We received a letter at the last JIC (Joint Insurance Committee) meeting. Please see the letter below. BCBS is going to be requiring pre-authorization for many medications (listed within this letter), many of which our clients are on. Doctors have likely received this and are working with clients to address this issue, but it may be helpful for you to be aware as well, to help your clients be prepared for this change. Effective Oct. 1st 2016. 

Blue Cross Blue Shield - Pre-authorization Letter (medications

Your work is stressful.  Your family situation is, too.  It’s hard to catch a headline or a minute of the evening news without beginning to feel dread for all the things happening in our world and communities.  In addition to that, it’s election season!  We are flooded with opportunities to feel frustrated, overwhelmed, angry, and some kind of way about our daily experience.  

So, what do we do?  How do we maintain a sense of calm and positivity when there are so many things we come across in a given day that can drain us of these things?  Here are 4 strategies for keeping peace of mind in stressful times:

NCSCSW continues to monitor legislation that impacts Clinical Social Work through their association with the Professional Association Council (PAC). We continue to follow legislation attempts to consolidate occupational licensing boards. This effort is alive and well in North Carolina and is apparently a focus across the country as well. We will keep our members posted on developments and will let you know of opportunities to give feedback to legislators

Two representatives from Alliance Behavioral Health presented at the August PAC meeting on how best to help Licensed Independent Practitioners (LIPs) successfully complete Medicaid monitoring. Alliance has developed many helpful resources to assist LIPs in their monitoring efforts, including sample policies and forms, videos on various areas of monitoring, links to valuable resources including Clinical Policy 8C, etc. These resources link to the NC DHHS website and will likely be applicable for other LME/MCO areas as well.

“Who am I? Why am I here?” Admiral James Stockdale famously opened the vice presidential debate in 1992 by asking these questions. Last month, the NCSCSW Board had our second-ever retreat to plan out our goals for the next few years. Our purpose was to assess where we and the Clinical Society are now, and where we want to go from here.

The retreat was a reminder for me of why I joined the NCSCSW in the first place. To me personally, the NCSCSW represents the best and the brightest of clinical social workers in our area – smart, committed, caring professionals who love what we do and who want to help each other. The Board absolutely exemplifies that. If you haven’t met us yet, come out to one of our events and do so!

In May of this year, NAMI sponsored a talk on a new clinic which opened in Raleigh in early July, called Ketamine Treatment Centers of NC, the first of its kind in NC. Ketamine has been around as an anesthetic since the 1960s, once called the “buddy drug” because it was available to soldiers on the battlefield during the Vietnam War to inject each other if they had a serious injury. Although still used as an anesthetic, it has many other uses, and has since been shown to be effective (40-70%) for retractable depression, suicidality, the depressed phase of bipolar, PTSD, OCD, and recently for fibromyalgia. It’s a synthetically made drug similar to the DM in Robitussin DM (Dextomethorphan).

I was intrigued, by the information, and shared it with Susan, a 67 year old client of mine who had been suffering from extreme OCD for the past 43 years. She had several failed attempts at Exposure/Response Prevention therapy (ERP), the “gold standard” in OCD treatment. Although she was able to tolerate the ERP with a reduction in her symptoms while hospitalized in the past, she was unable to follow through with response prevention after she was discharged and returned home. I began to see her in my office in October 2015, and noted that she had a significant trauma history, some of which seemed to relate to her symptoms. We worked together on resolving many of her traumatic experiences; however, the trauma reduction did little to reduce her OCD symptoms.

“How can you stand to listen to people’s problems all day?” It’s a question we are all asked at some point. I answer by patiently stating that I see my role not as listening to venting, but of helping people to make positive changes in their lives. But if I’m honest, there are times when I do start to feel like I’m just listening to people’s problems all day. That’s a clear sign that I’ve over-extended myself and not taken enough time for self-care. When that happens, I can’t be effective with my clients, or in any other part of my life.

My first line of self-care is being clear with myself about my role. I am not truly the friend, let alone the parent, of my client. I can’t take them home and re-parent them. I can only spend one hour a week trying to help them find their way toward the goals they have set for our work together. That is, THEIR goals, not mine. I might feel for them for the abundance of troubles they are carrying, but what are THEY choosing to work on at this time?

A couple of weeks ago, while at dinner with my husband and another couple, all of whom are in the “helping professions,” I shared my enthusiasm about a new therapy I had recently learned which seemed to be yielding positive outcomes. Much of my clinical work, including this new method, might be categorized as energy psychology, a term used loosely to define a mind-body approach to healing. As I explained the technique, called Image Transformation Therapy, I could see the expressions of my comrades change from enthusiasm, to confusion, to disappointment. Then, the dreaded words: “Well, you know, if they think it works, then it works, and that’s great. There’s a lot to be said for the placebo effect.” Interpretation: “Let’s move on to something real. Something evidence based.”

Later that evening, as I tried to move the disturbance of feeling angry, dismissed and misunderstood out of my own body, I realized they might be right, but for the wrong reasons. The placebo effect is generally understood as a positive response to a fake or sham treatment, due to a belief the treatment would work. Attributing a positive client outcome to placebo, just because we don’t understand the mechanism for healing, is dismissive of the practitioner as well as of the treatment. If positive expectations account for a more positive outcome, then this would be the case whether the intervention was fake, flawed or even perfect. What is the mechanism of healing? How important is a client’s receptivity to the intervention? If someone is receptive to treatment, is it possible they are able, through any seemingly viable technique, to access their internal healing response much the way the body performs many other autonomic processes on the physiological level? The beauty of this homeostasis is that it is not necessary for us to understand how it works, because the system is self-regulating in an appropriate environment.The wisdom of the body to heal the mind is no different. Set up the appropriate environment through interventions such as CBT, DBT, exercise, diet, increased human connectedness, a loving or therapeutic relationship, healing rituals, energy psychology, etc, and if the right elements are present, then the conditions are adequate enough for the mind to heal itself.

Attending Dr. Kim Strom-Gottfried’s training on ethics, “Colleagues and Ethics: Am I My Co-Worker’s Keeper” presented opportunities to discuss colleague to colleague ethical dilemmas across the clinical social work continuum.  This event was hosted at the University of North Carolina at Chapel Hill’s School of Social Work, where Dr. Strom-Gottfried is a professor. It was sponsored by the Society.

One of the example situations provided by Dr. Strom-Gottfried was regarding use of SnapChat*. She presented us with the following scenario: As an intern, what would you do if your teammates on a community-based mental health team sent you a SnapChat that was disparaging of a shared client? This  is unethical behavior by a mental health professional for a multitude of reasons: it violates the client’s privacy, doesn’t treat the client or colleagues with dignity, and disrespects the team dynamic and reinforces negative stereotypes about people with mental health disorders.

“Are there any precautions I need to warn my driver about?” asked the woman who runs a food delivery program for low income residents. I’d recently set up a service similar to meals on wheels for one of my clients. “Like what?” I asked, genuinely puzzled. The client in question was a woman in her mid-sixties who could probably be blown over by a strong wind. “Well, she said she has HIV, so I’m wondering if my driver should take any precautions while delivering food."  I hesitated, “I highly doubt the driver would come into contact with her bodily fluids, right?” I said. “Well, saliva though." she said. I felt myself go bug-eyed on the end of the line. I found myself tangentially saying “No studies have proven saliva as a mode of transmission for HIV and even if it were possible, no one could produce saliva in enough quantities to transmit HIV and ….” My words trailed off. “Wait..." I asked. "How would the driver be exposed to her saliva anyway?” “Oh, I don’t know….” she said sheepishly, "I just wanted to make sure.” 

Make sure of what? The implications offended me. I wanted to say, you own a Hazmat suit right? Make sure to wear a breathing mask and for the love of god- avoid ALL EYE CONTACT! But alas, I am a professional.  I kindly told her not to worry about her driver, as HIV could not be spread through food delivery. I also offered to provide her with a few helpful websites to reference if she were interested. At the end of the conversation, I shared with her that I was concerned about how my client would feel if the people delivering her food treated her as a contagion. She assured me the drivers have no knowledge of the client’s diagnosis.

Dear Members,

The following letter is from the NCSCSW Board of Directors opposing NC Session Law 2016-3, commonly known as House Bill 2 or HB2, because it is contrary to our code of ethics and social work values.  If you would like to add your signature, please click on the link below and type your name to sign.  Then close the document and it will automatically save.  Please sign this, if you are a NCSCSW member, by Tuesday, 4/26 at 12:00pm at which point this will be sent to our leaders in the legislature.

Hello Members,

Good news from last week: the Legislative Committee that was considering significant changes to many licensing boards has decided to postpone any decisions for now. The following link has more details.  Click Here for a News & Observer Article

Welcome to the North Carolina Society for Clinical Social Work’s inaugural blog post!

We are hoping to create a space where clinical social workers across North Carolina can contribute their thoughts and experiences to share with their colleagues. The intent of this blog is to provide readers with a variety of features and opinions regarding current events, individual clinicians and agencies, self-care, social work education, policy changes, state wide advocacy efforts, private practice suggestions, and various ethical dilemmas. We are here to discuss and consider all things related to clinical social work in an informal and professional atmosphere. We want to be a blog written by clinical social workers for clinical social workers.

Dear Members:
It is important for clinicians to know available services for clients in crisis. It is preferable to refer clients who are experiencing a mental health emergency to a more appropriate resource than the Emergency Department when more appropriate referrals exist. Crisis Solutions of NC has been working to identify alternatives to emergency rooms for clients in crisis. Please visit their website at www.crisissolutionsnc.org for more information and resources in your local area.

Below is a link to a Mental Health Services Guide for Wake County from NAMI-Wake.