• By Robert Booth, Executive Director, Center for Clinical Social Work

    In 2017, 2100 citizens of Massachusetts died from accidentally overdosing on opioid substances. A larger number overdosed but did not die.

  • As the VHA goes about providing “equitable relief” to the 24,000 veterans who were denied proper TBI (Traumatic Brain Injury) screening, VHA clinical social workers should be given a major role in providing tre

  • Muhammad Ali died on June 3 of septic shock, after enduring the effects of severe brain injury for 35 years. If it was “a fight” with his disease, it was certainly not a fair one. Nor was it Parkinson’s Disea

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    In Massachusetts, primary care providers (PCPs) receive a failing grade in screening their patients for behavioral health issues despite their aptitude for screening for med/surg issues. This finding comes

  • ThumbnailMore adolescents and children are receiving mental health care than ever before; yet more than half of those who need it most do not get it, according to a study sponsored by the New York State Psychiatric

  • ThumbnailThe future is coming—but whose future is it, and what will it do to you? Every year begins in hope and ends in a widening gap between those who have money and power and those who do not, between those who have the

  • ThumbnailBill Cosby, 77, formerly America’s best-loved entertainer, is being bombarded with allegations that, for most of his career, he was an abuser of women and a serial rapist. People are especially outraged because he

  • ThumbnailIn the continuing political and judicial controversies regarding the Affordable Care Act (ACA), its economic aspects have been overlooked. For the major healthcare insurance companies, the ACA has been a great a

  • ThumbnailVA Secretary Bob McDonald has begun to take action against the executives who have created and perpetuated a “culture” of mismanagement and indifference within the VA. He has visited 40 VHA sites in the past four

  • ThumbnailIf the crucial piece of good behavioral healthcare is an effective therapeutic alliance, the future of online behavioral therapy seems assured. Why? One has only to think of the current uses of apps such as

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    Because of a videotape released by TMZ on Feb. 19, 2014, it was public knowledge that NFL star running back Ray Rice (of the Baltimore Ravens, Super Bowl champs) had knocked out his fiancée Janay Palmer in an

  • ThumbnailDomestic violence, and the consequences for its victims, perpetrators, and all of us, are much in the news thanks to the NFL‘s ongoing bungling of the case of abuser/running-back Ray Rice, formerly of the Ravens.

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    Stung by public reaction to the National Football League’s coddling of admitted domestic abuser Ray Rice, a member of the Super Bowl champion Ravens, Roger Goodell, commissioner of the NFL, today confessed that “I didn’t get it right” and decreed that he would inflict severe punishment on any NFL employee who engaged in domestic abuse. Under the new rules, a first offense earns an automatic six-game suspension, while a second offense brings a lifetime ban from the league. To be considered an offense, Goodell explained, an act would not require conviction in court proceedings, but would be judged by him under the NFL’s personal conduct policy.

    In Goodell’s earlier finding, Ray Rice’s domestic violence—he beat his fiancée senseless and it was caught on videotape—had cost him a fine and a two-game suspension. That “disciplinary decision led the public to question our sincerity, our commitment, and whether we understood the toll that domestic violence inflicts on many families,” said Goodell today, while claiming that now the NFL does understand that “domestic violence and sexual assault are unacceptable. We clearly must do a better job of addressing these incidents in the NFL. And we will.” But NFL players are paid millions of dollars for their violent services; and their off-field violence, unfortunately, reflects violence in society as a whole. Will the new policy make a difference in the NFL and in America?

    Stay tuned.

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    We are now, as we have always been, a nation profoundly divided by race and by violence. The first eight decades of our history, in which white men ran everything and slavery was the law of the land, continues

  • In a country where millions of Americans are afflicted with depression and PTSD, and where many of them do not get treatment (whether by intention, inability, or system failure), social media may become the key to twitterdiagnosing large populations who are suffering in silence, of a sort.

    At the American Statistical Association national conference in Boston last week, a presentation titled “Depression, Economics, and Population in Social Media,” was given by Elizabeth Hohman, David Marchette, and Glen Coppersmith of the Navy and Johns Hopkins University. In it, they reviewed the Twitter traffic of people across the country, including the posts of those suffering from PTSD and Seasonal Affective Disorder (SAD) and how they differed from those of the general tweeting population. The researchers looked at word usage and applied a “depression classifier” algorithm to the content of millions of brief messages. They found that those living in areas of high unemployment produced Twitter content correlating with depression, and that PTSD-related content could be traced to areas with large populations of veterans.

    Carried forward and further refined, such work could revolutionize large-scale public-health efforts in behavioral healthcare, so that it will be possible to find untreated victims by listening for 140-character cries for help.

  • ThumbnailDomestic violence just got a not-so-surprising reaction from the National Football League, in its decision regarding the quasi-punishment of running back Ray Rice, an admitted abuser. The NFL decided that Rice, a

  • Teenagers, so into social media and devoted to their circles of friends, value “caring about others” more than anything else. Right?

    Wrong—very wrong, according to Harvard’s Graduate School of Education, whose

  • In her presentation “Whose Death Is It Anyway? How Clinical Social Workers Mitigate Conflict with Patient, Families, and Staff During End of Life,” at the Association of Oncology Social Work (AOSW) conference, Vickie Leff, Palliative Care Clinical Social Worker of Duke University Hospital (Durham, NC), observed that, at the end of life, the issues in the hospital setting usually get very complicated: family, specialists, primary team, and RNs/staff all compete for the care of the patient, whose voice is sometimes lost in the cacophony.

    Seeing the Whole Picture Image from haaretz.com

    These conflicts and complications are “tailor made for clinical social workers,” per Leff. “Out of chaos,” she said, “clinical social workers are the ones who see the whole picture.”  Their role is essential to the intervention, and must be asserted: “We need to step in,” she said, “and not wait to be invited.”

    Using clinical skills and a big-picture approach, the clinical social worker interprets behaviors to all concerned, from family to specialists to staff, conversing with each party to reframe, give perspective, and bring closure to the inevitable “drama that can’t be fixed.”

    The outcome of the clinical social worker’s efforts, as of the intervention itself, can never be precisely predicted, but the clinical social worker’s role—as problem-solver, patient-advocate, and upholder of the bio-psycho-social point of view—is always crucial to the intervention. And, finally, per Vickie Leff, clinical social workers should take the further step of writing papers and participating in research, “and not leave that to other professions.”

    Do you, as a clinical social worker, have the sense of your own professionalism and the importance of your role to assert yourself in multidisciplinary endeavors, knowing that it is likely that you are the only one who can bring order to the chaos, focus to the team, and assurance to the family and patient?

  • Mary Turney and Christine Healy, clinical social workers, of the Moffitt Cancer Center (Tampa, FL), spoke at the Association of Oncology Social Work (AOSW) conference about the challenges of “Moving the AYA Initiative Forward: Social Work’s Leadership Role.” The AYA (Adolescents & Young Adults with Cancer) movement is important—cancer is the largest disease-related killer of those aged 15-39—and offers great opportunities for clinical social work leadership, especially since (per Chris) “from the psycho-social point of view, those with the most power have the least understanding” of the needs of this patient population.

    For success in AYA, as in many other hospital-based endeavors, clinical social work training in team-building and person-in-environment must be connected to a strong will to succeed, advisors from the patient community, and the ability to build multidisciplinary alliances—all for the cause!

  • Maryann Tierney presented on “the effects of PTSD on Grief and Other Traumatic Events: Cancer Diagnosis” at the Association of Oncology Social Work Conference. In it, she stressed that a traumatic experience can affect one emotionally, psychologically, and cognitively.

    “The emotional memory of fear and the cognitive memory of the experience become a learned emotional response, and it is this response which motivates one to react in a way to ensure survival”—and often to cause emotional distress.

    Whether from the battlefield or cancer trauma, these issues are increasingly a part of the client experiences that clinical social workers must address.

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