for Lions Quest Skills for Adolescence and Skills for Growing Social Emotional Learning Programs. 

CEU Opportunity for Reading This Article!
NASW Illinois members can earn one CEU by completing an online quiz (LINK) regarding this article! The free CEU opportunity is only valid until October 1, 2012, after which the CEU fee will change to $15.00. Nonmembers must pay the regular $10.00 rate for the CEU, which will increase to $15.00 after October 1, 2012.

As providers in the mental health field, most of us have weathered significant changes in the way mental health services are provided. In the past two decades, there has been greater emphasis placed on diagnosis and pharmaceutical treatment of mental health conditions. How have the changes influenced recipients of mental health services? Is it possible that a mental health diagnosis in and of itself influences the individual’s self-identity? Does pharmaceutical treatment chemically change an individual’s personality? Is it possible that diagnosis and pharmaceutical therapies alter an individual’s emerging personality when treatment is provided early in life? 

In her book, Coming of Age on Zoloft: How Antidepressants Cheered Us Up, Let Us Down, and Changed Who We Are, Katherine Sharpe discusses her years of treatment for depression. Katherine was initially diagnosed with depression after moving away to college. She had some initial struggles adjusting to the changes and went to the college health center for assistance. Katherine reports that her appointment lasted twenty minutes and resulted in a diagnosis of depression and a prescription for Zoloft. While concerned about taking an antidepressant, Katherine states that she began to feel better and adjusted to school establishing a good support base and doing well in her courses. Katherine didn’t tell any of her friends about her diagnosis or medication until one afternoon in her sophomore year. To her surprise, all seven girls involved in the discussion reported having been on or currently taking some form of an antidepressant. This started Katherine thinking. 

Katherine discusses the turmoil she experienced in taking the antidepressant. Her belief was that depression was an illness and antidepressants were the formal treatment for such an illness. Katherine had never really seen herself as sick. She reports struggling with feeling less anxious on the antidepressant, meaning that it worked. Could it be that this was proof that she truly was mentally ill? How could all seven of her friends also been diagnosed with a mental illness and prescribed antidepressants? This experience caused her to question the validity of her diagnosis and the diagnostic process itself. These questions often created an inner turmoil over whether or not to continue the medication; however when she discontinued the treatment her symptoms often eventually returned. This pattern also seemed to support that she was mentally ill.

The author does an excellent job of providing a brief informative overview of several factors that have influenced mental health treatments in the past twenty years. She includes a synopsis of both the advent of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the beginning of pharmaceutical treatments. She also discusses the difficulties that some experience in discovering effective medication that don’t impose significant negative side effects.

For a period of time in reading the book, I was concerned about the author’s focus and how this could negatively influence readers in their treatment decisions. As the author’s story unfolds, her real focus seems to be about her own self-discovery and how both medication and eventually therapy supported her through this discovery process. In the last third of the book, the author begins therapy for the first time after years of “treatment” for depression. The author begins to give up the quandary about who she might have been had she never begun treatment for depression and begins to focus on what might have happened without such treatment. It is through this discussion that the author makes some very valid points for persons struggling with mental illness and for providers. As providers we need to do a better job educating clients about medication, their function, and their limitations. We also need to discuss the diagnostic process and what a mental health diagnosis truly means for the client. Finally, all the research shows that the best form of mental health treatment consists of a combination of medication and therapy. As professionals, we must continue to defend the significance of therapy as a necessary element for the treatment of mental illness. Medication alone will never suffice. In this book Coming of Age on Zoloft, the significant point is that antidepressants have provided an excellent tool to support the recovery process. Medication can assist in stabilizing an individual’s mood. The problem is that it isn’t and will never be the answer to mental illness. Therapy must always be an essential component to the treatment process. 

An effort to address this situation began this summer by Annette Johnson of the University of Illinois at Chicago (UIC),  Brenda Lindsey of the University of Illinois at Urbana-Champaign, and Mary Bragg, president of the IIllinois Association of School Social Workers (IASSW) to engage appropriate staff at the Illinois State Board of Education in an attempt to negotiate a solution to the problems created by P. A. 97-607. I set up a meeting with Linda Tomlinson, who is in charge of certification at ISBE, and we met with Linda on July 12, 2012, in Springfield, Illinois. We were pleasantly surprised to find out that Linda was in agreement with our proposal to amend the provisions of the School Code on internships and content area testing. However, since the General Assembly is not scheduled to reconvene until late November for Veto Session, we agreed that a legislative fix would not address the 2012–2013 academic year. 

We then discussed options for 2012–2013. We agreed that a student who had not passed the content area test could engage in a practicum or field placement starting at the beginning of the school year. The content area test is being offered on November 10th, a student would be able to take that exam and get the results back by December 7th. If successful, the student could commence his or her internship from that day forward. The problem then would be satisfying the 600 clock hour requirement between December and the end of the school year. We agreed to have another meeting once a discussion was held with representatives of the other universities.

That conversation was held on July 18, 2012. It included most of the universities and NASW Illinois Chapter Executive Director Joel L. Rubin participated in the call. There were a lot of concerns expressed about the 600 clock hours, the timing of the exam, and paid internships since the state board is not allowed to reimburse school districts for the student's services unless they are in an internship. 

Annette, Mary, Brenda, and I had a follow-up conference call with Linda Tomlinson last week. She agreed to pursue an amendment to the ISBE administrative rules regarding the 600 clock hours of internship that would align the rules with CSWE standards, which are less stringent in regard to internship hours. It should be noted that the 600 hour requirement is not in statute, only in rule. A rules amendment can be completed faster than a legislative change. However we will still be working with the state board on a legislative change regarding the completion of the test, but it is very likely we will not be able to introduce legislation until the spring session. She also agreed to see if the results of the November 10th test could be made available sooner than December 7th. 

We are hoping to have a follow-up conversation with university representatives this week.

In other news, the governor has called a special session of the Illinois General Assembly for August 17, 2012, to consider pension reform. This is the same day the Illinois House will convene to vote on whether to expel Representative Derrick Smith for misconduct stemming from criminal charges brought by the U.S. attorney's office in Chicago. Also, Representative Connie Howard, who was not running for re-election in 2012, resigned this month. Representative Howard represented a district on the southeast side of Chicago for years. She will probably be replaced by Elgie Sims, who won the Democratic primary election in March. Elgie is a a former senate staffer and lobbyist.

Through the work of the Legal Defense Fund, NASW has participated with a coalition of allied organizations to file amicus briefs in two cases where the plaintiffs have challenged the legality of the Defense of Marriage Act (DOMA) (1996), the federal law that defines marriage as between one man and one woman for purposes of federal benefits, regulations, and other federal matters. The cases are Massachusetts v. United States Department of Health and Human Services (DHHS) and Golinski v. Office of Personnel Management (OPM). This article reviews each of the cases to provide an understanding of the legal issues requiring review by the U.S. Supreme Court in order to make marriage and its benefits equally available without regard to a person’s sexual identity.

For a complete up-to-date list of ALL classified ads, be sure to visit the NASW Illinios Chapter Classified Ads: http://www.naswil.org/news/networker/networker-classifieds/.

OFFICE FOR RENT - Evanston: Windowed office w/sink and waiting room in Carlson Bldg in downtown Evanston for sublet on Friday, Saturday and Monday. This is an attractive office in a well maintained classic medical building. Contact Daniel Gray, LCSW at 847-604-0555.

OFFICE FOR RENT - Frankfort: 2 offices in 5 office suite with social workers, psychiatrist, psychologists, counselors. All have windows. By hour, day or month. Classroom and group room available. Shared reception room. Call 815-469-8876 or e-mail acompaan@sbcglobal.net.

PROFESSIONAL DEVELOPMENT: Announcing Upcoming Conference for Association of Christian Therapists / October 4 – 7, 2012 / 2012 Theme / “Reconciling Ethical Challenges in Healthcare & Healing:  Listening with the Heart of Jesus in the Workplace” / Marriott Chicago – Schaumburg IL / Please contact:  WWW.ACTHEALS.ORG / Or Phone:  703-556-9222 

OFFICE FOR RENT - Chicago/Lakeview: Spacious, fully furnished private office with lots of light near Diversey and Sheridan available full-time, by day or for shorter time blocks. A comfortable waiting room, kitchenette, bathroom, copy machine, and internet connection are included in this three office suite occupied by mental health professionals. Close to public transportation; street parking available. Call Kitty Mann at 773-248-3701or 773-469-9084 or email kbmann@uchicago.edu

OFFICE FOR RENT - Arlington Heights: Bright, sunny, furnished office in 3 office suite, plus waiting room and bathroom. Handicap accessible. Plentiful parking. Days, evenings, and weekends available. Call Drs. Sandra Viola or Rebecca Bier. (847) 670-9123.

OFFICE FOR RENT - Buffalo Grove: Buffalo Grove/Long Grove area. 1 office suite left among 8 other Psychology/Psychiatry/LCSW offices. New paint, New carpet. Private waiting room. Possible share situations. Call Susan (847) 913-1400.

NASW ILLINIOS CHAPTER JOB BOARD

For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/. 

• Child & Adult Therapist - Home of the Sparrow, Inc.
• Licensed Clinical Social Worker - Professional Clinical Services
• General Director - JCC Chicago
• Group Therapist - Compass Health Center
• Addiction Specialist - Human Service Center
• Social Worker (Kellogg Cancer Center) - NorthShore University Healthsystem
• Resource, Social Worker (Care Management/Social Services) - NorthShore University Healthsystem
• Therapist/LCSW - Decatur Psychological Associates
• Licensed Psychotherapist - Anxiety & Stress Center, P.C.

The new NASW Illinois Chapter leadership team, who were recently elected or re-elected to board positions, officially began their terms on July 1, 2012. A full profile of the 2012–2013 NASW Illinois Chapter Board of Directors can be found here. We look forward to their leadership. 

On behalf of the chapter, I would like to thank the following members of the NASW Illinois Chapter Board of Directors who completed their service to the association on June 30, 2012.

• Maudette Care, Secretary
• Joan Lodge, Jane Addams District Chair
• Travis Nottmeier, Southern District Chair
• Joan Ente, Member At-Large
• Megan Sarasek, Graduate Student Representative
• Sherri Funk, Undergraduate Student Representative

I would also like to thank Joe Monahan and Diana Stroud from Illinois for their service as they conclude their respective terms as Region IX Representative and National Treasurer. Not to worry though as Illinois will continue to be well represented by past NASW Illinois Chapter President, Kathy Wehrmann, as Region IX Representative on the National NASW Board of Directors (Regional IX now includes Illinois , Iowa, Kentucky and the International Chapter). 

As we enter the summer, I wanted to provide an update on several member initiatives currently in progress:

• Private Practice Shared Interest Group (SIG) Google Groups: Following a focus group and survey to private practitioners in the membership, an online Private Practice Shared Interest Group (SIG) forum has been established. Using Google Groups as its platform, this online forum is intended to provide a common place for private practitioners in the NASW Illinois Chapter membership to share knowledge and resources pertaining to their work. With over 1,000 private practitioners in the NASW Illinois Chapter, we hope the Private Practice SIG will become a vital way in which our private practitioner members communicate with one another statewide. This online forum is intended to put be the voice behind private practice and hopes to provide help where it can in pushing private practice forward as a stronger force in the world of social work. I would like to thank NASW Illinois Chapter member Justin Tobin for his assistance in moving this project forward. 
• Jobs Summit Work Groups: Working groups following the February 2012 Social Work Jobs Summit have been meeting for the past two months, with a significant amount of collaboration between the schools of social work around the state and employers in the practice arena. A set of recommendations and action steps will be developed later in the year. 
• NASW Illinois Chapter Political Action Committee (NASW IL PAC): By late July, the NASW IL PAC will be in full election mode, working to support NASW Illinois Chapter–endorsed candidates and to mobilize NASW Illinios Chapter members to become involved in the election process. For more information, contact Kyle Hillman at khillman [at] naswilpac [dot] org. 

During the month of July, the chapter is offering a half-day training on The Role of the Mental Health Provider in Treatment Adherence: HIV/AIDS as a Case Study. This training is free for NASW Illinois Chapter members and is taking place in collaboration with the national NASW HIV/AIDS Spectrum: Mental Health Training and Education of Social Workers Projects to support the implementation of the National HIV/AIDS Strategy (NHAS), which focuses on the twelve metropolitan areas in the country most severely affected by the HIV epidemic. To register go to http://www.naswil.org/calendar/events/2297/.

I hope you enjoy this month’s issue of the Networker. Several of this month’s articles are related to HIV/AIDS issues, including an article by Nathan Linsk and Rita Amadi, who will be presenting at the July 20, 2012 event, as well as an ethics-related article by Ruth Lipschutz on “Ethical Considerations with HIV/AIDS.” 

Additional features include a private practice article by Rob Smith, “Instilling Hope and Resilience in Marriage After an Extramarital Affair,” and a school social work article by Jane Herron. I had the opportunity to write this month’s book review, which reviews an important book that was published this past March, Social Work Matters: The Power of Linking Policy and Practice, edited by Elizabeth Hoffler and Elizabeth J. Clark. I hope you find it of interest. 

Enjoy your summer!

Joel L. Rubin, MSW, CAE, has served as executive director of the 7,000 member Illinois Chapter of the National Association of Social Workers (NASW) since October 1999. He has over twenty-five years of nonprofit management and fundraising experience including extensive work with boards of directors, committees and volunteers, and advocacy around a wide variety of social work, human service, and international political issues. Joel is a graduate of the Wexner Heritage Fellowship Leadership Program and a current adjunct professor at the University of Illinois at Chicago Jane Addams College of Social Work as well as Loyola University Chicago School of Social Work.

A number of factors are known to positively affect medication adherence for chronic illnesses. These include use of available supports, a means to accommodate one’s daily routine, an understanding of the implications of poor adherence, and individualized problem-solving strategies within a culturally competent framework. 

Adherence to medication has been a particular challenge for people living with HIV/AIDS due to the need for high levels of medication maintenance to avoid development of drug resistance. To address the issue of HIV/AIDS adherence, social work and mental health professionals have developed a number of techniques to assess and strengthen readiness; supported successful adherence through dialogue about challenges and solutions; and provided a holistic approach to empower clients and families. The National Association of Social Worker’s (NASW) HIV/AIDS Spectrum Project has developed a successful social work–based intervention—the ADHERE model—which utilizes these elements. While this approach was developed within the context of HIV/AIDS, the principles and techniques may be applied to a variety of chronic health situations. 

On July 20, 2012, the NASW Illinois Chapter will present a 3.5 CEU workshop on The Role of the Mental Health Provider in Treatment Adherence: HIV/AIDS as a Case Study as part of the NASW Spectrum HIV/AIDS Project. The goal of the NASW Spectrum HIV/AIDS Project is to provide the necessary HIV and mental health practice skills for people working in social work, mental health, and substance abuse fields to enhance and promote culturally competent practice with individuals, families, and communities affected by HIV/AIDS. 

As the National HIV/AIDS Strategy (NHAS) is implemented, the NASW Spectrum Project is conducting the NASW Chapter HIV/AIDS Partnership Initiative which will sponsor workshops in twelve cities identified by the NHAS as having the highest HIV/AIDS prevalence in the United States; there will be additional workshops in three states identified as having emerging communities particularly affected by HIV/AIDS. This collaboration with the NASW is to support the NHAS’s goals by increasing the number and diversity of providers through continuing education and professional development. The NASW Illinois Chapter is one of the first to host these workshops.

Using HIV/AIDS as a case study, the content of this workshop will review factors affecting adherence, the role of the mental health care provider in adherence, the benefits of harm-reduction strategies, and stages of behavior change to identify barriers and steps to adherence. A holistic practice model will be reviewed as one step towards promoting culturally competent practice with women, their family, and within the broader communities affected by HIV/AIDS. In addition to demonstrating the ADHERE model, the workshop will use interactive case-based exercises to encourage participants to formulate ways in which to apply the approach in their own practice and program development. 

This project is funded through the NASW Chapter HIV/AIDS Partnership Initiative, in collaboration with the NASW HIV/AIDS Spectrum Project (CMHS #280-09-0292).

To sign up for the 3.5 CEU workshop on The Role of the Mental Health Provider in Treatment Adherence: HIV/AIDS as a Case Study on July 20, 2012, plesae click here to register: http://naswil.org/calendar/events/2297/. 

Nathan L. Linsk, PhD, is professor of social work in family medicine at the University of Illinois at Chicago and founder/co-investigator of the Midwest AIDS Training and Education Center. His areas of research includes family care, older adults, HIV, and HIV medication adherence and health professional training. Nathan helped develop social work educational programs, case management programs and para-social work training for orphans and vulnerable children in several countries including the United States, Romania, Ethiopia, and Tanzania. He is founding co-editor of the Journal of HIV/AIDS and Social Services (2001 to present).

Rita Amadi, MSc, LCSW, has over eight years of experience working in the field of HIV/AIDS at a public agency. She currently works as health administrator with the Ryan White Program. Rita has worked as HIV surveillance staff, streamlining HIV/AIDS reporting, and supporting information dissemination. Rita has also worked as a communicable disease control investigator conducting HIV counseling, testing, and partner notification for syphilis patients. Rita has extensive experience working with kids with developmental delays. She is currently a PhD candidate at Loyola University Chicago School of Social Work. Her research interest focuses on immigrants and HIV/AIDS.

Many couples come to marriage counseling after one partner has had an extramarital affair. Both spouses may be expressing anger, fear, blame, hopelessness, helplessness, and despair. They just don’t know what to do to salvage their marriage. Some want to do whatever it takes to stay married. Sometimes the betrayed partner doesn’t know how to get rid of the negative feelings and thoughts. The partner who committed the betrayal may have much confusion about why he/she had the affair, and shame leads him/her to not wanting to discuss it with the other partner. One or both partners may be ambivalent about staying married, hold much anger and resentment, and may have already discussed divorce. In any case, both have come to marriage counseling, which may be a very important indicator that they want to remain married. They need to learn new skills to regulate their emotions and properly express themselves.

Couples often present themselves with similar identifiable interactional patterns. However every couple has different beliefs about what led to them being in their current predicament. Most couples have not placed much emphasis on maintaining their marriage connection. They haven’t dated, had personal intimate conversations, or had sex in quite some time. Their focus has been on their day-to-day lives, children, work, family, and financial stressors. It is also common that the couple is conflict avoidant, so resentments may build as issues are not discussed. When they do discuss their issues, they may have extreme arguments. Becoming locked into who-is-right-and-who-is-wrong–gridlocked thinking may lead to experiencing feelings of despair and hopelessness, or what Viktor Frankl (1984) called the “existential distress.”  

Outside relationships often begin due to the lack of connection in a marriage. Individuals may begin by having an innocent conversation with someone. These conversations may then lead to spending more time with this person. According to Shirley Glass (2003), the individual begins to have more intimate conversations and have fun together with this new person, also known as the “emotional affair.” Sooner or later the innocence transgresses set marriage boundaries, and the couple begins to engage in sex, more commonly known as the “extramarital affair.” (Glass 2003)

Affairs may be a way in which individuals avoid his/her own problems with emotional or sexual intimacy. The longer the avoidance, the more distant partners becomes from their spouse. It is like living in a fantasy world where the spouse having the affair totally separates the marriage from the affair. They begin to live two lives in a secret world. According to Shirley Glass (2003) most affairs average two years in length. Partners often find out about the affair, and their marriage goes deeper into chaos. 

According to William O’Hanlon (2001), marital therapy is a means of assisting a couple in changing their problematic relational patterns. Moving from blame (i.e., who is right or who is wrong interactions) to both partners taking responsibility for their own behaviors in the present is a primary goal in therapy. The partner who has been betrayed needs to develop trust. 

Partners who had the affair need to show their spouse that they are truly sorry for wronging them. They need to answer many questions about what led to their seeking someone outside of the marriage. This honest and intimate interchange of placing the issues on the table can lead to clearing the slate, and allows for the foundation of a stronger intimacy to develop. Couples need to work through problem issues in a safe environment. They need to express to their spouses what has been kept inside or secret. The repression of thoughts and feelings and conflict avoidance is also known as confluence (Erv Polster, 1973). Marital confluence occurs due to fear of losing the relationship and having insecurities about being vulnerable with one’s partner. 

How does one develop trust in their spouse after a betrayal? Stopping the blame between partners is a key to developing hope and positive interaction. Blaming places the partner on the defensive and maintains distance in the marriage. Betrayed partners need to expect their spouse to be accountable to them and to establish clear boundaries around their marriage. No locks on cell phones. No secret passwords on e-mail. Secrets will eventually show up sooner or later; they just do. Both partners need to stay focused in the present and work towards having an agreement of not bringing up the past. In William Glasser’s Choice Theory, he discusses how bringing up the past is a choice. Doing so will only intensify the vulnerabilities in one’s relationship which in turn magnifies the pain. According to Froma Walsh (2009), the facilitation of forgiveness is central to healing the soul. Healing takes place with couples showing genuine concern for one another. Being mindful or very aware of the positive things that one does for one’s spouse each day is a key ingredient of building positive interaction and hope. Commenting on positive things and showing appreciation for positive behaviors in one another reinforces the development of a healthier connection. 

Every couple is different in terms of how long it takes to move from being angry and bitter to being nice to one another. As the healing in the relationship moves forward, a couple may experience less revisiting of the past and more focus on the here and now. Couples can be given an assignment to imagine how they want their relationship to be in three months. Once they have that image, couples can then begin to enact behaviors that will operationalize the newly imagined behaviors in their relationship.

Instilling hope in marriage after a betrayal is complex. According to James Prochaska (1994), change occurs in five stages. Marital therapy can be very successful by educating and enabling couples to implement behavioral changes through stages. Couples can build resilience and hope in their relationships on an ongoing basis by observing their successes at each stage. 

REFERENCES

• Frankl, V. (1984). Man’s search for meaning.
• Glass, S. (2003). Not “just friends.”
• Glasser, W. (1999). Choice theory: A new psychology of personal freedom.
• O’Hanlon, W., & Hudson, P. (1992). Rewriting love stories: Brief marital therapy.
• Polster, M., & Polster, Erving. (1973). Gestalt therapy integrated.
• Walsh, F. (2009). Spiritual resources in family therapy.

Robert J. Smith, LCSW, ACSW, SW-G, BCD, has thirty-three years of clinical experience and has worked with patients of all ages, with severe and chronic mental health issues, concomitant medical illness, and alcohol and substance abuse problems. He specializes in treating married and unmarried couples using a combination of gestalt therapy, solution-oriented, cognitive-behavioral, and systemic approaches. He also has specialized training in utilizing clinical hypnotherapy as an adjunct to psychotherapy for treating stress, mental health, and pain. Robert can be found online at http://www.RobSmithLCSW.com. His office is located in Niles, Illinois.

Wraparound services (WRAP), according to the DuPage Local Area Network 39 Wraparound Services brochure, are “needs-driven, strengths-based, individualized services, provided according to a plan developed by a child and family team.” These services can take the form of intense case management and specific school social work services to assist parents, families, and children, and they can be provided by a district-employed school social worker or a special education cooperative employee. Wraparound services can also take the form of services developed by a WRAP facilitator who provides access to funded services through the Illinois Department of Children and Family Services and the Illinois State Board of Education.

Historically, WRAP services have been provided by an employee of the special education cooperative serving my school district. However, this past school year, my school district withdrew from that cooperative and elected to provide wraparound services through a school-district employee. Luckily, the special education employee who had been providing WRAP services to our district was hired as an administrator in our district. So we gained a wonderful administrator and a person with lots of experience in WRAP services. One year ago, I was selected as our school district’s WRAP services facilitator. Our new, WRAP-experienced administrator was my go-to person as I took on this new role.

My district is an elementary school district serving almost 4,000 preschool through eighth-grade students. We have nine buildings: seven elementary buildings and two middle schools. The district is well funded with 93.4% coming from local sources and 6.5% from state and federal sources. There are 342 certified staff members, 15 school social workers, and one school counselor. I have been employed in the district for over twenty years as a school social worker.

My first two cases were referred to me last summer through our director of special education and through a building school social worker. The cases involved one family on the verge of homelessness and another family with multiple children diagnosed with Autism Spectrum Disorders (ASDs). As school began in August 2011, new cases came my way. Building-based school social workers, teachers, principals, and other administrators referred these cases to me. Sometimes a referral came before a building-based school social worker was made aware of a family’s or student’s special situation. It soon became clear that we needed to develop a formal referral process with forms that documented important information about the referral. These were completed in the fall of 2011 and communicated to district-level and building administrators and building-based school social workers.

Once the process was defined, I discovered that there were really three levels of service I needed to provide. Consultation to administrators, teachers, and school social workers became the first level of service. Second, I provided individually designed, time-limited school social work services which required more time and intensity than building-based school social workers were able to provide. The third level of service became ongoing, multidimensional services provided to families with complex needs. Building-based school social workers were my point persons and gatekeepers of WRAP services, remaining always involved in the referral and in the planning of services.

Over the course of this past year, I have provided WRAP services to 22 families including at least eight consultations, six time-limited social work services, and ongoing, intense services to eight families. I have made contact with tax-funded and private organizations that provide a variety of services. Examples include Easter Seals-Chicago, Bridge Communities, DuPage PADS, Family Shelter Service, local realtors and rental agents, school-based parent-teacher organizations (PTO) and family support groups in my school district and in the neighboring high school district, special recreation associations for persons with disabilities, village recreation organizations, childcare agencies and centers, community agencies serving children with special needs (Giant Steps and Charlie’s Gift), local park districts, Parents, Families, & Friends of Lesbians and Gays (PFLAG), special transportation providers for children, SAFE Families for Children, physicians and therapists, Illinois Department of Human Services, and vocational counselors. I have also learned how to negotiate the DuPage Local Area Network (LAN) process for funded services to families. For students who meet specific criteria, LAN funds are available for summer camps, sports and hobby equipment, mentoring and tutoring, and clothing and basic needs. The Illinois Department of Children and Family Services (DCFS) and the Illinois State Board of Education (ISBE) provide this funding and require extensive paperwork that documents the wraparound plan, team members, specific goals for life needs, and funding requested. Plans are presented for funding approval to a panel of persons representing the agencies, and fiscal agents oversee the monies disbursed and spent. In my first year, I spent many hours providing services to families—direct contact hours—and providing consultation services. It was rather late in the year when I was able to learn about this funding source and its processes. It is a great resource! I have also depended on PTOs, local parent support groups, our school district’s Special Education Department and Business Office, and local groups such as the Hinsdale Rotary Club for funding when LAN funding was not an option. 

There are a variety of issues that initiated referrals for WRAP services. These include behavior and mental health issues in children, parents, and families, school refusal and truancy, severe financial stress and serious health issues in family members, and homelessness. Five families were referred for assistance as they became or after becoming homeless. Six families were dealing with family members with Autism Spectrum Disorders that were extremely difficult to manage. At least five families were seeking after-school childcare for children with special needs. These children would normally have been served in a village program that was tax-funded and provided aide support to the child in the after-school program. However, our village did not have a facility for such support. As this need came to light, I called together local leaders of my school district, village recreation staff, and special recreation department. We collaborated to provide an after-school childcare program in one of our elementary buildings. My school district was very supportive of this effort and provided the space, some equipment, and some personnel (myself and a school nurse for consultation on medical issues). In its initial year, the program served seven children, both with and without special needs. The district arranged transportation to our central site from four elementary school buildings. The special recreation department provided trained staff, programming, and a structured, safe, and fun environment for our students. It was a wonderful thing!

WRAP services were provided in a variety of settings. I met with parents in coffee shops, with families in their living rooms and at their kitchen tables, with children at the local library, and I took children and families on community excursions to practice behaviors rehearsed in at-home sessions. I accompanied parents to appointments, provided crisis intervention in homes and in schools, and met with school-based WRAP teams specifically formed for the support of students. When these teams needed support, I met with individual educators to problem solve and discuss situations of concern. I attended individualized education program (IEP) meetings, observed in classrooms and on playgrounds, and I accompanied students on field trips. I visited schools and service providers’ offices. I talked and communicated in person and via telephone, text message, fax, and e-mail. My daily work schedule was flexible to allow me to see families in the evenings and on weekends.

This has been a fabulous year of learning for me. My role in WRAP services has allowed me to provide social work services that go beyond what most building-based school social workers are able to provide. One of my former administrators recently said to me, “You now have the job title for the services you have always wanted to provide.” She is so right! As school social workers, we are always aware of the boundaries of our practice. I am now able to stretch and move beyond those boundaries to meet the needs of families. 

Jane M. Herron, MSW, MEd, LCSW, is a school social work specialist through NASW and holds Type 73 and Type 75 certificates. Currently Jane serves as an RtI interventionist and WRAP services provider in the Hinsdale Elementary School District 181. Jane is chair of the Illinois School Social Work Supervisors and Coordinators Council.

I began reading Social Work Matters at the end of the recent session of the Illinois General Assembly, whose body of work does not particularly reflect social work values or good social work policy. We can only hope that developments in Springfield and Washington, DC, will reflect, as the editors of Social Work Matters note in their introductory comments, “...the direct connection of practice to policy and the ethical obligation of social workers to understand and foster the relationship between the two.” (By way of full disclosure, I have known both of the book’s editors for several years. I have had the honor and privilege of serving as executive director of the NASW Illinois Chapter during Dr. Clark’s tenure as National NASW Executive Director. Elizabeth Hoffler served as an intern in the NASW Illinois Chapter office during the 2007 to 2008 academic year.) 

Contributors to Social Work Matters reads like a who’s who of social work leadership and practitioners—that includes five NASW National Presidents; social work ethics expert Frederic Reamer, who interestingly writes about his area of practice, corrections; as well as writers from Illinois including Robyn Golden, LCSW, director of health and aging at Rush University Medical Center who writes about “Health Care Reform and the Role of Social Work.” The collection of forty-seven entries are divided into fourteen sections covering administration, advocacy, children and families, communities, corrections and the courts, direct practice, education and loan forgiveness, equality and social justice, finances, government programs, health , HIV/AIDS, parity, and research. Each vignette uses a very effective formula: it begins with a paragraph entitled “Social Work Matters,” followed by a narrative based on real-life cases of clients served by professional social workers and concludes with a section on why the policy matters and discussion questions. 

Of the many messages contained in this collection, two stand out. One being that policy cannot be separated from practice and is in fact what drives practice. And secondly, social workers play a key role in educating others about clients’ struggles.

I can’t emphasize enough the timeliness of many of the vignettes. They speak to many of the current challenges faced by the profession. In a selection titled, “The Business of Social Work,” by NASW Executive Director Betsy Clark, Clark discusses the many misperceptions about nonprofits, that nonprofits have been “mistakenly defined as non-business,” and that somehow social work should avoid using the term “business.” Obviously, the intense competition for resources in today’s nonprofit market makes it imperative that social workers have an understanding of business principles. “Understanding the structure of and the funding stream for an agency or program is an important first step, because that dictates the mission and the program goals,” of an agency. Essentially, having this knowledge will give social workers the ability to make a business case for the existence of a program or an agency. Clark notes that business and financial skills that social workers need to successfully manage nonprofits (such as budgeting, forecasting, financial operations, and fundraising) are not always present. Making sure that social workers working in administration have these skills will make sure that the “business of social work is too important to be left to those without a social work focus.”

Another contribution that resonated with me and reflects the impact of the current recession is Reeta Wolfsohn’s, “Financial Social Work.” Wolfsohn is the founder of the Center for Financial Social Work. She notes that, “regardless of the type of social work practiced, the presenting problem, the setting, or the population, financial problems and stress are part of most people’s lives and need to be understood, addressed and managed.” Financial social work, as Wolfsohn explains it, is a “behavioral mode that moves clients beyond basic needs with a psychosocial, multidisciplinary approach focused on the thoughts, feelings and attitudes that determine each person’s relationship to and behavior with money.” The current problems with our economy make this area even more important; we need to advance good policy that addresses the health and financial well-being of Americans, especially those living in poverty or recently impacted by the recession. 

Robyn Golden and Melissa Frey’s, “Health Care Reform and the Role of Social Work” should be re-read in light of the June 28, 2012, Supreme Court decision to uphold most of the provisions of the Affordable Care Act. It calls for an expanded role for social work in the area of care coordination and the need to advocate for the value and provision of our core skills by urging that care coordination become a reimbursable and fully accessible service to those who require it. 

Social Work Matters is an important contribution to social work literature. It is a timely reminder of who we are and what we do, and that our work truly matters. If you are looking for an energy boost about the importance of what we do, this is the book to read. 

Social workers have the potential to address HIV/AIDS issues in almost any setting. From programs with specific HIV/AIDS-related services to medical/health facilities, community mental health centers, residential, schools, criminal justice, employment-related services, the military, or private practice, social workers may need specific clinical, ethical, and legal HIV/AIDS-related knowledge for best practice. Ethical practice evolves from the development of four key areas: self-awareness, knowledge, skills, and resources. These areas flow from three key sections of the NASW Code of Ethics. 

1.01 Commitment to Clients
Social workers' primary responsibility is to promote the well-being of clients. 

1.02 Self-Determination
Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others. 

1.04 Competence
(a) Social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience.

Additionally, the components of best practice detailed in this article are informed by social work’s core values:

• Value: Service
• Ethical Principle: Social workers' primary goal is to help people in need and to address social problems.
• Value: Social Justice
• Ethical Principle: Social workers challenge social injustice.
• Value: Dignity and worth of the person
• Ethical Principle: Social workers respect the inherent dignity and worth of the person.
• Value: Importance of human relationships
• Ethical Principle: Social workers recognize the central importance of human relationships.
• Value: Integrity
• Ethical Principle: Social workers behave in a trustworthy manner.
• Value: Competence
• Ethical Principle: Social workers practice within their areas of competence and develop and enhance their professional expertise

Self-Awareness

Self-awareness is the foundation of ethical practice. Tremendous discrimination and stigma still exist related to HIV status. What are my beliefs, values, potential judgments, or fears related to HIV/AIDS, and how might these impact my clinical work and ethical decision-making? How do my religious or spiritual views affect my practice? What are my beliefs/values related to STDs, sexual practices, communication in relationships, causes of illness, rights to services, or educational and employment opportunities? What are my beliefs and values related to disclosure of HIV status in various situations? Am I comfortable talking openly about various sexual practices? What are my beliefs about what constitutes “safe sex”? What is my level of clinical, ethical, and legal knowledge? When do I need to seek out appropriate consultation?  

Social workers do not always have adequate supervision or knowledge resources available in their practice settings. The responsibility is on the individual social worker to identify when a supervision/consultation need arises and to seek out a qualified professional to provide that service. Social workers sometimes face the dilemma between the need for outside consultation and their financial limits/obligations. NASW members can receive some free ethics consultation through the NASW Illinois Chapter Ethics Committee and with Dawn Hobdy, head of the NASW Office of Ethics and Professional Review. A list of web resources is included with this article.

Knowledge

Social workers in any setting need knowledge of:

• Federal, state, county and city laws/regulations
• Agency policy
• Resources for referral and support

Illinois laws related to HIV/AIDS include:

• AIDS Confidentiality Act (410 ILCS 305) 
• AIDS Confidentiality and Testing Regulations (77 Ill. Adm. Code 697) 
• Illinois Criminal Transmission of HIV Act (720 ILCS 5/12-16.2) 
• Illinois law on access to a person’s own medical records (735 ILCS 5/8-2001)
• Illinois Sexually Transmissible Disease Control Act (410 ILCS 325)
• Perinatal HIV Prevention Act (410 ILCS 335) 

Federal laws include:

• Americans with Disabilities Act (ADA) prohibits disability-based discrimination in employment, state and municipal services, public accommodations, commercial facilities, transportation, and telecommunications. 
• Family and Medical Leave Act (FMLA) allows a family member to take unpaid leave from their place of employment to care for an immediate family member (parent, spouse, and child) in certain circumstances. 
• Federal Rehabilitation Act of 1973 prohibits disability-based discrimination by federal employers or contractors or by programs receiving federal financial assistance
• Health Insurance Portability and Accountability Act (HIPAA) 

“Federal, state and local law prohibits discrimination against people with HIV/AIDS in all workplace settings, state and municipal services, public accommodations, commercial facilities, transportation, and telecommunications. The U.S. Supreme Court has interpreted federal law as protecting people with HIV—including those who may be asymptomatic, because the virus limits certain major life activities. The law also prohibits discriminating against a person with HIV/AIDS because an employer fears it will it will lose customers, or because co-workers are afraid of working with an HIV-positive person. It is also illegal to discriminate against someone who associates with a person with HIV/AIDS.” (AIDS Law Project of Pennsylvania) 

Guidelines for confidentiality are defined in the Illinois Mental Health and Developmental Disability Confidentiality Act, the AIDS Confidentiality Act, and the NASW Code of Ethics. Section 305/9 (from Ch. 111 1/2, par. 7309) of the Aids Confidentiality Act defines disclosure guidelines. Social workers facing a dilemma in which they are considering disclosing a client’s HIV status without the client’s written informed consent should first consult an attorney. Illinois has mixed case law related to HIV/AIDS confidentiality and issues of transmission.

Skills

Skills are the tangible ability to operationalize the social work values. What are the particular needs of the population being served? What is my skill level with individuals, couples, families? In some settings, client’s reasons for being there may be directly related to HIV/AIDS concerns. In other settings, HIV status may not be a primary factor in seeking services. Skills are where awareness and knowledge come together. Best practice evolves from an honest self-assessment of clinical strengths and challenges and a commitment to ongoing professional development. Am I comfortable advocating for clients, potentially within my own agency? What situations generate discomfort or anxiety? Is my competency being compromised by an overwhelming workload? Do I need to advocate for myself to ensure my skill level with clients? 

Decision-making around documentation is another key area of skill development. Given the stigma around HIV and the confidentiality guidelines, determining the what, where, and how of documentation is crucial. Who has access to the records? Is HIV diagnosis required to receive services or for funding purposes? Are there ways to report data anonymously? Clear informed consent practices are essential. Clients should be informed at the beginning of services about the limits of confidentiality and any changes over the course of service. Clients have the right to know what will be documented and who has access to the information

Cultural competency is an important aspect of professional skill. The NASW Cultural Competency Standards define culture as, “ the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group” (NASW, 2000b, p. 61). 

Cultural competency refers “to the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each.” (NASW, 2000b, p. 61) 

Cultural Competency and Diversity (1.05c) of the NASW Code of Ethics states:

(c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability

Skill with HIV/AIDS requires understanding of the social impact of oppression and how to address the individual client/client system’s experience.

Resources

In all settings and positions, social workers need access to qualified clinical, ethical, and legal consultation. A clinical consultant has expertise with the relevant population, techniques, and setting. In addition to knowledge of relevant codes, theories, and regulations, an ethics consultant has expertise in critical thinking and ethical decision-making. Ethics consults are particularly important when confronted by dilemmas where there are competing ethical values. A consulting attorney should specialize in social work law.

If these resources are not available within the organization, social workers need to seek them out independently. When confronted with a difficult dilemma or crisis, it is important to have already identified appropriate sources of professional and personal support. In any professional complaint or lawsuit, one of the first questions asked will be what type of supervision/consultation was received and that person’s qualifications and level of expertise. 

INTERNET RESOURCES

Illinois

1. Illinois General Assembly Illinois Compiled Statutes (410 ILCS 305/) AIDS Confidentiality Act: http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1550&ChapterID=35
2. AIDS Legal Council of Chicago: http://www.aidslegal.com/links.html  
3. Illinois Legal Aid Disabilities Guidebook: Right to Confidentiality for People with HIV or AIDS: http://www.illinoislegalaid.org/index.cfm?fuseaction=home.dsp_content&contentID=225
4. Illinois Compiled Statutes 410 Public Health: http://law.onecle.com/illinois/410ilcs303/index.html  
5. Illinois Department of Public Health Laws and Administrative Rules: http://www.idph.state.il.us/rulesregs/rules-indexbytopic.htm 
6. Illinois Criminal Transmission of HIV Act (720 ILCS 5/12-16.2): http://www.aidslegal.com/LegalAssist/Criminal_Transmission.pdf
7. Illinois law on access to a person’s own medical records (735 ILCS 5/8-2001): http://www.aidslegal.com/personsmedical.html

Federal

1. AIDS Law Project of Pennsylvania - ADA and FMLA Information: http://www.aidslawpa.org/get-help/legal-information/discrimination/
2. HIV and Legal Rights in the Workplace: http://www.aidslegal.com/Publications/Workplace_English.pdf
3. Reference Guide to HIV as an ADA Disability: Aids and the Law: http://aidsandthelaw.com/wp/?page_id=223
4. EEOC’s New ADA Regulation: What Does it Mean for People with HIV?: http://aidsandthelaw.com/wp/?page_id=219
5. Confidentiality of HIV-Related Information Act and HIPAA Privacy Rule: http://www.aidslawpa.org/get-help/legal-information/confidentiality/
6. How to Respond to a Subpoena: http://www.aidslawpa.org/get-help/legal-information/confidentiality/how-to-respond-to-a-subpoena-faqs/

Ruth Lipschutz, LCSW, ACSW, is a licensed clinical social worker with postgraduate certification in ethics, mediation, Transformational Imagery, hypnotherapy, and Eye Movement Desensitization and Reprocessing (EMDR). She received her MSW from the University of Illinois in 1978 and went on to complete the two-year postgraduate training program of the Institute for Family Studies at Northwestern University. She has extensive experience in the areas of ethics, mental health, addictions, traumatology, program development and implementation, supervision, consultation and Alternative Dispute Resolution. She is the chairperson of NASW’s National Ethics Committee and has served as a panelist, consultant, mediator, and trainer for the NASW Illinois Chapter Ethics Committee. She is currently in private practice.

I.  Affordable Care Act

As most of our readers know by now, on June 28, 2012, the United States Supreme Court issued an opinion upholding most of the Affordable Care Act, also known as "Obamacare." The vote to uphold the law was 5–4 and was written by Chief Justice Roberts. The majority decision surprisingly held that the mandatory individual coverage provisions of the act were constitutional under Congress' taxing power. (The individual coverage mandate is enforceable as a penalty assessed by the IRS as part of the individual's income tax return.) It should be noted that a 5–4 majority of the court, including the Chief Justice, held that the individual mandate was unconstitutional under the Commerce Clause of the U.S. Constituition. The government's main argument in support of the consitutionality of the individual mandate rested on the Commerce Clause. 

The court, however, struck down provisions of the act that allowed the federal government to withhold a state's Medicaid funding if the state fails to implement the expansion of Medicaid to all individuals whose incomes does not exceed 133% of the federal poverty level. The expansion is required under the act by January 1, 2014. The court found that Congress had exceeded its power under the Spending Clause of the Constitution. 

The decision in National Federation of Independent Business v. Sebelius means that, unless repealed, the Affordable Care Act provisions that have already become effective and those that are scheduled to go into effect in the future are consitutional. The decision has political and policy implications. The results of the November election will have a huge impact on the future of the law. Assuming no repeal or major changes occur, it will be interesting to see how many states decide not to comply with the new Medicaid expansion requirements, which are funded 100% by federal funding for the first three years and 90% federal funding after that.    

The court's decision leaves many other legal, political, and policy questions open. 

II.  State Legislative Update

The governor has signed SB 2840 into law. The new law, interestingly called the SMART Act, makes about 60 changes to Medicaid and other health programs. Most of the changes eliminate or reduce benefits and coverages. The purpose of the bill is to save $1.6 billion in spending on Medicaid and related health programs. The most controversial changes include eliminating the Illinois Cares Rx Program,  reducing adult dental coverage to emergency extractions; limiting prescription eyeglass replacement to once every two years, restricting beneficiiaries to four prescription drugs per month unless a waiver is granted, scaling back eligibility for the waiver for children who are medically fragile or technology-dependent, eliminating state funding for General Assistance cash and medical assistance, and making it harder to qualify for the Home Services Program. The Department of Healthcare and Family Services is in the process of notifying beneficiaries of the changes, most of which take effect this month.

The governor has also signed a state budget for FY 2013. He line-itemed out funding for the Tamms and Dwight Correctional Center, some halfway houses and a youth correctional center. He wants to use some of these funds to add money back into the DCFS budget, which was cut over $80 million by the Illinois General Assembly. The Illinois State Senate and the governor would like to add money back in for K–12 education, which was cut about $200 million in the budget bill. Clearly, budget issues remain for consideration during the fall veto session.

The governor has also signed HB 3887 into law. This is the "Penn State" bill that makes athletic personnel, higher education staff, and early intervention services providers mandated reporters of child abuse and neglect.

• OFFICE FOR RENT - Chicago/Lakeview: Spacious, fully furnished private office with lots of light near Diversey and Sheridan available full-time, by day or for shorter time blocks. A comfortable waiting room, kitchenette, bathroom, copy machine, and internet connection are included in this three office suite occupied by mental health professionals. Close to public transportation; street parking available. Call Kitty Mann at 773-248-3701or 773-469-9084 or email kbmann@uchicago.edu
• OFFICE FOR RENT - Arlington Heights: Bright, sunny, furnished office in 3 office suite, plus waiting room and bathroom. Handicap accessible. Plentiful parking. Days, evenings, and weekends available. Call Drs. Sandra Viola or Rebecca Bier. (847) 670-9123.
• OFFICE FOR RENT - Crystal Lake: Psychotherapy office space near post office in Crystal Lake for rent part-time or full-time. Suite of 4 offices with contemporary decor, no receptionist. Includes use of newly furnished offices; use of water cooler/microwave/refrigerator in separate kitchen/break room; use of copier, fax and scanner with ink and paper supplied; utilities; wireless internet; cleaning services. Free parking. Convenient location for clients in Crystal Lake, McHenry and surrounding communities. Julie 847-404-3194.
• OFFICE FOR RENT - Chicago: Beautiful, professionally decorated 16th flr. Michigan Ave. office overlooks Millennium Park, great lake view. Suite has a four person waiting room, separate exit and entrance, as well as a sink, frig. and microwave. Available weekdays, evenings, and Saturdays. Close to public transportation and discounted parking available. Pictures of the office can be seen at http://youtu.be/lJ_7GaDrj30 Call Antoinette at 312 719-8498 or email antoinette@drkavanaugh.com.
• OFFICE FOR RENT - Buffalo Grove: Buffalo Grove/Long Grove area. 1 office suite left among 8 other Psychology/Psychiatry/LCSW offices. New paint, New carpet. Private waiting room. Possible share situations. Call Susan (847) 913-1400.

NASW ILLINIOS CHAPTER JOB BOARD
For a complete and up-to-date list of job board postings, visit the NASW Illinois Chapter Job Board: http://www.naswil.org/education-career-development/association-job-board/. 

• Therapist/LCSW - Decatur Psychological Associates
• Center Director - Metropolitan Family Services
• Psychiatric Social Worker - Good Samaritan Hospital
• Social Worker - The Admiral at the Lake
• Licensed Psychotherapist - Anxiety & Stress Center, P.C.
• Therapists for Private Practice - Marilee Feldman

A while back, I had an interesting conversation with a friend who is a nurse practitioner in the area of oncology. She told me that as a medical professional seeing terminally ill patients every day, she is saddened when she encounters patients who receive medications and undergo procedures that will only diminish their quality of life and oftentimes prevent them from interacting with their family during what could be their final days. Death can be a very scary thing for both the person facing it as well as their loved ones, but it is a part of life that we have to accept. As I reflect on the lives of the people in my family who lost their lives to cancer, I remember how difficult it was initially to accept the diagnosis and how painful the process of losing them was for our family. I have learned that there are times when the patient has accepted the diagnosis and the family has not, and in an attempt to please family members the patient will sometimes undergo treatment to appease family members even though the results are futile and decrease his or her own quality of life. It is natural to want to try various medications and procedures in hopes of slowing down a process that is inevitable, but we should also be mindful of the quality of life that may be loss in the process.

Every situation is different, and there are certainly treatment options for some; but for others, no amount of treatment will change their prognosis. Many believe that the use of palliative care/hospice services means giving up, but these services are in fact very beneficial to patients and their families. These services provide an opportunity for patients to have continued communication with their families and not have to undergo the rigorous types of treatment with side effects that are sometimes extremely painful and debilitating. It also provides the opportunity for the patient to make a smooth and peaceful transition surrounded by loved ones and, in some cases, familiar surroundings. 

I have had the privilege to meet and interact with some amazing oncology nurse practitioners and hospice social workers who do incredible work with patients and families at the end of life. I challenge each of us to give this some thought and be more proactive in speaking with family members about their end-of-life wishes. It’s never an easy topic, but certainly learning more about palliative care and hospice services could provide an option of a helpful and comforting process.

Yolanda Jordan, MSW, LCSW, has an extensive background in abuse/neglect issues in the field of child welfare. As a placement manager with the Illinois Department of Children and Family Services, she is responsible for managing supervisors who are responsible for children who are placed in the foster care system. Yolanda is also a practicing psychotherapist and has been in private practice for the past ten years. Services are provided to children, couples, and families with a special emphasis on relationship issues that African American women face.

Yolanda is a graduate of Western Illinois University where she received her bachelor of arts in mass communications and master of arts in public communications human relations with a minor in African American studies. Due to her extreme love for people and having the heart of a servant, she continued her education and received a masters in social work with an emphasis on child and family practice from the University of Illinois at Chicago’s Jane Addams College of Social Work. Yolanda has been an active member of the NASW Illinois since 1996 and enjoys the work of advocating for the profession of social work and the community that social workers serve.

Funding was received through the Center for Mental Health Services, of the Substance Abuse Mental Health Services Administration, and will support efforts to accelerate a federal response to HIV/AIDS as outlined in the National HIV/AIDS Strategy.

Evelyn Tomaszewski, NASW senior policy associate for human rights and international affairs and the spectrum project director, said the funds will help build collaboration with NASW chapters and CMHS grantees, including the Minority AIDS Initiative Targeted Capacity Expansion grantees, as well as CMHS Mental Health Care Provider Education Program partners at the American Psychological Association and the American Psychiatric Association.

“We plan to update and expand distance learning opportunities through NASW WebED,” Tomaszewski said. “We’re also working towards expanding the number of expert trainers who, in turn, will provide continuing education and professional development workshops targeting the 12 communities identified in the United States as having the highest AIDS burden, while also targeting  those communities with growing or emerging incidence of HIV/AIDS.” 

PHOTO: Lisa Cox, left, and Nathan Linsk, members of the NASW HIV/AIDS Spectrum Project advisory committee, join the group’s discussion at its meeting in December. The program has received a contract modification of $334,000.

The HIV spectrum project advisory committee convened in December to discuss goals and brainstorm ideas with members, placing an emphasis on working with NASW chapters, as well as state and local health and behavioral health departments and affiliated community-based programs. 

The advisory committee also discussed the continued need for preservice education.  

“HIV has been around long enough that students now don’t see it as a phenomenon,” said committee member Diane Green-Smith. 

“Not a single school (in my area) has a course on HIV,” said committee member Dinas Moncada, a clinician and trainer. “If social workers aren’t prepared to deal with it, who is? It’s up to social workers to continue to be there.”

Through collaborative efforts with the chapters, Tomaszewski sees the project’s potential to build on the network of social work practitioners who have the expertise and hands-on experience in HIV/AIDS prevention, care and treatment. 

“This initiative will further position social workers as leaders in addressing the goals of the National HIV/AIDS strategy,” she said. “While we work in diverse fields of practice, we all have the opportunity to work toward HIV/AIDS prevention.”

For more information on the project, visit http://www.socialworkers.org/practice/hiv_aids/.

From February 2012 NASW News. © 2012 National Association of Social Workers. All Rights Reserved. NASW News articles may be copied for personal use, but proper notice of copyright and credit to the NASW News must appear on all copies made. This permission does not apply to reproduction for advertising, promotion, resale, or other commercial purposes.

Public Citizen of the Year: Jeffrey B. Ford, JD (East Central District) 
Jeffrey B. Ford (JD, University of Illinois at Urbana-Champaign) was sworn in as judge on July 1, 1985, after eight-and-a-half years in the state’s attorney’s office and in private practice. In 1994, he was awarded the State of Illinois Outstanding Support Person by MADD. In 2010, the Illinois Traffic Safety Leaders presented Judge Ford with the Joanne Blair Award for exemplary leadership in the area of traffic safety in Illinois. The Department of Psychology at the University of Illinois recognized him as a Distinguished Alumni at its graduation in May 2011.

Social Worker of the Year: Lynn Cadmus, AM (Jane Addams District)
Lynn Cadmus (AM, University of Chicago) has worked as therapist at Family Counseling Services in Rockford for nearly twenty-three years. Subsequently, she accepted a position at Janet Wattles Center (JWC) as therapist, and sixteen months accepted her current position as Trauma Therapist with the Therapeutic Intervention Program (TIP). TIP Court is Winnebago County’s mental health court, and Rosecrance Ware Center (formerly JWC) staffs the mental health part of the team.

Lifetime Achievement Award: Warren Heinke, MSSW, LCSW, ACSW (Jane Addams District)
Warren Heinke (MSSW; University of Wisconsin-Madison; LCSW, ACSW) assumed his first position in 1970 as a social worker and, later, supervisor with a Wisconsin direct services agency doing foster care, treatment foster care, and adoptions.  He became Regional Director of the Northern Region of Children's Home + Aid (Rockford, IL) in July 1982.  Program development was his special niche, and he expanded the region from a staff of 5 to 94 until his retirement in October 2009 as Regional VP.  He traveled with International Activities Network exchanges to Birmingham, England, and Hamburg, Germany, and People-to-People NASW trip to Soviet Union. He has been a member of NASW since 1971.

Dynamic Psychotherapy and Bereavement Counseling: A Philosophical Framework

Perhaps life’s most profound contradiction is that from the moment we are conceived, we begin to change and die. Change is unstoppable, death inescapable. Consequently we live with loss, and since we are essentially feeling beings we react to our losses by grieving and mourning. But we don’t like to say it. We don’t like to hear it. Indeed the historian Arnold Toynbee proclaimed, “Grief is un-American.” And to a certain degree we arguably need our self-protective systems to shield us from the thought of nonexistence and to live our lives feeling less impeded. Unlike the rest of the animal kingdom though, we humans can reflect upon the meaning of our experiences, and the price we pay for this gift is our confrontation with the unmoving fact of mortality. However, that same capacity has resulted in the creation of therapeutic approaches and environments designed to help individuals go through the grief and mourning processes in as natural and supportive a way possible. Psychotherapy is often an environment in which loss—whether ushered in by change or death—can be supported and worked through. In order for it to be effective, however, the quality of empathy and attunement to the grief and mourning processes must be informed by a philosophy grounded in bereavement counseling.

Social Work
As an outgrowth of our leading edge, person-in-environment perspective, social work has made important advances in many areas of the mental health field. Research and clinical treatment modalities have illuminated and provided caring pragmatic interventions to populations suffering with unemployment, rising violence, physical and sexual abuse, the cycle of poverty, alcoholism and drug addiction, broken families, suicide, gangs, increasing levels of stress, and major depression—to choose just a few. Despite all of these areas having their own policies and practices, they are all loss experiences. In fact, we might conceive of them as existing on a continuum of loss—an insight highlighting their commonalities and offering potential perspectives on optimal assessment and treatment. 

Psychotherapy and Change
In addition to death, loss comes in many forms and is, in fact, inevitable due to the dynamics of change built into life itself. With this knowledge and the skills to help individuals react to and integrate their experiences of loss and change, dynamically-trained psychotherapists can help reframe grief and mourning in terms of going through natural phases such as shock and numbing (defense mechanisms), confrontation (awakening to the reality of the loss and the scope of change inherent in it), and accommodation (learning to return to pre-loss functioning/changing/growing). This therapeutic empathic responsiveness affords the potential for reduced helplessness, a greater sense of control and coping ability, and maybe even increased meaning—especially in troubled times. 

In a sense, our lives are peppered with small dyings—losses along the way that are often unavoidable. Break-ups. Dashed dreams. Conflicts. Upset expectations. The list goes on. Such experiences constitute the terrain of psychotherapy. Each of us to some degree carries along a reservoir of losses. Yet by facing these losses with social support and personal determination, we can attempt to fill life with purpose and meaning even as they threaten to divest it of such values. Many Zen practitioners believe viewing changes as small dyings prepares us for actual death. “Die in the morning so you need not die at night.”

Bereavement Counseling
In the case of dealing with an actual death, I believe it is helpful for survivors to 1) Define grief and mourning, and 2) Learn about the three fundamental phases of the process: shock and numbing, confrontation, and accommodation. 

Grief reactions are universal (though extremely personal), normal, spontaneous, and unlearned. They are acute and expressed physically, emotionally, behaviorally, cognitively, and spiritually. The quality, quantity, and timing of these normal reactions (not discussing so-called pathological forms of bereavement in this article) are influenced by many factors such as the circumstances of the death, the quality of the relationship, social support, developmental stage, educational and religious backgrounds, coping abilities, previous exposure to loss, and so forth. Social work’s person-in-environment perspective enables a clear understanding of these many factors. Mourning, on the other hand, is a larger, more encompassing process of which grief reactions are a part. Mourning is both socio-culturally influenced and psychologically driven; it is the long, arduous back and forth trek of avoiding, confronting, and finally accommodating to the world without the person who has died. Drawing from William Worden’s thoughts, it is the ongoing work of facing the fact that death occurred, feeling and expressing the pain, learning to get used to the environment without the deceased, and withdrawing the energy put into the old attachment in order to begin channeling it into new relationships and causes. It does not, however, mean severing psychological ties with the deceased. In fact, for most mourners, the liveliness of memory and the internalization of and identification with the deceased remain with them even as they learn to let go of the physical relationship. It is what Therese Rando calls the bittersweet nature of bereavement—moving forward with the scar of loss, holding onto what must be retained, and letting go of what must be relinquished.

Guidelines
With this philosophical stance in mind, psychotherapy and bereavement counseling can proceed optimally by responding to the often nonlinear presentation of grief and other life content through the therapeutic alliance. The following are guidelines to support this approach:

• Give explicit permission to grieve and mourn
• Follow and help name the range and depth of feelings in response to loss
• Recognize the phases and tasks of grief work
• Know and define the difference between grief and mourning
• Sometimes focus more explicitly on grief, other times on different content
• Listen for and attend to developmental needs
• Remember we cannot take away the pain from the bereaved
• Learn to tolerate feelings of helplessness (in self and others)
• Do not give pat answers to profound questions
• Be willing to view the loss from the person’s unique perspective (religious/spiritual or not)
• Elicit memories, lessons, identifications, details (both positive and negative) of the relationship with the deceased
• Hold out the hope/expectation that through the process of accommodation, the pain will subside and life will rebalance
• Promote social support and a family systems approach when warranted

Conclusion
In sum, by seeing the reality of loss in change itself, individuals can be helped therapeutically as it affords them better understanding, potentially increased meaning, reduced helplessness, and a greater sense of control and coping ability. In addition, learning the definitions of grief and mourning can be useful for many individuals to help with loss through death. Psychotherapy, with its focus on sustained empathic attunement to the client’s developmental needs as they are expressed in and through the therapeutic relationship, and bereavement counseling, which aims to help support directly the acute expressions of grief and the life-adjustment of mourning, are a potent combination. When interlaced, both approaches encourage psychological integration and movement through the natural phases of shock and numbing, confrontation, and accommodation, while promoting a purposeful life in spite of life’s most profound contradiction.

REFERENCES

• T. Rando. Treatment of Complicated Mourning. 1993.
• W. Worden. Grief Counseling and Grief Therapy. 1992. 

David Fireman, MSW, LCSW, directs the Center for Grief Recovery and Therapeutic Services (http://www.griefcounselor.org) as well as holds a practice grounded in the social work values of social justice and personal transformation. His approach draws from self and depth psychologies. His extensive background in helping others grows out of a sincere respect for inherent individual differences, social learning, the interplay of love and loss throughout the life span, finding purpose and meaning, and placing value in the power of the therapeutic relationship. He is an active and involved therapist and presenter who believes that the rare combination of honesty and courage bring about lasting change.

CEU Opportunity for Reading This Article!
NASW Illinois members can earn one CEU by completing an online quiz (LINK) regarding this article! The free CEU opportunity is only valid until August 1, 2012, after which the CEU fee will change to $15.00. Nonmembers must pay the regular $10.00 rate for the CEU, which will increase to $15.00 after August 1, 2012.

A second grade boy was on the school playground swing. He stared off, not really focusing on anything, just swinging. When a playmate said a friendly, “Hi,” the boy’s reactions were aggressive and more intense than warranted for a simple greeting. Or were they? A first grade girl was repetitively picking at her arm when she was moved to a new table after a four-day weekend. Then she picked at her new classmate’s nametag. She didn’t attend to her teacher and was intensely startled when her teacher touched her shoulder. This little girl’s self-absorbed behaviors were certainly psychopathological. Or were they?

All school staff—not just social workers—benefit from knowing about trauma reactions and interventions, and trauma-informed care brings a healing atmosphere to a school. If together we could see trauma though the eyes of the above two children, their reactions and those of so many others would be seen as expected responses to terror, as normal reactions to an abnormal situation. We could then anticipate the collapse of coping mechanisms as a result of the traumatized child’s sense of powerlessness, helplessness, at fault, and anger. We would believe any child old enough to laugh and experience pleasure could also experience trauma and grief. We would know trauma is sensory, not cognitive, and would be prepared to help soothe activated trauma-aroused survival mechanisms. The arousal stress of trauma damages the left brain (the language side, neocortex) which is responsible for certain cognitive tasks and storing memories. This makes it difficult for traumatized children to use language to make sense of and cope with their experience. It can then become hard to follow directions, to recall what a teacher has said, to focus, to plan, or learn from consequences. Often behaviors associated with attention deficit hyperactivity disorder (ADHD) or learning disabilities (LD) are actually unidentified trauma reactions. Coping, planning, and thinking don’t occur in trauma—survival does. Restoring safety and control helps the student shift back into the neocortex, which makes learning possible again. 

Trauma refers to the sensory and emotionally overwhelming situations that create feelings of loss of safety, power, and control. All developmental areas can be affected, including identity formation, body integrity, reactivity, ability to manage behavior, moral, and spiritual development, and the ability to trust. Trauma affects learning, cognitive processing, memory, and the brain. According to James (1994), “Symptoms of trauma, such as flashbacks, hyperactivity, and dissociation, not only interfere with children’s learning but are often not recognized as such; they can be mislabeled as conduct disorder, oppositional and defiant behavior, lying.” (p. 11). Characteristics of the fight-flight-freeze responses of trauma as listed online in the Parent Trauma Resource Center of The National Institute for Trauma and Loss in Children (TLC) include: distressing memories; unwanted, intrusive images and thoughts; distressing dreams or difficulty going to sleep for fear of having the dreams; acting or feeling as if the event were recurring; irritability, anger; sense of a foreshortened future; hypervigilance; exaggerated startle response; regression; and post-traumatic play that is not fun. If no trauma-specific interventions are provided, trauma reactions can last for years after the experience, or suddenly reappear years later when the sensory memory of the trauma is aroused by a sight or smell or feeling. Trauma reactions may not be prevented, but trauma’s powerful hold on our students’ learning and behavior can be loosened if sensory interventions are provided appropriately.

Trauma’s cognitive distortions impede using cognitive-based interventions alone. It’s not enough to simply tell children they are safe because that telling happens on a cognitive thinking level. But trauma images and sensations are stored implicitly in the right brain (limbic area) which controls our social and emotional functioning. By reducing the trauma arousal level, the right brain can function again because the child feels safe. It is this emotional right brain which ultimately determines the manner in which the thinking left brain will react: tune out or listen; dissociate or have fun; be in constant motion to keep memories at bay or learn; feel terrified and helpless or feel safe and capable; react and survive or think and relate. When safety, power, and control are returned to the student through sensory interventions offered within a caring relationship, a child’s story is given a visual language so it can be cognitively reordered. This brings the healing. 

In becoming a trauma-informed school, knowing the above information must direct all staff interventions, but a school social worker is usually the one at the front line, helping, soothing, listening. We social workers tend to forget a crucial first step: self-care. My district calls this “Having ice cream for dinner” if that’s what takes care of you. Reflect: Ask yourself, “How do I feel right now?” Calm yourself and own your own feelings about what the child has told or shown you. Relate: Say to the child, “I feel scared right now, and I need to know how you feel. Show me or tell me what happened.” And Regulate: When we reflect and regulate ourselves, we are able to co-regulate with a child, like breathing a dance together. Co-regulating brings oxytocin, the soothing anti-stress hormone, into the trauma-aroused brain. The primary factors in healing the brain are positive relationships and positive environments—and repetition of both. 

Obtaining research-based training is the key to becoming a trauma-informed school. An excellent resource is The National Institute for Trauma and Loss in Children (TLC) located in Michigan. On-site and online classes are available and informative. From this training, staff will learn that educating with facts and normalizing reactions are both interventions that heal a traumatized child. Consider this statement: “Perhaps it’s not the situation that induces trauma but how that situation is being experienced” (Steele & Kuban, 2011). An event traumatic to one child may just be a bad experience to another. It may also be traumatizing at one stage of life and not earlier or later. Other factors to consider when assessing the impact of an event: the child’s temperament, strengths, health, attachments, intelligence; cultural and community understanding of trauma; reaction of caregivers and first responders; safety given afterwards; degree of bodily violation and violence; persistence of threat, terror, and proximity. Traumatized children experience themselves, their world, and us as helpers through the distorted lens of trauma so this knowledge must shape our responses. It also prevents any secondary wounding through poorly-attuned treatment. 

Sensory-based interventions take the “can’t think” (no language) state to the “can think” (language) state of cognitive reframing, from victim thinking to survivor/thriver thinking. Sensory interventions are shaped by the characteristics of the child, the personal environment, and the traumatic event itself. The process of recovery must include nurturing interventions such as holding, touch and gentle eye contact, and corrective interventions, such as time in (not time out), predictability, consistency, and infinite patience. Stepping back (Teachers, too!) when confronted by an outburst, then self-regulating and using describing words (“I think this surprised you and you wanted it to stop. What would help you feel safe?”) all validate the child’s experience. These actions, which strengthen a caring relationship, help students trust enough to self-regulate. They empower children to make choices and identify things that self-soothe. It is the relationship that heals, and you make the difference! 

Teachers can integrate soothing, predictable activities into everyday lessons, from doing relaxation exercises at the start of the day or during difficult transitions to announcing schedule changes. Encourage teachers to anticipate behavior triggers, reduce external sensory stimuli, and build in breaks for playing. Laugh together! Use a confidential question box, or let students write an advice column. Have a child make a personal Care Box or set aside a Cool-Down Corner filled with sensory calmers because children can’t learn until they are calm. Use visual cues for academics and emotions. Make and display posters of Coping with Difficult Feelings. Constantly acknowledge strengths. Activities in social work times can include the psychomotor activity of drawing the event or creating symbolic stories. Teach deep breathing, self-talk, and body awareness. Play games that require planning, future-thinking, and helping others. Begin and end the day in a safe and empowered place. These activities give language to feelings and soothe the emotional right brain so learning can occur. Knowing that “routine is structure, structure is control, and control is safety” can inform all our approaches to soothing the arousal of trauma. 

Remember the child is more than the trauma! All staff can recognize trauma reactions and use the trauma-specific sensory interventions children need. School social workers can actually lead the way for a school to be trauma-informed. Normalizing the reactions to the event and asking questions about then and now help create hope for a future. When traumatized children feel safe and in control, they can swing freely and play; they can attend to teachers and learn. If we “see” the child’s behavior as expected reactions to trauma, not intentional defiance; if we do not judge the rightness of the behavior but witness the trauma story; and if we unfold together the child’s strengths, the healing journey towards a resilient future has begun. 

REFERENCES

• James, B. (1994). Handbook for the Treatment of Attachment-Trauma in Children. New York, NY: The Free Press.
• Parent Trauma Resource Center. (2007). Retrieved April 25, 2012, from www.starrtraining.org/tlc. 
• Steele, W., & Kuban, C. (2011). Advancing Trauma-Informed Practices. Clinton Township, MI: TLC Institute.

Lori S. Rueffer, MSW, LCSW, ACSW, CTC-S, has been a school social worker for East Aurora School District #131 since 1997. She is certified as a Trauma Consultant Supervisor through The National Institute for Trauma and Loss in Children. Lori implemented the district-wide trauma intervention program and provides yearly trainings for staff. She supervises MSW interns, has presented at the annual Illinois Association of School Social Workers (IASSW) conference, and volunteers as a GriefShare facilitator at her church. She was a crisis counselor at Northern Illinois University (NIU) after the shooting tragedy of 02/14/08. Her self-care includes praying, gardening, walking with her husband, and FaceTiming with her married daughters. 

Bullying as a significant problem was brought to the attention of the American public after a rash of student shootings happened in schools. In an eighteen month period starting in Bethel, Alaska, and ending with the shootings by Dylan Klebold and Eric Harris at Columbine High School in 1999, there were seven school shootings. This was something previously unheard of. What would bring about such behavior?

Jessie Klein’s book, The Bully Society, offers some explanations and some possible solutions. Ms. Klein is assistant professor of sociology and criminal justice at Adelphi University. She has worked in other capacities including a school social worker, social studies teacher, and substance abuse counselor. 

The book has an extensive review of many of the school shootings, shows various ways in which violence presents itself in schools, and also offers some solutions. The lens beneath which school and other violence is viewed is that of masculinity, specifically hyper-masculinity. 

Ms. Klein states, “Masculinity intersects with race, class, and sexuality. A boy’s masculinity is effectively diminished to the extent that it is associated with anything other than being wealthy, white, heterosexual, and traditionally able-bodied” (p. 52). Ms. Klein states that even the few boys who meet the criteria of masculinity are still scared of losing their status and are hypervigilant about fending off perceived threats to their status.

Girls are not spared this quest for hyper-masculinity. They too are in a competition to be on the top of the pecking order and exhibit a similar competitive process with different behaviors, though physical aggression is increasing among girls. Girls have an additional burden in that their status is dependent upon the whims of the top-ranked males. No matter how highly ranked a girl is, if a boy dislikes her, her friends will abandon her and she will lose her status and become the victim of bullying. This is the harsh reality of schools presented in The Bully Society. 

Ms. Klein maintains that school shootings are a result, a reaction to bullying. The shooters were victims of dominant, hyper-masculine males. The shootings were an attempt by the shooters to prove their own adequacy as a male—their attempt at hyper-masculinity. 

Many different forms of violence towards others are explored, including hazing, sexual harassment, racism, gay bashing, cyber bullying, and even a section on “the bully economy.” These are illustrated by personal stories from the victims themselves. Ms. Klein gives a sympathetic voice to the victims of bullying throughout their stories. 

Extensive interviews were conducted as part of the research for the book. This research is evident in the detail that Ms. Klein presents. Many different types of violence fall under the umbrella of bullying in this book. 

There is no clear definition of bullying offered. All forms of aggression and violence are lumped under the umbrella of bullying. Dan Owleus, who was one of the initial contemporary researchers of bullying in 1977, offers a definition. His definition is the foundation for most other definitions of bullying: “A student is being bullied or victimized when he or she is exposed, repeatedly, and over time, to negative actions on the part of one or more other students.” 

One of the key elements is the phrase “over time.” Research has shown that the “over time” part of bullying is a significant component. That is not to diminish the effects of other types of violence, but there is a large body of research that shows that the “over time” has an insidious effect on the recipient of the bullying. The effect on someone who is called a name or pushed by a stranger in school is far different than someone who is bullied over time. There is no differentiation discussed in the book. 

Schools are presented as dangerous and hostile environments where one is constantly on alert of being attacked or attacking. Part of the reason offered for such environmental conditions is a lack of adult protection and intervention. Those adults, principals, teachers, and even parents, who should be protective, often bully students themselves; they ignore bullying and do not punish the bullies.

Though that happens, Ms. Klein’s statement, “Fraternity members, football players, and other elite students are virtually encouraged to flout the law. As a result, only 5% of their victims’ tend to report crimes by these students, since the campus social order virtually guarantees that the claims will not receive fair consideration (p. 76),” seems to be an overstatement of the problem. 

The problems Ms. Klein presents are real; unfortunately, however, the problems are the only things presented. There is no perspective on the pervasiveness of bullying. A national study found that 29.9% of students are involved in bullying either as a bully (13.0%), a victim (10.6%), or both a bully and a victim (6.3%) (Nansel, Overpeck, Pilla, Ruan, Simons-Morton, & Scheidt, 2001). The perspective that those numbers offer is not apparent is this book. Since only the problem is presented, one is left with the impression that all students are somewhere on a continuum of bullying. 

I have worked as a school social worker. Yes, bullying exists in schools as do other forms of violence, dominance, and aggressions. Yet most students survive, even thrive. Not all students are caught up in the competition to be at the dominant, hyper-masculine top of Ms. Klein’s pecking order. Many form other subcultures within the school aside from the jocks and preps Ms. Klein presents as high status students. There are even acts of kindness and compassion occurring regularly in schools. The majority of principals and teachers I have known are caring and compassionate. They are not tolerant of bullying or violence in any form, no matter who the perpetuator. 

The last section of the book is about what can be done about the problems caused by hyper-masculinity. Research shows that the larger the group involved in the intervention, the more successful the outcome. A lone classroom is better than nothing; a school is better than a classroom; a whole school district better yet; and if the community beyond the school is also involved, the best results are produced. This is consistent with the data presented in the book. 

There are a number of unanswered questions arising when reading The Bully Society. What is the difference between those few students who choose a violent response to bullying by shooting and those other students that receive similar treatment and don’t resort to violent retaliation? If the intervention programs are effective in reducing the hyper-masculinity, what is the impact of changing those children with regard to their ability to function in a world that values hyper-masculinity? 

Richard Jezioro, MSW, LCSW, is currently in private practice working with children, adolescents, families, individuals, and veterans. He spent many years in school social work and child welfare before developing his current practice. 

Oncology social work is the practice of our profession within the medical community—specifically with those affected by cancer—and aimed at improving the quality of life. Cancer is now a global epidemic. Men have a one in two chance of developing cancer while women have a one in three chance. There are 12 million cancer survivors living in the United States, and it is estimated that 1,638,910 people will be diagnosed this year (American Cancer Society, 2012). Oncology social work is “designed to promote the patient’s best utilization of the health care system, the optimal development of coping strategies and the mobilization of community resources to support maximum functioning” (Association of Oncology Social Workers, 2001). As the number of those facing cancer has risen, so has the field of oncology social work.

Oncology social work was born out of the specialty practice of medical social work and built on the foundation laid by Ida Cannon and Harriet Bartlett at the turn of the century. The early days of medical social work began at Massachusetts General when Ida Cannon (who was a nurse) identified that treating the medical condition of a patient and not addressing the patient’s social environment was ineffective (Cannon, 1923). Two decades later, as the practice of oncology treatment was evolving, hospitals nationwide identified that social workers were necessary to meet the psychological and environmental needs of cancer patients (Holland, 2004). During the 1970s, oncology social work and meeting the emotional needs of the cancer patient gained momentum as various hospitals and individuals became the first leaders of the psycho-oncology field.

Oncology social workers began to spring up at hospitals throughout the country. Within the field of medical social work, this new sub-specialty of social workers found that the needs of cancer patients were unique, as were the practice skills. Most facilities employed one oncology social worker which led to a phenomenon referred to in the field as “the lone ranger.” As a mode of practicing good self care and attaining continual improvement of clinical skills, oncology social workers began to network with one another. Oncology social work evolved to recognize the importance of continuing education specific to cancer and end-of-life. The field also identified the importance of research to demonstrate the impact of psychosocial interventions to the medical community. Research and significant findings provided the credibility that physicians, nurses, and other health care practitioners require. As in all areas of social work, research is the method in which to continually improve clinical skills and outcomes for those we service.

Practicing Oncology Social Work

The term “cancer” often invokes fear and anxiety, which in turn leads people to ask why anyone would want to do such work. Being surrounded by life and death each day takes a certain set of skills. It also takes a certain type of social worker. The challenges are just are numerous and very real. Positions can be difficult to obtain, not only because a master’s degree in social work is required, but because cancer centers and organizations are looking for experience and clinical certification. This makes it hard to initiate the career, which is compounded by each facility having usually only one oncology social work position. A significant portion of the oncology social work positions lie within the in-patient case management departments of hospitals. Case management and discharge planning carries a high stress level. Given the current trend in health care of holding the discharge planner responsible for getting the patient out of the hospital in the least amount of time, hospital social workers are put in a position which adds stress to the patient’s current situation. Reflective of the economy and most any area of social work practice, an oncology social worker’s caseload can be heavy and overwhelming. In the midst of practicing during the Affordable Care Act era, oncology social workers are challenged with guiding patients and obtaining resources when laws and regulations are changing. There are constant changes in medical advancements which drive constant adaptations by the oncology social worker. External forces such as the economy crisis, changes in Medicaid coverage, practicing in an increasingly litigious society, and servicing patients who are not legal citizens are all current obstacles which need to be overcome. Above all, the biggest challenge facing the field is clinician burnout or compassion fatigue. “Oncology social workers are prime candidates for compassion fatigue, especially when their empathy is not balanced by a flexible approach to the work and the ability to work toward their own goals, not those set by others” (Stearns, Lauria, Hermann & Fogelberg, 1993). Self-care, work-life balance, and peer support are essential to developing a successful oncology social worker. Oncology social workers give a piece of themselves every time they lose a patient, and there are times when coping with their own grief of losing someone who meant something in their lives. Watching individuals suffer can be the hardest part of this work.

While the challenge of such intense work is daunting, the rewards of such a career far exceed any of the downfalls. In working with people who are facing death, one cannot help but be changed and learn quickly what is important in life. A very special patient who was dying once said to me, “You are the only one left in my life who looks at me and really still sees me.” That was the first patient I lost, and I often say that it was the work that changed my life. Doing this work, the oncology social worker has the opportunity to learn the lessons of true forgiveness, love, spirituality, and integrity. The oncology social worker is the individual who facilitates processing Erikson’s ego integrity versus despair. Being part of the process fosters an individual’s growth and beliefs of the world around them. The clinician also receives the gratification of being in the midst of a crisis and being able to tangibly help solve a problem or provide crisis intervention. An oncology social worker can help obtain medications, financial assistance, or help create a safe home environment in addition to a large number of other resources. Oncology social workers may go home at the end of the day with the knowledge that their patient may have relief of pain because of a resource they identified. Helping strengthen a family or a couple who are falling apart creates a feeling of success and fosters a sense of control in a disease which takes so much from so many. When survivors come back to their physicians for follow-up in the years following treatment, the oncology social worker bears witness to the success and triumph that comes with winning the battle. When a child does this, there are few greater feelings. Because the oncology social worker is present through the course of treatment, they get to view people gain back the ability to walk or talk. There are so many powerful moments, such as when a child who stopped walking stands up because of receiving proton therapy treatment; or when an adult can say thank you when a few weeks prior they could not speak; or even when a young adult survivor who underwent chemotherapy comes back to the center to ask about schooling to become a social worker. These moments bring euphoria and pride. These patients at that moment are true survivors, and the social worker played a part in that.

The number one question I have experienced is people asking, “How could you do that work every day?” My response is simple: “How could I do anything but this work?”

REFERENCES

• American Cancer Society. (2012). Cancer Facts & Figures 2012. Retrieved from http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012
• AOSW. (2008). Oncology Social Work Tool Box. Washington DC: AOSW.
• Cannon, Ida. (1923). Social Work in Hospitals: Contribution to progressive medicine, Volume 2. New York: Russell Sage Foundation.
• Holland, Jimmie. (2002). History of pyshco-oncology: overcoming attitudinal and conceptual barriers. Psychochosocial Medicine, 64, 207.
• Stearns, N. Lauria, M., Hermann, J., & Foeglberg, P. (1993). Oncology Social Work: A clinician’s guide. Atlanta, GA: The American Cancer Society.

Maureen Brinkman, LCSW, OSW-C, is manager of patient services at Procure Proton Therapy Center in Warrenville, IL, as well as the Illinois representative for the Association of Oncology Social Work (AOSW).

Both the Illinois House and Senate have passed SB 2840, a Medicaid "restructuring" bill, interestingly called the SMART Act. The bill combines cost-saving measures to combat fraud, scrutinze vendors, and institute more care coordination and managed care with serious cuts to certain programs and services, and the elmination of some programs.  

When Governor Pat Quinn presented his budget address earlier in February, he asked for $2.7 billion in cuts to Medicaid to keep the program solvent. This has been accomplished— at least on paper—by cutting $1.6 billion, raising $800 million in new cigarette tax revenue and $300 million in other savings.   

Among the programs impacted by SB 2840 are the Illinois Cares Rx program, a prescription drug assistance program for senior citizens and persons with disabiities (Eliminated); adult dental coverage (Limited to emergencies); and a waiver that pays for in-home nursing care for medically fragile or technology-dependent children in order to prevent nursing home or hospital adminssions (Significantly scaled back). The Home Services Program operated by the Department of Human Services Division of Rehabilitation Services willl also be cut back by raising the qualifying determination of need (DON) score from 29 to 37.

Part of the $2.7 billion savings was realized by passing SB 2194, which raises the tax on cigarettes and other tobacco products. It is also predicted by the governor that approximately 60,000 will stop smoking and 80,000 children will not start smoking as a result of the higher cost.

On the budget front, the Illinois Senate sent three budget bills over to the Illinois House last week; they are now being amended in the House.   Hearings were scheduled for today and then recessed. We expect the budget to be passed in the next two days, but there is still a chance they will go into overtime.

In other legislative action, both houses have passed SB 3261 which sets standards for hospital charity care for uninsured patients. The bill, among other things, calls for the Attorney General to adopt rules to establish standard provisions for applications for financial assistance and to also set standards for assistance, including eligibility for certain financial assistance and needs-based programs such as SNAP.

Also for a second time, the Illinois Senate today failed by one vote to pass HB 5290, a bill to requires school districts and certain private schools to adopt policies which address bullying and incorporate certain elements such as a complaint procedure. Certain groups such as the Illinois Family Institute oppose the bill and sought an opt-out of school events, assemblies, and programs to which a student's family has moral, personal, or  religious objections.