2021 Blueprint of Federal Social Policy Priorities - Recommendations to the Biden-Harris Administration and Congress - National ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2021 Blueprint of Federal Social Policy Priorities Recommendations to the Biden-Harris Administration and Congress
About National
Association of Social
Workers (NASW)
NASW PRESIDENT
Founded in 1955 and headquartered in Washington, Mildred C. Joyner, DPS, MSW, LCSW
DC, the National Association of Social Workers (NASW)
is the largest membership organization of professional
social workers in the nation, with 55 state/territorial
chapters and over 110,000 members. NASW works to
enhance the professional growth and development of
its members, to create and maintain professional
NASW CHIEF EXECUTIVE OFFICER
standards, and to advance sound social policies. Angelo McClain, PhD, LICSW
January 2021
©2021 National Association of Social Workers. All Rights Reserved.
TABLE OF CONTENTS
Introduction ............................................................................................................................................1
Supporting Our Essential Social Work Workforce ..................................................................................2
Continue COVID-19 Recovery..................................................................................................................5
Improve Access to Mental and Behavioral Health and Provide High Quality Health Care to All..............7
Close the Health Gap ......................................................................................................................9
Ensure Healthy Development for All Youth ......................................................................................10
Build Healthy Relationships to End Violence ........................................................................................13
Advance Long and Productive Lives ....................................................................................................15
Eradicate Social Isolation ....................................................................................................................17
End Homelessness ..............................................................................................................................18
Background..................................................................................................................................18
COVID-19 Housing Crisis ..............................................................................................................18
Racial Disparities and Impacts ......................................................................................................19
Create Social Responses to a Changing Environment ..........................................................................20
Harness Technology for Social Good ....................................................................................................21
Eliminate Racism ..................................................................................................................................22
Build Financial Capability and Assets for All ........................................................................................24
Reduce Extreme Economic Inequality ..................................................................................................25
Achieve Equal Opportunity and Justice ................................................................................................29
Continue to Reform the Criminal Legal System and Promote Smart Decarceration ............................29
Reform Immigration Policy ............................................................................................................30
Advance Political Justice ..............................................................................................................31
Protect and Provide for Maltreated Children ........................................................................................32
Serve America’s Veterans and Their Families ......................................................................................33
Advance LGBTQ Rights and Equality ....................................................................................................34
Promote the Rights of People with Disabilities ....................................................................................35
References............................................................................................................................................37
INTRODUCTION
Our nation’s 700,000 professional social workers are an essential workforce and the nation’s
largest provider of mental and behavioral health and social care services. Social workers
develop and champion policies to enhance human well-being and help meet the basic needs
of all people, especially those who are vulnerable, oppressed, and/or living in poverty.
The National Association of Social Workers architects of the Civil Rights Movement and the War
(NASW) warmly welcomes the Biden-Harris on Poverty were social workers. Whitney M. Young,
administration and the117th Congress. We are Jr. (past President of NASW) is widely recognized as
delighted to share our 2021 Blueprint of Federal the coauthor of President Lyndon B. Johnson’s War
Social Policy Priorities outlining urgently needed on Poverty initiative. Dorothy I. Height worked closely
policy solutions in 21 issue areas. It is organized with Martin Luther King, Jr. on landmark reforms for
according to the Grand Challenges for Social Work children and families.
which is a science-supported agenda for social
progress, developed by the social work profession. Given our profession’s long history of advancing social
The recommendations are immediate, tangible and justice, it is no surprise that five members of Congress
meaningful steps to promote mental and behavioral are social workers: Sens. Kyrsten Sinema (D-AZ) and
health, address economic inequality, and ensure that Debbie Stabenow (D-MI) and Reps. Karen Bass (D-CA),
civil and human rights are protected for everyone. Sylvia Garcia (D-TX), and Barbara Lee (D-CA). Countless
We welcome the opportunity to work with you, our others can be found among the ranks of current and
60+ national coalitions and other stakeholders to former administration officials and congressional
achieve an America as good as its ideals. staff. Social workers not only provide direct services
in a broad range of settings—including, but not
Social workers have a long history of helping to limited to, health care facilities, schools, child welfare
promote policy solutions to challenging societal agencies and correctional institutions—they also lead
problems. Social worker Harry Hopkins played a health and human services agencies, perform
critical role in policy development during the Great cutting-edge research, and develop and implement
Depression while serving as a close advisor to sound federal, state and local policy.
President Franklin D. Roosevelt. President Roosevelt
also appointed social worker Frances Perkins as We look forward to continuing to partner with
Secretary of Labor, making her the first woman ever Congress, the administration and other stakeholders
appointed to a federal Cabinet position. Many of the in advancing these priorities.
1
SUPPORTING OUR ESSENTIAL
SOCIAL WORK WORKFORCE
The nation’s 700,00 social workers all occupations through 2029—a 13 percent
are an essential workforce and have growth rate compared with an average growth
been since the founding of the rate of 6 percent (Bureau of Labor Statistics,
profession more than a century ago. 2020). Specifically, the areas of aging, child
We are among the most racially welfare, mental and behavioral health, veterans’
issues, health, education, and corrections will see
diverse mental and behavioral health
a rapid increase in the need for professional social
and health care professions and
work services in the near future. Of particular
provide critically needed services to
note, almost all child welfare programs struggle
millions of Americans every day in a with recruiting and retaining qualified and
broad range of settings including effective child welfare staff. Turnover rates remain
healthcare facilities, schools, child high, at 20 to 50 percent nationally (National Child
welfare, community agencies, Welfare Workforce Institute, 2020). Federal
correctional institutions, and private investments in social work and social work
practice. The master’s degree is the education are critically needed to ensure that
terminal degree in our profession. there is a sufficient supply of social workers to
meet evolving demands.
A subset of our profession, clinical social workers
(CSWs), are eligible to participate in Medicare and Low salaries continue to be a major barrier to
Medicaid. CSWs were first included in these ensuring a sufficient supply of social workers.
government programs in 1989. All states have More than 60 percent of full-time social workers
licensing requirements for CSWs. The definition of earn between $35,000 and $59,000 per year with
clinical social work and their scope of practice are 25 percent earning between $40,000 and
articulated in the Social Security Act and in state $50,000 per year. The median salary for social
regulation. CSWs aim to improve and/or restore workers ($50,470) is $11,190 less than the
the psychosocial and/or social functioning of median salary for teachers ($61,660) (Bureau of
individuals, couples, families and groups. This is Labor Statistics, 2020). Notably, the overwhelming
guided by the “person in the environment” majority of social workers are women, suggesting
framework that is central to social work practice. unaddressed gender bias in compensation.
The services social workers provide are in demand Skyrocketing educational debt loads exacerbate
more than ever due to COVID-19, but the supply is the situation. According to a 2019 study by the
not projected to keep pace with demand without Council on Social Work Education (CSWE),
policy action. The Bureau of Labor Statistics master’s graduates have, on average, more than
projects that the employment of social workers is 50 percent more debt today; in 2019, the average
expected to increase much faster than average for loan debt amount was $46,591, compared with
2$30,789 in 2009. On average, baccalaureate not reflect the scope of practice for today’s social
graduates had $29,323 in loan debt in 2019, workers. This includes providing services to people
compared with $24,683 in 2009 (Salsberg, E., who, although not mentally ill, are experiencing
Wyche, K., Acquaviva, K., Sliwa, S., Richwine, C., major challenges (such as a physical illness or
& Quigley, L., 2020). Black/African American family crisis) for which they need the support of a
social work students have more student loan CSW. Second, CSWs are only reimbursed at 75
debt than their white peers (CSWE, 2021). Many percent of the Medicare physician fee schedule.
are the first in their families to receive a They are the lowest paid mental health providers
professional degree. in Medicare. With reimbursement rate reductions
implemented in Medicare for CY 2021, the
Additional barriers to maintaining a strong, stable reimbursement level is even lower. Appropriate
workforce are the pervasive and significant safety reimbursement would help to address the poor
risks that social workers encounter on the job. compensation of social workers.
Between 2011 and 2013, there were nearly
25,000 assaults annually, with almost 75 percent At the state level, there is currently no permanent
occurring in health care and social service settings interstate licensure portability. CSWs must seek
(Harrell, 2011). In the last few years alone, we and pay for a separate license for every state in
have witnessed the murders of five social workers which they wish to practice. It can take months for
while they were on the job. Thousands of others states to process and represent a significant
have experienced assault-related physical injuries expense for an already undercompensated
with lifelong repercussions. Clients, too, suffer profession. Telehealth expansion, especially during
secondary trauma when there is violence in the COVID-19, has created major new opportunities
service setting. Numerous states, including for interstate practice. Larger federal investments
California, New Jersey, Washington, and Kentucky, should be a priority—especially for professions
have adopted safety guidelines for social workers that provide critical mental and behavioral health
and other social services professionals. In 2013, and social care services.”
Massachusetts became the first state to pass
social worker safety legislation. NASW has in the NASW calls on national leaders to:
past two Congresses worked to enact legislation
to promote social worker safety which would » Facilitate and fund interstate licensure
establish a grant program to provide for safety portability for clinical social workers
measures such as GPS equipment, security (CSWs).
systems, self-defense training, and conflict
prevention, among other measures. » Make permanent the telehealth expansion
under COVID-19, including removing site
The current federal and state regulatory landscape and geographic restrictions, enabling the
is another impediment to a strong workforce. use of audio-only devices and payment
Federally, CSWs face two challenges. First, their parity with in-person payment rates.
scope of practice in the Social Security Act, the
“diagnosis and treatment of mental illness”, does
3» Provide student loan debt relief for social » Increase social work reimbursement rates
workers including the Public Service Loan and ensure that social workers can work at
Forgiveness (PSLF), federal loan the top of their license.
cancellation, and others.
» Federal policies should support increasing
» Pass the Employer Participation in the number of licensed social workers in
Repayment Act (S. 460/H.R. 1043 in the school based settings and public child
116th Congress), which allows employers to welfare agencies.
make nontaxable payments up to $5,250
toward employees’ student loans. » Invest in programs to strengthen the social
work workforce by providing training
» Pass the Improving Access to Mental Health opportunities, including stipends and
Act (S. 782/H.R. 1533 in the 116th scholarships to social work students and
Congress, lead Senate sponsors social practitioners (Title IV-E, Health Resources
worker Debbie Stabenow and John and Services Administration [HRSA]) and
Barrasso and House lead and social worker Substance Abuse and Mental Health
Barbara Lee) to enable CSWs participating Services Administration (SAMHSA).
in Medicare to bill independently to provide
Health and Behavior Assessment and » Expand Title IV-E education partnerships.
Intervention services and services to skilled
nursing facility residents, and to increase » Establish targeted student loans and loan
their reimbursement rate. forgiveness for public child welfare service.
» Offer loan forgiveness on all federally
» Pass the Protecting Social Workers and subsidized loans for BSW or MSW
Health Professionals from Workplace graduates who are employed in public
Violence Act (S. 2880/H.R. 5138 in the child welfare.
116th Congress, lead Senate sponsors
social worker Kyrsten Sinema and Lisa » Increase funding to Schools of Social Work
Murkowski and House leads Julia at Historically Black Colleges and
Brownley and Elise Stefanik) to promote Universities, Tribal Colleges and
safety on the job. Universities, and other minority-serving
institutions to further diversify the social
» Pass the Dorothy I. Height and Whitney M. work workforce.
Young, Jr., Social Work Reinvestment Act
(H.R. 1532 in the 116th Congress, lead
House sponsor social worker Barbara Lee)
to support the social work workforce.
4CONTINUE COVID-19 RECOVERY
NASW looks to the new administration » Provide additional COVID-19 economic
and Congress to galvanize the country relief and stimulus packages; include direct
around fighting the most devastating payments to all adult Americans including
public health crisis in America since adult dependents.
1918, and its economic and many
» Implement a nationwide mask mandate and
other impacts. The rapid deployment
condition COVID-19 relief funding on
of the COVID-19 vaccines is crucial
implementation of effective mitigation
in our recovery and the relief
strategies, including, but not limited to, the
packages to date continue to be use of masks and social distancing as well
instrumental in mitigating the as notice to and quarantine of close
devastation. But more action is contacts of individuals infected with
needed to save lives and livelihoods. COVID-19 in schools and institutions of
higher education.
The year 2020 ended with 9.8 million fewer jobs
than before the pandemic recession hit in » Create universal testing and contact
February and 546,000 fewer jobs than January tracing systems.
2016 (Gould & Shierholz, 2020). Job growth has
further declined nationally, and unemployment » Expand eligibility for Supplemental
insurance claims have increased from already Nutrition Assistance Program (SNAP) and
spiking levels. The economic calamity is mandate that states modify work
exacerbating pre-COVID housing insecurity. requirements for SNAP eligibility for
single adults.
The pandemic, like other public health crises in
the past, has laid bare persistent and unacceptable » Extend unemployment benefits, including
health and economic disparities, with a Pandemic Emergency Unemployment
disproportionate number of Black, Brown and Compensation, Pandemic Unemployment
Indigenous people bearing the brunt of the impacts. Assistance (PUA), and Pandemic
Unemployment Compensation; expand
NASW calls on national leaders to: PUA to individuals who are advised by a
medical professional to leave their
» Deploy the COVID-19 vaccine as quickly employment to protect a high-risk
as possible, prioritizing essential workers household family member.
(including social workers) and those at
highest risk for infection and/or poor » Place a sufficiently lengthy moratorium on
outcomes. housing evictions and home foreclosures
and provide rent forgiveness.
5» Promptly increase the national minimum » Strengthen and modernize the public
wage to $15 per hour. health system.
» Increase access to capital for minority » Provide grant funding for summer instruction
businesses. to enable students to catch up to
grade-level educational standards and take
» Take comprehensive action on student loan other steps to tackle the acute learning and
debt relief. achievement gaps and learning loss that
Black, Indigenous and Latinx children, and
» Ensure access by immigrant communities children from low-income households,
to COVID-19 medical treatment and overwhelmingly face.
follow-up services.
» Ensure access to COVID-19 medical
treatment in jails and prisons, including
repealing the Medicaid Inmate Exclusion
Policy.
6IMPROVE ACCESS TO MENTAL
AND BEHAVIORAL HEALTH AND
SOCIAL CARE SERVICES
Mental and behavioral health are use treatment (Substance and Mental Health
crucial components of overall health. Services Administration, 2019). Drug overdose
Social workers play a vital role in deaths rose from 38,329 in 2010 to 70,237 in
promoting mental and behavioral 2017, and opioid-involved overdose deaths rose
health and do so in a broad range of from 21,088 to 47,600 during that same period
(National Institute on Drug Abuse, 2020). 5.6
settings and communities and with a
percent of people 18 or older have an alcohol use
wide array of populations. This includes
disorder (U.S. Department of Health and Human
providing services to diagnose and
Services, 2020).
treat mental illness and to restore
and improve social and psychosocial Indeed, Americans have some of the worst mental
functioning. But it also includes health-related outcomes, including the highest
providing services to those who do suicide rate and second-highest drug-related death
not have a mental illness, such as rate among high-income countries. The pandemic
promoting wellness, prevention and is intensifying the demand for services and treatment.
identifying and addressing social
needs stemming from the social Mental health also plays a major role in physical
determinants of health. health. Mental illnesses, such as depression and
anxiety, affect the ability to participate in health-
Nearly one in five U.S. adults aged 18 or older live promoting behaviors. In turn, problems with physical
with a mental illness (51.5 million in 2019) (U.S. health, such as chronic diseases, can negatively
Department of Health and Human Services, 2021). impact mental health and decrease a person’s
Mental disorders are among the most common ability to participate in treatment and recovery.
causes of disability. The resulting disease burden of
Transforming our mental health system involves
mental illness is among the highest of all disease
integrating physical, mental and behavioral health
burdens. Moreover, suicide is now the 10th leading
care an estimated $10 billion to $15 billion could
cause of death in the United States, accounting
be saved each year for Medicare and Medicaid
for the deaths of approximately 48,000 Americans
and $16 billion to $32 billion for the commercially
in 2018 (Centers for Disease Control and
insured through effective integration of mental
Prevention, 2020).
health care with other types of medical care
Substance use disorders (SUDs) affect millions of (Melek, 2012).
Americans every year. In 2018, approximately 7.8
The Affordable Care Act expanded on the Mental
percent of people aged 12 or over needed substance
Health Parity and Addiction Equity Act of 2008,
7requiring all health plans in the Health Insurance » Pass the Health Equity and Accountability
Marketplace to cover mental health and substance Act (S. 4819/H.R. 6637 in the 116th
abuse disorders, but coverage for mental health Congress).
care also varies depending on the state where the
patient lives. It is unacceptably difficult for many » Continue investments in the infrastructure
individuals and families to find mental and for substance use disorder prevention and
behavioral health care that is accessible, treatment, including adequately funding the
affordable, and covered by insurance. Substance Abuse and Mental Health
Services Administration’s (SAMHSA)
Prevention and Treatment block grant.
NASW calls on national leaders to:
» Fund the National Institute of Mental
» Make permanent the telehealth expansion
Health, the National Institute on Drug
under COVID-19, including removing site
Abuse, Health Resources and Services
and geographic restrictions, enabling the
Administration and SAMHSA to support
use of audio-only devices and payment
research integrated among mental and
parity with in-person payment rates.
behavioral health care providers and
» Enforce current legal and regulatory universities nationwide.
requirements around parity and identify
» Expand the use of Home and Community
and address gaps.
Based Services waivers and other financing
» Support co-responder initiatives and mechanisms to support community-based
legislation such as the Community-Based services that promote independent living
Response Act (S. 4791/ H.R. 8474 in the for all people with serious mental health
116th Congress, led by Sen. Chris Van conditions.
Hollen and lead House sponsor, social
» Pass the Comprehensive Addiction
worker Rep. Karen Bass).
Resources Emergency Act (S. 1365/H.R.
» Invest in the further development of the 2569 in the 116th Congress), which will
national 211 call number for community provide emergency assistance and funding
information and referral services. to areas most affected by the opioid crisis.
» Pass the Behavioral Health Coordination » Reform 42 CFR 2 to improve information
and Communication Act (H.R. 7723 in the sharing and health care integration.
116th Congress) to establish the position of
» Implement the National Suicide Hotline
Interagency Coordinator for Behavioral
Health to coordinate the programs and Designation Act (P.L. 116-172).
activities of the federal government relating » Fund social workers and other health care
to mental health. providers in schools and promote the
» Pass the Social Determinants Accelerator expansion of mental health programs in
K-12 and higher educational settings.
Act (H.R. 4004 in the 116th Congress), and
the Improving Social Determinants of Health » Repeal the Medicaid Institutions for Mental
Act (H.R. 6561 in the 116th Congress). Diseases (IMD) exclusion.
8PROVIDE HIGH-QUALITY
HEALTH CARE FOR ALL
CLOSE THE HEALTH GAP Telehealth expansion by both public and
commercial health plans has been instrumental in
Six in 10 American adults have a connecting millions of Americans with health,
chronic disease and four in 10 have behavioral health and social care services during
G rand Challenges for Social Wor k
the COVID-19 pandemic. NASW strongly supports
at least two such diseases. (Centers
making this expansion permanent, including the
for Disease Control and Prevention,
removal of geographic and other site restrictions
2021). Furthermore, health problems
and restrictions on the use of audio-only devices.
that were once thought of as issues
for middle-aged and older adults, It has been well-documented that social factors or
such as obesity and diabetes, are needs, not medical care, account for up to 80
today reaching crisis proportions percent of health outcomes. Addressing these
among children and teenagers. More social needs is therefore a public health
than 18 percent of children and youth imperative. According to the National Academies
are obese (Centers for Disease of Science, Engineering and Medicine’s 2019
Control and Prevention, 2019). study, Integrating Social Care into Healthcare
Delivery, social workers are “specialists” in
All of these risk factors, for the oldest to the identifying and addressing non-medical, social
youngest among us, are contributing to declines needs. Indeed, the demand for health care social
in life expectancy — the first downward life workers is projected to grow significantly through
expectancy in U.S. history and a phenomenon not 2026 (U.S. Bureau of Labor Statistics, 2018). To
seen in most other economically developed realize the promise of social care in improving
nations — as well as greater suffering, poorer health, the federal government should institute
quality of life and astronomical health care costs. innovative funding mechanisms to reimburse
social workers for these services.
NASW supports the enactment of a national
health care policy that ensures access to a full, Regulatory barriers to social work services also
coordinated continuum of physical and mental must be removed. Despite participating in Medicare
health and social care services for all people. A since 1989, clinical social workers are still not
single-payer system that ensures universal access permitted to be directly reimbursed by Medicare
to these services is the best means to achieve to provide care to skilled nursing facility residents,
this goal, and the Affordable Care Act (ACA) or to individuals receiving Health Behavior and
moves the nation in the right direction. The ACA Assessment Intervention (HBAI) services.
should be preserved and expanded. Eliminating these barriers should be a priority.
9As the COVID-19 pandemic has laid bare, wide » Protect and expand the Affordable Care Act
racial and ethnic disparities in both health and (ACA) and ensure that all Americans have
health care persist. Even when income, health access to health insurance coverage.
insurance, and access to care are accounted for,
» Ensure that all health insurance plans cover
disparities remain. Low performance on a range of
the Essential Health Benefits.
health indicators—such as infant mortality, life
expectancy, prevalence of chronic disease, and » Protect and expand Medicaid and enable
insurance coverage—reveal differences between continuous enrollment for Medicaid and the
racial and ethnic minority populations and their Children’s Health Insurance Program (CHIP).
white counterparts. Eliminating racial disparities in
Grand Challenges for Social Work
health care is vital to pushing the entire health » Revise guidance to states on Medicaid
care system toward higher quality and better cost waivers regarding block grants, per-capita
containment. Research demonstrates that achieving caps, work requirements, eligibility
health equity requires approaches that address the restrictions, and cost sharing, among others.
social determinants of health—the social, economic,
» Create financing structures to promote and
and environmental factors that influence health.
reimburse for social needs care provided by
Racial disparities in health can be reduced through
private and public health insurers and
strategies that help bridge health care and
require delivery sites to screen for social
community health, increase focus on prevention
care needs.
and primary care, and support testing and spreading
of new delivery and payment arrangements. In » Strengthen and enforce ACA Section 1557
addition, initiatives to foster increased workforce Non-discrimination provisions.
diversity, maintain accurate, complete race and
ethnicity data to monitor disparities in care, and » Make permanent the expansion of
setting measurable goals for improving quality of telehealth, including removing site and
care are needed for achieving better health for all geographic restrictions, enabling the use of
racial and ethnic and gender-identity groups. audio-only devices and payment parity with
Because social workers are among the most diverse in-person payment rates.
mental and behavioral health and health care » Protect Roe v. Wade and ensure access to
professions—well-educated to address the needs
reproductive health services.
of all populations—investment in social work is
critical in reducing health disparities.
ENSURE HEALTHY
NASW calls on national leaders to: DEVELOPMENT FOR ALL
YOUTH
» Prioritize health equity and eliminate health
According to UNICEF (2020), the United States
disparities including developing a White
ranks near the bottom of dozens of advanced
House-led strategy focusing on the social
nations on the mental and physical well-being of
determinants of health and enacting the
its children. Of the 41 nations ranked for child
Health Equity and Accountability Act
poverty, the United States was fourth from the
(H.R. 6637 in the 116th Congress) and
bottom. Children of color remain the poorest group
similar legislation.
10in the nation. Congress and the administration address these needs improves educational
must take action to prioritize and meet the needs outcomes which translates into improved life
of children and adolescents, especially youth of outcomes including economic security—a key
color, who are now the greater proportion of the determinant of well-being. Social workers in
total population of children. More than six million school settings help communities address systemic
young people a year receive treatment for severe issues such as school dropout, adolescent
mental, emotional, or behavioral problems (Perou, pregnancy, child abuse, homelessness, and
R., Bitsko, R.H., Blumberg, S. J., Pastor, P., juvenile crime, as well as emotional and behavioral
Ghandour, R.M., Gfroerer, J.C., et al., 2013). problems such as substance use and suicide.
Strong evidence shows how to prevent many
G rand Challenges for Social Wor k
mental and behavioral health problems before Between 1990 and 2014, the high school dropout
they emerge. By unleashing the power of rate decreased from 12.1 to 6.5 percent (U.S.
prevention through widespread use of proven Department of Education, 2016). The decrease
approaches, we can help all youth grow up to can be credited, in part, to an increased focus on
become healthy and productive adults. attendance and dropout prevention. Despite these
gains, vast disparities in America’s schools still
Youth suicide is a major public health problem. persist, with dropout rates reaching more than 50
For youths between the ages of 10 and 24, percent in communities of color and low-income
suicide is the second leading cause of death, and communities. The COVID-19 pandemic has only
rates have increased more than 10 percent from widened this gap.
2007 to 2017 (Cutin & Heron, 2019). In addition
to fatalities, thousands of young people annually School social workers have the skills necessary to
receive medical treatment for self-inflicted identify, prevent, and intervene with at-risk
injuries. Children of color, boys, foster youth and students. Research findings reinforce the need for
LGBTQ youth are also at an increased risk for more school social workers; more preschool and
suicidal behaviors. science, technology, engineering, and mathematics
education; and less suspension and expulsion.
Health services play a crucial role in the lives of Widespread implementation of these measures
children, allowing children to grow and develop can help increase graduation rates for these
to their fullest potential. The Children’s Health students. Expansion of social work services to
Insurance Program has enabled states to provide students in their fourth and fifth years of high
insurance coverage to 8.4 million children, school is also a promising approach to improving
including the Maternal, Infant, and Early the transition to college.
Childhood Home Visiting Program. Children’s
health coverage is sliding perilously backward. NASW calls on national leaders to:
This trend must be reversed.
» Sufficiently fund the Supplemental Nutrition
Unaddressed social, emotional, and behavioral Assistance Program (SNAP), daycare
needs of children interfere with their academic vouchers, school lunches and other
achievement. Providing supports and services to anti-poverty programs.
11» Provide universal access to high-quality » Increase funding for childcare and the
pre-kindergarten programs for all 3- and Maternal Infant and Early Childhood Home
4-year-old children during the school day. Visiting Program.
» Provide universal school meals. » Pass the Family and Medical Insurance
Leave (FAMILY) Act (H.R. 1185/S. 463 in
» Bridge the digital divide so all students
the 116th Congress) to create a national
have reliable and affordable access to
paid family and medical leave insurance
internet-based learning.
program.
» Increase the number of social workers in
» Pass the Counseling Not Criminalization in
Gra nd Challenges for Social Work
pre-K-12 educational settings.
Schools Act (S.4360/H.R. 7848 in the 116th
» Increase resources to support Congress) that would divert resources from
community-based programs including school-based law enforcement and toward
Temporary Assistance for Needy Families evidenced-based and trauma informed
(TANF), Maternal and Child Health Services, services.
Maternal, Infant and Early Childhood
Program, Head Start, Early Head Start, and
the Affordable Care Act.
12BUILD HEALTHY RELATIONSHIPS
TO END VIOLENCE
Interpersonal violence has a 2020). This is, in part, spurred by the national
traumatizing impact across the recognition of our over-reliance on arrest as an
lifespan on individuals, families, effective and equitable strategy to prevent harm.
communities, and society. Developing There is also growing consensus about the
G rand Challenges for Social Wor k
and broadly implementing importance of empowering, intersectional, and
trauma-informed care (Kulkarni, 2019).
interventions to promote healthy
relationships and reduce violence
The risks and protective factors for child
should be a high priority for policy
maltreatment, youth violence, intimate partner
action. Interpersonal violence costs violence, sexual violence, suicide, and elder abuse
lives and well-being, and squanders are significantly shared and have origins in the
our nation’s personal and financial stressors of daily life, the impact of adverse
resources. Estimates of the cost of environments and childhood experiences, power
violence in the U.S. reach 3.3 percent norms and differentials between dominant and
of the gross domestic product (Mercy non-dominant groups, and interpersonal
et al, 2017). relationships that mediate these challenges
toward a safe—or violent—resolution (Wilkins,
In their lifetimes, 44 percent of U.S. women et al., 2014). Violence too often leads to more
experience sexual violence, physical violence, or violence because we lack the resources and array
stalking by an intimate partner (Smith et al., of interventions to intervene.
2018). Violence against women leads to health
and mental health issues, injury, and homicide. There is growing recognition of the evidence base
Further, millions of children are exposed to for mediation, restorative practices, and counseling
intimate partner violence each year. Women from as contributors to the service array to prevent and
marginalized groups are at higher risk for violence safely respond to intimate partner violence (Davis,
and homicide. Many men and women experience Frederick, & Ver Steegh, 2019; Pennell et al., 2020;
arrests because of involvement in domestic Wagers & Raditz, 2020). Funding for research on
violence—a result that flows from a restricted set these approaches—and others that rely on
of carceral responses that may not always be in strengthening relationships to reduce violence—
either of their best interest. is critically needed. Additional research on risk
assessment is also needed as well as research
Alternative social service approaches are needed. into alternatives to current interventions—those
A growing interest to find safe non-carceral that do not compromise safety but enhance and
alternatives for those involved with violence is empower women’s opportunity to stop violence
emerging (Goodmark, 2020; Moment of Truth, and maintain important family relationships. These
13research efforts should specify resources for » Help reframe the idea of public safety to
understanding the needs of women of color whose promote practices that resist abuse and
concerns have not been adequately recognized. oppression, encourage the empowerment of
women, and support safety and
NASW calls on national leaders to: accountability. These would include
decriminalizing victim survival by
» Revise and reauthorize the Violence Against addressing such policies as mandatory
Women Act (VAWA) to eliminate barriers to arrest and failure to protect.
providing women with services that are
trauma-informed, empowering, » Invest in research studying safe
Gra nd Challenges for Social Work
survivor-informed, and research informed. alternatives to incarceration for the
VAWA should be modified to allow such perpetrators of violence such as mediation,
research as part of the Office of Violence restorative practices, and counseling and to
Against Women (OVW) grant program. identify alternatives to current interventions,
especially for women of color.
» Support research to seek alternatives to
current interventions, including under the » Increase funding for Grants to Support
OVW, the US Department of Health and Families in the Justice System.
Human Services, National Institutes of
» Enact gun violence prevention measures.
Health and the Agency for Children and
Families.
» Enact the Securing Urgent Resources Vital
to Indian Victim Empowerment (SURVIVE)
Act (H.R. 1351 in the 116th Congress) to
make grants to Native American tribes for
programs and services for crime victims.
14ADVANCE LONG AND
PRODUCTIVE LIVES
The rapid aging of the U.S. population substance use disorders—but will also foster
presents opportunities for all economic security in later life.
generations. The experiences and
contributions of older adults benefit The social work profession is an integral
G rand Challenges for Social Wor k
all of us and strengthen our component of the support structure for older
adults and families. At the micro level,
communities. At the same time, as
gerontological social workers support the goals
much of the U.S. population lives
and strengths of older adults and families through
longer, healthier lives, many of us are
various modalities, such as care coordination,
affected by physical illness and options counseling, caregiver support, health
disability and lack the economic education, and psychotherapy. Furthermore, social
security to meet our basic needs. workers serve older adults and families in the
Health and economic disparities public, nonprofit, and for-profit sectors and
related to race, ethnicity, gender, throughout all levels of the Aging Network (local,
gender identity, and sexual orientation state, national, and Tribal Nations), including in
often have a cumulative effect in later Area Agencies on Aging and other community-
life. Ageism impedes full participation based social service organizations as well as
within the paid workforce, volunteer numerous health, behavioral health and other
workforce, and other aspects of settings. By working together, the social work
community life. profession, NASW, and the federal government
can create a society in which older adults and
All of us should have universal, equitable access people of all ages thrive.
to affordable, comprehensive, high-quality health
care (including for mental health and substance NASW calls on national leaders to:
use) and long-term services and supports (LTSS,
» Support reauthorization of the Elder Justice
which include accessible housing and
Act (EJA), full funding for all programs
transportation) as we age. Federal leadership and
authorized by the EJA (including the
investment in enhancing and creating such
creation of a multi-stakeholder Advisory
systems will help all of us to maximize our dignity,
Board on Elder Abuse, Neglect, and
health, and independence as we age. Such
Exploitation), and increased funding for
leadership will not only enable us to remain
Adult Protective Services, the State
engaged in our communities—thereby reducing
Long-Term Care Ombudsman Program, and
the occurrence or severity of elder abuse, neglect,
the Social Services Block Grant.
and exploitation and of mental health and
15» Preserve the integrity of original Medicare » Pass the Improving Access to Mental Health
and reject proposals to change Medicare Act (S.782/H.R. 1533 in the 116th Congress)
from a defined benefit program to a defined which enables Medicare beneficiaries to
contribution program, to privatize the access two types of services from
program further, to raise the age of independent clinical social workers under
Medicare eligibility, or to shift additional Medicare Part B: (a) Health and Behavior
costs to beneficiaries. Assessment and Intervention services,
which help beneficiaries with emotional
» Strengthen Medicare outreach and
and psychosocial concerns that arise
enrollment by equalizing promotion,
because of a physical condition and (b)
Gra nd Challenges for Social Work
enrollment, coverage, payment, and
discretionary mental health services while
regulation between original Medicare and
simultaneously using skilled nursing facility
Medicare Advantage and by providing
benefits under Part A.
sufficient, sustainable funding to Medicare
State Health Insurance Assistance » Within long-term care facilities, improve
Programs. the ratio of residents to social services
staff and strengthen the personnel
» Enforce Medicare beneficiary access to the
qualifications of social services staff to a
full scope of Medicare home health
minimum of a baccalaureate degree in
services, including medical social services.
social work (without substitutions).
» Make permanent Money Follows the Person
» Support development of an equitable,
and protections against spousal
universal social insurance financing system
impoverishment for individuals who use
that provides comprehensive, affordable,
Medicaid-funded home and
high-quality long-term services and
community-based services and increase
supports that enable people with
the income threshold and eliminate the
disabilities and older adults to maintain
asset eligibility test for Medicare Savings
maximal quality of life in their setting of
Programs and the Part D Low-Income
choice.
Subsidy program.
16ERADICATE SOCIAL ISOLATION
Social isolation is a silent killer— » Incorporate the contributions of and
as dangerous to health as smoking. increase support for the current Aging and
National and global health Disabilities Networks, many of which
organizations have underscored the provide services and supports to prevent
hidden, deadly, and pervasive and mitigate social isolation.
G rand Challenges for Social Wor k
hazards stemming from loneliness » Advance the new authorities provided in
and social isolation. People with the recently reauthorized Older Americans
disabilities and older adults (along Act and promote future budget requests to
with family care partners) are at bring those proposals, including
particular risk for loneliness and programming to reduce social isolation, to
social isolation, and this risk is fruition.
exacerbated by public health
» Bolster resources for federal programs that
emergencies such as COVID-19 and serve family caregivers and people living
natural disasters. Our challenge is to with Alzheimer’s disease or other forms of
educate the public on this dual health dementia and/or paralysis, traumatic brain
hazard, support health and human injury, limb loss or difference.
service professionals in addressing
loneliness and social isolation, and » Create a new HCBS innovation fund to help
promote policies that deepen social states and other jurisdictions test
innovative, evidence-based HCBS models
connections and community for
that could enable people with disabilities
people of all ages.
and older adults to remain engaged in their
communities.
NASW calls on national leaders to: » Augment resources to integrate
community-based services within HUD
» Provide funding and promote infrastructure
Section 202 housing for older adults.
support to help communities become
livable (including age friendly) for all » Support legislation, such as the ACCESS Act
abilities across the life span. (S. 3517/H.R. 6487 in the 116th Congress),
to enhance nursing home residents’ access
» Rescind the Healthy Adult Opportunity
to telecommunications devices and the
Initiative, which could (among other harms)
Internet.
decrease access to home and
community-based services (HCBS) for » Implement other interventions to mitigate
people with disabilities and older adults by loneliness and social isolation of nursing
allowing states to implement block grants home residents in an ongoing manner.
and per-capita caps.
17END HOMELESSNESS
BACKGROUND The physical environment of most homeless
shelters makes those in poor health and those
On any given night, there more than a with disabling conditions susceptible to the
half million people in the United COVID-19 virus. However, it is the combination of
the following characteristics that makes this a
States who experience homelessness.
high-risk group:
Of that number, more than 50,000 are
Gra nd Challenges for Social Work
» Poor health: High rates of chronic medical
family households. About 17 percent
conditions, behavioral health conditions,
of the homeless population are infectious illnesses, acute illnesses, and
considered chronically homeless exposure to elements (e.g. hypothermia,
individuals (National Alliance to End violence).
Homelessness, 2020). Periods of » Large congregate settings: Shelters, public
homelessness often have serious and transportation, soup kitchens, health clinics
lasting effects on personal and many other service venues where this
development, health, and well-being. population receives care are large, crowded
congregate settings.
The generally accepted definition of housing » An aging population: Many people experiencing
affordability is no more than 30 percent of homelessness are older, have limited mobility,
monthly income going toward housing costs. and have even higher rates of poor health.
Families or individuals who pay more than 30
percent of their income for housing are considered COVID-19 HOUSING CRISIS
“cost burdened” and can have difficulty affording The COVID-19 pandemic has exacerbated the
necessities such as food, clothing, transportation, crisis of housing insecurity and homelessness.
medical care, and saving for the future. Almost Nationally the rental market is beginning to see
half of renter households and 21 percent of owner the culmination of what many experts have
households are cost burdened, with Latino and predicted—namely, the ever-growing number of
Black households experiencing higher cost renters who have lost their jobs due to COVID-19.
burdens (Joint Center for Housing Studies of Even worse, the national rental industry is in
Harvard University, 2020). danger of collapsing because of non-payments of
rent. A second crisis is therefore anticipated due
This situation is further concerning when we to the loss of real estate tax revenue to
consider that the multigenerational households municipalities, resulting in cuts to the budgets of
that are overcrowded spaces are vectors for the counties, cities, and school districts.
spread of COVID-19. Given that the COVID-related
economic crisis will likely continue to lead to high Our nation may be facing the most severe housing
eviction rates, the number of homeless families crisis in its history. In the absence of robust and
and individuals increases. swift intervention, an estimated 30 million to 40
million people in America could be at risk of
18eviction in the next several months (The Aspen with only 7 percent of white families (Opportunity
Institute, 2020). Many property owners, who lack Starts at Home, 2020). The Aspen Institute (2020)
the credit or financial ability to cover rental further finds that:
payment in arrears, will struggle to pay their » Communities of color are twice as likely to be
mortgages and property taxes and maintain renters and are disproportionately likely to be
properties. The COVID-19 housing crisis has low-income households that carry a high rental
sharply increased the risk of foreclosure and cost burden.
bankruptcy, especially among small property » People of color, particularly Black and Latinx
owners; long-term harm to renter families and populations, constitute approximately 80
individuals; disruption of the affordable housing percent of people at risk of eviction.
G rand Challenges for Social Wor k
market; and destabilization of communities across » Black households are more than twice as likely
the country. as white households to be evicted.
» A recent analysis in Milwaukee found that
Given that pandemic-driven job losses are women from Black neighborhoods made up
exacerbated by the recent expiration of pandemic only 9.6 percent of the city’s population but
unemployment benefits, coupled with 2020 delays accounted for 30 percent of evicted tenants.
in the provision of relief packages, unemployed
renters are at an even greater risk of financial The Centers for Disease Control in 2020 issued
crises leading to eviction. an order to temporarily halt residential evictions in
order to prevent the further spread of COVID-19.
The National Low-Income Housing Coalition This rent moratorium has been extended through
(2021) estimates that Congress must allocate at January 31, 2021. Given the scope of the
least $100 billion in emergency rental assistance pandemic, further extensions will be necessary.
to stave off evictions and possible homelessness.
NASW calls on national leaders to:
RACIAL DISPARITIES AND
» Protect and expand the national Housing
IMPACTS
Trust Fund.
COVID-19 struck when 20.8 million renter
households (47.5 percent of all renter households) » Sustain Housing First as a primary policy
were already cost-burdened, according to 2018 objective.
numbers. The pandemic has placed even greater
numbers of people at risk of displacement for the » Prioritize employment initiatives targeted to
first time in their lives. The situation has been homeless people.
particularly dire for Black and Latino households,
» Preserve and increase resources for federal
which are disproportionately affected by job loss
affordable housing programs.
and infection rates. Racial and economic
inequities are deeply rooted in housing » Ensure protections for low-income renters.
segregation and discrimination. Presently, 25
percent of African American families and more » Promote equitable access to affordable
than 16 percent of Hispanic families live in housing and opportunity.
neighborhoods of concentrated poverty compared
19CREATE SOCIAL RESPONSES TO A
CHANGING ENVIRONMENT
Health and medical experts agree – Climate and Health Equity in the
climate change is one of the greatest Secretary’s office.
threats to human health, mental » Integrate health, mental health and health
health and societal well-being that equity in all climate policies across the
Gr and Challenges for Social Work
the world has ever faced. Climate federal government.
impacts – from hurricanes and
wildfires to sea level rise and drought » Pass Environmental Justice for All Act
– are affecting the health and safety (S. 4401/H.R. 5986 in 116th Congress) or
of millions of people in the U.S., and similar legislation to address the
disproportionate adverse human health or
threatening the air, water, food, and
environmental effects of federal laws or
shelter we depend on for our
programs on communities of color,
survival. The health and mental
low-income communities, or tribal and
health impacts of climate change and indigenous communities.
climate pollution also damage our
economy. The toll on our health and » Invest in the infrastructure needed to
economy continues to rise as we enable individuals and communities to be
delay action. climate-ready and mentally resilient,
including but not limited to the Center for
Climate change is exacerbating stark and Disease Control’s Climate and Health
persistent health inequities. Children and pregnant Program.
women, economically fragile individuals, older
» Re-enter the United States in the Paris
adults, people with disabilities and chronic
Agreement and enact ambitious measures to
illnesses, communities of color, Indigenous people
advance the agreement’s goals of limiting
and tribal communities, immigrants, the
global warming, including through dramatic
unsheltered, outdoor workers, and communities
reductions in greenhouse gas emissions.
affected by a history of disinvestment and
systemic racism are disproportionately harmed by » Ensure that COVID-19 economic recovery
climate pollution and climate change. efforts include measures aimed at shifting
the US economy away from reliance on
NASW calls on national leaders to: fossil fuels and toward cleaner sources of
energy.
» Declare the climate crisis a health
emergency and elevate it as a top priority » Reverse regulatory rollbacks and adopt
of the U.S. Department of Health and robust protections against environmental
Human Services and establish an Office of harms.
20HARNESS TECHNOLOGY FOR
SOCIAL GOOD
Innovative applications of new digital NASW calls on national leaders to:
technology present opportunities for
» Make telehealth expansion under COVID-19
social and human services to reach
permanent including removing geographic
more people with greater impact on
or site restrictions, allowing the use of
G rand Challenges for Social Wor k
our most vexing social problems. audio-only devices and ensuring parity
These new technologies can be in payment with in-person service
deployed in order to more payment rates.
strategically target social spending,
speed up the development of » Expand internet connectivity for
effective programs and interventions underserved households.
and bring a wider array of help to » Unlock government data to drive solutions
more individuals and communities. to social problems by promoting the
accessibility and mining across agencies
of administrative records.
21You can also read
