This article was originally published on May 4, 2022. It was updated on June 24, 2022.

The Supreme Court overturned Roe v. Wade today. Our School’s previous statement reaffirms our commitment to fight for reproductive justice:

Nearly 50 years ago, the U.S. Supreme Court ruled on Roe v. Wade, which guaranteed a person’s liberty to have an abortion without excessive government restriction. 

As of today 26 states are likely to pass legislation completely or partially banning abortions. 

Fundamentally abortion is an issue of reproductive justice, racial justice, health care access, class, and gender equity. As a profession, if we are committed to social justice, we must be willing to stop seeing abortion as the shadow “hot button” issue.

Even before this news, our Equity and Inclusion Committee was organizing to form a BUSSW learning community to collectively deepen our knowledge about reproductive justice more broadly, as well as abortion specifically. The SCOTUS opinion propelled us to develop this learning community sooner. In addition to reading books and articles about our past and present reproductive landscape, we will invite speakers and trainers from local reproductive health organizations and abortion fund agencies to support our learning. This work will help us act on the information we learn so we can contribute to reimagining how people access abortion care and other reproductive health-related services in the United States. 

In the coming weeks, members of the Equity & Inclusion Committee will hold space for our community to collectively discuss social workers’ role in this moment. In the meantime, there are three things members of our community can do:

1. Learn about abortion access in your state. If you live in Massachusetts, abortion will remain legal and accessible but we know our BUSSW community stretches across the country and the communities we live in and serve will be affected differently by this ruling.
2. Support abortion funds, practical support organizations, and independent people along with Planned Parenthood, so that reproductive justice organizations can continue to strengthen and sustain the power needed to navigate the rapidly shrinking landscape of abortion access. These are the groups that will ensure that all people, especially those living in states hostile to abortion, can access the care they need.
3. Tell five friends about abortion funds and share our Massachusetts Abortion Funds’ Resource Guide. This guide is not specific to Massachusetts, but rather contains information about donating to funds, how to talk about abortion, and how to access help.

Thanks and credit to doctoral candidate Greer Hamilton for her editorial leadership on this statement, and MSW student Kate Glynn for initiating the discussion to develop reproductive justice programming.

In solidarity,

Dean Jorge Delva
Equity & Inclusion Committee Chairs: Dawn Belkin Martinez & Ellen DeVoe

People migrating from South and Central America to the United States face a harrowing journey, braving some of the world’s most inhospitable environments by foot, often exposed to violence along the way. Those who make it to Mexico and the U.S. border are then faced with further trauma in camps and detention centers that are overburdened and under-resourced. Many of these migrants come to the United States seeking a better life for their families, often leaving family members as they make the costly trek north. Although less documented in the news, these family members suffer their own trauma from separation, often left behind in difficult circumstances. CISWH is providing essential trauma and mental health care services not only to migrants at the U.S. Mexico Border, but to family members waiting in Nicaragua as well.

The role CISWH plays

Family separation has been on the rise in Nicaragua, especially after the COVID-19 pandemic hit the Central American country hard, shuttering tobacco factories and other key industries leading to lay-offs for thousands of workers. Over 100,000 people have migrated from Nicaragua to neighboring Costa Rica and beyond since 2020. CISWH is working with the Superemos Foundation, a Nicaraguan non-profit providing community development through education, training, a comprehensive domestic violence program and related health and social work programs, to provide separated families with education and mental health support.

Professor Luz López, CISWH Global Health Core director; Ellie Zambrano, CISWH executive director; and Winnie Chen, administrative coordinator, were joined by two MSW students, Madelyn Fermin and Lauren Glaser, for a trip to Nicaragua in April 2022 where they participated in a cultural exchange and interprofessional partnership with the Superemos Foundation and the National Autonomous University of Nicaragua (UNAN-FAREM) in Estelí. Superemos Foundation collaborators included program co-founder Stephen Sefton, social worker, Sindy Alvarado, psychologist Karen Villareyna and lawyer, Maria Felix Castillo.

The CISWH and Superemos teams conducted interactive seminars on trauma care, violence prevention, and the psycho-social impact of migrant families’ separations for nurses, physicians, lawyers, and community health workers based in the communities of San Nicolas and surrounding rural areas. They also presented seminars for social work, psychology, and medical students at UNAM-FAREM. The Superemos Program works in collaboration with the Nicaragua Ministry of Health (MINSA) and the Ministry of Families. This cultural immersion experience serves to deepen BU social work students’ knowledge, clinical practice, and the cultural adaptations needed to work with migrants in both Central America and the United States.

“We as social workers have a key role in working with migrant families in their country of origin or at the Mexico/U.S.border. I feel so grateful to contribute as part of CISWH during this critical time,” Prof. López says.

Part of this work focuses heavily on care for women currently experiencing or surviving domestic abuse. Domestic violence is endemic in Nicaragua, and many women flee the country, with or without their children, to escape it. Working with Superemos, Prof. López and the CISWH team are training local nurses and physicians in preventive measures against domestic abuse. They’re also ensuring that practitioners have the tools they need to identify existing cases of abuse. These doctors and nurses can then connect women and their children with services from the Superemos Foundation and the Ministry of Family, offering protection and connecting women with family members who can keep them safe. This community-centered approach keeps women and their children together, while building strong preventive measures in rural areas in Nicaragua.

“We learn from the families as well – about their resilience. It was a two-way participatory process which was very, very helpful,” Prof. López says.

What’s next

As the federal Title 42 order is extended in the United States, families will remain separated and migrants will continue to be stalled in poor conditions at the U.S. and Mexico border. CISWH offers ongoing support to migrants and their families and continues to provide resources to ensure that nurses and doctors in rural areas can travel to Nicaragua’s capital, Estelí, to receive essential training. CISWH will also continue to train social work and psychology students in Nicaragua via Zoom. Prof. López plans to work with families directly, too, offering virtual consultations and social work support to families experiencing separation.

In the meantime, Prof. López highlights that there is much work to be done stateside as well. She wants to raise awareness about the families traveling to the border in hopes of improving their families’ circumstances. “People need to know these are hardworking families,” Prof. López says. “They don’t want to leave their kids behind. They very much care for their children and want to provide them with economic and educational opportunities.”

By definition, children and youth with special health care needs (CYSHCN) require more health care services than children typically do to ensure their optimal health, quality of life and well-being.  About 20% of children in the US have special health care needs, and their care comprises about half of all pediatric health care spending. 

Health care spending in the US has historically been based on payment for acute, time-limited health care needs, and payment has not typically been attached to improved outcomes.  However, CYSHCN require a different approach, since their health care needs are ongoing and effective spending on improved health care in childhood pays dividends throughout the life course.

With health care costs spiraling for all populations, increasing attention is being paid to improving the cost-effectiveness of spending through payment reform. To date, the development and testing of payment reform has primarily focused on adults rather than children, who have different health and social needs.  This leaves gaps in knowledge around what kinds of benefits best serve CYSHCN, which payment models are the most cost-effective and how to identify and test new quality measures that ensure what’s being paid for matters to children, families, providers, and payers.

In a new paper from Academic Pediatrics co-authored by Meg Comeau, CISWH senior project director and principal investigator for the Catalyst Center, a team of experts recommend a financing research agenda focused on filling the knowledge gaps around benefits, payment models and quality measures in the care of CYSHCN.

The State of Research on Healthcare Financing for CYSHCN

To inform their research recommendations, the authors highlight three existing observations on current health care financing for CYSHCN, including:

• Underinsurance is a common problem for privately-insured families raising CYSHCN, and results in financial hardship for many.
• Almost half of all CYSHCN are enrolled in Medicaid coverage, along with most children with medically complex conditions.  Medicaid managed care may include capitation (a set amount of money per enrollee) and an emphasis on care coordination as a way of increasing value.
• Most of the existing research on increasing value in health care financing for CYSHCN focuses on models tested in specific environments (hospital-based outpatient clinics, for example) with limited numbers of participants, making it difficult to generalize findings to different settings and larger populations.

Recommendations for Future Research

Based on the current landscape of healthcare financing for CYSHCN, the authors identified three topic areas for research that addresses the specific needs of CYSHCN, their families, and their healthcare providers:

1. Assess value by evaluating the fit between benefit packages and the needs of CYSHCN through comparison of different payment models with typical patterns of need.
2. Develop models to measure return-on-investment for care coordination activities.
3. Use a multistakeholder process to identify and rank health care value outcomes for CYSHCN, as a precursor to developing and testing new quality measures.  Included in this process should be families raising CYSHCN, pediatric health care providers, and both public and private payers.

Using this agenda, researchers can begin to build a robust body of evidence that can lead to innovative financing that addresses the unique needs of CYSHCN and moves the focus from spending on health care to investment in children’s overall health and well-being.

 

Read the full article here.

Historically, social workers are change leaders. They have been at the forefront of critical moments in U.S. history, advocating for civil rights, minimum wage and safe workplaces, women’s reproductive rights, immigrants, and LBGTQ communities. Because of this experience and exposure, social workers are uniquely qualified to understand the social complexities that influence health and how those factors impact peoples’ everyday lives. Most recently, we are seeing an integration of social work and behavioral health within medical care settings, with policy and funding to back it up. How do we build on this interdisciplinary momentum to create systemic change in healthcare that supports the whole person? The answer is social work leadership.

CISWH Executive Director Eleanor Zambrano paints a picture of social work leadership and explains how CISWH supports social workers who are looking to become leaders in the field.

What is a social work leader?

Social work leaders are the community engagement experts–the community organizers, activists, and advocates. They are systems thinkers. Social work leaders understand that change has an ecological impact. That’s why it’s always so important to think about a whole person, because if their socio-economic situation or status is inequitable, there are direct correlations to how it impacts their health.

What role do social workers play in community health settings? What does that landscape look like currently and how is it evolving?

Social workers really value the importance of direct practice, clinical practice, or interactions with communities. I think that informs a lot of social work leadership and there is an opportunity here to utilize practice experience to drive health policy. That’s why interdisciplinary work is so important. We need to have a cross-sector of professionals at the table when we’re making or changing policy.

Social workers’ direct experience, expertise, and practice within community health settings; their understanding of community engagement; are all invaluable when it comes to community change. They have the ability to amplify the voice of a community and to understand what is needed in terms of how healthcare systems plan for care.

Additionally, we learn a lot about policy in our work. Even when a policy is really well thought out, we need to think about how we engage communities in those changes. Without that preliminary relationship-building, it makes it really difficult to create real change. Social workers have a unique ability to capture opportunities and make connections, build upon existing relationships, and create partnerships in their communities.

What does civic engagement in social work look like in practice?

We recently hosted an event where two social workers spoke about their work in civic health and it was a great illustration of what it looks like. For example, Justin Hodge is a professor at the University of Michigan. He has been serving in public office, and is also teaching in academia and training social workers. A big part of his work is focused on how do we engage social workers in the political context and help them understand how it impacts the work they’re doing.

A lot of times there is a disconnect about whether or not it is ethical for social workers to be political. There’s also the concern that we’re not going to have much impact. But the truth is, policy changes and leadership decisions impact us all the time, because it directly affects the way in which we can engage in the delivery of care–whether it’s through parity in reimbursement for care or whether it’s in how we access communities to provide innovative types of care.

How is CISWH supporting social workers to become leaders in their communities?

One of the areas that we’re focused on is the representation of social work in healthcare. We are developing research and data that supports the need for social work in healthcare settings. The impact is pretty significant when you talk to healthcare providers, because these are issues that really impact the future of care. For example, if you have patients who need care but are struggling to get to their appointment, social workers are the ones who help them access or navigate systems so they can follow through with doctor recommendations.

Another way is through our CISWH fellowship program for graduate students. Most of the CISWH fellows work closely with social work leaders including our Core directors. These provide opportunities for them to see themselves in leadership roles. And they can explore potential future career opportunities as they see what goes into developing social work strategies. We’re focused on building communities within the Center and inviting leaders and students to participate, provide feedback, and inform the work that we do.

How do we center social justice in this work?

Social workers often need to maintain a balance around racial equity and health equity in various settings. When you work for government or state programming, there are a lot of restrictions in terms of disclosure and how you interact with these types of political systems. But there are also many non-partisan ways in which you can advocate for people to ensure everyone has what they need to thrive.

Social workers are focused on this – making sure everyone has what they need in order to be their healthiest–and that is a social justice issue. We know that our society is unhealthy in many ways. . So we ask, do our clients have access to what they need? Do they have opportunities to thrive? These are the questions that we really need to focus on.

 

Learn more about CISWH’s work. 

This graphic was originally presented at the Association for Maternal and Children Health (AMCHP) 2021 national conference and created by Karina Branson at ConverSketch.

The Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity (CMC CoIIN) team at the Center for Innovation in Social Work & Health, alongside partner organization Family Voices National, has released a new infographic that shares CMC CoIIN’s learnings on how to build robust and meaningful family partnerships that lead to improved quality and innovation in clinical systems of care. The tips in this infographic can help elevate and integrate family leaders as equal partners in this important work.

The Problem

Bringing families on board is not done consistently and can be challenging. How does one get started with family outreach? How do clinics and healthcare organizations make sure that community voices are heard?

It Starts With Values

CMC CoIIN works with teams to embed family engagement by making sure that teams and organizations have three core values baked into their action plan:

• Accountability: Outline an action plan to ensure that your team is truly working towards implementing family engagement and partnerships.
• Equity: Everyone involved must be on the same playing field. Doctors, family members, and other members of the care team all play a valuable role in improving care for children with medical complexities.
• Transparency: CoIIN organizes family leader affinity groups where family leaders can bring their true, and sometimes challenging experiences and work through them together before bringing them back to the larger team. Affinity groups provide a safe and supportive space that honors the community’s lived experiences and builds trust with the wider team.

Systemic Barriers

Values provide a good starting point for family partnership work, but it’s important to be aware of the inherent systemic barriers that prevent teams from putting them into practice. These barriers include:

• Family leaders deserve to be paid for their invaluable work, however funding is often not allocated for this role nor is it built into medical family advisory board policies.
• Families are often not seen as equal members of the care team.
• Larger systems changes are required to break down silos and truly engage with families and build strong relationships.

CoIIN’s Proof of Performance

CoIIN has a proven plan to combat these systemic barriers:

• Family engagement is required. Every single team must have family leaders engaged in their leadership team.
• Flexibility is key when it comes to working with families and interdisciplinary teams. CoIIN takes an adaptive approach when it comes to supporting teams by incorporating their specific needs.
• CMC CoIIN supports teams with technical assistance and coaching. They provide ongoing instruction on how to work together as a multi-disciplinary team where family partners play an active role.

Tools for Individual and System Change

Family Focus Groups Facilitator Guide
View the tool

Each state team is required to host focus groups with family members of kids who are enrolled in the clinical program. The focus groups asked families about their child’s quality of life, as well as overall family wellbeing. CoIIN developed a family-driven process in which family leaders come up with the focus group questions, approach, and structure. Rather than simply looking at hospitalization rates or other quantitative data, these focus groups give teams a fuller picture of children and family needs.

Family Engagement in Systems Assessment Tool (FESAT)
View the tool

The FESAT tool helps teams understand family engagement’s role within a medical system. Teams will assess family engagement within four categories and score themselves before coming together to discuss progress and reach consensus on how the work can move forward. These four categories are:

• Transparency: Do families feel like they know what’s going on behind the scenes in regards to their child’s care? Are family needs represented in decision-making and policies?
• Commitment: Does the clinic really have commitment to family engagement and family partnership? Are families involved in tangible ways that can be measured?
• Representation: Are diverse families represented in systems level decisions? Does your family leader and general interdisciplinary team match the patient population that you’re working with in terms of different identities i.e. race, disability status, etc.?
• Impact: Does the work that you’re doing in terms of family engagement and partnership actually make a difference? Are the patients who are coming into the clinic feeling the effects of these efforts?

 

View Infographic

 

CMC CoIIN is an HRSA-funded project that aims to improve the quality of life for children with medically complex conditions and their families, and increase the cost-effectiveness of their care. The project is housed at the Center for Innovation in Social Work & Health (CISWH) at Boston University School of Social Work.

For more information on the CMC CoIIN’s work around family engagement and family partnership, please visit their website.

Photo by Barbara Zandoval on Unsplash

Dr. Luz M López, director of CISWH’s Global Health Core and clinical professor at BUSSW, will join a Border Studies Program at the Texas border from March 4 – March 14, 2022. The program is focused on identifying practices to best support migrants at the Rio Grande Valley Texas border—an area that includes Brownsville and McAllen, Texas, and Matamoros and Reynosa, Mexico. Prof. López will join Dr. Carrie Preston, director of the Boston University Kilachand Honors Program and co-founder of the Initiative in Forced Displacement; and Dr. Muhammad Zamad, professor of Biomedical Engineering. A group of 9 BU students, including dual degree MSW/MPH graduate student, Sharette Bello-Suazo, fill out the BU team headed to Texas next month.

The BU team will collaborate with Refugee Services of Texas, The Rio Valley Relief Project, La Posada Providencia, and the University of Texas Rio Grande Valley School of Social Work, organizations currently working with displaced families in the area.

“[Our Texas partners] wanted a social work perspective and clinical mental health support. They learned about the work I had been doing previously with trauma and immigrants and refugees, and I was very happy to collaborate,” said Prof. López.

Displaced people come to the United States border escaping violence, fear, and trauma, only to be faced with more of the same upon arriving in Mexico and the U.S.

“Some are in tents on the border. Some are in detention centers in very difficult conditions, and some are hosted by families or organizations in the area. The goal of this trip is to interview those who are displaced and learn more about the conditions so we can determine how we can contribute and fill in gaps,” Prof. López added.

The COVID-19 pandemic, as well as evolving political and policy challenges are additional hurdles for migrants, and will also be topics of the BU team’s research. Once the initial study is completed, the team hopes to arrange support groups for the families that are waiting for their immigration status, giving them space to talk about their emotional needs. The group aims to provide support to overburdened staff as well, in addition to providing translation and documentation services.

“This is the first iteration of the IFD Border Studies Program, and we are eager to provide additional support for ongoing initiatives to build on what we learn,” said Dr. Carrie Preston. 

Prof. López hopes the border program will serve as a learning opportunity for students. “My intention is to also see if we can further collaborate with our partners in Texas and give our students practical and skill-building experience providing services to those families.”

Rather than a one-and-done research initiative, Prof. López sees the Border Studies Program collaboration as a way to provide sustainable, community-centered support to migrant communities.