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MGH Community News |
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MGH Community News |
| December 2015 | Volume 19 • Issue 12 |
Highlights
Sections
Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
SNAP Work Requirement and Time Limit Update As reported last month (Looming SNAP Cliff for Able-Bodied Adults without Children, MGH Community News, November 2015), able-bodied adults without children (ABAWDs) from most areas of the state will be subject to a 3-month SNAP time limit beginning in January unless they comply with, or are exempt from, work requirements. Disability Standard is More Generous than Other Programs It is particularly important for us to know (and to be able to educate other providers) that the SNAP standard of illness or disability is a much less strict than the Social Security standard. It is even lower than the EAEDC disability standard. The SNAP disability standard is “a mental or physical illness or disability, temporary or permanent, which reduces their ability to financially support themselves.” Examples include:
Social Workers Can Sign the Medical Report Form LCSWs and LICSWs can sign the one-page medical report form. You do not need to provide a detailed diagnosis or medical documentation. The full list of accepted signatures: physician, physician’s assistant, designated representative of the physician’s office, nurse practitioner, osteopath, licensed or certified psychologist, drug and alcohol abuse counselor, certified mental health counselor, licensed independent clinical social worker, licensed certified social worker, and certified midwife. Illness/disability fact sheets and medical report form:
Additional Resources and Information Both Mass Law Reform Institute (MLRI) and DTA have posted more materials on ABAWDs and the time limit.
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New DTA Policy to Screen Homeless Individuals for Exemptions DTA reported this month that approximately 13,000 (of the 28,000) ABAWD individuals potentially affected by the 3 month time limit are homeless. DTA is planning to screen each homeless client that contacts them. Based on the answers to the questions below, the homeless individual may be determined exempt from the time limit and work rules. These homeless individuals will NOT need to provide a DTA ABAWD Medical Report form as well. We encourage advocates meeting with homeless clients to contact DTA and ensure that these five questions are asked. DTA is working on developing a homeless screening form as well. For ABAWD individuals who are coded in the BEACON system as "homeless," DTA will ask the following questions:
A correct answer to two (2) of the questions above would allow DTA to tag the individual as exempt. For example - an individual who lacks a stable night time residence and has not been employed for at least 6 months in the last 3 years would be exempt. Similarly, a homeless individual who may be regularly staying in the same shelter but does not have regular access to health care would be exempt. DTA Robo Calls to ABAWDs DTA is doing a series of mailings to roughly 28,000 ABAWDs - including their ABAWD brochure, medical report and screening form. DTA has also programmed "robo calls" to all those for whom they have phone numbers. Here is the DTA text of the robo call auto message to clients (English version): "This is a call from the Department of Transitional Assistance. On January 1, 2016, you or a member of your SNAP household may have to meet work requirements to keep getting SNAP benefits. You recently got or will get information about the work program rules by mail. If you have any questions or think that these rules do not apply, please call DTA at 1-877-382-2363. This rule does not apply to people living in certain parts of the state. If you did not get the mailing because you moved but have not told DTA your new address, please call 1-877-382-2363. " - Patricia Baker, Mass Law Reform Institute, e-mails to SNAP Coalition, December 2, 2015, and December 23, 2015.
Chelsea Revere Winthrop (CRW) Elder Services is Now Part of Mystic Valley Elder Services A version of the following was e-mailed to Social Service staff on 12/21/15. Effective October 1, 2015, Chelsea Revere Winthrop (CRW) Elder Services is now part of Mystic Valley Elder Services. Clients and/or program participants of the former CRW Elder Services may still reach their care manager by calling the same number: 617-884-2500. This is also the number to call for new referrals for residents of Chelsea, Revere or Winthrop. For the time being they will maintain the previous CRW office location. Thanks to Jenn Harris for alerting us to this change!
PCAs and Employment – Frequently Asked Questions The following article is a series of employment related questions that are frequently asked by individuals with disabilities who use PCA services. The answers are provided by Ray Glazier, a wheelchair user who utilizes the services of a Personal Care Attendant (PCA) at work and home. His experience includes over twenty years as Director at Abt Associates Center for the Advancement of Rehabilitation & Disability Services. Q: The accident that paralyzed me also bankrupted me, but at least I have MassHealth coverage for my PCA services and other stuff I've finally been offered a job, but not sure I can earn enough to pay my PCAs out of pocket. What can I do? Q: OK. But what is that "reasonable" monthly premium? Q: Why would I need two insurance plans if I don't have a family? Q: But what about PCA services on the job? Q: But this is my first experience of employment as someone with a disability, and I'm not sure about workplace personal assistance needs will be. Q: I can foresee difficulty recruiting PCAs for assistance at the worksite during my work hours. -Excerpted from Disability Issues, Vol. 35, No. 3 (Fall 2015), December 03, 2015. Read it online.
Department of Mental Health Area Office Consolidation As of November 1, 2015 the Department of Mental Health (DMH) has consolidated two of their sites. The East Suburban Site Office became part of the Northeast Area and is now known, somewhat confusingly, as the Arlington Site. It is confusing as the mailing address for applications for services, authorizations for release of protected health information, etc. for the Arlington Site is in Tewksbury. The Northeast area/Arlington Site now includes the following additional towns: Acton, Arlington, Bedford, Belmont, Boxborough, Burlington, Carlisle, Concord, Lexington, Lincoln, Littleton, Maynard, Stow, Waltham, Watertown, Wilmington, Winchester and Woburn.
The new mailing address for these towns: The new application for services includes an updated list of DMH Offices by town or see http://www.mass.gov/eohhs/docs/dmh/services/application-address-directory.xls. Please destroy any previously printed versions of the application and download the updated version from the DMH website: http://www.mass.gov/eohhs/gov/departments/dmh/service-application-forms-and-appeal-guidelines.html (it is also linked on the Staff Access area of our website).
Mass. Sets New Rules for Nursing Home Closures and Sales Nursing homes have been sold and closed at a rapid clip the past two years in Massachusetts, but the public has had virtually no say in the process. That will change under rules finalized this month, more than a year after state lawmakers directed regulators to create a system that is more open to the public. Elder advocates and the labor union that represents many nursing home workers had long lobbied for such a process. Until now, the state health department’s decisions about nursing home sales and closings have been conducted behind closed doors — unlike the review for hospitals, which are required to undergo public scrutiny, even for renovations. The dizzying changes in the state’s nursing home industry have alarmed advocates, who say closings have left families in the lurch, scrambling to find other nursing homes for their relatives. Some sales have raised questions about the quality of care delivered to the 40,000 residents in the state’s roughly 400 nursing homes. Under the new rules, operators would be required to notify the public before nursing homes are sold or closed, and hearings would be mandated for any closings. The rules, to take effect Jan. 1, require a nursing home intending to close to send written notice to the state health department four months in advance. A public hearing will be mandatory at least three months before the facility closes, and a closure plan must be distributed before that hearing to a long list of interested parties, including nursing home residents, their families, staff members, unions representing workers at the nursing home, elected state and local officials, and the offices of local and state ombudsmen. The rules are not as strict for companies intending to sell a nursing home. Those companies would be required to notify the same list of interested parties, but a public hearing would be required only if at least 10 people petitioned the state health department. Under existing rules, companies planning to sell a nursing home must notify the health department three months before the sale takes place. That time frame will not change under the new rules. -See the full Boston Globe article.
ABLE Act Closer to Becoming a Reality Nearly a year after the ABLE Act was signed the IRS has issued new guidelines that resolve advocates’ basic concerns, and it looks like ABLE Accounts will soon be a helpful tool in the special needs arsenal. The ABLE Act was enacted to allow parents of children with significant disabilities to help pay their children’s expenses, similar to a 529 Account for college savings for typical children. An ABLE account (called a 529A Account) allows donors to put up to $14,000 into the account per year, to grow tax-free. (The money transferred into the account is post-tax, but any earnings on the money in the account is not taxed, and all distributions are tax-free, so long as the distribution is a qualified expense.) In addition to the tax breaks, another benefit is that the account value, up to $100,000, will be disregarded in determining eligibility for Supplemental Security Income (SSI) and Medicaid. In other words, a person can have up to $100,000 in an Able Account and still be considered to have less than $2000 in assets, thereby qualifying for SSI and Medicaid. As a result of these new rulings, we think the major roadblocks of the ABLE Act accounts have been removed, and we should see them begin to open in Massachusetts in 2016. -See the full Margolis & Bloom blog post. (For more information see ABLE Accounts – Additional Details and Comparison to Third Party Special Needs Trusts, MGH Community News, February 2015.) -Thanks to Clorinda Cottrell for the related question that spurred us to investigate the status of this disability planning tool.
Trauma Teams Reach Out to Crime-Riddled Neighborhoods As the lifelong effects of trauma are becoming more widely recognized, the city has created a program to help residents who are repeatedly exposed to violence. “The chronic exposure to violence does affect individuals and families in ways they are not even aware of” and can cause feelings of helplessness and anxiety, said Dr. Huy Nguyen, interim executive director of the Boston Public Health Commission. When combined with other issues such as poverty, the effects of trauma can also lead to health complications including obesity and heart disease, Nguyen said. To help combat those effects, the city launched an initiative with community health centers in the neighborhoods most affected by violent crime. In the spring, the city stationed Trauma Recovery Teams — trauma-trained clinicians and a community worker — in each of eight community centers in Roxbury, Jamaica Plain, Dorchester, and Mattapan. The clinician and community worker provide counseling, organize peer support groups, and offer assistance with shelter, food, and health care. “These health centers have a broader definition of their role working in the community, promoting resilience and healing,” said Catherine Fine, the director of violence prevention at the Public Health Commission. Team members are deployed within up to 72 hours of an incident, Nguyen said. The trauma teams are tapped into a system that alerts them whenever there is a shooting, homicide, suicide, accident, or any other traumatic incident. When helping victims of violence, “You may think mental health and counseling, but it starts with concrete needs,” said Phillomin Laptiste, associate director of the Bowdoin Street Health Center. Those who are affected by traumatic experiences tend to need ongoing support, Nguyen, of the public health commission, said, and the goal of the trauma teams is to continue providing services long after “the story of an incident has died down.” Repeated exposure to violence is not uncommon, according to city health officials. Forty-six percent of the 480 people who have received services from the trauma teams this year said they have been exposed to multiple incidents of violence in the community, according to data provided to the Globe by the Boston Public Health Commission. The Commission defines “chronic exposure” to violence as experiencing multiple traumatic events or dealing with a single type of traumatic event over a prolonged period of time. Most of the trauma teams’ clients are black or Latino and are 17 years old or younger. At a City Council hearing in October, Nguyen said 48 percent of high school students in the city know someone who has been shot or killed. After the 2013 Boston Marathon bombing, many victims received counseling and other trauma-related services, leading some to call for similar assistance for city residents who cope with traumatic experiences every day.“The bombing highlighted not just the ability to respond to a terrorist event but also that there is ongoing trauma in communities of color,” Nguyen said. City officials said there are currently no plans to expand the teams, which were funded this year by federal grants and $730,000 of city funds. -See the full Boston Globe article.
Baker Adding More Beds for Addiction Treatment As many as 415 new addiction and psychiatric treatment beds could open in Massachusetts by the end of 2016, in addition to the 300 beds already created during Gov. Charlie Baker's first year in office, according to the Executive Office of Health and Human Services. The lack of inpatient treatment options has been a primary concern for advocates and the families of people seeking to overcome drug and alcohol addictions. The waiting lists for some long-term residential programs can be as long as six months and treatment professionals say that too often patients relapse after leaving detox because they cannot find a treatment program with room to take them. The potential addition of 700 new beds over two years would be a dramatic addition to the current treatment infrastructure. As of Dec. 1, 2014, a month before Baker took office, there were just over 4,000 beds across all spectrums of care, according to Department of Public Health records. "Most of the beds are going to end up being privately created," Baker said recently at an event in Boston. "I think a combination of some of the statutory changes that have taken place, the funding that's been made available for this -- you're going to see people responding creatively," he added. The increased demand has also drawn the attention of several for-profit companies that cater to individuals who can pay for their care out of pocket. The price of those programs, which can cost tens of thousands of dollars, worries some advocates who fear that a large portion of the new beds will be unavailable to most Massachusetts residents. "(Private facilities) absolutely can be very costly and we don't want to have a system of care that's only available to families that can afford private pay," DiGravio said. "We feel strongly that whatever beds are put online should be available to as broad a cross-section of the population as possible." Because many of the new programs are still in the permitting process, the Department of Public Health is not releasing specific details, such as their locations, the type of programs, or the number of beds per facility.
Baker has publicly announced, however, that 43 beds for involuntarily committed women -- known as Section 35 beds -- will open in January at Lemuel Shattuck State Hospital and Taunton State Hospital and 53 more Section 35 beds for women will be created over the course of 2016. Megan's House, which provides long-term care for women, is operated by a nonprofit organization set up by the family of Megan Grover, who died of a heroin overdose in 2014. It was funded entirely by the Grover family and other private donors. In Westminster, the innovation is coming from a for-profit company: Healing Hills Village, which hopes to open in March at the site of the Wachusett Village Inn. The facility will be an all-inclusive treatment campus where patients can progress from detox to a sober-living apartment. Treatment beds opened as of November under the Baker administration
Proposed beds that could or will open during 2016
Source: Massachusetts' Executive Office of Health and Human Services - See the full Lowell Sun article.
Debt-Collection Practices and Consumer’s Rights A Waltham law firm used unfair and deceptive practices to collect debts from hundreds of thousands of Massachusetts consumers in recent years, in one instance taking out a civil arrest warrant against a 90-year-old woman, Attorney General Maura Healey alleged in a complaint filed this week in Suffolk Superior Court. The case highlights a troubling trend. The debt-collection industry and the law firms that pursue collection cases have come under scrutiny in recent years. Roger Bertling, director of the Consumer Protection Clinic at Harvard Law School, said that the practices alleged by Healey and the consumer protection agency are fairly common. “Debt-collection work is still the wild, wild West,” he said. Debt-buying companies purchase uncollected debt from credit card companies and banks, then farm out the collection work to law firms in each state, paying the law firms a percentage of the amount that they collect. Typically, debt collectors take up to a 30 percent cut of the money they get, according to consumer groups. According Healey’s complaint, Lustig, Glaser & Wilson downloaded large computer files from debt-buying companies that listed debts and debtors in Massachusetts. But the spreadsheets provided few details about payment histories, the original contracts, ownership of the debt, or disputes over the amounts owed — all of which would be necessary to establish and verify the debts, according to the complaint. Within a few days of the download, the law firm would send so-called demand letters, and then start robocalls, according to court documents. The law firm would push consumers to pay the debts, even when their only income was from Social Security or veterans and unemployment benefits, all of which are exempted by law from debt collection, the lawsuit said. If consumers failed to pay, Lustig, Glaser & Wilson lawyers filed complaints in district courts. Since many consumers didn’t show up to contest the complaints, the law firm won default judgments without having to provide proof. The judgments allowed the law firm to garnish wages for the debts and to seek civil arrest warrants, according to the attorney general’s complaint. “This firm and its owners made a living off of taking unfair advantage of Massachusetts consumers,” Healey said, “many of whom could not afford a lawyer or were unfamiliar with the legal system.” Healey’s office is seeking to have civil penalties levied against the law firm, along with an order that it make restitution to consumers harmed by its practices. -See the full Boston Globe article.
Room to Breathe – Education And Material Support for Those with Chronic Respiratory Illnesses The Room to Breathe Initiative of the Mass. Coalition for the Homeless assists low-income families and individuals who are living with chronic respiratory diagnoses to improve their home environment to lessen environmental triggers with a goal of improving their quality of life. Chronic respiratory diseases may include chronic obstructive pulmonary disease (COPD), asthma, emphysema and chronic bronchitis, cancer, and lung disease related to HIV/AIDS. The program currently serves families from Salem, Lynn, and Peabody, MA. The Room to Breathe Initiative assists eligible households with improving their homes through education on what causes triggers as well as material support with air conditioners, vacuums, beds, and minor home improvements. All households that are referred for assistance will receive a home visit from a trained case manager (bilingual in Spanish) who will do a room by room assessment on how the indoor air quality can be improved and managed. Assessments will determine how to create the best home environment possible by knowing, minimizing or eliminating exposure which cause respiratory triggers.
More information on the website: http://www.mahomeless.org/room-to-breathe
Medically Induced Trauma Support Services This program is no longer in operation - has been subsumed into the Betsy Lehman Center: Patient and Family Peer Support Network (https://betsylehmancenterma.gov/for-patients/patient-support)
Medically Induced Trauma results from an adverse medical event that occurs during medical and/or surgical care. An adverse event is an injury that is due to a medical intervention. It may or may not be an error, but is an undesirable outcome that results from some aspect of diagnosis or treatment, not an underlying disease process. Most importantly, these events affect the emotional well-being of the patient, family member, and/or clinician. Medically induced trauma is different from other types of traumas in that patients and their families may feel:
Medically Induced Trauma Support Services (MITSS) Medically Induced Trauma Support Services (MITSS) was founded to provide a network that links those affected by Medically Induced Trauma with resources that provide continued support and promote healing. Their purpose, as described in their brochure, is to create awareness about the impact of medical trauma, promote open and honest communication among patients, families, and caregivers, and to provide support services to all individuals who have been affected by a Medically Induced Trauma. Services MITSS offers therapeutic educational support groups for patients and their families led by an experienced clinical psychologist. MITSS staff and volunteers answer hotline calls, offering encouragement and support, while providing resources and information on various related topics. They also work with medical organizations to provide education and process improvement. MITSS provides services including online peer to peer support groups, an in-person educational support group, and telephone support. For clinicians they offer peer support and consulting for organizations to enable them to build their own clinician-support infrastructure. Read the patient and family brochure. For confidential telephone support, call 617-232-0090 or 1.888.36MITSS (1.888.366.4877). For more information call or visit the website www.mitss.org.
ExceptionalLives Website With the help of Margolis & Bloom Attorney Karen Mariscal, the new Cambridge-based non-profit ExceptionalLives has launched its free, inter-active online website (http://exceptionallives.org/) for special needs families (especially low-income families) to help parents navigate the often unfamiliar situations they face in providing care for their exceptional family members. ExceptionalLives' first Guides show parents how to:
Each Guide walks caregivers step-by-step through the process, breaking each task down to manageable increments. . If you have any questions, you can contact Karen Mariscal or contact Exceptionallives. -From Margolis & Bloom e-newsletter, November 24, 2015.
MassHealth and Commercial Insurance Cannot Require Prior Authorization for Detox and Clinical Stabilization An earlier version of this article was e-mailed to Social Service Emergency Department staff on 12/3/15. Some provisions of Massachusetts’ Chapter 258, a 2014 law addressing access to substance use recovery services, are taking effect in 2015. An updated provider bulletin from MassHealth clarifies that pursuant to the new law, effective Oct 2015, neither MassHealth nor its managed care plans can require prior authorization for acute treatment, e.g. admission to a detox facility or for clinical stabilization services. The treating clinician's judgment on medical necessity must be accepted, at least for acute care and the first 14 days of clinical stabilization. Prior authorization is likewise not required for the following covered substance use disorder treatment services:
(Note this only applies if the service is normally covered under the patient’s plan.) Learn more: Managed Care Bulletin 2, Nov 2015. Private insurance plans sold in Massachusetts are subject to the same prior authorization restrictions. See Division of Insurance (DOI) Bulletin 2015-05, July 2015 A related April 2015 report “Access to Substance Use Disorder Treatment in Massachusetts” from the Center for Health Information and Analysis includes two appendices which list different kinds of treatments and available sources of payment for each treatment: commercial insurance, MassHealth or the DPH Bureau of Substance Abuse Services. Note this report precedes the Oct 2015 change in prior authorization restrictions. See the full report, see the aforementioned Appendices only. -Adapted from Health Announcements e-mail distribution list, on behalf of Vicky Pulos, Mass. Law Reform Institute, December 03, 2015.
Medicare Reminder – Good Cause for Late Appeals If you can show good cause of why you did not file a Medicare appeal on time, you can file a late appeal. The good cause exception applies at each level of the Medicare appeals process and it applies whether you are appealing a denial from Original Medicare, a Medicare Advantage plan, or a Part D prescription drug plan. Good cause reasons for filing late are judged on a case-by-case basis, so there is no complete list of acceptable reasons for filing an appeal late, but some examples include:
If you think you have a good reason for not appealing on time, send in your appeal with a clear explanation of why your appeal is late. -From Medicare Watch, Volume 6, Issue 46,The Medicare Rights Center, December 10, 2015.
Evictions In East Boston: The Push For A ‘Just Cause’ Ordinance Many long-term tenants in Boston’s neighborhoods are being issued “no fault evictions,” forcing them out because of skyrocketing rents and home values. “It’s displacement on a massive scale,” says Matt Nickell, an attorney at Greater Boston Legal Services. Housing advocates like him call this an “eviction crisis,” and its epicenter is East Boston. “Tenants are, more and more, seeing this as a threat to their very livelihood, their housing, their life. Because rents are rising so rapidly that no mortals can pay them.” The eviction crisis is so bad, say Nickell and his fellow advocates, that they’re calling for a major change in Boston city housing laws. They want the city to pass a so-called “just cause” eviction ordinance that would make it much harder to remove tenants from apartments simply because rents are rising. For 25 years, Olga Pasco had been living in an apartment at 175 Maverick Street in East Boston as a month-to-month tenant. The building had been owned by the same family for roughly 30 years. But, on Dec. 1, 2014, the old owner sold Pasco’s building and two others to a group called Maverick Street Realty, LLC. Pasco says no one in the building was informed about the sale until February 2015. A few days later, Pasco and every other tenant in the building received a letter. It was a “no fault eviction notice,” formally known as a notice to quit. The letter stated that Pasco’s rent was being raised to $2,000 per month. Average rents in her building had been around $800. The letter stated that, if tenants couldn’t pay the new rent, they had to vacate the units by Aug. 1. She and the other tenants are on a high priority list at the city’s Department of Community Development and one tenant has already been re-housed, but affordable housing advocates say that Olga Pasco’s case is typical of what they’re calling an eviction crisis in Boston. “East Boston, at this point, feels like the epicenter,” says Lisa Owens-Pinto, executive director of City Life/Vida Urbana. “Things are changing so quickly, so rapidly. This is a citywide crisis, but this is the heart of the crisis.” “This is a big business for these guys,” says Nickell. “Their business plan is to bring in people who are not the people who currently live in East Boston.” Walking around Maverick Square, he points out five recently sold buildings where the new owners are investors or investment groups. “They’re really remaking the community on a grand scale,” says Nickell. Take Maverick Street Realty, LLC. In the past year, the company made six separate purchases in East Boston for approximately $5.2 million. However, the mortgages associated with those purchases total $18 million, all of which is financed by the same group — Acquisition Funding, LLC, a corporation owned by Shem Creek Capital, a Boston commercial real estate finance company. Neither Maverick Street Realty, LCC or Shem Creek Capital responded to requests for comment. -See the full WBUR Radio Boston article with links to the full series.
After the Asylum: How America's Trying to Fix Its Broken Mental Health System Patients with mental illness are being detained in emergency rooms, often for weeks at a time. Psychiatric boarding happens all over the country. It’s often the only option for emergency room staff; they can’t turn away mentally ill patients, even though they’re not trained to deal with them. Essentially, all they can do is stabilize the patients and keep them in bed, often in seclusion or strapped down for days or weeks at a time. Some health-care advocates have proposed a remedy that would have been unthinkable just a few years ago: returning to the traditional mental hospital, the very institution that reformers fought so hard to abolish in the 1960s. Last January, Dominic Sisti and two co-authors from the University of Pennsylvania medical school called for the return of long-term psychiatric care in a journal article titled, “Bring Back the Asylum.” They wrote that “for persons with severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community-based treatment, the choice is between the prison-homelessness-acute hospitalization-prison cycle or long-term psychiatric institutionalization.” They left no doubt that they considered institutionalization to be the best option. Shortly after the article ran, Sisti says, “I was deluged with cranky and almost angry emails.” Some critics accused him of advocating a return to the inhumane treatments and overcrowded conditions portrayed in Ken Kesey’s famous book, One Flew Over the Cuckoo’s Nest. Sisti and his co-authors responded that they were asking readers to imagine a new type of institution, one that would be a safe and caring refuge for mentally ill patients who were unsuited for community-based care. They wouldn’t be the asylums of the 1950s and wouldn’t have to be called asylums, despite the perhaps unfortunate title of the article. “We have this hole in our spectrum of health care for mentally ill individuals,” Sisti says. “We were looking to inject ourselves into the conversation.” -See the full Governing article for a discussion of ongoing efforts in Washington state and an enlightening review of the background and contributing factors of the problem.
Commentary: Muslim Immigration and Integration- Some Facts and Perspective Commentary from Westy Egmont, Director, Boston College School of Social Work, Immigrant Integration Lab. Stoked emotions and cultural ignorance are making the inclusive goals of the social worker more essential than ever today. Islam is a minority religion in America, and our national ignorance makes integrating Muslim immigrants a formidable task. Current media coverage and public discussion has ignored the successful settlement of millions of Muslims during this generation and political rhetoric diverts attention from the positive outcomes of this immigrant population. Having taught multiple summers in the neighborhoods of Molenbeek (Brussels) and St. Denis (Paris) in which radicalized young adults have created renewed negative focus on Muslim integration, this commentary offers a subjective summary of observed lessons. It begins by noting the ignorance in Western society about Islam. Here are some facts about Islam in the U.S. as background:
An in depth study by Claire L. Adida, David D. Laitin, and Marie-Anne Valfort, Identifying Barriers to Muslim Integration in France,(2) provides important lessons to the U.S. The authors note that in France, a Muslim candidate is 2.5 times less likely to receive a job interview callback than is his or her Christian counterpart. A high participant number survey reveals, consistent with expectations from the correspondence test, that second-generation Muslim households in France have lower incomes compared with matched Christian households. The U.S. pattern is notably different: U.S. Muslims have higher than native-born income, higher employment levels and report less discrimination than their European counterparts. Overt prejudice has risen sharply in the U.S. and may make Muslim integration increasingly similar to France, that is to say, less integrated. After the Paris terrorist attacks, U.S. political figures repeatedly pursued policy directed at all Muslims with disregard for the facts. Donald Trump called for closing mosques, a database of all Muslims and barring Muslim admissions while Ted Cruz goes in an opposite direction than President G.W. Bush's explicit respect of Islam by making "Syrian Muslim terrorists" his catch phrase. States seek to ban Muslims refugees. U.S. foreign policy includes increasing Middle East attention, from Iraq to Afghanistan and Syria, and a public impression has arisen that conflates geopolitics and religious affiliation. References to Islam differ from the coverage of other violent minorities, such as gang cultures of "Catholic" Central and South America or the shooter at Planned Parenthood in Colorado. Anti-Muslim discrimination is often directed at Arabs although in the U.S. two thirds of all Arabs are Christians. Taking the lesson that discrimination leads to disaffection, it follows that increasing negative rhetoric, overt prejudice, misinformation and discrimination in the labor market can increase the potential cultivation of a radicalized second generation element. On the broad scope, adherents to Islam have done well as a minority in the U.S.- having one of the highest rates of naturalization, having earnings above the national average, having distributed themselves across the states and having high civic engagement, all of which suggests successful integration. It might be argued on one hand that, being such a small minority, Muslim Americans have engaged fully with the dominant culture. Muslims moving into the West have generally brought appreciation for tolerance and acceptance of those of different faiths and race. Mosques have one of the most diverse memberships by nationality of any organization in the U.S. Overreaction to current events can sweep away decades of positive integration in the U.S. Social workers remain the cultural navigators and often build the environments of trust to foster mutual understanding and acceptance. Boston College Professor Peter Skerry writes: "In the wake of 9/11, Americans demonstrated significant forbearance and understanding of their Muslim neighbors and fellow citizens. Today, the Muslims who I know well are as concerned and alarmed for themselves and their families as they were back then. In the weeks and months ahead we shall see Muslim and non-Muslim what, if anything, we have all learned about American religious pluralism and tolerance since that horrendous day more than fourteen years ago." U.S. citizens control the outcome of increased diversity of religion as well as of race and national origin. How we live with diversity is a critical agenda for all. -Read the full commentary.
More Than a Quarter of Boston Residents are Foreign Born A new report says more than a quarter of the people living in Boston in 2014 were born outside the United States. The Boston Redevelopment Authority report says the number of foreign-born residents of Boston increased by nearly 20 percent from 2000 to 2014.
- From WGBH news
Alcohol and Cancer: Drink at Your Own Risk Fine wines, craft beers, cocktails, and champagne are considered by many as complements to good company and fine cuisine. The last thing anyone wants to hear is that alcohol causes cancer. However, the sobering truth is that alcohol consumption increases the risk for cancer, and this link has been known for some time. In 1988, the International Agency for Research on Cancer (IARC) declared that alcohol was a carcinogen. The World Cancer Report released in 2014 highlighted the role of alcohol in cancer, finding that alcohol accounts for 3.5% of cancers (about 1 in 30 cancer deaths) globally. Recent data indicate that the proportion of cancers attributable to alcohol worldwide has increased. In 2012, alcohol consumption caused 5.5% of all cases of cancer and 5.8% of all cancer deaths. This increase is believed to be attributable primarily to an increase in the prevalence of drinkers and in the amount of alcohol consumed, particularly by women. Jürgen Rehm, PhD, Director of the Social and Epidemiological Research Department at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada, describes how our knowledge about the role of alcohol in cancer has advanced during the past year. "Very simply, the cancers that have been determined previously to be caused by alcohol have been confirmed. There is no discussion about whether alcohol causes these cancers. The fact that alcohol is a carcinogen has been clearly confirmed." The cancers that Dr Rehm refers to include those of the oral cavity, pharynx, larynx, esophagus, breast, colon, rectum, gallbladder, and liver. It is also considered probable that alcohol increases the risk for pancreas cancer, although the evidence is inconclusive. Recent evidence suggests that melanoma, as well as cancers of the stomach, lung, and prostate, may be associated with alcohol consumption, although only with high levels of consumption and to a moderate excess risk. There are also differences of opinion on whether liver cancer should be considered an alcohol-related cancer and whether the risk for colorectal cancer is increased in both sexes or only in men. -See the full Medscape summary article for more, including new evidence of the Alcohol-Cancer Link.
Opinion: Improving End-of-Life Care Andrew Dreyfus is the president and chief executive officer of Blue Cross Blue Shield of Massachusetts. Here is an excerpt from his recent Boston Globe opinion piece. A 2014 report by the Institute of Medicine called “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life” found that, despite some progress over the past 20 years, a wide gap still exists between the kind of end-of-life care we want and what we usually receive. Many of the report’s recommendations for improvement focus on two broad areas — communication among patients, loved ones, and clinicians, and the care patients get during advanced illness and at the end of life. Research finds cascading benefits from talking early about our end-of-life care wishes. Despite all the benefits, these conversations are far too rare. Changing the status quo will require hard work on multiple fronts: broader training of clinicians on how to talk to patients and families about end-of-life care; electronic medical records that document our care preferences and make them available to any clinician we encounter during a medical crisis; public education about the value of advance care planning; and broader availability of the medical, emotional, and spiritual support that palliative care can offer. Three years ago, I joined the advisory board of Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Ariadne is led by surgeon and author Atul Gawande, whose most recent book, “Being Mortal: Medicine and What Matters in the End,” explores aging and end-of-life care with extraordinary insight. Among many initiatives, Ariadne has developed a new approach to improving communication among patients with advanced illness, their families, and clinicians. Its Serious Illness Care Program includes training and coaching for clinicians; a system for documenting personal goals and priorities in a patient’s electronic record; and a conversation guide that addresses patients’ understanding of their illness, their preferences for information and family involvement, their personal life goals, fears, and anxieties, and the trade-offs they are willing to accept. Several months after my mother’s death in October 2013, I found myself at Ariadne Labs listening to the early findings from a trial of its new program at the Dana-Farber Cancer Institute. The results were striking. For patients under the care of physicians trained on Ariadne’s program, conversations happened earlier, more frequently, and with a greater focus on patient values, goals, and priorities. Doctors embraced the approach, as did patients, who also reported feeling less depression and anxiety after their conversations. It was here that I heard the echo of my personal experiences, for these were the same kinds of conversations that had allowed my father, mother, and brother some peace at the end of life. And here was an approach — based on evidence — that could give this opportunity to others. I returned from the meeting with two questions. How could Blue Cross Blue Shield help spread Ariadne’s success to more physicians? What else could we do — as a health insurance plan — to improve care for our members with advanced illness? We started by offering to sponsor clinicians from across Massachusetts to attend Ariadne’s three-day course last June. If a hospital or physician group sent one person, we’d pay for the second. Our ultimate goal was to create champions inspired to set up the Serious Illness Care Program within their health systems, a process that we would support financially. And to help spread Ariadne’s innovations, we are collaborating on a short, online version of the training that will be available to Massachusetts clinicians through the Blue Cross website. As our work with Ariadne deepened, we also learned from local and national experts in hospice and palliative care and studied best practices from other pioneering health plans. As a result, Blue Cross will make a number of changes in our approach to advanced illness care, communication, and coverage for 2016. We will: expand member benefits to allow the earlier use of the kind of hospice care that was such a blessing for my family; change payments for advance care planning to include mental health clinicians in recognition of the important role that they play in these critical conversations; develop a new program to help individuals with advanced illness receive more care at home; and add advance care planning to the wellness program we offer to our own employees. This last work is in partnership with two local organizations — the Conversation Project, which prepares people to think and talk about their end-of-life care values and preferences, and Honoring Choices Massachusetts, which helps people collaborate with their care providers to set goals, plan for the future, create health planning documents, and ensure that their choices are honored throughout their lives. -See the full Boston Globe opinion piece.
Inflammation Fans Flames of Depressive Symptoms A new study supports a link between inflammation and depression and adds to the literature by associating inflammation with specific symptoms of depression, including sleep troubles and lack of energy and appetite. Individuals with depression are known to have elevated levels of inflammatory markers, such as C-reactive protein (CRP), and it has recently been suggested that this association may be symptom specific, Markus Jokela, PhD, from the University of Helsinki, Finland, and colleagues note in a research letter published online November 18 in JAMA Psychiatry. "Higher levels of inflammation are particularly likely to underlie depression symptoms that characterize sickness behavior, including fatigue, reduced appetite, withdrawal, and inhibited motivation. From an evolutionary perspective, such symptoms have the beneficial effect of preserving energy resources for use in fighting infection and promoting healing processes," they say. Dr Jokela and colleagues tested the hypothesis that the association between CRP and depression is symptom-specific using data on roughly 15,000 men and women who participated in three US National Health and Nutrition Surveys. -See the full Medscape summary article.
Light Therapy Highly Effective for Major Depression The combination of bright light therapy plus an antidepressant significantly improves nonseasonal major depressive disorder, and light therapy alone is more effective than antidepressant monotherapy, a randomized, placebo-controlled trial suggests. "I've studied bright light therapy in winter depression for a long time, but we always thought that winter depression was different from nonseasonal depression," Raymond Lam, MD, University of British Columbia, Vancouver, Canada, told Medscape Medical News. "So this was the first study that was placebo-controlled, and I think that while light therapy could be used on its own for some patients, more severely ill patients need combination therapy, whether that combination be an antidepressant plus psychotherapy or psychotherapy plus light therapy or light therapy plus an antidepressant." The study was published online November 18 in JAMA Psychiatry. The trial randomly assigned 122 patients to light therapy alone for 30 minutes a day; a placebo device, which was a negative ion generator; the combination of light therapy plus fluoxetine (multiple brands), 20 mg a day; or a negative ion generator plus placebo. Approximately 30 patients were enrolled in each of the four treatment groups. Light therapy consisted of 30 minutes a day of exposure to a fluorescent light box as soon as possible after awakening. The negative ion generator was modified to emit an audible quiet hum but was deactivated so that no ions were emitted. At the end of the 8-week treatment interval, mean changes in MADRS score from baseline were significantly greater among those who received the combination of bright light plus fluoxetine than for any of the other treatment groups. -See the full Medscape summary article.
The End of Hitting Rock Bottom? “Beyond Addiction: How Science and Kindness Help People Change”, published in 2014, is a guide to a decades-old approach for addicts’ families called Community Reinforcement and Family Training, or CRAFT. CRAFT suggests conversational techniques, helpful questions, and ways of responding to a substance abuser’s (often bad) behavior. It’s like an etiquette guide for dealing with addicts. Yet its goals are much more ambitious: by making loved ones feel listened to, empowered, and supported, CRAFT’s proponents say, family members can motivate them to seek help. And it appears to work. The CRAFT approach, while still not widespread, has gained some influential adherents. The Partnership for Drug-Free Kids, the antidrug advocacy group originally known for the “This is Your Brain On Drugs” advertising campaign, introduced a program called the Parent Support Network in 2013, where parents coach peers in CRAFT techniques over the phone. In Sweden, the government’s health department added CRAFT to its 2015 guidelines for how health professionals should treat family addiction problems. In September, a startup company called Cadence Online introduced an online CRAFT course aimed at parents featuring video segments and interactive training developed with Robert J. Meyers, the psychologist who originally developed CRAFT, and A. Thomas McLellan. “I was skeptical at first. I worked in the field, both of my kids were addicted,” said McLellan. “But CRAFT is among one of the most potent ways to change people’s behavior.” In the popular understanding of addiction, treatment-resistant people are “in denial.” No one can help them get sober, the prevailing wisdom says, until they experience profound personal loss — hit rock bottom, to use the phrase from Alcoholics Anonymous — and declare themselves addicts and get clean. The most popular family support group in the United States, Al-Anon, recommends family members “detach with love” until their loved one enters recovery. Psychologists who advocate CRAFT argue that family members can play a meaningful role in helping their loved ones — that the ideas of “in denial” and “hitting bottom” have no basis in empirical science, and no place in health care policy. “I hope in the next 10 years, we take ‘hitting bottom’ out of the lexicon,” said Dr. Carrie Wilkens, coauthor, along with psychologist Jeff Foote, of “Beyond Addiction.” “I want to eradicate it. It doesn’t need to happen, ever.” Foote and Wilkens run a substance abuse and mental health treatment center based in the Berkshires and New York City, the Center for Motivation and Change. They tell family members that they are a crucial part of their loved one’s recovery. “You can both take care of yourself and take care of them at the same time, you don’t have to detach,” said Foote. “Family is a very powerful force. It can be incredibly constructive.” CRAFT starts with a provocative premise: Most substance abusers aren’t in denial, but rather are ambivalent and guarded. They know their drug use causes problems, but they don’t want to admit it because doing so risks the loss of all sorts of things: their dignity, possibly their freedom, not to mention access to the benefits of the drug itself. With CRAFT, family members learn ways to lower loved ones’ defenses and encourage them to speak candidly. The advice essentially boils down to simple steps like asking open-ended questions, complimenting positive behaviors, and echoing the person’s concerns in a nonjudgmental way. Next, they learn to devise ways to improve their home life (without fixing or minimizing the ill effects of the drinking or drug use). When the struggling loved one feels understood and safe, the reasoning goes, he or she will be more willing to be vulnerable, to seek help. Gentle as the CRAFT method sounds, research indicates it is effective. In a study of 130 families published in 1999, nearly two-thirds of the participants who took CRAFT classes saw substance-abusing family members who had resisted treatment change their minds and get help — more than three times the rate of families who attended Al-Anon meetings and twice the rate of those who planned a traditional intervention (in the intervention group, several families decided not to go through with the final confrontation, lowering the rate). Similar results were repeated in another study published later that year, and again in 2002. The downside of CRAFT is that it’s difficult for families to implement in normal circumstances, let alone in the chaos of a home ravaged by drug or alcohol. It asks parents and spouses to change habits of speaking and behaving that have been ingrained for years, if not lifetimes. Then, consider the circumstances: How does one remain nonjudgmental and ask level-headed questions when a child is stealing a sibling’s money to buy drugs, or be patient with a spouse who is struggling to hold down a job? -See the full Boston Globe article.
Maternal Exposure to Anti-Depressants Linked to Autism in Children A new study provides some of the strongest evidence yet that using the most commonly prescribed antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs), like Prozac, Paxil or Zoloft during the final two trimesters of pregnancy may be linked to a higher risk of autism spectrum disorder for the child. The research, published in JAMA Pediatrics this month, involved the analysis of health records in Quebec from January 1999 and December 2009 that studied 145,456 full-term singleton infant births. Researchers identified 4,724 infants (3.2 percent) who were exposed to antidepressants in utero, with 4,200 exposed ruing the first trimester; 2,532 during the second and/or third trimester. Of the first group, 40 were diagnosed with autism and in the latter group 31 were diagnosed with autism. When taking into account maternal depression as a factor, that translates to no association for use of antidepressants in the first trimester but an 87 percent increased risk when used in the second or third trimester, Anick Bérard, a researcher at the University of Montreal, and co-authors wrote. -See the full Boston Globe article.
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