November 29, 2018 Compass
On October 19 Dr. Darla Spence Coffey, CSWE president and CEO, met with Dr. Elinore McCance-Katz, assistant secretary for mental health and substance use in the Substance Abuse and Mental Health Services Administration (SAMHSA). The role of social work in mental health and substance use was discussed. Additional priority topics for Dr. McCance-Katz were serious mental illness and school safety. Dr. McCance-Katz touched on her work with the Federal Commission on School Safety led by U.S. Secretary of Education Betsy DeVos. The Commission’s report on policy recommendations to improve school safety is expected before the end of the year.
Dr. Spence Coffey also met with Captain Sophia Russell, director of the Division of Nursing and Public Health in the Bureau of Health Workforce at the Health Resources and Services Administration (HRSA). The division oversees grant programs important to schools of social work, including the Behavioral Health Workforce Education and Training grant. Social work’s substantial involvement in the BHWET program was discussed during the meeting. CAPT Russell also highlighted HRSA’s current priority areas, including expanding telehealth and addressing the needs of rural and underserved populations.
CSWE submitted a letter to several federal agencies in response to attempts by the Trump Administration to establish a federal definition of gender as an unchangeable biological condition determined by genitalia at birth. The proposed definition runs counter to CSWE’s values and science and erases protections for transgender, nonbinary, and intersex people. In the letter
CSWE President and CEO Darla Spence Coffey notes that “trans individuals already face significant health disparities; this proposed change would only exacerbate those challenges. CSWE adamantly opposes this initiative by the administration and requests that this effort be terminated.” The administration’s next steps are unclear.
On October 10 the Eldercare Workforce Alliance (EWA) hosted a Twitter chat, “Preparing the Workforce to Address Mental Health and Substance Use in Older Adults.” Along with CSWE, other partners in the chat included federal participants such as the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Administration for Community Living, and EWA members such as the American Psychological Association, the American Society of Consultant Pharmacists, Community Catalyst, and the Gerontological Society of America. Questions ranged from how mental health and substance use issues affect older adults to solutions for addressing eldercare workforce shortages. The chat increased awareness about mental health and substance use needs among older adults by reaching an estimated 138,506 Twitter accounts.
As anticipated by a majority of polls, Democrats regained the majority in the House of Representatives and Republicans make gains in the Senate in the November 6 midterm elections. With a handful of races still too close to call, Democrats have picked up 37 seats in the House, and the Senate Republican majority has increased by at least one and probably two seats. With many moderate Republicans losing in the House and several moderate Democrats losing in the Senate, finding areas of common ground may be even more difficult in the next Congress as the House and Senate set up dueling agendas in the months ahead. Some initial topics in the House and Senate in which Democrats and Republicans have cited interest include health care, specifically reining in prescription drug prices, and infrastructure, although each party has a different notion of how much new public funding is needed.
Notable for CSWE members, Rep. Kyrsten Sinema (D-AZ), who has a social work background, won election to the U.S. Senate in Arizona. Rep. Sinema will join Sen. Debbie Stabenow (D-MI), who won her reelection bid, as the second social worker currently in the Senate. On the House of Representatives side, Sylvia Garcia (D-TX), a social worker earlier in her career, was elected to Congress. Three incumbent social workers will retire at the end of the 115th Congress and did not seek reelection in 2018: Rep. Luis Gutiérrez (D-IL), Rep. Carol Shea-Porter (D-NH), and Rep. Niki Tsongas (D-MA). The remaining three incumbent social workers each won reelection: Rep. Karen Bass (D-CA), Rep. Susan Davis (D-CA), and Rep. Barbara Lee (D-CA). Rep. Lee is currently a candidate for Democratic Caucus chair, the fourth-ranking Democrat in the House of Representatives.
With respect to education, the midterm election results present an opportunity for Higher Education Act (HEA) reauthorization in the new Congress. Entering his last 2 years as chairman of the Senate Health, Education, Labor, and Pensions Committee due to term limits, Chair Lamar Alexander (R-TN) probably will reengage the committee in the reauthorization of the HEA. Top HEA priorities for Alexander include a simplified Free Application for Federal Student Aid form, simplification and consolidation of student aid programs, and a greater stake for institutions for student loan defaults. Rep. Bobby Scott (D-VA), the likely incoming chair of the House Education and Workforce Committee, released an HEA reauthorization bill, the Aim Higher Act, which contains several proposals of interest, including increasing the maximum Pell Grant award, permitting the use of Pell for graduate education, increasing funding for Title VI international education, and the creation of a federal–state partnership to encourage states to provide tuition-free community college. Beyond the broad focus on education, there will be increased attention on issues of accessibility and college costs, diversity, campus-based climate, and regulatory changes pursued over the last 2 years by Secretary DeVos.
Regarding health care, Alexander and Ranking Member Patty Murray (D-WA) probably will seek to revive their efforts to fix the Affordable Care Act (ACA). During Republican efforts to repeal the ACA in the 115th Congress, the Senate HELP leaders made progress on a bipartisan plan to stabilize the health insurance markets to avoid predicted sharp increases in premiums, particularly for those buying insurance on the individual market. However, these talks fell apart in spring 2018, reportedly due to the issue of abortion coverage. Despite this setback, Senators Alexander and Murray expressed their interest in resuming bipartisan talks in the 116th Congress, and the Democratic takeover of the House portends easier negotiations with the other chamber if the HELP Committee can come to agreement on a bill. Rep. Frank Pallone (D-NJ), expected to be incoming chair of the House Energy and Commerce Committee, introduced a bill earlier this year on health market stabilization. Part of any ACA discussions on the Democratic side will include protecting individuals with preexisting conditions.
The Trump Administration published its Unified Agenda of Regulatory and Deregulatory Actions
(Agenda) on October 17. The Agenda includes regulatory actions by executive agencies that are likely to occur in the next 12 months and notes, “By amending and eliminating regulations that are ineffective, duplicative, and obsolete, the Administration can promote economic growth and innovation and protect individual liberty.” Below are pending regulatory actions that could affect higher education.
• State Authorization and Related Issues: The Department of Education (ED) proposes amending the regulations governing the legal authorization of institutions by states.
• Accreditation and Related Issues: ED proposes amending the regulations relating to the secretary’s recognition of accrediting agencies and accreditation procedures as a component of institutional eligibility for participation in federal student financial aid programs.
• Ensuring Student Access to High Quality and Innovative Postsecondary Educational Programs: ED proposes creating and amending regulations related to institutional eligibility and operations for participation in federal student financial aid programs. Regulations related to the definitions of credit hour, competency-based education, direct assessment programs, regular and substantive interaction, and other regulations will be considered. ED asserts that these regulatory revisions are “to promote greater access for students to high-quality, innovative programs of postsecondary education.”
• Eligibility of Faith-Based Entities and Activities, Title IV Programs: ED proposes reviewing and amending regulations related to the eligibility of faith-based entities to participate in ED’s higher education and student aid program to reduce or eliminate unnecessary burdens and restrictions on religious entities and activities.
CSWE provided comments for the January 2019 negotiated rulemaking and has nominated Dr. Stacey Borasky, CSWE director of accreditation, to serve on the rulemaking committee. Other regulations ED may address during the year include the following:
Updating Regulations Relating to the Graduate Assistance in Areas of National Need (GAANN) Program: The most recent GAANN competition
included several new areas of national need including National Civic Literacy.
• Updating Regulations Relating to the Higher Education Act Title III and Title V Programs: Programs authorized under Titles III and V primarily provide grants for minority-serving institutions. According to ED, these changes are intended to “further enable minority-serving institutions to strengthen student services and other elements of their missions.”
• Institutional Accountability: These rules relate primarily to Borrower Defense to Repayment (BDTR). A federal judge recently ruled that the BDTR regulations promulgated by the Obama Administration in 2016, which were delayed by the current administration, may go into effect.
• Program Integrity; Gainful Employment: These rules relate to the Title IV eligibility regulations governing certain postsecondary educational programs that prepare students for gainful employment in a recognized occupation. Similar to the timing issues associated with the BDTR regulations, ED has missed a filing deadline, which means the regulations developed under the Obama Administration remain in effect. New rules may be finalized by the end of the year.
On November 16 the U.S. Department of Education (ED) announced
its notice of proposed rulemaking (NPRM) to revamp the regulations under Title IX of the Education Amendments of 1972, the civil rights rules that dictate how institutions of higher education and K-12 schools address and respond to incidents of sexual discrimination, including harassment. The proposed rules make significant changes to the legal requirements of institutions, such as new definitions, a narrowed scope of institutional responsibility, evidentiary standard changes, and new due process protections.
Of note, the NPRM proposes a new definition of sexual harassment based on Supreme Court decisions. The proposed rule also further clarifies that an institution’s duty to respond is predicated under cases of “actual knowledge” of sexual harassment and with conduct that occurs within an institution’s “education program or activity” in the United States. Although requiring institutions to meaningfully respond to every formal complaint, the NPRM suggests ED review institutional actions under a higher “deliberate indifference” standard for Title IX violations to allow institutions greater flexibility in responding to cases brought forward and making disciplinary determinations. It also offers safe harbor protections for institutions that meet certain proposed procedures and encourages institutions to offer parties “supportive measures,” defined under the NPRM that include actions such as counseling and modification of schedules.
To bolster due process protections, the NPRM calls for institutions to provide equitable treatment of complainants and respondents, follow “reasonably prompt timeframes for conclusion of the grievance process,” ensure the burden of proof rests on institutions, offer equal access to evidence materials by both parties, and allow cross-examinations by each party’s choice of advisor at live hearings. Institutions could not use a single-investigator or investigator-only model. Further, the NPRM would officially allow case determinations to follow either a preponderance-of-the-evidence standard or clear-and-convincing-evidence standard, as long as the institution follows that same standard for code of conduct violations with similar disciplinary sanctions and in cases of complaints against employees or faculty members. CSWE will be providing comments on the proposed rules.
On November 13 the National Academies of Science, Engineering and Medicine (NASEM) hosted a meeting by Web conference
of the Committee on Integrating Social Needs Care Into the Delivery of Health Care to Improve the Nation’s Health (Committee). The Committee will produce a report outlining strategies and making recommendations on how to better align health care and social needs care delivery to address social determinants of health and reduce health disparities. That process has involved gathering public comments and expert testimony. During the Web conference the Committee heard three presentations from social workers on best practices and models of social needs care during and after hospitalization. Walter Rosenberg, director of social work and community health at Rush University Medical Center (RUMC), discussed the Bridge Model of Transitional Care; Dr. Victoria Rizzo, associate professor at the University at Albany School of Social Welfare, discussed the AIMS Model, which was also tested at RUMC; and Dr. Tim Rehnder and Michelle Brazeal of the University of Southern Mississippi School of Social Work discussed results from the Mississippi Integrated Health and Disaster Program. The models focus on the engagement of social workers in predischarge planning and postdischarge interventions with hospital patients. They were found to have positive effects on economic factors, such as reduced hospital readmission rates and lower average hospital visit costs, and on medical factors, such as lower blood pressure and reduced psychological distress. Questions from the Committee revealed an interest in access and scalability of current programs under these models, with Committee members asking about the percentage of patients eligible to participate and the care providers eligible to be trained to use these integrative models.
On October 4 the United States Department of Agriculture launched
a new interactive data tool to facilitate community engagement efforts to combat the opioid crisis. The Community Assessment Tool allows users to overlay substance misuse data with other datasets, including socioeconomic, census, and other public information. The tool will help community leaders, researchers, and policymakers assess effective efforts to address the public health crisis locally. “Local leaders in small towns across our country need access to user-friendly and relevant data to help them build grassroots solutions for prevention, treatment and recovery,” said Assistant to the Secretary for Rural Development Anne Hazlett. The announcement follows President Trump’s declaration of October as National Substance Abuse Prevention Month.
The National Institute on Aging (NIA), in the National Institutes of Health, recently released two requests for information (RFI), which are great opportunities to seed future ideas for research opportunities. The first RFI seeks feedback
on the NIA Strategic Directions, the document updated every few years to guide the overall priorities of the institute. Responses are due by December 14. The second RFI is an opportunity
to respond to issues related to Alzheimer’s disease and related dementias (ADRD) research needs and opportunities. In conjunction with the National Institute of Neurological Disorders and Stroke, NIA seeks input from scientists, clinicians, and other caregivers on current research activities related to the ADRD
research milestones and ideas for new areas to address in future plans. Responses to that opportunity are due by December 20.
On November 8 the Health Resources and Services Administration (HRSA) Bureau of Health Workforce (BHW) released a notice of funding opportunity for the fiscal year 2019 Geriatrics Workforce Enhancement Program (GWEP). According to the notice, “the purpose of this program is to improve health outcomes for older adults by developing a healthcare workforce that maximizes patient and family engagement, and by integrating geriatrics and primary care.” Schools of social work are eligible to apply. Proposals are due by February 6, 2019, at 11:59 pm ET, and grants will be made for 5 years.
On November 8 the Health Resources and Services Administration (HRSA) Bureau of Health Workforce (BHW) released a notice of funding opportunity for the fiscal year 2019 Geriatrics Academic Career Awards (GACA) program. The GACA program, which has not been funded since 2015, supports “the career development of individual junior faculty in geriatrics” by providing them “the necessary skills to lead health care transformation in a variety of settings.” Proposals are due by January 15, 2019, at 11:59 pm ET.