Policy BP8: Let’s do drugs!

How has U.S. federal drug and mental health policy positively and negatively affected mental health and substance abuse in the U.S.?  Use at least 2 policies for each (mental health and substance abuse) to defend your answer.

Happy Monday! What a perfect blog post for this part of the semester. I will only speak for myself, but I am in a place where my mental health is suffering. I can probably speak for everyone actually…

Good Stuff

  • NAMH came out of mental health reform. It provides social support and treatment for the mentally ill. They provided protections for those who were targeted by supporters of the eugenics movement.
  • The Mental Health Act of 1946 established the National Institute of Mental Health. This examined the mental health needs of the country. NIMH then released Action for Mental Health that modernized US psychiatric care.
  • The National Association of Mental Illness (NAMI) accepts philanthropy from drug companies and helped with further destigmatization.

Bad Stuff

  • Although deinstitutionalization is a good thing, helping to destigmatize mental health, now there are many mental health patients that are “adrift”, as the book states. This leads to chronic hospitalization and homelessness.
  • Psychotropic meds are now more routine than ever. Heck, I’m on anxiety meds! Meds that should be used within the controlled environment of a hospital are being prescribed to outpatients. The side effects of these drugs make it difficult for someone not in an inpatient facility to function.
  • NAMI takes money from drug companies. I can’t see how this is going to always be a good thing. HINT: special interests.

Overall, the destigmatization of mental illness and the use of drugs to treat mental illness is a very good thing.

Generalist Practice BP 8: Community Group Leadership

 

    Referring to Brueggeman’s article, what are 3 ways that social workers build community in groups through their leadership? Please explain your answers and give 2 concrete examples of how you have seen these elements accomplished in your own group experiences.

We’re back from Spring Break! This week has had a slow start, and I’m already looking forward to the summer. The quicker we can get done, the quicker we can get to graduation next Spring, right??

How do social workers build community in groups through their leadership?

  1. Gather People Together-as social workers, especially those in a macro environment, we have opportunities to gather people together for a multitude of reasons. Mobilizing community groups for a common purpose gives those groups a sense of belonging and power. In my practicum, I bring groups of kids together for several purposes. One is a group of 4th grade girls that meet to talk about bullying. They talk about their experiences and how to be better friends. Another time I’m able to gather a group is in the larger classroom setting. We talk about social skills, and the children learn how to navigate through the school appropriately.
  2. Express Feelings-social workers have the unique opportunity to motivate others to talk about their feelings. It is our job to create a safe environment for this to happen. In my personal experience, I have attended 12-step groups where the participants were encouraged but not obligated to share their feelings and experiences. One primary motivating factor was the promise of confidentiality in these groups. As a group leader in a school setting, I use open-ended questions and talk about my own experiences to motivate young group members to disclose their own feelings. This encourages the members and shows them they are not alone, and there is a trusted adult who has been through what they might be going through.
  3. Build Confidence-by building trust and showing group members that they are not alone in this world, a social worker can help those group members build confidence. Once confidence is built and maintained, those group members can begin to exact change in their own lives should they choose to do so. With children, confidence-building begins with teaching them a skill set. I led a group of children with anxiety issues, and through a structure curriculum, I was able to teach them tools for coping with their anxiety. Does this work all the time? No. But they feel better knowing they have the right tools to help themselves when they can. As a student in a cohort, it comforts me and gives me confidence knowing that we are all able to help one another. We use social media to disseminate information to each other, and this builds confidence within the group.

Brueggmann, W. G. (2006). In The practice of macro social work. Chapter 4

Social Policy BP 7: Medicaid and Medicare

Describe Medicaid & Medicare, including how they are administered, who they cover, eligibility, and efforts to cut costs in each program.

Can we talk for a moment about how grad students don’t get a Spring Break? Because we don’t. I went to Colorado for a few days with my son, and I had serious guilt about it. I knew everyone else in the cohort was slaving away on their little laptops, writing papers and other things for all the classes and everything that is due (and STILL managed to all be due at the same time).

That has nothing to do with Medicaid and Medicare. I just needed a moment to vent. Venting done.

I made this little chart that quickly touches on Medicaid and Medicare. One thing I found terribly interesting in the reading is that the Affordable Care Act (Obamacare) was created in part as a stop-gap to keep Medicare from going belly-up! It does appear that, unless the Boomers start actively dying, it will go belly-up sooner than later. And, now that it seems ACA has been chopped with no effective replacement (yet), we can say bye-bye to Medicare very, very soon. But let’s not think about that. Let’s look a my handy-dandy chart instead!

Medicaid

 

Medicare

 

Description

 

Largest public assistance program in the US. Medical coverage and who is covered is determined by the state under broad federal guidelines. Covers: inpatient and outpatient hospital services, prenatal and 60 days postpartum care, vaccines for kids, doctor services, nursing facilities for 21 and over, family planning, rural clinic services, and many other services. 2nd largest social insurance program in the US behind Social Security. Largest public payer of healthcare. Designed to help the elderly with prepaid hospital and optional medical insurance. Part A: Hospital Insurance. Part B: Supplemental Medical Insurance. Part C: Medicare Advantage Program. Part D: Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
How is it administered?

 

Administered through the state. Eligibility varies state-by-state. Administered by the US government. Premiums for Part A are derived from payroll taxes.
Who is covered?

 

Limited and low-income families with children who meet certain requirements. Supplemental Security Income recipients. Infants born to Medicaid-eligible women and through the first year of life. Poor children under 19. Foster and adoption assisted families and children. Other “needy” groups as determined by the state. Part A is provided free for persons 65 or older who are eligible for SS or Railroad Retirement benefits. Other parts of Medicare are available for a premium.
Eligibility

 

Each state has its own guidelines regarding who is eligible. This can cause wide variety among states. A person might be eligible in one state but not in another state, depending on that state’s guidelines. Must be 65 or over and eligible for SS or RR benefits. Part B available to US citizens and approved legal aliens.
Cost cutting measures

 

Many states require that patients on Medicaid also enroll in state-contracted HMOs. Medicare doesn’t cover everything, and there is a 3rd-party “Medigap” insurance available at a premium for things that Medicare doesn’t cover. The Affordable Care Act was also a cost-cutting measure that was projected to keep the Part A trust from going bankrupt until 2029.

Yay! You made it to the bottom of the chart. You are rewarded with a picture of one of my red tulips.

Jill

Generalist Practice PB7: Greenville-Spartanburg, SC

As evidenced in the text, what are three ways that the leadership of Greenville-Spartanburg, SC “re-invent[ed] their future” through global partnership?

Global partnership is a tricky subject. I don’t know many people who wouldn’t push for a strong local economy but NOT at the expense of the local product. However, if Greenville had pushed for this it could have spelled certain death for this community. Globalization was imminent, so Greenville embraced it and have had this aura of inclusion and globalization since the 50s. Here is what the leadership did:

  1. Milliken and Tukey, local business leaders, both worked to transform the Upstate South Carolina area to make it appealing to foreign business investors. They did this by exploiting the pro-business attitude of the area and pushing its well-known worker training programs.
  2. They went overseas to encourage foreign investors to come to Greenville-Spartanburg and put down roots, thus making a personal investment in the area and bringing their businesses with them.
  3. They pushed for business incentives and legal amendments to further encourage foreign businesses to plant themselves in the market in Upstate.

Thinking of a community with which you are familiar (feel free to use OKC or Pittsburgh from the text), how did that community diversify and restructure their future? Give 2 concrete examples.

  1. This process began over 60 years ago for this community, and it took the insight of two skilled businesspeople to clear the way for the globalization that has happened in Upstate. Now the area is filled with international restaurants, stores, multicultural events, and schools.
  2. Because of the push for business incentives and amendments as well as the strong worker training programs, international businesses are still flocking to the area. The workforce is skilled and flexible, the geographic location is ideal, and the area has spent 60 years cultivating an inclusive and culturally sensitive environment in which these businesses and people thrive.

Although I did not grow up in the OKC metro area, I can still see the results of global inclusivity that has happened in the area. I do recall visiting OKC as a teen and seeing how little there was here. Now the area is booming with shops, restaurants, night life, businesses, and cultural centers like the Civic Center. OKC has a strong sense of historic preservation as well, as there are memorials and museums all up and down the I-35 corridor and into the small communities. I am amazed at the volume of festivals scattered throughout the state and the amount of participants that are drawn to them each year. Oklahoma City’s globalization and preservation efforts have benefitted, not only OKC metro, but I believe the state as a whole.

Morse, S. (2014). Smart communities: How citizens and local leaders can use strategic thinking to build a brighter future (2nd edition). San Francisco: Jossey-Bass.

BP6: AFDC vs. TANF: the grudge match

Explain AFDC & TANF.  Discuss the ideological and political changes surrounding the switch from AFDC to TANF. Describe the differences & similarities between the two programs.  

These blog posts have been eerily on-target with whatever is going on in my life at the time.

I have a friend who experiences pretty intense instability in every area of her life. Yesterday I was helping her move out of her house because she was being evicted. After months of struggle and food insecurity, she finally filed for SNAP and TANF. I felt good that I was able to explain some of the benefits of it to her and also comfort her with the knowledge that, as a taxpayer, she’s already paid for these services. Now she gets to use them.

I’m a big proponent of working smarter, not harder (although I do work hard). I found this super nifty chart that lays out many of the similarities and differences in AFDC and TANF (Temporary Assistance for Needy Families).

A major ideological difference in AFDC and TANF is the idea that people were “living off the system”, since there were no limits on how long a person could be on assistance. TANF is a five-year limit. Another difference is the idea that children had to be deprived of support by one parent because of death, separation, divorce, or desertion.

I can see the perspective of those who feel that people “live off” welfare and do not support government support. Those people are likely recalling AFDC, however, and are uneducated on how TANF works. Check out the chart.

I pulled this from www.advocatesforyouth.org.

 

AFDC/EA/JOBS
(before 1997)

TANF
(after 1997)

Federal Funding
  • Unlimited for AFDC and EA
  • Capped entitlement for JOBS
  • Federal share of AFDC and JOBS costs varied inversely with state per capita income
  • Fixed grant
  • Plus: (1) contingency fund and loans for states with high population growth and low welfare spending; (2) welfare-to-work grants (through FY 2003); and (3) bonuses to states that reduce the number of out-of-wedlock births and abortions
State Funding
  • Matching required for each federal dollar
  • States must spend 75 percent of “historic” level (100 percent for contingency funds) and must provide matching for contingency funds
Categories Eligibility
  • Children with one parent or with an incapacitated or unemployed second parent
  • Set by state
Income Limits
  • Set by state
  • Set by state
Benefit Levels
  • Set by state
  • Set by state
Entitlement
  • States required to aid all families eligible under state income standards
  • TANF expressly denies entitlement to some individuals
Work Requirement
  • JOBS Program had participation requirements, but not work requirements
  • By 2002, states must have 50 percent of their caseload in specified work activities
Exemptions from Work Requirement
  • Parents (chiefly mothers) with a child under age three (under age one at state option)
  • None, but states may exempt single parents caring for children under age 1
Work Trigger
  • None
  • Work (as defined by the state) required after a maximum of two years of benefits
Time Limit for Benefits
  • None
  • Five-year time limit (20 percent hardship exceptions allowed)